The Good, The Bad and The Ugly Paramedic

Moving To A New Platform...Want To Follow?

noreply@blogger.com (Tammie Bullard) — Tue, 04 Aug 2020 08:10:00 +0000

From July 2020 this blog will be available at www.gbuparamedic.com/blog.

All of the posts here on Blogger have been migrated so can be read either here or there.

Thanks for reading...see you over at the GBU Paramedic site.

If you're just looking for a copy of the book you can find it at most major retailers online in paperback, hardcover, eBook and audiobook formats or visit the GBU Paramedic store to order yours now.

All Aboard! Welcoming Rapid Recruits Into Healthcare

noreply@blogger.com (Tammie Bullard) — Sun, 17 May 2020 15:31:00 +0000

The sea of healthcare is unsettled right now. In varying states of flux around the world, we are either inundated and struggling to stay afloat or, for the more fortunate, cautiously waiting. Full of hope and dread until the status quo changes for better or for worse.

A proactive approach to dropping anchor, however, appears to be haste. Accelerating the pathways that enable graduate paramedics, nurses, midwives, doctors and other health professionals to join our ranks, before the vessel we travel upon, together, begins to sink.

Numbers are already dwindling as frontline care providers step into new positions arising from pandemia. Countless others cannot perform traditional roles due to medical issues that render them highly vulnerable to COVID-19. Some struggle with stress and exacerbated mental health issues. Several had already tired of the environment, the workload and the morale, so plans to jump ship have been moved forward. Sadly, many have become sick, and some are tragically dying.

Whether we like it or not, our numbers must increase right now, before the growing gap in every healthcare workforce begins to take its toll. There are strong opinions out there, however, both for and against, fast-tracking qualifications and streamlining induction into the ranks.

When there are no options, it falls to us to knuckle down and roll with the changes. If we voice outrage now and throw spanners in the works of rapid recruitment drives, it will ultimately fall to us to carry the load for a long time to come. If patient numbers are not decreasing, staff numbers cannot afford to either.

So what are some of the for and against comments floating around both online and onboard?

"They know nothing!"

Some have completed university degrees, tertiary diplomas and various other courses with numerous real, live frontline placements and highly specific education. Others have spent weeks, months or years in training. Whatever the back story, all newcomers are in the unenviable position of being thrown in at the deep end. Be kind. Find out what they do know. Ask if there's anything they need help with.

"How lucky to avoid the length of study and training that used to be mandatory."

Newcomers may wish that they'd had the same level of opportunity to study and train before having to jump in feet first. Be kind. Find out whether they feel prepared. Ask what it will take to help close any perceived gap in knowledge.

"Their appreciation of safety will be minimal!"

Despite streamlining and reducing some of the hours afforded to workplace safety, in many instances, class sizes have been much smaller. Perhaps this more focused approach has been beneficial, we won't know until we try. Be kind. Find out which aspects of risk, hazard, manual handling and equipment training were thoroughly covered. Ask whether a refresher in the workplace would be useful.

"Why should they get the same pay, when they didn't do the same entry courses?"

Why shouldn't they? Anyone doing the same work, for the same number of hours, in the same workplace, deserves the same remuneration, give or take any increase based on length of service. Spare a thought for those receiving trainee rates, despite being thrust into the frontline of a pandemic along with everyone else. Be kind. Find out if they understand the payment and associated structures. Ask if they'd like assistance in navigating the finer points specific to each organisation.

"They're so inexperienced."

No matter the age of any new staff member, they are all adults. We, too, were inexperienced when we began, and we each hoped that we would be taken seriously. After all, it takes drive and self-motivation to pursue any role renowned for its challenging nature. Many of our most experienced predecessors entered into patient care with the bare minimum of training. This is rarely held against them all these years later, so let's not hold it against those joining us now. Be kind. Find out about previous life and work experience that may complement a new position. Ask what other life skills may be beneficial in the first few unsettling months.

"It's cheating the system."

If it feels like the system has been cheated, in any aspect, then so too has each newcomer. Cheated out of things that their predecessors were allowed to take for granted. Cheated out of well-deserved breaks between periods of intense training. Cheated out of the experience of live assessments. Cheated out of traditional celebrations post-completion. Cheated out of mental preparation time before leaping into new hands-on careers. Be kind. Find out whether they feel cheated. Ask what may help to ease disappointment or trepidation.

For any student, intern or graduate about to set sail, this may be daunting to read, but rest assured that such comments are a minority sentiment. If port were "for" and starboard was "against" a sudden influx of new staff, the entire remaining deck is full of those adaptable to, accepting of and nonplussed about the change.

It is advisable, however, is to pick a catchphrase in response to any cutting comment similar to the above. Rehearse it, get familiar with it. Keep it in a top pocket for ease of use when hostility pervades conversation around accelerated employment. Use it as standard, let it offer protection against becoming affected by the opinion of any negatively geared discussion.

It may not seem necessary in safe, calm seas, but that well crafted, finely honed, polite and concise one-liner may be the lifebuoy that prevents near-drowning in choppy waters.

For those who have long since embarked and fully settled, any hint of an archaic "eat our young" attitude is inexcusable. We have known this for decades and now is the time to drop it for once and for all. Instead, we can choose to help new staff aboard and enjoy the breath of fresh air that accompanies each intake.

Our new colleagues will occupy the same berths, with no free pass into first-class life. They're being thrown down into the hold to get stuck in with everyone else, ready or not. An unenviable position.

Tammie Bullard

Author & Paramedic

The Good, The Bad & The Ugly Paramedic is available in eBook, audiobook, paperback and hardcover from most major retailers or at the GBU Paramedic website.

Frontline Empathy is a Two Way Street

noreply@blogger.com (Tammie Bullard) — Mon, 20 Apr 2020 05:13:00 +0000

Empathy may be a confusing and contrary word, but one with great value, particularly in providing a buffer against professional burnout and in building positive relationships with patients. As one of those "soft skills" integral to the paramedic's toolkit, it is encouraging to see how widely it appears in research, training, leadership and culture.

Confusion arises, for the most part, around the definition itself. Amongst similar concepts of sympathy, compassion, mimpathy, compathy, unipathy and transpathy, each holds different meaning to the individual. For simplicity's sake, a broad overview of empathy may be that of understanding how another may feel in any given situation.

While we may also use words such as compassion and sympathy interchangeably, they are considered less developed, more reactive counterparts to the higher level of skill involved in being empathetic.

