Don’t settle for the work of others and then claim the product for yourself. Force yourself to be part of the process. This will in turn add much more value to the final product. It will also serve to establish structure and discipline within yourself.
Begin the process and soon reap the benefits of hard work, self discipline, and mental determination. The product is but a mere part of the whole. The process, however, is the lions share of the end result. So then, your journey (process) awaits.
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Own the day and go out the door with Intent.
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]]>Expectations are often considered a check box. To some degree the concept of expectations sometimes leaves a sour taste in our palate. This shouldn’t be the case, however. Expectations are crucial for individual success and are also pivotal for success within a team, organization, or agency.
Having individual expectations is fundamental to individual growth and development. This is where the concepts of self-reflection and humility play a crucial role in identifying personal goals. These personalized goals are silent, personal expectations you have for yourself that contribute to your growth as an individual. A brief note here on the difference between motivation and determination. Motivation will force you to develop the personal expectations, determination with force you to work for and meet those personal expectations. (Both serve there purpose, but understand the difference).
As it relates to team development and success, expectations are fundamental as well. You as a paramedic preceptor set the expectations with your candidate, just as your medical director has set the expectations with you. What is this in a simple term? Leaders Intent. You clearly articulate your intent as the preceptor, so that the internship runs as smoothly and is an exceptional success story. Both a success for you and for your candidate.
This is the opportunity that you have to get everything on the table. No more surprises. This greatly reduces stress, frustration and hesitation. Now everyone understands the expectations. This is the first step in creating a good environment, built on trust and communication. Communication drives success, and expectations drive communication.
Until next time as always... Own the day and go out the door with intent.
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https://www.emsworld.com/news/1224539/fla-county-pay-275m-medics-stroke-inaction
This article is an exceptional example of the consequences of complacency. The providers here demonstrate the exact opposite of what it means to be a patient care advocate. Poor work ethic, zero accountability, poor team dynamics, no personal integrity, the list goes on. Why is it that these characteristics get adopted? Certainly it is not the starting point of ones EMS career. Pridefulness creeps in, slowly and silently. These medics in their pridefulness thought they understood the event in front of them and wouldn’t even take vital signs much less do a thorough assessment. Did this contribute to the death? Not sure, but they certainly could have provided at least some standard of care. Seeing things like this is so upsetting. And it should prompt us all to consider how it is we operate as providers. Do we conduct ourselves with a humility towards the job, towards our patients? Always attempting to provide for patient advocacy and care. Or, rather, do we conduct ourselves with a prideful arrogance? Always assuming the answers and unwilling to do the work because of no personal integrity. And, how is it that one combats the demands of the job, with the workload, the stress, and all the other factors that contribute to a calcitrant attitude? The answer in short can be found in “Life and Death Matters” which lays the foundation of a successful and exceptional EMS career. But a short synopsis will do. Character. Methodical Approach. Decision Making principles. These factors greatly improve each providers mental state, which in turn contributes to exceptional patient care. Refuse to be like the providers in the article. Force yourself to be an exceptional provider by conducting yourself with personal integrity, personal accountability, and a humble approach to the job.
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President Theodore Roosevelt had a brilliant response to the critic and I quote:
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done the better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there in no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”
Refuse to be the critic. Refuse to be the one responsible for spreading malicious gossip. Refuse to be the one that stands on the sideline watching and waiting to pounce. These are fruitless endeavors and only serve to destroy one another rather than build up and develop one another. Force yourself to be the “man in the arena.” This is where leaders are forged, this is where leadership is molded and developed, IN THE ARENA. This is where EMS providers are called to work, in the arena. We are leaders, formal leaders. Stop the critique and get in the arena.
The last thought as we consider this: WE ARE LEADERS in EMS. Own the day and go out the door with INTENT.
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Review the story above for your motivation today. Motivation to be better today. And then become determined to be better for the future. The culture of apathy in prehospital medicine must stop. It is a very daunting task however it is a worthy one to engage in. Why do we become apathetic? Is it the call volume? The number of so called illegitimate calls? I believe we all suffer from apathy to some degree from time to time. But I also believe that if you conscientiously engage in combating that apathy it will work. Entire countries, cities, communities, and most specifically individuals look up to the first responders that serve them. May you go out the door and be worthy of that praise today, tomorrow and into the future. We must be better as a community, the days of apathy have gone on long enough and it is up to individuals to change it. Go save someone today. You wanted the task, now go save the person that an apathetic paramedic can’t. You can make that save because you are engaged. That save may be as simple as recognizing sepsis and calling an alert early so the patient now gets those IV antibiotics an hour quicker. That is a save brothers and sisters. That is a save. The apathetic and adequate paramedic doesn’t make those saves. Go make that one today. Own the day, and today go out the door with intent.
