Beyond the PCR

We’ve all been there. Green as a fresh pea from granny’s garden, right out of school. The pristine reflection of new shiny boots. Fresh pants still bright and crisp.

You run a call and spend the next few hours, even days, evaluating your patient care, interventions and overall outcome of the situation you faced. Your inner voice stays on repeat—did I give the correct medication? Was my mask-to-face seal tight enough? Did I correctly analyze and treat that rhythm?

You make mental corrections to the small things, only learned through time and experience.

Eventually you get your first big call that doesn't run so smoothly. Maybe it’s the first time you’ve seen a person present like this. Perhaps your head isn't in the game and you throw your training out the window. The years of education and preparation are gone faster than the donut you grabbed on your transfer at 3 a.m. this morning.

You don't insert the bougie into your 6.5mm ET tube that should have been at least 7.5mm. You start to intubate holding the laryngoscope in your right hand. Wait, did my partner see that? No? OK, good. You switch to your left hand and move on. You don't go for the glucometer nor that second vascular access needed by the emergency room.

You arrive at the ER and give a report to the RN your two-year-old could have delivered better. The patient did not improve. In fact they seem worse off than when you found them.

You spend the next few nights mulling over the call. You reach out to more experienced providers for input and allow for constructive criticism. You take note of what you could have done better. You keep hearing the chant that the patient was not going to have a positive outcome no matter what you did, and to learn from your mistakes for the next call.

You say to yourself, I promise I’ll never let this happen again. I will study every Monday and make sure I’m more prepared next time. You set study dates in your calendar and even open that EMS book for the first time in six months.

Time passes. You run more calls than you can count. Your boots are now dull and used for lawn work. Your pants are a faded blue. Your medication choice, mask sealing and rhythm analysis skills don't linger with you any longer than the time it takes to enter the information into your patient care report. Your priority has shifted from continued learning and striving to merely finishing.

Then one day your normal routine is abruptly interrupted. A student arrives, trusting in your knowledge and experience to help him develop into a proficient EMS provider.

Everything’s going great until it happens. Tones drop. “Unresponsive male. CPR in progress.” You know the battle that lies ahead. Lingering in the truck for just a moment, you take a drink of water, shed your jacket and head into the house, your seasoned partner at your side and the student trailing behind.

You and your partner work through the call the same way you always have—the same way you were taught when you were that “green pea.” Despite your best efforts the patient dies. You return home and finish eating the steak alfredo that was prepared before the call came out. As always, the evaluation of the call stops as soon as the patient care report is sent off.

But the student doesn't move on quite so easily. Twenty-four hours goes by, and you receive a text message from him: “Did I do CPR correctly? Was my mask-to-face seal tight enough? Did I correctly place the quick combo pads?”

Through this single text message you’re forced again to perform an evaluation beyond the patient care report. You give the student some constructive criticism, tell them they did a good job, and assure them that nothing they did would have changed the outcome.

You complete a thorough evaluation of your actions on the call, much like you did when you were new. But this evaluation is different. You’re now a seasoned provider and you have years of experience under your belt. You think through each treatment and get stuck on something. Something that no QI/QA committee would catch, because it’s common practice where you work.

You do some research, and find out the thing you got caught up on is in fact not the best practice.

Through new research, as well as battling complacency and "dinosaur tradition," we have the ability to educate our colleagues and students. Bringing new protocols and procedures into practice has the power to improve patient outcomes. If we “experienced” providers can look beyond the patient care report, we have the ability to change the culture of EMS.

Chris Magill, NRP, is education coordinator for Miller County Ambulance District, Eldon, MO.