In the current climate, paramedics are feeling both the warmth of widespread empathy, for the role we are playing in pandemia, and the contrasting cold of its absence.

Unintentional though this may be, the chill occurs when others fear our potential to contaminate, or we are dismissed by other health professionals, as we have no central hub to safely contain ourselves within, or forge solidarity against the danger of the outside world.

Never before has it been more evident that maintaining empathy must not be forgotten or taken for granted. It's a two-way street whether we're amid a pandemic or stepping through the routine of everyday life.

With the mutual co-operation of experienced, empathetic road users, both directions can flow in synchronicity. Keeping to our expected paths, indicating intentions, acknowledging courteous behaviours with thanks and resisting the urge to yell aggressively demonstrate our understanding.

Respecting and following directions or signs, exercising patience when deviations arise and slowing down to give way when necessary, make our empathetic approach to the situation apparent. So how does this apply to prehospital roles?

Patients

We became paramedics to care for patients during emergencies.

Attempting to understand their situation and how they may feel briefly, can help us to deliver the best type of care. It might be "just another call for chest pain" but labelling such may render us blind to their needs and decrease patient satisfaction.

In return, anger and complaints become more likely with a possible compromise to our physical, professional and psychological safety.

Bystanders

Passers-by don't sign up for emergencies in which they unexpectedly find themselves involved. They stop to assist out of kindness or a myriad of potential, unknown reasons.

An empathetic approach to enlisting their help, or moving them along, may gain mutual understanding and co-operation more quickly while reducing unnecessary frustration. Theirs as well as our own!

Colleagues

We wear the same uniform, but we're not necessarily the same people. Although it's easy to assume that someone may be better or worse off, based on what little we know, unless we are intimately connected, the reality is that we have no idea.

Maintaining empathy for colleagues, without preconceived opinion, may help to create unity and decrease work-based stress, while one-upmanship and pity contests only widen any divide.

Support Staff

No matter our understanding of each other's roles, frontline and support staff work in vastly different environments. The nature of emergency services is that any interaction between the two is limited or non-existent.

Throwaway comments, therefore, regarding the perception of each other's demands, habits and attitudes quickly become inflammatory. Primarily when delivered by third parties interacting between both areas.

Bi-directional empathy may be integral to avoiding resentment and increasing mutual respect when the ability to build in-person relationships does not exist.

The Organisations We Work For

Embracing an empathetic approach to organisational culture, while more challenging to adopt, may benefit morale, motivation and mindset.

Every ambulance service comprises a group of humans surrounded by infrastructure. That's all. If we aim to understand and therefore empathise with how any organisation, as a whole, aims to fulfil its purpose, we gain more precise direction relating to the individual role that we choose to play.

We may find ways of working with others to make this happen. We may realise that we do not fit the organisation's overarching aims and can begin seeking alternative career pathways. We may strive for a leadership role from which we attempt to promote positive change.

We may ultimately free ourselves from the shackles of frustration by taking the "personal" out of the "entity" and potentially increase our professional longevity as a result.

Interprofessional Service Providers

Interaction with police, firefighters, other emergency services, nurses, doctors, patient care assistants, nursing home staff, roadside recovery technicians and other personnel will involve some level of presumption. Our assumed perception of the challenges they face, or lack thereof.

If we can gain a better understanding, by seeking clarification through collegiate conversation, we may encourage similar empathy towards the challenges we face as paramedics, thereby improving rapport.

The Paramedic Profession

Overall, paramedicine garners a positive response, but it is not something to be taken for granted. We continually step over the line from our territory, into that of others, quite literally.

Most professions work at their place of business, where patients and customers step in, then step out. While visiting, they form an opinion of that industry, before leaving and returning to their domain. Paramedics, however, must enter the realm of others for every single call.

Appearance, body language, demeanour, words and actions are the only tools available to create an instant, positive impression. There are no pleasantries such as impressive infrastructure, plush surroundings, ambient music, soothing aroma or polished reception staff to engender positivity.

If we can utilise empathy and seek to understand how patients, families and bystanders may perceive our arrival and interaction, we create the significant potential to set the scene, proceed safely and communicate effectively.

Our Loved Ones

Those that keep the home fires burning rely on us to be ourselves when we are not in uniform. If a family member greets us with a problem similar to three patients we've encountered today, this does not make them the fourth. The clock must re-set so that we listen, understand, validate and support them with a fresh approach.

When they mention stressors which sound trivial to us, after the enormity of what we've experienced during recent shifts, we absolutely must empathise, or risk losing this meaningful personal connection, should we dismiss their concerns.

Maintaining empathy for those we care most deeply about, may be vital in avoiding any reluctance to interact with us over time.

Ourselves

We must, at all costs, maintain individual wellbeing otherwise, as with primary surveys, we are of no use to others when we put ourselves in danger. Self-empathy is pivotal in maintaining the boundaries that each of us must uphold, to feel physically and psychologically safe.

Ultimately, throughout each shift, we have a choice in whether we stick to our side of the empathy street or not.

We can choose to travel in a one-way direction, where we continually run into obstacles along the way until we are left wondering why all other road users are frustrated with us. Would it be fair to then bask in praise for the paramedic profession, despite a lack of empathy and understanding for others?

Alternatively, we can harness and enhance this skill, with the same level of pride we afford to our clinical prowess. Although it requires a little extra effort, without doubt, we may then feel more comfortable with the reciprocal rewards of empathy and compassion from those traversing the other side of the two-way street.

Thanks for reading

Tammie Bullard

First published in the Australian Emergency Services Magazine Vol 18, Issue 2, 2020

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Paramedics in Pandemic "No Man's Land"

noreply@blogger.com (Tammie Bullard) — Thu, 26 Mar 2020 13:27:00 +0000

Together, through the worldwide pandemic we find ourselves drowning in, stand millions of paramedics, EMTs and frontline ambulance personnel. Despite our numbers, never has the prehospital arena felt so lonely. With so many messages coming from far and wide about how to pave the way through the good, the bad and the ugly of paramedicine right now, it made sense to put some of it down in words.

In every minute of every shift, through this unfolding horror of sickness, uncertainty builds and isolation grows.

For every interaction outside of the ambulance, we have no idea whether we’ll be greeted with relief, respect, ridicule or revulsion.

Commentators may group us in with other healthcare professionals…but for the time being, we don’t really belong anywhere.

No desire for pity or sympathy is sought in these words, it's simply a soothing of the soul for those in similarly contaminated boots. That they feel some sense of belonging. That they know their feelings are shared. By almost every colleague. In almost every ambulance. In almost every country right now.