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Keep in mind you may never know what the patient is going through. What they are experiencing on a personal level. It may be their worst day ever, or they may have called as a result of their worst day ever. Why not take that opportunity to try and make their day a little bit better by having met you, by having to interact with YOU the paramedic or first responder. Make it your goal with your patient and their families to remember YOU for how well you treated them, how well you took care of their family, or how well you compassionately solved their problem. Make no mistake they will remember you on the day they have called you. You may not remember them but they will remember you. Make that memory of pain or suffering a little bit brighter because YOU walked in the door, because YOU solved their problem.
Own the day and go out the door with intent. —Field Medics—
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Our thoughts and prayers go out to the Lubbock Fire Department and Lubbock Police Department. We are saddened to hear about the loss of a firefighter and police officer working a car accident on the Interstate. Keep an eye out for each other and be smart about your response to accidents and other incidents. Mitigate as much danger as possible. As always own the day and go out the door with intent.
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]]>How easy it is to brush off the seemingly routine call. How easy it is to pass up your methodical approach in lieu of an easier way. Refuse to do this. Remain ever committed to the patient in front of you. Don’t skip steps and quickly dismiss your patient because of your frustration or exhaustion. Your patient deserves your best, give it to them, because what we do matters. Stay tuned for part 2.
Own the day and go out the door with intent. —Field Medics—
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So, what does make this job so great? Is it the alarms we run? Maybe the rescues we get? Perhaps it’s the saves we make? Possibly the unprecedented privilege of impacting a complete strangers life in a moments notice, hopefully for the better. Are these things what make our job so great? I say no, this is what makes our job important. This is what makes our job necessary. This is what makes our job unique and at the same time unequivocally difficult yet satisfying. But is it what makes the job great? No, not for me. What makes this job great is not what we do, but WHO we do it with.
Thank you to all the first responders out there. Keep up the work, the grind, the night shifts, and the day. Keep answering the call, meeting tragedy at the threshold and holding the line. What you do matters, it is important, it is necessary. But while doing so take time to comfort each other, lift each other up, encourage each other in their difficulties and moments of weakness. Take a moment to realize that WE are what make this job great, not what we do.
— Own the Day and Go out the Door with Intent —
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Today it is so easy to become motivated. Motivated through others, motivated through some writing, or motivated through some social media post. This motivation, however, is brief. You must move beyond motivation. Motivation serves it's purpose to inspire and guide you towards goals. However, motivation will not carry you to the end goal. After becoming motivated, you must adopt a determined disposition. Determined to achieve that goal. Then execute.
Execution is what actually moves you forward and towards the things you wish to achieve. This is accomplished through the determined mindset. Start with the small things that need to be accomplished and begin executing a plan to accomplish your vision.
This is extremely important when it comes to the paramedic or first responder. You must execute a training plan, you must execute a reading plan, you must execute a personal plan in order to become better. Don't settle for being briefly motivated to become better. Develop a plan to become better and EXECUTE it. Maybe that looks like being determined to read for 30 min a day, maybe working out consistently, or studying your discipline daily.
Become determined to be better. Develop an idea or plan and EXECUTE it. Execute, Execute, Execute. This will move you forward and you will be better for it. As always Own the day and go out the door with intent.
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I was recently having a conversation about the importance of decision making and what the foundation of your process should be. Humility is the answer. Your process should be founded in humility. You should never be making decisions based off of some emotional response to the situation. Likewise you shouldn't be making decisions founded in arrogance. And lastly you shouldn't be forcing decisions based off of your subjective opinion about the situation. These examples can quickly contribute to bad decisions. However, the factor that will immediately contribute to good decisions is humility.
If you move forward with the principle of humility as your foundation for decision making it will greatly improve your decisions. This is so for several reasons. First, it allows for you to continually reassess your decisions and anticipate and evaluate. Secondly, humility causes your decisions, to by default, be in your patients best interest instead of anything else. This is called the pt advocate. Thirdly, humility forces you to reevaluate your own understanding of the decisions made and will force you to better prepare for future situations or circumstances that you feel need further preparation. Lastly, humility forces your leadership to be better. You by default are making decisions based in your teams best interest rather than your now.
This is brief and simple, yet important. Humility may single handedly be the most crucial principle as is relates to you as a paramedic, first responder, leader or team member. And the great thing about humility is that it's infectious. When you begin operating with humility your team members will follow, and additionally, your patient will recognize it.
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]]>These two principles integrated together is the key to your EDGE as a provider. Humility is the tool to keep your edge sharp. This is so because of two reasons.
