Dear New Guy...

Dear New Guy,

Welcome to the wonderful world of ambulance driving. I specifically say "driving" because that will be your job until the medic you're with gets over himself, retires, or dies. Please be cognisant of your own limitations. Just because you intubated airway Annie 92 times does not mean you will be good at it. In fact, pretend you suck at everything and go from there. You may have had straight A's in school, this ain't school.

Please understand that I am not angry, burnt out, or too proud. The things I am telling you are for your own good. You may be yelled at by your senior medic. Please understand that this is not a reflection of your stupidity, well probably not; it's probably a reflection of the "old fart's" lack of patience. You may feel like you know it all, you don't, you never will.

Surprise, not every call is a dire emergency. In fact, most calls are more related to comfort than life. This may be hard to imagine after running megacode after megacode in your lab scenarios. You probably didn't learn this stuff in medic school, be kind. Your patients are not made of stain resistant plastic, they are in fact flesh and bones. Empathy is a word you should look up and try to emulate.

It's okay to freak out on scene, just don't let anyone know you are. One day you will be a lead medic and all eyes will be on you. Your partner, the patient's family, and anyone else on scene will freak out if you do. Move with a purpose, and look like you know what you're doing. This may be the best advice anyone will ever give you.

Be obsessive compulsive. Nothing is ever too clean. You should know where everything is and how much you got of each. This is the practice of a good medic.

You can't save them all, in fact you won't save most. Get over it, learn from any mistakes you have made. This requires you first realize you aren't perfect.

For God's sake, give some pain control. If they say they hurt, you should probably believe them. Not everyone is heroin Hank, seeking a fix.

Contrary to what you may believe after reading this far, I love this job. This is the best job you'll hate to love. Once you think you've got it all figured out, something new will humble you once again.

You will be underpaid, overworked, and under-appreciated. Don't forget what it feels like right now, when you are brand new. If you come into work every day like you did on your first day, you will love coming in and hopping on that rig.

yourself in five years

original cartoon


Shaggy said...

Well, that about sums it up. I should print this out and hang it at the base! Don't worry, if I do, I will give you the credit:)

Adam Thompson, EMT-P said...


No worries, there's no copyright. I'm on shift right now, and this just came to me. Reading Rogue's last post sparked this I think. Glad you enjoyed it. Now I just gotta learn how to draw like that Paul Combs so I can stop stealing his stuff. Have a good one.


Walt Trachim said...

Very nice...

Medic 7 wrote about you - I had to come and see for myself. This is a superb blog. Do you mind if I add you to my blogroll?

Adam Thompson, EMT-P said...

Thanks, of coarse not.


Karen Brook Westhaver said...

LOVE this. Major flash back :-) Back in the day I was the only woman [and a grad student at that...among the youngest on the squad] who'd worked their way up to paramedic. Spent most of my time in a busy ER of a hospital where I could do more than the ER nurses. But there were lots of time, too, when I was the only woman on the truck. Wish I'd had this to read then!

Adam Thompson, EMT-P said...

Unfortunately, even if I read this, I probably would of thought it was beneath me. How far we have come. I just hope that in 5 years I am not ashamed of the way I am now!


Rogue Medic said...

People continue to ignore pain management. Most of our calls are because of pain. Pain management is one of the most consistently effective treatments we have. Pain is common and we can help.

Adam Thompson, EMT-P said...

Couldn't agree more RM. I think we have all withheld pain management at some point, even though it was called for. I have much improved since my first days out, hence the letter.

Shaggy said...

Oh, I just got called in on a pain management call. Right off the bat, I will admit I gave fentanyl without calling for orders on a medicasl patient. Unless it is an extremity injury, we have to call for the blessing. I chose not too, in part because I was sure there was a protocol to allow for it, but I found out otherwise. Eitherway, I was called in on it. Not that I gave it without a protocol. That was not the primary issue. The issue was I gave fentanyl to a woman with severe abdominal pain. Abdominal pain. Didn't I know that you don't give pain meds to patients with abdominal pain until the ED attending evaluates them? Hmmm, I was taught that back in the early 90s, but since then have learned that is a bunch of horse pucky. A woman who was having severe pain at the sight of her recent cholecystectomy deserved analgesia. Maybe I should have followed the rules and called first, but regardless, she needed relief from pain. Abdominal pain patients should not get analgesia? Come on, who the hell still believes that? Obviously my director did.
Sorry, I know this had nothing to do with the original post but I blame RM for starting this tangent.

Adam Thompson, EMT-P said...

Always blame RM, it makes life easier.

I think you should have called for orders if that's your guideline. Knowing better puts you in the head of the class, but not calling can cost you more. I think with protocols that restrict you to calling, you have to work on your relationship with the docs. The better they know you, the more your intelligence will show threw making it more likely to get the order you want.

Some docs don't like their ABD pain patients drugged up because they want to be able to evaluate them and get them in and out. The analgesia somehow inhibits their exam.

I agree with you though, that's an outdated approach. Maybe present some research to your medical director if possible.

Rogue Medic said...


That is something that I do not expect to change any time soon in Pennsylvania.

There is no research to show that pain management impairs the assessment of the ED physician or the surgeon. Still some surgeons throw a hissy fit over any analgesic prior to their arrival. Some ED physicians stand up to them, some need to start ignoring the surgeons on this.

The research is not great, but it all says the same thing. Either pre-surgeon assessment opioids have no effect on the surgeon's assessment, or they improve the assessment of the surgeon. The patient is now able to sit still for an abdominal exam and the patient is able to localize the pain. therefore, the assessment is improved.

Fentanyl is an excellent prehospital treatment for abdominal pain, because it will wear off long before the surgeon gets to the patient. The ED physician may continue the fentanyl and it does not prevent the surgeon from titrating tiny amounts of naloxone to get the level of pain to where it assists with assessment.

Surgeon. Titrate. Same sentence? The surgeons certainly should be able to do this.

I call OLMC, give them a quick report and ask for fentanyl orders. If they do not agree, I mention the lack of evidence of any problem with opioids for abdominal pain. They usually give me the orders that are appropriate for the patient.

Shaggy, you blame me? But I am innocent and pure and . . .

OK. I can't continue that. I certainly do encourage aggressive pain management.

Any medical director who does not encourage aggressive pain management is harming patients.

Shaggy said...

I stand guilty of not being 100% sure of my protocols in what I am and am not allowed to do. I actually have a good relationship with my medical command staff and I have yet to meet an ED attending who frowns on giving analgesics to those with abdominal pain. In fact, it is almost the opposite. Though I stand corrected in yes, play the "mother may I game", wich by the way was not an issue with my medical command strangly enough, but the issue I had was someone in authority in my service who does not understand the concept of analgesia in medical patients. People like this then mentor new people, who will then not even consider calling for analgesia on behalf of the medical patient.
And RM, I have to blame you for a tangent. You always have the tendancy to stir the hornet's nest.