Once we were welcome in the homes of patients with relief…but now with reluctance. Confronting PPE instils panic, fear and genuine concern that we carry with us a high risk of contamination. Suddenly, we are greeted with wariness instead. Don’t be scared. We’re protecting everyone by covering up.

😷🦠

Once we were welcome to collaborate in hospitals, combining our guidelines for best patient care…but now each emergency department has its own strict protocol. We must adapt immediately upon arrival. Each different from the last. Each different from our own. Each demanding that we adopt without question. Each wondering why the paramedics don’t know how they work. Suddenly we are deemed wrong, or uneducated. Try to remember we’re working to multiple guidelines and protocols, not just one, but all aiming for the same outcome.

🏥🚑

Once we were welcome in nursing homes by staff relieved to have us take over care…but now protocol demands we be assessed at the door. Temperatures checked. Questions asked. Suddenly we are a potential danger to staff and residents. Try finding ways to meet in the middle, maybe by wheeling resident beds to the front door so we can assess or transfer there.

👵🏻👴🏼

Once we were welcome to request supplies and replenish our stock…but now we can't access the basics of what we need. Due to shortage, suggestion that we’re demanding too much, or the impossible difficulty caused by an ambulance being unavailable just to re-stock. Suddenly, we have to make do in our mobile offices with no reserves to fall back upon. Please bear in mind very few of us want to overuse or pilfer, if a whole lot of us say we need things, chances are we really do actually need them.

🧴🛒

Once we were welcome to drop in and interact with support staff and communications centres in our organisations…but now we’re locked out as we're likely to spread disease. Suddenly, outsiders in the very ambulance services we represent. Any chance you get to message or connect with the frontline, please take it, we’d love to feel connected.

📟🙋

Once we were welcome in public, greeted with smiles and waves by families with small children…but now small hands are tugged in the opposite direction. Parents fearful that we're marinated in virus. Suddenly the givers of illness, to be avoided at all costs. Feel free to move away but a friendly smile or wave makes our day and stops kids thinking we’re something to be scared of.

🧸🤩

Once we were welcome (albeit reluctantly) to eat meals in our vehicles…but now our less than ideal dining options are terrifying. For most, with no breaks, there was never a choice and, for those to whom they were allocated, meal breaks no longer exist. Suddenly, we spend entire shifts surrounded by pandemia, but must force ourselves to eat amongst it too. Let’s look after our crewmates and keep the cabin surfaces clean enough to eat dinner off (okay maybe we don’t want to push our luck!)

🍽🥯

Once we were welcome to stand outside of ambulances and briefly catch up with colleagues…but now media cameras and onlookers capture us on screen. Suddenly, we are public property. Let us catch a breather between calls instead of filming us during these rare minutes of much needed downtime.

📸🤦‍♂️

Once we were welcome arrivals at the scene of most calls…but now we face hostility and frustration from the distraught as we don PPE. "We must have a spotter to ensure full protection.” “We must take our time.” “We must not take shortcuts.” We are told. No matter how dire the emergency, no longer do we soothe, calm and control the chaos on arrival. Suddenly we appear heartless and selfish to everyone nearby. Please be patient and let us protect you, your loved ones, ourselves and everyone we’ll attend to during the incubation period thereafter.

🧤🤿

Once we were welcome over the threshold of our own homes...but now we risk taking work home to our families in the most lethal manner. They know that we are constantly exposed in the community, in our ambulances, in hospitals. They know that we don’t get to escape into clean areas throughout our shifts. Suddenly we cannot escape into our personal lives without guilt and fear. Let’s make the best decisions for ourselves, with our families, it’s not for peers and colleagues to mock or disagree with anyone’s personal choices.

👩‍👧‍👦👨‍👧‍👦

Once we were welcome to prepare ourselves in private for the constant public scrutiny of prehospital care…but now we don in public, we doff in public and so the cycle continues. Suddenly we stand on pavements in full public view, vulnerable to all manner of surroundings as we attempt to make ourselves presentable. Leave us to get on with this unpleasantly public part of our jobs and please don’t approach during vital social distancing, no matter how well intentioned.

🙅🏼👍🏼

Once we were welcome in triage areas and staff facilities…but now we stand with the sick in public waiting areas and must exit the same way. No access to bathrooms. Nowhere to fill water bottles. No kitchen to make a cup of tea or heat our food. Suddenly we’re not part of the team on either side of the security screen. If you see us looking fed up and stranded in your hospital, please be kind and if there’s time, point us to any clean facilities that we can use.

💧☕️

Once we were welcome to feel safe in the majority of cases…but now we face the wrath and anger of families and loved ones when we can’t provide care in the normal way. When our response times are delayed in dire emergencies. When we must refuse to transport family members with sick patients. When we can’t enter a scene without first being fully prepared. Suddenly the absence of security or means of escape is more noticeable than ever before. Try to understand the reasons behind delays or why we have to say no sometimes. We know it’s upsetting, but it’s not through our choice.

🙏🗣

Once we were welcome to use restrooms in fuel stations or restaurants on the run…but now they are closed. No option but to hold on. No respite from a painfully full bladder without requesting a return to base. Suddenly we’re more isolated from basic human comforts for longer than ever before. If you have facilities that you’re allowed to let us into when paying for fuel or grabbing a takeaway coffee, please consider letting us use your bathroom.

🥴🧻

Once we were welcome in coffee shops and restaurants…but now we are shunned by patrons fearful of their takeaway being contaminated. Suddenly we are the unclean. We go to great lengths to keep our uniforms clean, we have a vested interest in not carrying disease around with us all day, so please be kind, we’re not as yukky as some might think.

😢🛁

There’s no-one to blame and nothing that can be done.

These reactions are perfectly natural in times of pandemia.

But a little understanding and kindness goes a really long way.

For every paramedic stuck in the "no man’s land" of healthcare. 😍🚑

The Good, The Bad & The Ugly Paramedic is available in eBook, print and audiobook formats online and in stores, visit gbuparamedic.com for details.

A book for best patient care and paramedic professionalism, written by a paramedic, for paramedics at any stage of their training or career. With a friendly tone and non-judgmental approach, each chapter steps through examples of where the reader may sit, on a scale of good through bad and ugly in the prehospital arena, and highlights why it matters in the long run. For information about the author and the book, follow the links below.

Ambulance Detectives

noreply@blogger.com (Tammie Bullard) — Tue, 18 Feb 2020 00:43:00 +0000

When we get it wrong at work…how does it feel?

