Dear Stupendous Students 1,

To all the Interns..

So you want to be a Paramedic? Here’s a funny story: One of my favorite partners in the world, EMT-Paramedic Dave Gordon and I went to a call for a male possibly overdosed. We had a student that day. Also on scene were a few Police Officers and Firefighters. It is worth noting that the ambulance had to double park against a row of cars in front of the residence, then enter up several stairs and across a very long porch to the front door. The front door also happens to be situated poorly in the architecture of this residence, and has to be fully closed for admittance behind it, and up the stairs, down another long hallway where a male was scattered across his bed. The male, for reasons solely the responsibility of prescribed medications and ETOH, was shall we say, less than cooperative. Because of his state of altered mental status and other circumstances EMS determined it necessary the male seek medical attention at a definitive care facility. However, because of his altered state, the male determined any intervention into his current condition would not go unchallenged. 

The next 15 minutes proceeded thusly: 2 Paramedics, 1 Paramedic Student, 3-4 Police Officers, and a sprinkling of Firefighters wrestling one raging, belligerent, and ruggedly strong male out of the bedroom, down the long hallway, down a flight of carpeted stairs, past the front door to get it open, then through the door, down the long porch and wooden outdoor stairs, across the row of cars and onto the ambulance stretcher where he finally, blessedly began to calm down. It took that many of us only to ensure we did no harm to the innards of the residence, or to the male himself. The ungraceful shuffle through the indoors and out, with hands fluttering, hair whipping, elbows flapping, spittle flying, backs flattening up against the wall then peeling themselves off to dive back into what resembled the dusty tumbleweed of the Tasmanian Devil’s approach, was a visual commodity I will never be able to un-see! By the time Dave, the student, and I collapsed on the vinyl covered bench seat of the ambulance we were sweating, panting, and looking like the three finalists of an IronmanTriathlon. It was then that Dave asked the funniest question in history: He propped elbows up on his knees, and chin up on his hands, looked at the student and asked poignantly, “So you want to be a Paramedic?” LOL!

Field Internship on the ambulance with experienced Paramedics is necessary for every student to pass into practicing Paramedicine. To lessen the pain for both the students and the preceptors, here’s my official guide to Being a Stupendous Student: Let’s begin with before you begin: 

1. Be on Time! Duh, right? No. Be on Time! Don’t know where Medic 2 is located? Find out before you ever think about traveling there and Be on Time! Not sure what traffic is like because you live an hour away? Google it, take a test drive, ask your instructor...whatever it takes to Be on Time! Not only does it reflect heinously on your professionalism, we often get called out 30 seconds or less after reporting for duty so Be on Time OR (see #5 for what might happen if you’re not!) Oh, and by the way folks, Be on Time!!!! 
2. Your uniform should be: clean and free of fading, staining, and holes. It should absolutely represent your school, college, or training center where you received your PARAMEDIC training!  NOT your department, volunteer squad, or favorite beer. 
3. Your paperwork should be in a neat binder, or folder that is easily portable. When it is time for signatures, present it in an organized fashion, already completed with times, dates, and patient care reports written. Not only does the department refuse to pay employees overtime to sit there and redundantly sign off on skills, the employee is not too keen on sitting there and doing it for free! Follow the pattern of the crew you’re riding with: when they document you document, while one crew member is waiting for the other to finish documentation, get that crew member to sign the skills you did with them, etc. 
4. Pack your lunch and snacks. Be prepared to run back to back calls. We may or may not be able to take you to the store for lunch or snacks. The hospital may not be offering your preferred vittles. Set yourself up for success by having food and drinks handy, especially on long shifts where we may run 10 or more calls. 
5. Bring reading materials, study/field guides, or other small items for your personal entertainment. This is not because we are mutes and want to ignore our students, we all love to get our gab on. But if we are 2 or 3 calls deep and have alot of documentation or organization to do, it’s best if you’re not fidgeting around or worse, wandered away somewhere when we get another call. If that does happen, let me apologize in advance: you will get left at the hospital or EMS station! Students are important, but patients come first. Stay with your preceptors!