Initially, humility allows you to ascend to the top of your practice. It causes you to be in a constant state of bettering yourself, sharpening and honing your skills, knowledge, and practice. Being in a state like this causes you to be moving ever forward and ultimately reaching the pinnacle of your practice. This pinnacle is manifest by your extreme confidence when going out the door and willingness to be accountable for all your decisions on each scene. Being humble is the only way to truly reach the top.
However, there is more. Once you have ascended to the top using humility, you MUST remain humble. The mindset that is in a constant battle with humility is complacency. If you reach the top of your practice, you have done so with humility. But, if you change your mindset and adopt a shred of complacency you will quickly fall from the top. This is why humility is the key to your precision sharpness and your knifes edge. Once ascending to the top, humility forces you to stay there. Humility won't allow for anything but the best and continued development. Complacency, in contrast, allows for in improper approach towards the job and you will quickly fall from the top.
So, remain humble and use humility to reach the pinnacle of your practice. Once getting to the top, use humility to stay there. Refuse to adopt an attitude of complacency and always remain on top of your practice.
Until next time... Own the day and go out the door with intent. Follow us on Instagram and Facebook. Make sure to like and share.
]]>Integrating the concept of self-reflection into your practice will cause confidence. When reflecting on your practice and skills with HUMILITY in mind it allows you to identify deficiencies or skills within your own practice that can be addressed. After identifying these deficiencies we must create a plan in order to become better. This is integrated with the idea of INTENTION. We then execute our plan with the intention of addressing the deficiency. This in turn leads to confidence because you are truly becoming a master at your practice or skills. This is a short and brief example of why humility can and will contribute to your confidence.
More to come as we develop this roadmap. As always... Own the day and go out the door with INTENT!
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]]>What exactly is intention and why is it so important? Intention is born out of self discipline. Intention is the principle of acting with purpose. Remember? Intention is decisiveness with purpose. This is a great definition. Intention is not arbitrarily acting with no direction. You act with purpose in order to accomplish a specific goal or task.
Why is intention so critical to your success? Intention is a reflection of your self discipline. We as medics and firefighters or first responders can literally prepare our entire careers for a few life changing moments or calls. This is the key... PREPARE WITH INTENTION. We've discussed the importance of preparation in previous blogs and I encourage you to go back and read those.
Stop and think about this concept for a moment. The most successful individuals you can think of have devoted their lives to preparing with intention. They have mastered the unique prerequisites of self discipline and preparation. Why should the medic or firefighter or first responder be any different? We shouldn't be any different.
Stay tuned as we continue to develop this roadmap. As you can see we are starting to INTEGRATE several concepts here. Operating with an integrated approach towards your paramedicine or firefighting is essential to be truly effective and successful.
As always, own the day and go out the door with intent.
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]]>Motivation is a great thing. However, motivation is actually a small part of your success. Today everyone becomes quickly motivated by what they see or what they hear or read, however, what good does motivation do without execution? You can walk in to the station with the motivation to go train but if you don't execute and turn that motivation in to action you've gained nothing. When you become motivated to accomplish something quickly begin executing small steps required to accomplish that goal. Don't consume yourself with what the end product exactly looks like. Once you begin executing small things your big picture and goal begins to clear up.
Something else that is important to execution is your personal growth. You begin to learn more and more about what it is you're doing. Think about sitting around and talking about pulling a hose line for a fire attack. You are motivated to do it but don't exactly know where to begin. So, you sit back and try and evaluate every possibility and every contingency so that you accomplish the perfect hose lay. You become paralyzed with action because you aren't quite sure how to exactly accomplish this so you fail to execute and learn nothing. Instead, just go execute. Go out the door and pull the line. You may not know exactly what it looks like at first but as you begin to execute the goal becomes more clear and the motivation has turned to execution. In turn your growth increases exponentially because of your execution. It's like the person who wants to learn how to do push-ups. One person reads all they can about how to do the perfect push-up because they don't want to mess it up. Another person has the motivation to do push-ups but instead of inaction they begin just doing push-ups. They are not perfect push-ups at first. They are of low quality and even may illicit some criticism at first. However, after days of execution the push-ups begin to increase in quality and now they are exceptional. All the while the first person is still reading about how to do the perfect push-up. At the end of the day, who has accomplished more? Who has learned more about push-ups? Arguably the one who has been executing the push-ups. Don't fear the reps! Go out the door, in the station, on the training ground, with the mindset of execution. You will see you quickly become better and your big picture begins to come in to focus. You will now have laser like precision and ability to accomplish your goals. Execution, Execution, Execution. Just start with Execution. As always, own the day and go out the door with intent.