If we make a mistake in provisional diagnosis and treatment…how does it affect our patient?

For those of us who feel comfortable that we’ve been "in the game" long enough that we don’t need to be concerned, it’s vital to remember that it’s not just new paramedics and healthcare professionals making errors. One of the most common causes of medical mistakes and misdiagnosis is that of overconfidence.

In the case of paramedics, we often remain oblivious to any incorrect clinical interpretations, as we are not providing our patients with an official diagnosis and we don’t often see them again. Any alteration in treatment pathways will usually occur in hospital, once more specific diagnostic tests and assessments have been completed. It is possible, therefore, that without recognition of such errors and their associated humbling emotions, we are at risk of becoming overconfident.

This does not simply mean complacency (although that features in the mix) it is often related, instead, to experiential bias. We throw around the term “differential diagnosis” with great frequency in teaching, but how much time do we spend teaching its finer points, including, most importantly, the avoidance of bias in our decision-making skills?

All paramedics, amongst a group possessing equal levels of education, clinical training, and experience, will all assess and analyse each situation slightly differently, often reaching different conclusions. The subconscious process of integrating a patient’s medical history, signs, symptoms and assessments, with our medical knowledge and experience, can often be influenced by four varying types of bias, without us even realising it.

Availability bias regarding which conditions are at the forefront of our minds and are therefore easier to retrieve. In a healthcare setting, a practitioner is more likely to re-diagnose conditions that they have recently encountered, than consider other options less common, frequent or recent to their experience.

Representative bias around the similarity of signs and symptoms we may have seen before, whereby it appears obvious, therefore we may forget to investigate similar conditions. A study of both qualified and student healthcare providers found that adding a suggestion of unrelated social factors to patient history swayed their decision making, so that an otherwise clear diagnosis may instead veer towards a social or situational cause. For example, simply stating that alcohol could be smelt on a patient's breath, or the patient was recently made redundant, influenced the clinician to such a degree that, despite clear evidence of textbook CVA and STEMI symptoms, they were less likely to be diagnosed accurately.

Anchoring bias through which we set our thoughts so firmly on the things we know, or have seen before, rendering us unwilling and possibly incapable of changing our minds to incorporate new knowledge or data. This can be highlighted in situations whereby diagnosing clinicians remain firm in their decision, despite diagnostic evidence and/or autopsy later contradicting their initial opinions.

Confirmation bias tempts us to assess or test specifics to “rule in” or confirm our original ideas, whilst failing to test and assess other specifics which may “rule out” or come up with differential diagnoses instead. Perhaps the most dangerous of the group, there are two distinct ways in which confirmation bias can negatively affect patient care.

Firstly, upon assessing a patient, information may be sought to corroborate what we expect to find, rather than starting with a blank canvas. Upon gaining that corroboration, it becomes more likely that we may stop asking further questions due to our perception of having reached a satisfactory conclusion.

Secondly, in terms of treating a patient, opportunities to rely upon vital checks such as medication names, doses and expiry dates may be missed. By reading the details out to a colleague before showing it to them, may result in dangerous confirmation bias, should they be distracted or too busy, rather than simply requesting that they read the details on the vial to us instead.

Closing the case, and therefore our minds, in terms of diagnosis, is a common cause of clinical error. With a natural human tendency to stop looking for other possibilities once we’ve found a good solution to a problem, we risk premature closure of our differential diagnostic thoughts. So how can we avoid falling into these habits when we’re fatigued and under pressure?

1) Discussing our findings and differential diagnoses aloud may be useful in maintaining an open mind, as well as inviting in the shared knowledge and experience of a crewmate, or telephone support clinician. If fear, ego or lack of confidence prevent us from doing so, at any stage of our career, we may be doing our patients a huge disservice and putting them, as well as our professional reputations and careers, at risk.

It may be that we are working with a crewmate who seeks to mock or discredit us, should they view this behaviour as “weak” or “unconfident” or some other inappropriate judgment of our actions. Yes, this makes it undeniably challenging, in which case it may be necessary to either have a frank discussion with them about how their behaviour is affecting patient care, or simply keep the thought process to ourselves in those instances.

Even if the conversation has to be internal, in our minds, it is still possible to ensure that we purposefully step through the information and differential diagnosis options, thus maintaining safe habits that we can then bring into future working relationships when the team dynamic permits.

2) Developing a habit of seeking to contradict any provisional diagnosis we have in mind. If we remain vigilant for additional information rather than dismiss it as irrelevant to the case we have formulated in our thoughts, we are actively seeking the best answer, rather than the easiest, quickest or most impressive.

The only thing we have to prove, as paramedics, is that we can carry out our roles to the very best of our abilities. In doing so, patients receive the highest level of care possible, the organisations we work for maintain good standing within the local community, the prehospital profession gains momentum and respect within the medical world, individual reputations remain intact and are enhanced over time, and as individuals, we go home to our loved ones and sleep soundly at night, free from unnecessary work related regret or concerns.

We may be labelled as “indecisive” or “overthinkers” or “over treaters” or “stress heads" or “indecisive” or any other unkind term, but the benefits of our extra effort will always far outweigh any adhesive residue those labels leave behind.

3) Using the time we have initially upon arrival, albeit limited, to make our best decision, but keep going back to the tried and tested primary and secondary surveys we’re all familiar with for the duration of the job.

It is often considered impressive, particularly to newer paramedics, that some clinicians will attend a patient and immediately pick a diagnosis, before sticking with it unwaveringly. Whilst this may look slick and professional to some, the ever-present risk remains that vital, potentially life-threatening, information may be missed. Being able to work with a provisional diagnosis and confidently reassess for improvements, deterioration, and reactions to treatment is safe, thorough, proactive and professional at all levels.

Similarly, we can picture ourselves at home, watching a thriller, in which the lead detective has a murder suspect in their sights. We feel frustrated when they won’t continually talk to colleagues about every aspect of the case, and we start willing them to share newly gained information which may change their mind.

Once we’ve made our second cup of tea, and hit the play button to settle back in, we find it infuriating to realise that they are still fixated on the original suspect, despite new clues coming to light. Why won’t they just look around and re-assess before it’s too late?

By the time we’ve spent the final nail-biting hour on the edge of our seats, watching them arrest and charge the wrong person, we are incensed that the killer has escaped and another innocent victim had to suffer unnecessarily.

Perhaps we can apply the same to our clinical practice and adopt the ambulance detective approach to best patient care and professionalism?

