r/ems

Had a call today where I helped another medic and EMT on our ambulance for a guy who fell off a roof. We decided to give Fentnayl for pain, I removed the narc box, put it on the counter, and took one vial of Fentanyl out. My memory is spotty from what happened next but I thought I placed the Fentnayl on the counter, reached over to grab a needle and syringe, was asked to look at the patients back quickly, then when I went to grab the Fentnayl vial I couldn’t find it.

We briefly looked but ultimately wanted to get going to the trauma center. When the crew got back we spent an hour ripping apart the truck. When they transferred patient care they briefly checked around the pt and the sheets just in case it somehow got on them.

I already did everything internally that I had to do but we have no supervision on the weekends. My direct reporting supe is aware but I’m freaking out over this. My department is fairly good at just culture and my supervisor took it well when I told them, but I’m still spiraling over this. I’ve handled narcs hundreds of times before but never have had something like this happen. Anyone gone through something similar or seen something similar happen?

Edit to add my story:

I was a 19 year-old, new EMT that kind of sucked at the job. A male medic that I had a bit of a crush on took me under his wing. Late one Saturday night, we were sitting at an auxiliary post which was just a small room with a couple of recliners, in an empty office building. He forced himself on me. Two weeks later, the same thing happened.

My company just started using dash cameras that face forward but also into the entire front compartment (driver and passenger). They don’t have audio recording but are able to be “live-streamed” and log events like speeding, phone usage, etc. We were told that the cameras would not be used against employees and were primarily for safety/liability purposes. However, employees are now apparently being written up based on things observed through the cameras, including being out of the proper uniform and even hygiene/grooming-related issues. I understand addressing legitimate safety concerns, reckless driving, etc., but this feels different from how the cameras were originally presented to employees. For example; if you’re in violation (speeding, breaking, phone usage, yawning,etc.) you get a verbal warning first time- but they are issuing paper write ups to go along with it for not having proper uniform on (t shirts instead of dress shirts,etc.). Curious to gauge others thoughts on this and how you would handle…

Hello everyone!

I'll be taking a Primary Care Paramedic student in about a month. It'll be my first ever student that I'm precepting. I'm looking for tips on how to properly teach and prepare the student.

When I look back at my previous preceptors, I can think of the following:

My PCP preceptor was strict, but I found that it didn't really prepare me well for being a PCP, and I think a lot of this was because they didn't properly set out expectations and goals, and this is one thing I want to change for my student. Basically, a 15 minute sitdown where I say "This is what I want you to do, this is what I expect of you by the end of each tour, and this is how we'll review calls."

My intermediate ACP preceptor was excellent at demanding perfection, making sure I was held accountable, was able to properly analyze and self-criticize myself on how I could do better, being quick to snip bad habits. I can honestly say being her student made me a far better practitioner, focused on doing the ordinary extraordinarily well. The downside? It was basically like the movie "Whiplash". Each and every call was followed by a 20 minute sitdown detailing every single thing I didn't do perfectly right, telling me that I was worse than a brand new EMR, calling me an undiagnosed autist, questioning if I had actually gone to school or was lying about attending class, telling me "I'm not here to teach you, you've already been taught. I'm here to take what you should already know and see if you're worthy of passing.", telling me to do wrong treatments, and if I did what she said she would say "You know that's wrong, and you did it anyway because you're a pushover. It's your job as an ACP to tell over people they're wrong, and you are failing your patient if you keep being a pushover."

Anyways, I probably need to talk to a therapist about that practicum even though it was so long ago, but what I will say is that it really reinforced a standard of excellence and self-critique and improvement. That's the kind of thing I want to pass onto my student, without all the toxicity and suicidality that I experienced, and being healthy about celebrating things you do well and reinforcing those positive habits.

I don't want to be a dickhead preceptor, but I also don't want to be a lazy preceptor that offers no teaching and passes everyone.

PCP Practicums in my province are 16 days, 4 tours long. I'm thinking of taking the following approach:

Days 1-2: Mainly observing. Make sure they know how to use the autoloader, stairchair, and set expectations. Also telling them that if I want to step in I'll say "I'll handle this", and also give them a code for when I want them to step back in to be again. Explain to them that I want them to ask questions and that there's no such thing as a bad question. For the first 2 days, I'll be attending every call, showing my student what I want to see from them - A sick/not sick verbalization, Primary Assessment verbalizing findings and 3 life threatening differentials I want to rule out, interventions with justifications for each intervention, and secondary assessments verbalizing findings. I'll also get them to try interventions when appropriate (IVs, Med Admin, etc) I'll talk with them after the call regarding the approach I take, why I took it, why I performed interventions, and a discussion on the pathophysiology of the patient. I'll also be with them to look through the ambulance, show them where things are.

Days 3-4: Letting them begin to attend calls, getting a scene size up, primary assessment, vitals, SAMPLE, OPQRST, secondary. I would intervene if they are missing an assessment by saying "Let's do this assessment".

From that point on, it's basically a case of getting them comfortable with their assessments, skills, and self-confidence through repetition. I would step in when necessary (If an assessment is being done or an intervention needs to be done), but I would hand the call back to the student, and discuss why I stepped in.

I would want the student give their own feedback immediately after each call, asking them to tell me one thing they could have done better, and one thing they did well. I would then offer my feedback the same way, so that no matter what, each piece of feedback would end on a positive note. I might occasionally quiz or question my student when not with a patient, and if they don't know the answer, I would encourage them to read up on it.

Maybe towards the later parts of their practicum, I might test them and push them with the classic "Are you sure?" questions, to see if they can handle being pushed around from other practitioners/providers on scene, and encouraging them to push back against me.

My goal is to prepare my student to be able to handle all aspects of a high acuity BLS call independently with minimal prompting.

This is kind of a basic idea of how I want to teach my student. I want to set them up for success as an entry level PCP. It's still a month until I start with the student, so I'm reaching out and trying to get tips and find the best way to teach. I would really appreciate any kind of tips or feedback. Thank you!