Throughout education a main struggle students face is whether or not they can grasp the information to perform well on exams. Exams are an effective way of ensuring a student can understand the information, but what it fails to do is assess whether or not the student can use the knowledge in a practical setting. When it comes to emergency medicine no amount of schooling, studying, or tests can prepare a healthcare provider for the patients they will encounter. Having confidence in the knowledge they have is one thing, but being able to perform under pressure is an additional challenge.
This summer I attended EMT school and became an EMT. In the 10 weeks, that felt more like 10 seconds, I learned more about how to provide effective healthcare to others than any textbook or classroom could ever teach me. Something I never considered, working as an EMT, is how essential your own mental and physical health are to how you perform on the clock. Physically, before a shift one should be well rested, hydrated, fed, and in good shape to handle the shift. Healthcare workers don’t typically get to work nine to five. Instead a shift may consist of working 12 hours or 24 hours straight where one may not get so much as a second to sit down and put their feet up. The healthcare profession is demanding physically, especially in emergency medicine. There are no appointments. Instead of having a lunch break you eat in between calls, but that is only if you can. In addition, it is important you take care of your body with good food and sleep, so you have the energy to keep going through the long nights and early mornings.
Working in emergency medicine is not solely physically demanding, the most demanding part of the job is mental. I will always remember my first trauma call I had in EMT school. I stepped out of the back of the ambulance onto the scene, and my preceptor asked me, “What do you think we should do?” Without so much as a second of hesitation I responded, “I think we should call 911.” It was my initial thought. Of course, I realised a moment after that we were 911, so it was up to us to help. That was the moment in my life when I realised the importance of working in emergency medicine. It is up to you. You are the saving grace. You are the last resort. You are 911. We instantly jumped in holding C-Spine precautions, checking mental status, and ABC’s, doing all we were trained to do as best as we could.
In emergency medicine, I had to learn that just because a patient dies doesn’t mean I did something wrong. In reality, you are the last resort, in cases of life or death the patient is already dying, and all you can do is use your BLS skills to try to help prevent the inevitable. That was a very challenging concept for me to come to terms with, but in emergency medicine you can only do what you are trained to do and help with the skills you have even though sometimes it might not lead to the outcome you desire.
That is why it is so essential to find a way to destress. For me, I decided to take up going to the gym, and going on walks. I enjoyed listening to new albums that would drop throughout summer, and trying to listen to a new album a day as I walked around campus. I found it a productive way to sort through my thoughts and emotions from previous calls, and positively learn from them without letting my emotions get the best of me. Additionally, I found that physical activity was a perfect destressor for me, because it gave me a positive way to deal with my stress while bettering myself.
Performing under pressure is another key aspect to emergency medicine. In a typically primary care setting the nurses or physicians have time to go over each patient, read up on medical history, and think through each case as it is likely not urgent. Whereas, in emergency medicine you do not have time to weigh pros and cons and deliberate amongst peers. Instead, you have to be so knowledgeable of BLS skills that you know what to do the second you see the patient and understand how their signs and symptoms need to be treated. In a way it’s like solving a case, the patient has a situation and it’s up to you to be the detective and figure out what the culprit is and how you can effectively help stabilise them, so they can make it. Or in the case of an EMT stabilise them enough to make it to the hospital. With some patients there can be time constraints. For instance, if someone is in cardiac arrest you only have about 8 minutes from the onset to start performing CPR in hopes to save them. That includes the time it takes to get to the patient as well. It is essential to be able to think and act efficiently under pressure, and not let the stress or intensity of any call overwhelm your best judgement.
Overall, working in emergency medicine the best piece of advice I have is to treat every patient how you would want someone in healthcare to treat you and keep a positive attitude. In emergency medicine cases the time you see your patient is probably one of their worst days, so do everything you can to make it just a little better.