First written for and published in the Australian Emergency Services Magazine Vol 17 (1) 2020 available via free subscription at https://ausemergencyservices.com.au/mag-rack/.

References

Kothari, S. S. (2012). Clinical errors. Annals of Paediatric Cardiology, 5 (1) 1-2. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327005/
Cassam, Q. (2017). Diagnostic error, overconfidence and self-knowledge. Palgrave Communications, 3 (17,025). Retrieved from https://www.nature.com/articles/palcomms201725
Berner, E. S. & Graber, M. L. (2008). Overconfidence as a cause of diagnostic error in medicine. The American Journal of Medicine, 121 (5) S2-S23. Retrieved from https://www.amjmed.com/article/S0002-9343%2808%2900040-5/fulltext
Elston, D. M. (2019). Cognitive bias and medical errors. Journal of the American Academy of Dermatology, 81 (6). Retrieved from https://www-sciencedirect-com.ezproxy.ecu.edu.au/science/article/pii/S0190962219322832
Klein, J. G. (2005). Five pitfalls in decisions about diagnosis and prescribing. The British Medical Journal, 330 (7,494). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC555888/

Read more from The Good, The Bad & The Ugly Paramedic in eBook, print and audiobook format. Available online and in stores through major retailers or visit gbuparamedic.com for details. A book for best patient care and paramedic professionalism, written by a paramedic, for paramedics at any stage of their training or career. With a friendly tone and non-judgemental approach, each chapter steps through examples of where the reader may sit, on a scale of good through bad and ugly in the prehospital arena, and highlights why it matters in the long run. For information about the author and the book, follow the links below.

If Paramedics Had The Ego Of Ants

noreply@blogger.com (Tammie Bullard) — Wed, 12 Feb 2020 10:31:00 +0000

One of the subjects that comes up often in articles, blog posts, social media comments and in general ambulance related conversation is that of ego. Whilst we tend to use it as a negative reference, it’s important to remember that it does have some benefits.

Paramedics need to step up in unusual circumstances as a matter of course, so we absolutely must do whatever it takes to make ourselves feel brave at that moment. We need to convince ourselves that our voices have value, simply so that we can force ourselves to command enough bystander attention to ensure safety at a scene. We must step out of our comfort zones almost every day, and step into the unknown, so we need to boost our egos to be able to keep stepping out so that we can continue to step up.

The Merriam Webster Dictionary defines ego as a sense of self, when contrasted with another and likens it to self-esteem. Similarly, psychoanalytic theory of ego defines it as "The organised conscious mediator between the person and reality, especially by functioning both in the perception of and adaptation to reality." So we need it, we really need it, just to do our everyday jobs, for us to function at the high level expected by the communities we serve. If that ego aids in carrying out our duty, in a world where we have to function within our perception of circumstance as well as adapting to the reality of the situations we find ourselves in.

When does it become a problem though? Is it a problem when we’re at work and our ego prevents us from listening to suggestions of better, safer ways to do things? Will it put our reputations in harm’s way because colleagues eventually lose all respect for us, when our ego continually shuts them down and ridicules them? Does it create difficulties in being so quick to judge and criticise that we often incorrectly assume that a patient is wasting our time, or seeking drugs? Can it negatively affect relationships in real life, and online, when we jump in with opinions and thoughts simply because we’ve become so used to having to speak up quickly and clearly that we forget to think it through first? Could it prove difficult when our ego refuses to let us speak up and ask for help in times of deteriorating mental health?

Perhaps a simple lesson in humility can be learned from ants. I’ve been seeking out information on ants since I first listened to a podcast about their caregiver ants last year. Researchers have found that a nurse or paramedic equivalents carry out first aid and ongoing treatment for their injured comrades, but only after they’ve efficiently triaged. Maybe they turn up in an “ambulANTs?" (Sorry.) Any ant with five or more injured limbs is not rescued, simple as that, but for the others, they take them back to the colony and lick their wounds until they either recover or die.

With this newfound fascination, I discovered the most interesting news of all, that they have no ego, none at all.

That is where their lives may seem a little kinder, more simple and dare I say rewarding, than the “dog eat dog,” “eat our young”, “survival of the fittest” and “paragod” situations we’re creating for ourselves over time. So, how do researchers think they do it? Their overriding goal and collective desire is for their colony’s wellbeing, and without a collection of egos competing for the limelight, they take care of each other and get the work done.

Ants live in colonies and, without fail, work together to create enormous, impressive and strong structures despite their tiny size
They know what their roles are and they stick to them because they are made to feel valued, and empowered, within the clearly defined roles they inhabit.
Their leaders know that they cannot survive without all of the ants in the colony performing well, whilst the ants know that they can’t survive without the direction of their leaders.
Ant energy is unified and always focused in the same direction, so they just don’t have reasons to argue or create friction amongst their ranks, they’re too busy aiming for a shared goal.
Communication is constant between every ant in the colony so that they maintain close rapport and build effective relationships.
When they run into a problem that they can’t handle alone, ants immediately summon help so that the issue can be dealt with quickly and effectively.
As a group, they look to see what needs to be done and just do it, even if it means laying down in a pothole for hours, to make a smoother road for other ants to travel across.
Leader ants can focus on what needs to be achieved if the rest of the colony are performing as expected, so it’s worth their while empowering and valuing every member of the colony.
If something happens to knock a colony of ants off course, and a few things go wrong, their lack of ego and unified approach lets them bypass obstacles without upset or delay.
The more pressure ants find themselves under, their colonial lines become straighter, whilst their speed becomes more consistent, strengthening their approach to overcome the problem.
And finally, because these little critters have no ego, they have no urge to overtake each other, no craving to prove any point and no desire to mock others.

(Have a quick three minute listen for yourself about why ants just seem to stay on course https://www.npr.org/2015/01/19/377743242/why-ants-handle-traffic-better-than-you-do.)

With this in mind, how do our egos look in comparison to our ant counterparts, and can we adopt a similar approach, so that we can soften ours ever so slightly? Perhaps we can build the value and importance of this into paramedic education. Teach new ways of keeping the ego in check, so that it serves us well when we need to maintain just the right amount of self-esteem to be able to stand up and makes ourselves heard. Demonstrate the benefit of an ant's attitude to the role, so that we’re working together for the wellbeing of our entire profession. Our patients. Our colleagues. Our predecessors. Our future paramedics. Ourselves. Our colony.

Thanks for reading.

