lab with stethoscopeYes. In one main way.

When you show a Labrador retriever a stick or a ball, they start to go a little nuts. They shake and whine until they get to retrieve. This same thing can happen when new paramedics see the drug box. Instead of shifting into deep clinical decision making, they shake and whine like the Labrador retriever until they get to stick some device or medication into a patient.

Maybe it isn’t exactly like that… but it seems that way sometimes.

We’re not saying that new paramedics’ decisions are bad. We’re just saying that there are times when more experienced medics might take a slightly more conservative approach—often, one with more clinical thought and less focus on opportunity to use a drug or device.

These differences fuel age-old stereotypes. New paramedics and those in training sometimes call their more experienced counterparts “slugs,” because they think the experienced medics try to avoid using meds and skills. For their part, experienced medics often sit back and sigh as the new medic treats a patient using what seems like an overly aggressive approach.

Here’s the difference between a new paramedic and an experienced paramedic, boiled down to two sentences:

The new paramedic says: I can give the medication.

The experienced paramedic asks: Should I give the medication?

For providers of any experience level, three questions will help sort out the most correct approach with a patient. These questions aren’t a traditional part of the patient assessment and decision-making scheme. Instead, they sum up the practical application of the “five rights” of medication administration:

  1. Does it matter whether I give this medication?
  2. Can it cause harm?
  3. Am I really doing it for the good of the patient?

One of the greatest pleasures in education comes from teaching the process of critical thinking. We can think of few things more rewarding than helping a new EMS provider learn a process for making good decisions.  Educators aren’t the only influence here. Agencies, patients, and trial and error all help to shape a clinical provider’s thinking skills.

If you’re a trainer or a field training medic, we’d love to hear your responses to these questions:

How do you teach students decision-making skills?

How can education help to create providers with more clinical decision-making competence at the outset—and less Labrador retriever instinct?

We look forward to reading your comments!

 

Join the discussion 11 Comments

  • Carl w French says:

    BINGO you pretty much summed up my feelings. You and I have had this discussion several times but I am a big believer that The biggest difference to teen paramedics and those of lower bases level is that they need to be turned into clinicians versus technicians. We have to be expected to not have to rely on flowchart medicine ( see this, do that). my expectations of my paramedic students, is that they need to be able to tell me why they are doing everything including blood pressure’s. The ultimate wrong answer for me to hear is “because I can/should”. It is my personal belief that with properly instructed and motivated preceptors the clinical phase of anybody’s training should be where they are trained to use everything they have learned in the `didactic portion of paramedic school. This is where critical thinking should be honed. I have always called it the art of Street Medicine.

  • Carl w French says:

    Pardon sone autocorrects. I knew I never should have done this on my phone……

  • I used to be a Labrador Retriever medic.

    Oddly enough, I was only a year removed from training Labrador Retrievers prodessionally.

    • Dan Limmer says:

      Me too (the labrador retriever medic). My labradors have always trained me more that I trained them.

      I wrote a story about a friend who became a paramedic. I titled it Turbo Medic. Everything had to be hard and fast and about skills. I’ll have to see if I can dig that one up somewhere.

  • Andrew Terry says:

    Personally, I came out of paramedic school the exact opposite. I felt that SO responsible for the implications of even BLS medications that I second-guessed and over analyzed every decision I made. I think that new paramedics are carrying a tremendous amount of cognitive load and it takes a long time to sift through that load and pare it down to the stuff that really matters on a call.

    I truly wish that paramedics could come out more experienced, more mature, etc. But we expect an awful lot out of new paramedics, and all too frequently without adequate support, supervision and feedback. Consequently, once I can verify that a new medic knows and can execute the protocols in real life (and I think it’s harder than this article acknowledges – anybody can panic and just run a patient in), I then begin to get them to think about the concept of reasonable care.

    Perhaps both a lab medic and an overwhelmed medic are both possibilities. In my opinion, there just is no way to expect matute, fully-fledged executive functioning and decision making for newly minted medics. It takes time, reflection, and good mentoring.

    My 2 cents…

    • Dan Limmer says:

      Thanks for posting Andrew. It is actually quite common to have one (or more) bouts of challenges and confidence issues on the path to becoming a clinician. I sure did.

      When I became a medic it was all about skills. After missing some IVs n the first few months I lost confidence. I was fortunate to have a safety net. Then I continued on in my cocky labrador ways. 🙂

      Later I wasn’t really active because of jobs and other things. With a little bit of time away I came back and found my skills were ok but the choreography and decision making were a bit rusty. It came back but it was a bit freaky to have to catch back up after so many years.

      It isn’t a linear course and certainly differs from person to person. But it is a worthwhile course–and somehow we and our patients survive the early days!

  • Glenn says:

    The simple art of placing a hand on a shoulder, holding a hand or two or even a friendly conversation might be all that is required for that ride to the ED. Compassion sometimes out weighs medicine.

    • Dan Limmer says:

      Yes, Glenn. This is so true–and often not realized until later in a career after the labrador phase diminishes. Sadly, many never stay in the game long enough to get to that point.

      And you are also correct in using the word “art” in that sentence. It is an art when done right–and very beautiful to see and do.

  • Carolyn Henneforth says:

    IMHO, newer medics have put so much time, effort and money into their training, that when they are finally on the streets, they get a little too eager to play with all the toys they studied so long and hard. I consider myself fortunate that I was already working as an EMT for a very busy service in downtown Kansas City, MO when I started medic school. I think that made a difference in my desire to use the drug box…..I saw it being used everyday, so it wasn’t new.

  • Dan Limmer says:

    Carolyn–I think the experience is vital. If you had some great mentors and examples it makes a big difference. Sometimes maturity and personality come into play too.

    Whatever the reason it was good for you–and your patients!

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