I want to begin by saying that as a student and also as a seasoned medical professional there is never just one way to prepare for providing true emergency medical care to a patient. You can study, plan and prepare as best as you can but there will always be that one situation that you just can’t be 100% ready for. I began my medical career in 1999 as an EMT and when I stepped into the Emergency Room for the first time as a student I felt overwhelmed and yet also right at home. I was soon flung into my first trauma, it was exhilarating and terrifying at the same time. You find yourself repeating over and over pearls of wisdom that your instructor or another EMT professional has told you while trying to remain calm. I remember the words my instructor told me “ ABC’s are always the priority otherwise you can bandage or splint the patient and have a perfectly splinted dead guy!” It may sound crude to put it that simply, but it’s really true that the Basic Life Support is the foundation to all care you provide at any level. I am now a Registered Nurse who worked in a Level One Emergency Room, those words from almost 20 years ago ring as true today as they did in 1999.
I have since advanced from BLS to ACLS and PALS but the basics will always remain the priority. I can honestly say that I thought having “field” experience would prepare me for what I would see in the Emergency Department. After all it is a more controlled scenario than being out in the ambulance. What I learned is that it can be more chaotic in a controlled chaos way. You may say controlled chaos is a misnomer, but in emergency medicine it’s the norm. In a trauma room you have multiple disciplines all working at the same time in tight spaces giving and following orders. You have to be prepared to listen more than talk, do as you listen and all while others are circling around you in a kind of dance. Keeping composure in the saddest of cases is probably the best preparation you can have. It’s ok to breakdown and cry or feel the emotion of what you just saw, but you have to learn to set it aside in the moment. In the moment you are focused on your patient and their Airway, Breathing and Circulation you should try to monitor your own. Deep breathing in through your nose and out your mouth, slowing the heart rate down and bringing the immediate task at hand back into focus through to the end. It’s very easy to get tunnel vision on major trauma and even in major medical emergencies.
They teach you in school to treat others as you would treat your own family. Applying all the knowledge you accumulate through school and time as a medical professional is one step. Realizing that all people come from varying degrees of life and situations. We are in part medical caregivers but also confidants to the people we serve. You may be that one person who they finally reach to for help with a situation. The addict who is screaming at you while your trying to get an IV is just as important as the elderly woman there with chest pain. Preparing mentally is as important for a provider in an ER as it is to prepare physically. You learn to set aside the notion that you are being personally attacked if a patient is screaming at you, you have to do that in order to be an optimal caregiver. I truly believe in those moments you learn the most about what kind of caregiver you are.
Lastly, physical care for you is so important. Keeping in good health and physical shape makes your life and dealing with emergencies much easier. We live in a world of obesity and self neglect. No judgments on the people who are in that situation but its the state of healthcare these days. We have seen increases in obesity related disease and also injury to the healthcare worker. Whether you are an EMT, RN or a Doctor, you are at risk of injury from lifting and moving patients who are sometimes upwards of 400 plus pounds. The advance in technology to accommodate these patients has helped relieve some risk, such as stretchers that are mechanized to raise and lower without much lifting. Although these things help it’s the responsibility of the healthcare worker to protect themselves from injury by being physically fit. In a busy ER, you may have extra help or they may be too busy to help. That’s when you must work smarter not harder.
So in closing I’d like to thank you for the opportunity to present this essay. I believe ACLS and BLS are truly the foundations for care and providing appropriate medical care. When you walk through the doors of the ER, Ambulance Bay, Firehouse or Hospital you should be as prepared as you can for the shift ahead. Keeping in mind that if you do your best work, regardless of the outcome, that is all you can do right then and learn from it afterwards.