More Ways to Cope With Paramedicine

Got that graduate placement? Just qualified? How do you survive? Here are some tips.

Being a paramedic is hard – there are those in the job who think it isn’t, but these people have been there for years and have acclimatised to it, and started back before it was the continuously growing nightmare that it is today. When I worked in communications in 2008, it was busy. The workload has steadily increased – what was “busy” slowly became normal. It’s now 2016 – our summer was non-stop, and now we’re in our “busy” period of winter respiratory madness. You think you know busy? Think again!

But there are some ways to mitigate against the hordes of sickness that you may not have fully realised. How do you keep going and avoid pulling the pin? Let us count the ways.

This is a marathon, not a sprint, and it’s hardly even a race

You know what the award for being super efficient is? Another job. When I started, particularly on night shifts, I’d have my patient off stretcher and paperwork done, pressing the button to clear, in around 15 minutes of arriving at hospital (ramping or triage delays not-withstanding). I was really efficient. One night, I ended up passing out in the write-up room; completely unaware that I was asleep for a good half hour, my pager went off to notify me that I’d been at hospital for a good 30 minutes and could now be sent on another job if needed. I don’t remember how I made it home that morning.

There’s zero point in busting your balls to get back into the race. The majority of pending jobs aren’t emergencies. Whether you clear now or take another 5 minutes to eat something or take a piss really doesn’t make a difference. That’s not to say you should spend 40 minutes dicking around at hospital (like some people I’ve worked with) – 30 minutes is usually enough to get your paperwork done and to take 5 minutes to not do anything. But rushing everything to try to get back into the field? For another idiot with a cold, or a toothache, or vomiting because they’re drunk? There’s no prizes for that except burnout.

If you’re sick, don’t go

I’ve made this mistake way too many times. “It’s just a cold, I’ll be fine” was what I said to my partners on those shifts, which was usually met with “You look like shit, and if you make me sick I’ll kill you.” They all got sick, by the way – even if I wore a mask. Incidentally each time I did it was a night shift, and my god even if we did nothing of value, the shift felt like absolute hell. You get a little surge of adrenaline with each job that staves off the sickness, but after each job you feel progressively worse. When you get that 0630 job in the morning, you’re basically ineffective.

Don’t go to work. Get a doctor’s certificate if your OIC or manager will complain, even if it’s just for a single shift. It’s simply not worth it. Stay home, do nothing, and recover.

Keep at least one RDO to do nothing

Some people spend their RDOs doing overtime, some spend them out doing all sorts of other activities, and both groups often come to work and go “Wow I’m so tired, I did so much stuff on my days off, feels like I never get a break!” Well, take a break. I make sure I have at least one of my days to do nothing. No house work, no overtime, not even really going out – I literally do nothing. I usually reserve the day before I go back to work for this. And it works – I feel like I’ve actually had a break before I go into another block of shifts. This doesn’t work for everyone obviously – if you can’t stand being at home this will likely make things worse – but if you’re constantly complaining that you don’t have time off, you need to re-evaluate what you’re doing.

As for overtime – why are you doing it? You should probably evaluate the financial gain in OT versus your health. I know plenty of people who do an obscene amount of OT – they rake in the cash, blow it on shit that they don’t need and which provides no financial return, and are miserable with no life outside of the service. If you’re having to do regular OT to make ends meet, it might be time to get financial assistance.

Stop Arguing with Comms

“Bravo 123, just confirming we’re going code 1 for vomiting, is this appropriate?”
“Comms to 123, uh caller states patient is having difficulty in breathing hence why it’s a code 1.”
“Um, 123, roger but this is not appropriate, I want this reviewed and downgraded.”

How many times do you hear this exchange? Or comments like “Bravo 123, just got this job at Somewhere, we’re 30 minutes away and haven’t had a meal, are we the most appropriate unit?” Yes, it’s a bullshit job from the sounds of the information given. Yes, you’re miles from the job and starving. Comms know that. They know where you are on the map. They know it’ll take you forever to get there. They’re hoping that another closer unit, which is equally as tired and hungry as you, will clear and be able to attend. But they have to attach you because they’re working under a policy that says they have to. There’s also a policy that says they’re supposed to feed you on time, but operational demand trumps pretty much anything else.