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]]>First of all this is a learning opportunity for us to become better. The days of us brow beating each other and "eating our own" so to speak need to stop, learning from each others mistakes makes us better.
Currently there is a viral EMS video circulating that shows an EMS crew seemingly letting an individual leave their ambulance only to be struck by a vehicle later in the night, resulting in the individuals death. Since this video has surfaced it has been widely shared and viewed. But, we must understand that we don't know the whole story despite thinking that the video and audio shows everything. However, what can we learn from this video? I argue that this video is a demonstration of why THERE IS NO GRAY only indecision! The video begins with the individual reportedly running down the highway naked, thats the first information we have. What are your initial thoughts? More importantly, pay attention to the demeanor of not only the patient but the providers after getting in the back of the ambulance. The patient clearly is not answering questions and cooperating with the providers. More importantly than the patient's demeanor, however, is the tone set by the providers. Field-Medics has articulated the 3 C's of setting the tone. Does it look like a proper tone was set at all during the video? I argue each of the 3 C's was never demonstrated by any of the providers. In fact just by watching and listening I have no idea who is leading the call. Secondly, I want to address professionalism. If you think this is an acceptable demonstration of the professional first responder, you are hurting this profession. It's time we all begin to act and conduct ourselves with the professionalism those we serve deserve. Third, what sort of Mental Status Exam does this patient deserve. I argue this is a supreme example of why the first responder must master the art of the Mental Status Exam. Field-Medics has also developed in detail the Mental Status Exam or MSE. There is so much more to the MSE than A&O x4, which in this case the patient doesn't even meet. Lastly, I want to address why this call is demonstrative of why THERE IS NO GRAY, only indecision. This comes down to an accountability and work ethic problem. Not one time in the video do you see a COMMAND decision being made and then an understanding of the OWNERSHIP for that decision. This is a lack of accountability and willingness to make the hard decision to take this individual to the hospital. And, I'll qualify that statement with this, it's actually assumed it is a difficult decision by those who think this is a GRAY call.... IT'S not. To quote Sam, "this is a Kobe Bryant slam dunk" and we all know that is a sure thing. In addition to the clear lack of accountability the idea of work ethic is obvious. I won't say anything else on that, but SERIOUSLY. This is a video that should be viewed with these concepts in mind. Please look back in our blog and read the series on the 3 C's of setting the tone. Read the series on the Mental Status Exam. And read the blog on Accountability and Liberty. Understanding these principles is important and liberating for the paramedic or first responder, soon you will see THERE IS NO GRAY. As always own the day and go out the door with intent.
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The final piece of the mental status exam is AFFECT. What is affect and why is it important? When used as a noun affect describes someone’s emotional response to a given situation. This is extremely important when evaluating the mental status of your patient.
You have identified whether or not your patient is alert, oriented, cognitive and coherent. The patient meets all these criteria, but the final piece to consider is their behavior, demeanor or in short AFFECT. Are they calm and cooperative and acting the way a reasonable person would act under the given circumstances? Or, is the patient combative, uncooperative, belligerent? There are many different words used to describe the affect of your patients. Are they flat, with no real emotional response or verbal response to you? Combative? Erratic, are they demonstrating erratic unpredictable behavior and thought process. Maybe on a drug overdose? They can tell you the presidents name and city you’re in but they are emotionally and psychologically detached, this is why you can tell immediately when you come on scene that the erratic unpredictable meth patient gets a ride to the hospital, it’s actually very black and white, not gray.
There are two populations however that AFFECT is extremely important. Do you think you can name them? The first is the most important. Pediatrics!!!!!!!! The pediatric patient for EMS is all about affect. How is your kiddo acting? They can’t answer all the normal questions we ask their adult counterparts. So is the child acting normal? If not then consider it altered mental status, because they are. Then treat them according to your guidelines. This is very important and will serve you well. The second is the geriatric population, but more specifically the patients that suffer from debilitating diseases like dementia, Alzheimer’s or Parkinson’s. Are they “acting” normal for them? This is what we are trying to determine when we ask their care provider. This is AFFECT, is their affect normal for them given the situation.
We hope this helps give you some tools to determine mental status with your patient and then be able to act decisively. As always own the day and go out the door with intent.
MSE: Awake, alert, oriented x4. Calm and cooperative. Able to follow commands and answer questions appropriately. Intact Cognition and understanding. Coherent with an intact linear thought process.
Obviously you change points of the exam depending on the patient (unconscious, unresponsive, paranoid and unpredictable with violent disposition, unable to answer questions with absent cognition and incoherent thought). Use this exam or make up your own. Just use it consistently! As always... Own the Day and go out the door with Intent!
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