So, you were on time (yay), you’re wearing appropriate apparel, your paperwork binder is ready to roll, and you have a book, lunch bag, and already introduced yourself to the offgoing and oncoming crew. I like you already! So, what to do now that you’re here...

See #4 :)

1. See that comfortable chair over there? DO NOT sit in it! Help the crew with whatever they’re doing: cleaning quarters, rotating the AutoPulse battery, organizing the stock cabinet. If you’re not assigned a task, offer or inquire where your help might be needed. Even though you’re not getting paid (we’ve all been there, done that...yawn), it’s never ok to watch your preceptors hoof it while you chillax! Within reason, of course! Don’t let anyone make you clean their P.O.V’s, or knit their grandmother a pretty new scarf, or install the latest whacker lightbar on their souped up ride...not saying I’ve seen it attempted...just saying! :)
2. The ambulance is your office. Step into your office and acquaint and acclimate yourself to the environment. Most EMS situations are dynamic, and the inside of the ambulance is no exception. It may look like a purdy little hospital-on-wheels-now but throw one acute patient back there and watch it transformed into a frenetic, mobile snow globe, raining 2x2’s. Make every effort, while you’re helping the crew check off and restock the truck, to know where everything is, including the first-in bag, advanced airway and O2, I.V. therapies, CPAP, spinal immobilization, auto pulse, pediatric/broselow supplies...and pretty much any and everything else that is on the ambulance! 
3. Be courteous and respectful to us, our equipment, and especially our patients! If you feel you are being mistreated or are uncomfortable around a patient, back off and explain later, or go ride up front with the driver. Under no circumstances will disrespectful, unethical, immoral...or any other kind of inappropriate behavior be tolerated. If you have judgements, criticisms, or snarky comments to make about the personal choices or lifestyles of the patient, keep them to yourself or speak to us privately AFTER the call. If you feel like posting personal details about your experiences with us on Facebook or prattling to your friends, DON’T. You will be sent home from the shift, and unwelcome to come back and finish ride time. I have a zero tolerance policy for any molecule of perceived or actual mistreatment of a patient. Be nice!
4. Restoring the ambulance to its ready-for-a-call splendor after a bad trauma or cardiac arrest is a time consuming task, usually the responsibility of the driver on that particular call. You will find yourself with more BFF’s than you can handle if you’re out there helping that medic clean the bloody equipment, disinfect the stretcher, and replace the I.V. start kits from the first-in bag. Know where the garbage is, and empty it. Know where the documentation computers go, and plug them back in. Know where the long boards are kept at the hospital, and replace them. Keep yourself in the mix at all times! Learn how to use the C-med radio, and call in a few med reports over the air. Not only will you learn more by doing, you’ll be helping and gaining the respect of your preceptors, patients, and interactions with hospital staff.
5. This goes without saying, but be knowledgeable! It’s perfectly ok to carry and use your resources...that’s what field guides are made for! If you freeze up and forget the mcg/min for an epi drip, I expect you to have the resources available to look it up.  I always have mine, and even when I’ve been a medic for 20 years I will still carry my resources around. It’s naive to think you will ever know, or ever remember it all. Now, if you forget how to apply a non-rebreather...well, that might be a different blog. ☺

Being a Paramedic Intern is an exciting and stressful time! Remember that every Paramedic preceptor you have has been in the same exact situation! Follow these 10 steps and I promise you’ll be starting off on the right boot. Tune in next Tuesday to my expanding blog for more information on How to be a Stupendous Student. Next week will feature my advice on how to act on a call, and the importance of good assessment. The week after, Stupendous Student 3 will feature every students favorite subjects: starting I.V.’s and “getting your tube.” See you on the ambulance :)