What's on your list?

about 8 years ago


Every career in pre-hospital care starts with a first day. Well, two first days. The first day of training, and the first day of placement, when you put all the training to the test on real patients who actually depend on you.

Almost every course, from basic first aider to student paramedic and beyond, builds heavily on the DR(c)ABCDE model that any emergency can be competently handled by working through the list of Danger, Response, Catastrophic haemorrhage, Airway, Breathing. Circulation, Disability and Examination/exposure. Fortunately it’s a tried and tested formula that works and saves lives every day.

But having the training and knowing the cornerstones of emergency medical care can only go so far in making you a great practitioner. You also need experience, which unfortunately you can’t download as an eBook, gain from a friend or master in a simulation. You need to get out there and do it.

These realities mean that many practitioners start with two lists: the `exciting list` and the `nervous list` which they gradually and informally check off until they have experienced each thing at least once, and therefore know how they would do it better next time.

I am excited to…

  • drive on blue lights to an emergency

  • drive on blue lights to hospital, with a patient on board

  • have an air ambulance arrive at a job

  • deal with a fire

  • force entry to a property

  • press the magic button on a defibrillator

I am nervous about…

  • doing chest compressions

  • telling someone their relative has died

  • looking after a very sick child a long way from hospital

  • driving a patient with major trauma passed several closer hospitals to access a major trauma centre
  • having an airway I am unable to manage

  • being confident in identifying a myocardial infarction and acting on it

Neither list neatly fits into a `top 5/10/20` as both are built on dynamic doubts and passions which are much more complex and change based on the culture you work in, the level of your training and your personality.

In a busy ambulance service, it often takes 2-3 years to see one example of everything, and the guarantee of emergency medicine is that next time you see the exact same situation, it may be completely different!

Are lists like these healthy? What is/was on your list? What are the things on your list still to check off?

Matt Green is a paramedic for an NHS Trust. Follow him on Twitter @MLG1611