Knowing

As you make your way through life, it is inevitable that you will continue to acquire knowledge, even without trying. Day by day, week after week you will be exposed to information about cooking, social behavior, world events, cleaning, automotive care, etc. By comparison, the information set that is represented in the field of emergency medical services is, for the most part, unique to itself. While one may pick up bits and pieces of emergency medicine during a first aid course, the bottom line remains: If you wish to become knowledgeable about prehospital care, you will need to actually make a serious commitment to accomplish the task.

Knowing What You Know

At the completion of an EMT-B course, the successful graduate will have worked through more than 1,000 pages of medical content. At the paramedic level, the volume of reading often runs to 5,000 pages and more. In my program, graduates will break the 8,000-page mark during the 9 months of the core curriculum. Even if it is just to obtain a basic understanding, that’s an impressive volume of reading to work through, but it is not the case.

For example, take a course on European history. Once you’ve completed the course and successfully passed the final, you have no real obligation or need to maintain those files in your stash of long-term memory. By comparison, significant amounts of the content you are exposed to in EMS must not only be committed to memory, but must be accessible on command. As if that “instant retrieval” hurdle isn’t difficult enough, the real challenge is taking what you know and turning it into practical application. You can be a rock-solid, 4.0 GPA student, but if you can’t apply all that knowledge to provide the care your patient needs, your fund of knowledge is, for practical purposes, useless. We must be able to comprehend and store vast amounts of knowledge and keep it readily available to boot.

Most EMS providers are looking at 6 months to a year or more before they can expect to be comfortable with their fund of knowledge and the independent practice of prehospital medicine. In a high-volume system, it might take a little less than 6 months. By comparison, in a low-volume system, it might take a provider several years. Either way, turning theoretical knowledge into practical application takes a serious commitment. And, at some point, you will get comfortable “knowing what you know.”

Knowing What You Don’t Know

At first glance, you would think it’s pretty easy to figure out what you don’t know about EMS. Go back and look over your quizzes and tests, and there you have it: 83% on patient assessment (17% you don’t know); 86% on pediatrics (14% you don’t know); 75% on OB/Gyn (25% you don’t know), and so on. Clearly, your performance throughout the class can point out areas that weren’t entirely mastered. Once you graduate, target continuing education offerings that match your short suits, and you can beef up your fund of knowledge quickly.

That being said, there are lots of things not taught in the classroom that you will need to know to have a long and productive career. Safe operation of an emergency vehicle, the touch pad codes to the seven hospitals you routinely transport to, the procedure to follow if you get a needlestick or other significant exposure, how to swap out the main oxygen tank without trashing your back are all things you don’t know until after your initial training, along with dozens and dozens of other items.

Last, but not least, on the list of things you don’t know comes only with practicing the craft of prehospital medicine: pattern recognition and intuitive thinking. If you are always in a “learning mode,” i.e., seeking out any and every opportunity to learn more about your medicine, you will find the opportunities plentiful. As you gain the experience that only running calls provides, you will start to see the patterns unique to the conditions that produce them. Take, for example, a narcotics overdose patient. Irrespective of whether it is a naturally occurring opiate (i.e. opium) or a synthetic opioid (i.e. fentanyl), an overdose of any drug in this classification will result in CNS depression and slow and shallow breathing that combine to deliver too little oxygen (causing hypoxia) and remove too little CO₂ (causing hypercarbia and acidosis).

As time passes and calls stack up, you will jump from “entry-level competent” to “proficient.” If you are diligent in the practice of your craft and continue to seek out opportunities to learn, then “own” your mistakes and work at not repeating them, over time you will see the list of things you don’t know slowly getting smaller. At that point, you may cross the line into being an “expert” prehospital practitioner. According to the 10,000 rule, it takes roughly 5 years of full-time work (at a minimum) at any given craft to become an expert. Painting, pitching, plumbing, paramedic are all the same: 10,000 hours to get there. But it all starts with knowing what you know and knowing what you don’t know.

Until next month….

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma
Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.

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