Wednesday, 5 May 2010

Driving Skills

At the age of 17, like so many others, I learnt to drive a car. Actually, that's not exactly accurate.
At the age of 17, like so many others, I learnt to pass my driving test.
I learnt about Mirror, Signal, Manoeuvre.
I learnt about road signs.
I learnt to parallel park.
I learnt to drive on slow roads and fast roads.
I learnt to reverse around the corner.
At 17 and a little bit, on a Monday lunchtime, I walked into the staffroom at the school where my mum used to teach, with a dozen pairs of eyes staring at me and my glum-faced expression, none brave enough to ask if I'd passed the test or not. My mum, standing the other end of the room and obviously knowing me better than anyone else there, saw straight through the fake sadness, spotted the glint in the eyes, and without a word spoken, threw her car key across the room to a round of applause.
That was the day I started to learn to drive.
At the age of 26, I learnt to be a paramedic. Actually, that's not exactly accurate.
At the age of 26, I learnt to pass the first of many tests to be a paramedic. Yesterday, a patient reminded me of it just by asking a simple question.
"Do you get taught how to stay calm through everything you see, or is it something you naturally have to have before you can join the Ambulance Service?"
To me, that hid an altogether different question: where do you learn how to become a paramedic?
Is it all the sitting in classrooms, bored to death by endless powerpoint presentations?
Is it by spending time in the operating theatres, practising cannulas and intubations?
Is it by listening to lectures on how to treat everybody the same?
Is it by reading through the book about drugs, their actions, their contra-indications and being able to recite them all off by heart?
The answer to all of these are easy. Yes. That's where you learn how to be a paramedic. Or at least, that's where you learn how to pass all the assessments that qualify you as a paramedic.
For me, that's not enough. I don't just want to be able to pass my driving test, I want to learn to be a good driver.
By the same token, I don't just want to be able to say that I have a certificate that says I'm a paramedic, pay my annual dues, and finished. That's the easy bit.
I want to be a good paramedic.
That's what you learn after you get your certificate.
That's when you learn how to use all the skills you've just been handed.
You learn to use common sense, you learn empathy, you learn sympathy.
You learn that the technique with which you cannulated your patient in theatre, where all is calm and controlled, won't be the same when you're cannulating a patient in cardiac arrest on his home floor with several family members watching your every move.
You learn that the worst case scenarios which always seem to occur in assessments, are really few and far between. But in the meantime you see cases of domestic violence that you were neither trained nor prepared for.
You learn all about how a heart attack patient might look and feel, you'll know how to treat and transport them, but how do you keep them calm and reassured?
You realise that you're an expert at CPR, yet you were never taught how to tell someone that their loved one has died.
You find that you were given a stab vest to wear, but are never quite ready for the time that a patient or their relative suddenly turns into a threat.
You discover that when you're treating a young child and their asthma attack, when your knowledge of the right drugs is important, that the way you are treating their parents is equally critical.
You find that even if you know theoretically how to treat every patient you see, sometimes you need to treat yourself. The trick you aren't taught is to know when that sometimes is.
Oh, and you learn to reverse around the corner again. This time in a truck.
The list is jumbled, just like the real world of the paramedic. A shift can, and often does, range from the sublime to the ridiculous, from the mundane to the life-threatening.
Despite every lecture to the contrary, you find that you can't treat everyone the same, because everyone is different. What you can do, is treat everyone to get the same result.
Most importantly, you learn that you cannot learn it all. Certainly not at once.
It takes time, patience, an open mind and a willingness to learn in order to perfect those driving skills.
Hopefully I'm getting there.


Anonymous said...

I'd say that applies to almost any job.

Difference is that if I make a mistake due to not being "fully trained" (ie experienced), a computer crashes. If a paramedic makes a mistake, perhaps someone dies.


Squeezey said...

Lovely post, very nicely said :)

Anonymous said...

top post, should be red by all wannabes!

ambulanceamateur said...

Telling someone that their loved one has died must be difficult. As a CFR, theoretically I don't have that job. However, when you're called to a patient "not breathing" - and hasn't been for most of the previous night - what do you do?

I'm not allowed to tell them that their loved one has died. I can't call it, but a paramedic can. However, I'm not going to do CPR on a cold body with no chance of resus.

What do I say to the rellys? I've managed to wing it so far, but what should I say?

Anonymous said...

In my first year of being in a 'real' job, making a hundred little mistakes every day (fortunately not life threatening), I often wondered how first year nurses/doctors/paramedics ever got through the day, when their mistakes could really mean something... How do you do it?

Michael Morse said...

Very well said. This is one of the best descriptions of what we do that I've ever read, thank you.

Anonymous said...

Spot on. This really should be taught to all nurses, doc's, paramedics and even first aiders.

I qualified as a Paramedic almost a year ago. People say "what do you want to do now, where do you want to be in 5 years time" etc. My simple answer, to become a GOOD paramedic. I am right at the beginning of my life as a Paramedic and I need time to gain experience to go from a Paramedic to a Good Paramedic. (I will be using that in a pending interview...)

You never stop learning. Just when you think you've seen it all, you'll get something new. There are always new treatments, new drugs, new vehicles (eventually). That is one of the delights and curses of the job. Never knowing.

Belief that because you passed a test and jumped through the right hoops means that you know it all is the most dangerous thing. I've seen it with young drivers, I've seen it with other people on the road, i see it with some student Paramedics. Over confidence can be lethal.

Anonymous said...

After nearly 30 years int he job, there is not a day goes by where I do not allow myself to learn something. Fortunately the BIG lessons are few and far between, but if I make my objective to learn, improve and in turn encourage others, then my day is well spent.

Great post. Thanks

Janice Ladden said...

I agree with what Anonymous said about someone dying when a paramedic makes a mistake. I had a minor vehicular injury which I thought had already healed by itself. Our next door neighbor, a medical student suggested I have it examined further and maybe undergo a physical therapy (
Dallas, Texas)
or elsewhere. I was at work and planned to visit the doctor the next weekend when the muscles in my arms, shoulder, and neck became painful and stiff. I could not drive and called my doctor. He provided me a driver and a car. From that time, I became more sensitive to the pain signals on my arms and back and requested the transport service when my wife could not drive to the doctor's office, rather than risking an accident along the way. Luckily nobody made a mistake in my case. In fact, I'm waiting for the med student to become a licensed md and patronize him.