Tyler Richins

Submitted 2022-08-02

Growing up, my family would often spend the 4th of July holiday week in a small town in central Utah called Bicknell near Capitol Reef National Park. My dad is a pharmacist, and each year he covered for an employee at the small clinic while they went out of town to see family. These summer family trips to Bicknell helped me develop an appreciation for rural communities. I enjoyed exploring Bicknell and the other local small towns in the area. I remember discussing with my dad about his experience working in the Bicknell Medical Clinic. He talked about how it served the whole county, and some people had to drive over an hour to get to their appointments. I gained respect for the sacrifice of time and money they made to access a clinic or hospital and developed a desire to practice in a rural setting.

I realize that this desire could result in me being the only provider for the community. As such, I have a responsibility to ensure that even if emergency medicine isn’t my “speciality” I still have the knowledge and skills to provide life-saving procedures on my patients to stabilize them until they can arrive at the nearest emergency room. During my time working as a Behavioral Health Technician/CNA at Highland Ridge Hospital (HRH), I have developed crucial habits and skills that will influence and benefit patients as I face emergency situations as an attending provider.

One of the routines I developed working at HRH was regular exercise. After starting at HRH, one of my coworkers and I started regularly going to the gym and lifting after work. Initially, I was hesitant that doing this would drain me even more after the long 12 hour shifts. I discovered these workouts did the opposite. The gym became a center for rejuvenation, as focusing on each exercise and feeling the muscles stretch as I lifted the weights relieved stresses from the day.

In addition to regular exercise, getting a good night’s sleep was critical to my physical well-being during the job. I had to get up at 5:15 in the morning to ensure I got to the hospital on time for my shift. While I found serving acute psychiatric patients very rewarding, it still was physically and emotionally draining work. I quickly learned that going to bed a lot earlier than I had prior to the job (around 10:30) was essential to ensure I would be fully rested and ready by the next morning.

One of the most physically demanding responsibilities was to restrain patients. While restraint was always a last resort, it was necessary when patients wouldn’t stop engaging in behaviors that put themselves or their peers in danger after verbal prompts proved to be ineffective. One restraint where I was particularly grateful I had developed the habit of regular exercise and sleep was on a large adolescent boy who weighed over 200 lbs. Thankfully, my habits enabled me to keep control during the restraint so neither of us were hurt until he received medications and was able to calm down.

In addition to being physically prepared, being well rested allowed me to think clearly and collaborate during my shifts. This was critical as I was able to communicate efficiently and address high stress situations at work. One day I was working with a technician named Aly. In the morning after we had taken all of the patient’s morning vitals, I started to record them in each patient’s medical record when I heard Aly exclaim, “Oh my gosh, oh my gosh someone help.”

I rushed out onto the floor and discovered a patient (who I will refer to as Bob) had stripped completely naked in the common area. I informed Bob that he needed to put his robe back on in a calm, firm tone and asked him what was wrong. Bob told me that he was being bothered by “the voices” in his head and that he wanted them to leave him alone. After hearing this, I assured him that I would reach out to the nurse and inform them to come help with his voices. Then I reminded him a second time to put his robe back on. Bob obliged and I immediately connected him with the nurse.

The aforementioned skills and habits will be crucial to ensuring I can approach emergencies calmly and confidently. The preparation and experience I gained from these previous experiences at HRH prepared me to approach emergent situations with confidence. I recognized how important my preparation was during the first life threatening emergency I experienced at HRH. I was checking on the patients and discovered a patient in their room on the floor. I called the patient by name but he didn’t respond. After calling him again and once again not receiving a response, I approached the patient and discovered he was lying on the floor with a long sleeved shirt tied around his neck. I immediately removed the shirt and notified the charge nurse, informing him of the situation and offering to help. The nurse asked me to assess the patient’s vitals. Thankfully, his vitals were within the normal range and he regained consciousness before any major permanent damage was done.

I will approach emergent situations as a provider similar to the methods I employed as a Behavioral Health Technician/CNA at HRH. I will continue to focus on my developed habits of regular exercise and a good sleep schedule to ensure I am well rested, de-stressed, and ready to handle whatever challenging situations I may face as a clinician. Collaborating with peers will ensure me and my team address the situation quickly and cohesively. I can’t wait to continue to collaborate with my peers in medical school and residency on how they approach emergencies. Together we will help each other become prepared providers who can deliver high quality basic, life-saving emergency medical care to our patients regardless of our specialty.

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