Tammie

References

Cheng, P. L. K. (2011). Learning teamwork and other lessons from the ants. Business Journal for Entrepreneurs, 2011 (1). https://poseidon01.ssrn.com/delivery.php?ID=455104081101117078117091122088106023001073052003031050086125094005008115113124077109036030058033030004038075013110102101024101114008047023021089068018024096023097081035028092067123098005070114125064097125121116064120098066087095114083121073084099067&EXT=pdf

Frank, E. T., Wehrhahn, M. & Linsenmair, K. E. (2018). Wound treatment and selective help in a termite-hunting ant. Proceedings of the Royal Society of London. Series B: Biological Sciences, 285 (1872). https://royalsocietypublishing.org/doi/10.1098/rspb.2017.2457

John, A., Schadschneider, A., Chowdhury, D. & Nishinari, K. (2009). Trafficlike collective movement of ants on trails: absence of a jammed phase. Physical Review Letters, 102 (108001). https://journals.aps.org/prl/abstract/10.1103/PhysRevLett.102.108001#authors

Merriam-Webster. (2020). Ego. https://www.merriam-webster.com/dictionary/ego

Youngsteadt, E. (2007). Ant highway repair. National Evolutionary Synthesis Center. https://nescent.org/eog/eognews.php-id=45.html

Thanks for reading.

Tammie

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As a current, practising paramedic in Australia, Tammie Bullard is passionate about prehospital care. With a background in metropolitan and country ambulance, academic study, clinical training, precepting and lecturing, she aims to put it to good use. Through the shared experiences of countless students, colleagues and mentors, her first book is designed to encourage effortless and ongoing self-reflection in every paramedic that strives to excel in their rewarding choice of career. Find out more about the author and the book through any of the links included below.

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Ambulance Driver or Paramedic?

noreply@blogger.com (Tammie Bullard) — Thu, 23 Jan 2020 17:57:00 +0000

As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing?

Do we fully engage in shared patient care with our attending partner, or do we switch off so that we can simply drive the ambulance and take it easy?

With so many countries and jurisdictions now regulated, or about to be, we are beginning to see considerable change in how paramedics operate within (as well as how we ourselves view) both attending and driving roles.

For some, this is likely to be welcomed, but for others, it may prove an unexpected stressor, as those “driver mode” days are well and truly over.

In the prehospital environment, there’s no doubt about it, someone has to drive when a patient needs to be transported to definitive care. If that someone happens to be a registered paramedic, however, as is often the case, it is expected that their involvement is not limited to sitting behind the wheel, driving from one location to another.

In Australia, for example, AHPRA’s Paramedicine Board describes paramedics as "practitioners" throughout documentation regarding registration. This comes with it several responsibilities and expectations relating to every interaction involving patient care.

Whilst working as a paramedic, our code of conduct within the professional standards, to which we have agreed upon submitting our registration applications, includes several aspects which apply whether we are attending, or driving.

Clear and effective communication with patients, colleagues and other practitioners is expected at all times, as well as taking steps to alleviate any patient symptoms or distress. Consideration of benefit vs harm in relation to clinical management must be maintained, along with appropriate consultation and shared decision making, between colleagues, during treatment of patients. Clear co-ordination and delegation of shared care between practitioners, as well as the responsibility to collaborate in order to mitigate potential risk to patients.

With this in mind, our professional autonomy, integrity and reputation must remain at the fore throughout every call we attend, no matter which seat we occupy in the ambulance. Now, more than ever, teamwork is a must.

Through various aspects of prehospital training, whether it’s in-house or via tertiary education, the provision of high quality health care is based around effective communication and teamwork. It is widely known that collaboration between practitioners improves patient outcomes, reduces medical errors and enhances patient satisfaction.Any failure within a team dynamic not only compromises patient care, but can create tension, negatively affect the environment we’re working in and undoubtedly cause distress to each practitioner involved.

In addition, with societal knowledge (and therefore expectation) of our roles increasing, the likelihood of more complicated complaints begins to rise. Paramedic behaviours and perceived levels of care are becoming an area of focus in other jurisdictions, not just the success or failure of clinical decisions undertaken. Examples such as delays in communication with family members and failing to ease the emotional stress of patients feature heavily. The psychological pressure, therefore, involved in coming up with appropriate solutions to patient care in stressful, unpredictable and ever changing prehospital situations intensifies.

None of us want, or need, the extra stress this creates, nor do we want to risk patient safety, therefore how do we begin to balance out both roles without stepping on a partner’s toes?

Five key aspects of teamwork may help to keep us on track towards best patient care, safe practices, efficiency, professional management of the scene and overall satisfaction of everyone involved in each call.

1) Deliver (and accept when in a secondary role) a leadership style that co-ordinates and plans with a conversational, collaborative approach between both paramedics.

Not only can this provide clarity and establish what needs to be done, it may ensure that with minimal additional effort, patients, family members and others on scene feel well informed and continuously reassured.

2) Mutually monitor each other’s performance to detect and avoid task overload, as well as prevent lapses in care.

Without questioning or criticising, both primary and secondary roles can help to keep each other on track and maintain a working environment that is supportive. Sharing information and updates both on scene and during transport may ensure that no individual feels alone in a pressurised situation.

3) Backup positive behaviours and provide supportive actions within shared care.

Assisting by setting up for interventions, gaining history from and providing reassurance to family members, and using body language or expression to support explanations our partner is giving, highlights a strong, patient focussed team. Not only is this likely to bolster the primary paramedic’s confidence in stressful situations, it may be pivotal in demonstrating the professional, cohesive and efficient nature of a paramedic team to each person present.

4) Create a truly team based approach by sharing ideas, taking the perspectives of both paramedics into account.

As the primary paramedic, verbalising a plan of action and requesting feedback is integral to involving a crewmate. Whilst this may prove challenging, dependent upon individual personalities, it may be the only way to ensure that a secondary paramedic agrees with what needs to be done. For best patient care and avoidance of risk, error or complaint, no matter how difficult it seems, it’s imperative that we find a way. In addition, if we are responsible for a trainee, or unregistered partner, ensuring that we know what’s going on at all times is the only way that we can keep our own registration intact.

5) Be adaptable, with both practitioners willing and able to ensure that changing conditions and situations are not only prepared for, but dealt with effectively.

Working together continuously and maintaining vigilance, whilst attending, driving or anything in between, may ensure that any change in situation is recognised.

The next time we feel frustrated at being called “ambulance drivers” perhaps we ask ourselves an important question. When it’s our turn to drive, are we giving our absolute best as the secondary paramedic within a professional, patient centred team, on every single call?

Thanks for reading.

