Beyond Competent

It was a number of years ago when I first heard someone describe “the journey from novice to expert.” The simplicity and logic of what I heard was crystal clear, and I saw the immediate parallel to EMS.

When someone enters a given field, almost without fail, they enter as a novice. For most of us, when we began our trek into EMS land, we only had to read the first 50 pages of our EMT textbook before THAT reality set in.

At some point in any field, continued study and practice take one to the level of being competent. For EMSers, successfully completing the course and passing a state or national credentialing examination represent that point. You have now officially moved from novice to the next level, and been deemed competent. With that, you sew on your patches and venture forth into EMS land. In time—usually around six months to a year or so—various aspects of the job become easier. You begin to develop your own “style” of running calls. Scene choreography and task delegation, two of the most difficult aspects of prehospital medicine, start to take shape.

As we continue to move beyond simply being competent and really work at polishing our craft, the essence of EMS becomes more distilled. This month, we’ll look at three aspects of our practice that will help you move beyond competent.

Learning

As mentioned earlier, those first 50 pages of the EMS textbook make you almost painfully aware of how little you know about prehospital care. By course end, you have obviously learned a lot; however, another reality awaits the insightful and introspective EMS provider. As you begin your work in the field and begin to interact with other healthcare professionals, you start to appreciate how much other people know in their respective disciplines. At this point, the light should come on: You realize that you have learned only enough to make you safe to work on patients. In other words, it’s not just about knowing what you know, it’s also about knowing how much you don’t know.

With this epiphany comes the understanding that if someone plans to continue to work and mature in their practice of prehospital medicine, they have now made a commitment to a lifetime of learning. I believe this represents having achieved a distinct level of maturity—a key element in the developmental process that moves you past competency and toward proficiency.

Serving

When entry-level EMS providers think about the term “emergency medical services,” the first two words seem to get a lot more attention than the last word. I don’t think they could be any more wrong. The data continue to bear out the fact that the majority of the emergencies we respond to are not life threats, and, as such, are rarely emergencies. While these events may seem emergent matters to the patient, only a few of our patients are even close to death’s door. In truth, the key word here is service. We are in a service industry, where our job is to serve others. It’s unfortunate how many of our colleagues just don’t seem to get that. It’s usually the calls that come in after 10 or 11 p.m. that really seem to turn up the volume on whining. Why is that?

Seems to me, if you are getting paid for 24 hours, then it’s not unreasonable to expect to work during any part or even all of that period. How many other professions get to earn their hourly wage while they are sleeping or relaxing in front of the tube? Across the industry, I believe that it would be a real plus to our profession to make absolutely certain that, when we are recruiting folks, we make sure they understand that EMS is a service industry. Truth in prehospital advertising is what I’d call it.

Caring

I’ve always said that if you can survive your first real vomiting experience (the one where you are the principal target), you definitely aren’t in EMS for the lights and sirens. To flourish in the field of prehospital medicine, you must enjoy caring for people.

In actuality, there are two different facets to caring. First is the actual provision of care: the techniques, therapeutics and technologies that we employ as we treat and transport our patients. That “taking care of people” aspect should be polished, honed and refined throughout your career. Skills become almost intuitive; patient care reports are clear, understandable documents that meet both billing and documentation needs; radio reports are succinct and to the point.

The second is having a caring attitude. While some providers say they care, and may actually pretend to care, most patients can tell, just by the words they say and the way they say them, that they couldn’t really care less about them and their well-being.

If you truly care about the patients you serve, it will be evident. Every aspect of your practice will include a caring touch, and that is something to be proud of. The ongoing cultivation and nurturing of a caring attitude and overall demeanor is yet another facet of moving beyond competent.

Collectively, continuing to expand your knowledge base, both in width and in depth, coupled with a real commitment to serve your patients to the best of your ability, all the while maintaining a true caring attitude, will take you far in prehospital medicine. It’s up to you to decide whether that is where you want to take your practice in EMS.

Until next month…