Dealing With DOWNTIME by ProQuest


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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

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               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

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