Arguing with them is absolutely pointless. Firstly, the chances of it changing anything are slim to none. Secondly, dispatch works on two principles – assume the worst, and the sickest person gets the closest car. There have been quite a few cases where a call has sounded like complete bullshit, yet when the crew arrives it’s actually critical. Call-taking is designed to catch the worst possible scenario, since nothing can be confirmed remotely. Just go to the job – whether it’s a code 1 or a code 2, whether you’re 30 minutes or 3 minutes, you’re on the job and you’re going.

Work to Live, Don’t Live to Work

The biggest trap to fall into is to become one of those people who have no life outside of the ambulance service. These people do as much overtime as they can, relish shift extensions, rush their paperwork to clear and get to the next job, and then when they can’t do any more overtime, they’ll spend the rest of their time studying up on prehospital care topics that ultimately lead nowhere. These people end up in one of two places: medicine, or out of the clinical field entirely. They burn out. It is inevitable. They live to work.

If your entire life revolves around the service, you’re doing it wrong and you’re going to suffer for it later on. There are no prizes for not having a social life. If you stay in the service for 25 years or whatever you’ll get a reward, but it’ll be the same whether you just did your rostered hours or did overtime to the max. You won’t be in the service for that long if you try and do it anyway. You will burn out. Take time to have a life – work to live. Do your job because you enjoy it and find it interesting, but also do it so that you can enjoy some quality of life. The service and public will rob you of your time and health – neither of which you’ll ever get back – so don’t make it worse by giving away more of it.

Be Competent, Be Safe – Don’t Overcompensate

I once worked with a guy for a few shifts who qualified around the same time as me, and basically spent all of his free time studying his Masters in prehospital care. An obscene amount of money and time required. We went to a 18 month old with a textbook croup cough. His response? “It’s not croup, they’re too young.” You don’t need a Masters to spot the problem here, and ironically a paramedic with just a Bachelor or even vocational training would probably have picked up on it better. More knowledge does not lead to a competent paramedic – unless that knowledge is actually applied and useful, it isn’t going to help you.

We have a very practical job, and we’re often constrained by guidelines. We get most of our decision-making in provisional diagnostics and deciding on appropriate treatment paths – and then we run up against protocols. Knowing how cyanide poisoning affects the electron transport chain in the mitochondria means absolutely nothing in the field: it changes nothing for our treatment. I’ve seen incredibly smart people, who knew more about pathophysiology than me, be completely paralysed by pretty simple cases because they couldn’t differentiate between three very similar provisional diagnoses – none of which changed the treatment pathway.

I worked with an incredibly clever paramedic, again relatively recently qualified, who was doing her Grad Dip. We went to an abdo pain case – common callout, vitals within normal limits, no high-risk factors suggesting anything was bleeding. She chewed up 30 minutes trying to decide what this diffuse abdo pain actually was – before just giving them morphine and loading them for transport. We were always going to do that. We never found out what it was. The patient felt better and was stable. Did all that extra knowledge help? Nope. By all means study up, but ensure you focus on what’s actually relevant to your job first, and keep it practical, or you’ll drown.

Extra Study Should Be Useful, Not For Show

There’s a new tendency creeping in with newer paramedics to immediately sign on for their Grad Dip or Masters straight after finishing the degree. Does it lead to better employment opportunities? Nope – they’re still highly inexperienced and have no hope in hell of getting a coveted Critical/Intensive Care Paramedic position. Instead, they spend their RDOs struggling with the study load, doing overtime, and trying to become practically competent.

This links with the point above – studying for the hell of it, because your friends are doing it, is probably not helpful if your practical skills are crap. Until you consolidate that practical side, you’re going to add extra stress that will burn you out even faster. There’s zero point increasing the stress (and your HECS debt!) when you’re early on and trying to cement your practical, on-road skillset, as well as adapting to the workload. You’ll hate the job that much more.

That said – this isn’t a job where you stop learning, so don’t think I’m advocating for an idiot workforce that never bothers to learn anything new. You need to keep learning. But you should keep it practical – learn about your weaknesses and then study up to improve them, rather than just doing a Grad Dip because “everyone else is doing it” and you feel inadequate because you haven’t done it. There are plenty of people with Masters and Grad Dips that are actually crap on road. Don’t become like that.



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