So I’ll start this post off by with a bit of an administrative announcement.  Moving forward it will be my goal to be writing more clinically driven, research oriented posts.  I will still be writing about other topics but I want to move towards topics that will help progress EMS forward and promote change.  As I’ve said countless times before, this blog isn’t just for the readers.  It gives me a chance to research and stay current on new trends in medicine.  So with all that said, here are 4 clinical things I wish I’d known when I started as a paramedic.

• Mean arterial pressures – Mean arterial pressure has been show time and time again to be a better indicator of hemodynamic status than standard BP. Most literature I’ve found on this topic doesn’t directly apply to an EMS or street based environment but the connection can be made.  MAP pressures should be kept above 65.  Some studies even suggest that trending under 70 can be a solid predictor of impending hemodynamic compromise.

• Pharmacology goes beyond protocols – This one made me chuckle as I was writing it. Think back to paramedic school, or even your last in-service training, and consider the last time you did training on pharmacology.  If you’re being honest then most of you would admit that it was centered on a drug or a dosage and not a classification or type.  In EMS we have a tendency to teach cookbook medicine and it just doesn’t work that way in actual clinical practice.  Particularly in the world of street-side medicine, the decisions we make in seconds may impact a patients clinical outcomes for a lifetime.  That is a massive responsibility and learning pharmacology solely by memorizing indications/contraindications and dosages/routes is a recipe for disaster.

• Assessment is a lost art – Look, listen, and feel. Let that idea really sink in.  It isn’t about documentation and lip service, it’s about truly investigating what is wrong with our patients.  In Maryland EMS I have often felt guided towards certain syndromes and pathologies without ever being given the full story and it is up to us as providers to get that full story.  Assess your patients and provide good pass on to the hospital.  I’m tired of hearing the excuse that they don’t care about our assessments, make them care by providing a high quality assessment.

• Airway algorithms – In the EMS world we take pride in creating order out of chaos. Despite many of our interventions not being evidence-proven one thing that has been shown to be true consistently is the EMS provider’s ability to provide leadership at the scene of complex cardiac arrests and other medical emergencies.  One thing I’ve never been quite sure of is why we haven’t applied this uniformity to other aspects of our clinical care, in this case airway management.  Now to be clear, this isn’t cookbook medicine, as most difficult airway algorithms allow for quite a bit of flexibility in regards to actual intervention.  What the algorithms provide is a uniform approach to managing an airway, difficult or otherwise.  If you’ve never been exposed to airway algorithms I strongly recommend the book Emergency Airway Management by Ron Walls.

So that’s my top four.  I’m going to end this post by talking about one non-clinical thing I wish I’d known.  We in EMS have got to get better about taking care of ourselves.  I’ve written at length about mental disease (which runs rampant) and I’ll probably do some stuff about physical health in the future as well.  Contrary to what we may believe we need sleep and proper nutrition isn’t optional until we are 30.  Every move we make and every bad thing we take adds up.  Take it from this cancer survivor, you only get so many chances to make up for poor health choices.  So until next time readers, stay safe out there!