Tammie

References

Austin, Z., van der Gaag, A., Gallagher, A., Jago, R., Banks, S., Lucas, G. & Zasada, M. (2018). Understanding complaints to regulators about paramedics in the UK and social workers in England: findings from a multi-method study. Journal of Medical Regulation, 104 (3) 19-28.

Bhatt, J. & Swick, M. (2017). Focusing on teamwork and communication to improve patient safety. American Hospital Association. https://www.aha.org/news/blog/2017-03-15-focusing-teamwork-and-communication-improve-patient-safety

Freytag, J., Stroben, F., Hautz, W. W., Eisenmann, D. & Kämmer, J. E. (2017). Improving patient safety through better teamwork: how effective are different methods of simulation debriefing? Protocol for a pragmatic, prospective and randomised study. BMJ Journals, 7 (6). https://bmjopen.bmj.com/content/7/6/e015977

Paramedicine Board AHPRA (2018). Code of conduct (interim). https://www.paramedicineboard.gov.au/Professional-standards/Codes-guidelines-and-policies/Code-of-conduct.aspx

Patterson, P. D., Weaver, M. D. & Hostler, D. (2017). Human factors and ergonomics of prehospital emergency care. Teams and teamwork in emergency medical services. CRC Press, Boca Raton.

Weller, J., Boyd, M. & Cumin, D. (2012). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate Medical Journal, 90 (1061). https://pmj.bmj.com/content/90/1061/149

(This article was originally published in the Australian Emergency Services Magazine in December 2019. Subscribe for free by visiting AESM online and read each bi-monthly issue as soon as it arrives in your inbox.)

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A First Responder Kind Of Christmas

noreply@blogger.com (Tammie Bullard) — Tue, 24 Dec 2019 13:36:00 +0000

It may be holiday season for many,

but in the world of a first responder,

through busy, crazy, intense shifts
our minds will try not to wander,

to our families, those we care for most,
but whom we’ll likely see the least,

whilst we tend to patient emergencies,
due to trauma, illness, famine and feast.

The demand is almost as high as the stress,
amongst a relentless barrage of calls.

Seasonal tension building up into fights,
too much alcohol resulting in brawls.

Domestic violence on a saddening scale,
illicit substances out of control,

people killing each other over this drug or that,
then themselves when the hit takes its toll.

The medical calls for those at death’s door,
in cardiac or respiratory arrest,

as their families bring fun to a screeching halt,
drowning in the sadness we all so detest.

Vehicle trauma caused by “one for the road”
or impatience to get to holiday destinations,

only to find that those few festive beers,
and the rushing, kills someone’s relations.

The isolated patients who place a call,
with a fabricated emergency reason,

simply to have someone show up and care,
because their loneliness peaks in this season.

The long term ill whose ailments don’t disappear,
just because the holidays have arrived,

so they wait too long despite urgent needs,
and of our attention they will be deprived.

A mental health patient who just can’t go on,
or for whom overwhelm drives them to despair,

so in desperation, with nowhere else to turn,
they call upon those who 24/7 are there.

No matter the emergency, or who the patient may be,
the factor that may risk appearing faded,

is that we signed up to deliver great care,
not be thoughtless, complacent or jaded.

So when we’re tired mid-shift and everything aches,
from lifting bodies, equipment and bags,

are we kind, at the level we’d like our families to receive,
or is this where our care factor lags?

With breaks non-existent and fatigue setting in,
are we short tempered, and less empathetic,

when the easiest option to soothe others and ourselves,
may be to listen and be sympathetic.

Some of life's inner turmoil and deepest discomfort,
can be caused by our own action or inaction.

We all know that feeling of instant regret,
when our eye rolls, or words, cause poor reaction.

The worst consequence we face is our conscience,
when it reminds us long after the call

that despite signing up to make a difference,
we broke trust and caused the worst damage of all.

Nobody’s perfect and we cannot expect,
that we’re infallible to our human reactions,

but hands on hearts, can we honestly say,
that we’re proud of all our patient interactions?

Throughout calls and pressure where do we stand,
at the caring, kind, good end of the scale?

Or across the bad, into the ugly divide,
where we take shortcuts and care less, so we fail?

Happy holidays first responders and all support staff,
we may be absent from families and home,

as we turn up for work, be it day shift or night,
one thing remains...we’re not in this alone.

Let’s be safe in our endeavours to fulfil our roles,
care for ourselves just as we care for others,

soothe our souls through simple kindness to patients,
bystanders and work sisters and brothers.

Tammie

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Beware The Paramedic Bluff

noreply@blogger.com (Tammie Bullard) — Sat, 21 Dec 2019 13:07:00 +0000

There exists an invisible phenomenon in paramedicine, along with many other professions, that whilst it's absolutely essential, it can quickly become debilitating if we don’t keep watch over its sneaky and pervasive nature.

In trying to quantify this unspoken “thing" that we develop, with time and experience, in order to write about it in The Good, The Bad & The Ugly Paramedic, it took days and days of mind mapping, scribbling and drawing before it began to make any sense.

Finally, describing it as “The Bluff” in the form of a coat that we wear when necessary, seemed to fit, and it is reportedly now a favourite chapter for many readers. Most commonly those with several years of experience, who tend to truly appreciate the potential benefit and, more importantly, the harm that can come from wearing it often.

We absolutely have to step up on so many occasions, so that we can meet the needs and expectations of patients, their loved ones, bystanders, our colleagues and inter-agency personnel. We literally have no choice. If we have signed up to step into first responder shoes, we quickly realise, right at the beginning of our careers, that we must fill them.

The reality is that we are human and, like all the humans we see before us on each call, situations can be challenging, stressful, chaotic, tragic, graphic, revolting and downright terrifying. The expectation, however, is that we will manage, de-escalate, organise, fix, sort and soothe the situation as soon as we arrive, and most of the time, we actually do. Remarkably enough, but not without the help of our good old bluff, after all, what else do we have to rely upon?

In order to turn up at confronting scenes and instil calm, controlled and safe surroundings immediately, was there a special school or university course that taught us how to keep our own feelings and fears in check?

For re-certification, with that irrational fear that makes live assessments more terrifying than the real calls themselves, who patiently instructed us in tried and tested methods, to prevent us from losing our minds in the midst of the pressure we find (and put) ourselves under?

When calls escalate, or suddenly become chaotic and unspeakably graphic, what stops us from listening to that overwhelming gut instinct to just turn around, start running and go home right away?

