The EMS Career Killer

     A few years ago, a young man who already had a BS and two master's degrees in hand came through my paramedic program. Upon completing the program, he told me, "I've just got to tell you, my previous education pales by comparison to what I've gone through this year. It was like having my head ripped off and a bucket of knowledge poured down my neck twice a week."

     In truth, that's not such a bad analogy. Reading six different texts totaling over 8,000 pages during a nine-month program is no small feat. Even EMT-B training is challenging, with almost 2,000 pages of reading in a 10-week time frame. Unlike a European history class, where you can purge your memory banks immediately after the final exam, being a quality EMS provider requires that we commit an extraordinary amount of information to memory and be able to tap those memory banks to best care for our patients.

     Once the new patch is sewn on, the next phase of learning begins-the one that should stretch across your career. As you gain more experience and become more proficient as a caregiver, the job gets easier. However, that in no way equates to "I have nothing left to learn." That mind-set is one of the hallmarks of the complacent provider, which is this month's topic of discussion as we look at ways to avoid the ultimate career killer: complacency.

     Change is never popular—Every EMT and paramedic I've ever worked with had unique aspects to their practice: how they conducted a patient interview, what gear they took in, how they wrote their narratives, etc. In short order, these individual subtleties and nuances firmed up, further solidifying their practice. While graduating as "entry level competent," providers then move into the process of becoming proficient, and that is simply a function of running lots of calls and continuing to polish their craft.

     Once a provider has settled into the job, his or her comfort level increases, as one might expect. Unfortunately, the practice of prehospital medicine is not static. Ours is a dynamic world, with new therapeutics, tools or other treatment modalities that require change to stay current. Of course, with change comes loss of comfort. Comfort will return, but I believe we need to recognize the cyclic nature of prehospital medicine. When change is indicated or required, we must make those changes or our medicine will stagnate and patient care will suffer as a direct result of our not being willing to stay current in our practice.

     What gets you to the top doesn't keep you there—With successful course completion and the new patch on your uniform comes the stark reality that EMS requires a commitment to a lifetime of learning. When you first come out of school, you should arguably be on top of your game. Your fund of knowledge should be current and contemporary and your skills practiced and polished to the -nth degree. Of course, you still have to grow up and own your patch, which can take six months to a year or more, depending on the call volume and patient acuity of the system you are in. But once you're really comfortable with where you are, you need to recognize that complacency is just around the corner. The following quote from MSG H.R. Montgomery, a senior medic with the 75th Ranger Regiment, U.S. Army, sums it up best: "The foremost problem is the mentality that once you've been trained in something, you are trained forever. There is no specialized training that is worth a damn unless there's a deliberate and enforced sustainment training program attached to it."

     Some of what you learned that is state-of-the-art today may be old news in six months and outmoded in a year or so. Just like an elite artist, musician or athlete, the pursuit of excellence requires an ongoing commitment if you wish to stay on top of your game. Continue to set goals. Once you've achieved them, take time to celebrate, then sit down and decide what goal is next on the horizon.

     Ignore your career and it will go away—Strangely, some providers think that once they have that patch and have settled into their practice, their career is on autopilot. In many cases, embracing that philosophy charts a course where their career flies straight into the ground.

     Leaving the classroom is not the time to stop learning—it's time to start learning more. First order of business is to tighten up whatever areas you were weak in during class. If you graduated with an 83% average, to me, that implies a 17% gap that needs to be filled.

     Next is deciding exactly where you want your education and training to take you, i.e., your next goal. It might be courses to finish a degree, or goal-specific classes like coursework to credential as an instructor. Even if you love street medicine and plan to stay in that role, it is essential to continue to nurture and feed your career from Day 1 until the time you hang up your stethoscope.

     The world of prehospital care is unique to itself and requires tremendous effort to work at a high level. With the slip into complacency comes increasingly lackluster medicine and mediocrity as a goal. Given that thought, who really wants to call 9-1-1 and have the person who comes to their door do the least he can to provide average care? "Not me," would be my answer. What about you? Until next month…

     Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of EMS Magazine's editorial advisory board.