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By Mike Rubin, BS, NREMT-P Dealing With What’s the most productive way to spend intervals between calls? I should warn you that I ﬁnd it hard to relax. Just ask my wife. She’ll tell you that my idea of a vacation is a to-do list, a half-ﬁnished manuscript and wireless Internet. Now would be a good time to feel sorry for her. When I swapped my ofﬁce for an What do we do between calls? downtime? Yes, if we view our work as ambulance in 1992, it felt good to get Not much, according to a 2008 EMS cyclical rather than as intermittent. On out from behind a desk (and even better Magazine survey. Over half of the either side of emergent responses are to shed the suit and tie). No more facto- 211 respondents listed watching TV, preparatory and recovery phases that ries to manage, budgets to balance or snoozing or gooﬁng off with coworkers help us maintain a state of readiness. sales to solicit. My goal was to work in a as their favorite on-duty pastimes. Only We can’t control chief complaints, but hyperactive 9-1-1 system where I could one third of the participants claimed we can take ownership of idle time and run calls constantly. they often engaged in other work duties treat it as a strategic resource. That didn’t happen. After a few or training when idle. Consider the following pre- and post- months in the ﬁeld, I had a much more I’ve had partners who treated down- call activities. Photo by Dan Limmer realistic view of EMS: many hours of time as mini-vacations. They felt they downtime punctuated by moments of were being paid to answer alarms, not VISUALIZE THIS medical madness. I envied coworkers wait for them. Each call was a discrete Some aspects of EMS don’t translate who had mastered the hurry-up-and- mini-shift; anything else was time off. well in polite company. For example, I’m wait mentality. Does it matter how we manage reluctant to characterize an unstable www.emsresponder.com EMS OCTOBER 2009 65 downtime patient as “good practice” to anyone not in this business, and I’m not going to initiate dinnertime conversation about how the second cardiac arrest of the day usually runs more smoothly than the ﬁrst. But really, rather than exhib- The need for orderly iting apathy or cynicism, these remarks preparation is essential merely contend that prehospital skills in EMS, especially when it comes to your are honed through practice. equipment and supplies. I won’t waste your time by rehashing studies that correlate performance to experience. That’s a tautology well within the realm of common sense. A much greater challenge is to determine how much practice is needed to main- wait a decade or more to gain that much technical skills, but Resusci-Randy, tain prehospital proﬁciency. experience. Torso-Timmy, STEMI-Steve and all their An interesting example of such How frequently do you need to synthetic soul mates are entombed in a research is a 1998 Swiss study of anes- successfully intubate to maintain conﬁ- locked (of course) training room. You thesiologists’ endotracheal intubation dence and competence? What about could try to convince the new guy that performance. Eleven ﬁrst-year residents other invasive and diagnostic proce- a Jamshidi needle doesn’t hurt much… needed an average of 57 attempts to dures? Do you get enough reps on real or you could consider a performance- achieve a 90% success rate. Even after patients in your EMS system? Does your enhancing technique known as mental 80 tries, two physicians still required agency offer supplementary training simulation. assistance to correctly place a tube. In facilities and equipment? Deﬁned by social psychologists many EMS systems, ALS providers would Suppose you want to work on your Shelley Taylor and Sherry Schneider as ON THE FRONT LINES
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