Mid-way through a night shift with a brand new intern and no back up available, which training certification provides us with the tools to support them confidently, on a gruesome multiple casualty trauma job, even though our own brains are struggling to keep up with demand?

During a paediatric resuscitation, when sadness drenches the room like a heavy fog, how did we learn to distance ourselves enough from the tragedy we’re right at the centre of, in order to maintain our composure so that we can perform challenging interventions and reassure our patient’s family?

Most of the time, the answers to these questions will be “No.” “No-one.” “Who knows?” “None” and “No idea!” And herein lies the bluff.

We mentally don that bluff coat just as we step out of our emergency vehicles. It protects us as much as it protects others. It provides us with just enough confidence to carry out the job, no matter how much stress we may secretly feel deep inside. The old adage of the graceful swan gliding around above water, whilst it’s feet paddle furiously beneath the surface. Without the bluff, would we be able to put our bravest of faces on? Possibly not.

For me personally, I am one hundred percent positive that I would never be able to drive up to a scary looking house, with people crying out and waving me over, in the middle of the night, in my own car, dressed in my favourite jeans and t-shirt and walk in with a friend, calling out casually “Hi there, my name’s Tammie and this is [insert friend’s name].” I can do it in uniform, however, but how? The only difference is my clothing and my vehicle. They, in themselves, start to form my bluff. Yes, I look more purposeful, the assumption of callers is that I’m well trained and qualified, I’ve also been tasked to attend, but even still, it’s that bluff that quashes most of the unsettled feeling in my gut as I walk in. Without it, I couldn’t keep doing my job. It keeps me going. It helps me to feel braver and more in control. It lends me the strength I need to look calm and settled enough that an intern or a colleague feels stronger too.

So how can this possibly be dangerous, learning to wear such a beautiful coat, that makes us feel so good? Sometimes, it feels too good, like eating too many cupcakes at a birthday party, rather than a delicious treat, it becomes a heavy, sickly feeling in our stomachs. The extra half hour in the gym, where we feel great, so we stay longer, but end up overdoing it and become sore for days. That extra couple of beers, because we’re having so much fun, that take us from feeling warm and fuzzy before bed, to suffering a monstrous hangover the next day. We need to know when to stop, when to take the coat off and remove the bluff, before it swallows us up.

If we wear it too often, how can we stay in touch with those true gut feelings that keep us safe? Are we at risk of getting so comfortable in that coat, that we forget how to keep ourselves open to learning new things? Do we become so complacent when we’re wrapped up in the bluff, that we may forget the importance of ensuring safety measures are in place every step of the way? Can the bluff make us arrogant enough that our peers refuse to communicate openly with us, for fear of us passing comment just to outsmart them? Is it possible that our families become less able and willing to connect with us, because our comfortable coat creates a barrier between our open, vulnerable, human selves and the bluff version that we begin to favour more often?

It may be a complicated concept to get our heads around as it’s something that we learn and develop individually, inside our own heads, rather than being taught in the usual paramedic or EMS based systematic methods. From reader feedback, however, it sounds like it's definitely worth taking a little time to pay attention to your bluff. Let me know what you come up with, I’d love to hear your thoughts on the subject either in the comments below, or on Facebook, Twitter or Instagram.

Tammie

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The Trouble With Great Expectations

noreply@blogger.com (Tammie Bullard) — Wed, 11 Dec 2019 07:40:00 +0000

Being a paramedic is not necessarily the job that many of us expect it to be once we get past initial training and into the role itself.

For some, it becomes a career with aspirations to progress into specific roles, for the challenges they bring and personal rewards that may be gained. For others, it may be disappointing that it's not always the exciting, high drama, constant lights and sirens rush that we thought it would be.

A large majority may find that it evolves into a vocation, passion and calling to make a little difference to a large number of people, with immense satisfaction over a working lifetime. In many, it may be just a good job. One that provides the type of lifestyle, salary and day to day reliability we're looking for, but we can take it or leave it overall.

Whatever the drivers behind becoming a paramedic are, whatever the reasons we remain in that role may be, and whatever the goals for our futures become, like any profession, we're a diverse bunch. Those drivers, reasons and goals are quite possibly the things that help us to connect, but also keep us accountable within such a large group.

In conversation amongst students, frontline medics, managers, support staff and senior leadership, it can be easy to fall into the trap of expecting our own, individual values, to be the same as others. With this trap, unfortunately, comes ultimate disappointment. Maybe not today, maybe not tomorrow, but someday soon, we'll find ourselves disappointed if we expect our personal moral compasses to be matched by everyone around us.

Whenever I have tripped and fallen into that little black hole of disappointment, I've had to drag my miserable self out by reassessing my expectations. Through reading books, articles and research, speaking to colleagues, friends and family, or listening to podcasts and motivational talks, it's the same answer every time.

It always comes back to my individual assumptions, and what I have expected. When in actual fact, I have no right to create preordained expectations of any individual, group, or organisation, unless specific guidelines, mission statements or commitments have been offered in writing.

Writing a book entitled The Good, The Bad & The Ugly Paramedic was the first challenge that I have undertaken with absolutely no expectations of either the outcome, myself, or others. The feedback, therefore, has been interesting, surprising, refreshing and exciting. It has also been the most satisfying challenge, simply because I had nothing to aim for, other than to create a text that I was happy to publish, because of something that I am passionate about. I can't believe it took me this long to learn such a simple lesson in life!

With this in mind, rather than aiming to instruct readers on how to do their job, based on my own expectations of paramedics, or that of an industry majority, the goal was to suggest ways of personally reflecting on what we do in paramedicine, from the outside in. Dropping our individual expectations of others, therefore, is the whole premise of the book, with a focus instead on our own expectations of where we fit on the good to bad to ugly scale. It's up to each reader to reflect on individual performance through questioning their current points of view.

Are we consistently happy with our own clinical practice?
Does our behaviour in public meet our personal expectations of what we hope to see from other emergency services personnel?
Do we utilise safety precautions to the same level we'd hope our loved ones will in their daily work?
Does our leadership performance match the expectations we personally used to have, of others in those positions before us?
Overall, do we deliver to our patients, the level of care and compassion that we hope other paramedics will deliver to our family members?

This blog aims for the same focus. To raise the questions, put some examples out there, and see what we can come up with on reflection, all by ourselves in the privacy of our own minds, with no expectations of others whatsoever.

Thanks for reading, feel free to subscribe, your details will never be shared with anyone else and, if you're passionate enough about any post to want to comment, please do. It would be great to hear from you.

Tammie

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