Week 3: The First ER Shift as a Paramedic Student

This week in the ER was a big one. It was my first clinical shift of the program as a paramedic student with patient contact. The morning started off fairly quiet so my partner and I had to find things to keep us busy, then a few hours in, it became very busy with a cardiac arrest (I'm not going to focus on that in this reflection as I shared some details in patho), and went back to being fairly quiet. Before I get into my reflection and learning points below, I wanted to include a few things that my partner and I did to keep busy and learn while the ER was quieter to hopefully help others with future ER Placements:

- Go through drawers in carts, look at the supplies and quiz yourself what you know about the supplies... our Clinical Instructor is also very willing to answer any questions.

- Ask our Clinical Instructor about Intravenous Infusion calculations - he showed us a great way to make the math quicker!

- Take a look at the Broselow cart and measuring tape for paediatric emergencies.

On to my learning points:

Take Your Pocket Guides with You

Although it made my pockets very bulky to have my ALS, BLS, Clinical Competencies book, and Pocket Pharamacopia stuffed into my pockets, I am glad I did because they were very useful resources! When talking to a paramedic with a pediatric patient who had accidentally ingested a medication, I was able to refer to my Pocket Pharamacopia for information about the medication. This turned into a dialogue about the secondary effects (side effects) of the medication, the implications of a child ingesting a large dose of the medication, and what the paramedics would do if any of the secondary effects occurred - as it was a PCP/ACP crew (like most Sudbury trucks), we were also able to learn about what medications the ACP would administer if necessary - another opportunity to refer to the Pocket Pharmacopia.

While waiting for the cardiac patient to come in and hearing about the multiple changes in status, I referred to the ALS for the Medical Cardiac Arrest Medical Directive and Return of Spontaneous Circulation (ROSC) Medical Directive to get an idea of what paramedics would be doing pre-hospitally. Reading these directives provided me with questions to ask our Clinical Instructor and lead to a great dialogue while waiting for the patient arrive. I didn't think of it during my shift, but the BLS has the Paramedic Prompt Card for STEMI Hospital Bypass Protocol so I read that guideline after the shift as that was one of the reports on the patient.

Ask the Paramedics about their Patients

Yesterday's shift appeared to have quite a few offload delays and there were many stretchers lined up in the hallway. The paramedics were waiting with their patients but I did not feel confident to ask them about their patients. Our Clinical Instructor encouraged us to talk to one of the paramedics about his pediatric patient and this turned into a great informal learning experience discussing medications, pediatric weight calculations (recalling the formula from Medico Legal), and ACP treatment. As this was such a great learning experience, I am setting myself a goal to talk to paramedics more when they are waiting to offload their patients. I am going to set myself a goal to introduce myself to at least two paramedics and ask if I can learn about their patients.

Pediatric Patients

The last patient that my partner and I interacted with was a pediatric patient who was brought in from school due to behavioural issues. Our Clinical Instructor encouraged us to get experience taking pediatric vitals. Before entering the room, the paramedic told the child that we would be taking his vitals - he jumped off the bed and exclaimed that he didn't want anything taken from him! A bad start right? My partner and I entered the room. We introduced ourselves and asked him his name. We asked him how old he was and if he went to school. We told him that despite being a lot older than him, we are also going to school. We did this to try and create some common ground with him and to take away our intimation factor. We asked if we could show him some of our equipment and started with the pulse oximeter. We talked about numbers and as it calculated, we asked him how high he could count. Once we got the reading on the screen, he quickly noticed that the number would fluctuate a bit and then he started breathing really deep to try and get the number to a perfect 100 - definitely a future medic with him! After SpO2, we chatted about his heart and told him that we had a way we could count the number of times his heart was beating by feeling his wrist. He happily complied for us to measure his HR and then proceeded to try and find his pulse himself. We measured his temperature and then ran out of time to do any other vitals. The big take away from this is that communication is key with pediatric patients. As it was not an emergency situation, we could take our time to do vitals and were able to include him in the process and help him to feel comfortable. One thing that I am going to do over the next week is to think of ways to build rapport with children quicker so that in an emergency situation I can get vitals quicker.

That's all for this week!

Laura