As many of you know out there in the world of EMT instruction, sometimes we think we got ‘through’ to the students and sometimes we get one of those classes where everyone seems to catch on fast, which feed off each other and raise the level of understanding to a whole new level.
And despite our shortcomings,we can be amazed that we were actually a great teacher; we pat ourselves on the back and say, as we get in the car and head home from class, ‘man, am I great or what??’ And then, something happens and we just sit and sulk for a few weeks trying to figure our where we went wrong.
A number of months ago after 11 grueling weeks of didactic and skills training for one of my more prolific and knowledgeable EMT classes, we moved on to the final skills testing component of the program. During the final, I allow some students to sit quietly and watch as we test out the skills.
For one student, during his medical assessment scenario, I gave him a relatively easy situation to figure out. An alert and oriented myocardial infarction patient on a 45 y/o male, with a history of breathing issues and family history of heart problems. The patient was sitting tripod with all usual signs and symptoms’ related to cardiac concerns. Basically a nice and easy one to analyze and treat for a basic EMT.
After the student had gone through his entire algorithm, he stated that what we have here is a MI and that he was now going to treat it. Ok, so far so good! He was not missing anything and stayed within the flowchart. But what happened next stunned not only me, but also the students who were in attendance witnessing the scenario unfold.
The student stated that he was going to dice the patients EPI pen and administer a hit to the leg. He did it and then asked me how his patient was doing. I stated that ‘your patient is worse’. He then stated that he was going to now administer ANOTHER hit of EPI and once again asked me, ‘how is my patient?’ Of course, again I stated that the patient is now ‘really bad.’ To my amazement he said 3 more times, I am giving MORE EPI, for a total of 5 hits to the exact same leg the exact same location and for an obvious MI.
I just sat there, thinking to myself, what in the world did I miss during the instruction of these students that would make this young man think that EPI was the go-to treatment for an MI when there was nitro and aspirin sitting right there in front of him? What did I do wrong??
Then to my surprise one of the students who was sitting quietly behind me and observing all this unfold just blurted out to the student, “what in the name of God did you see that made you want to give this guy 5 shots of Epinephrine while he was having a heart attack”?
We had a good laugh and I stopped the scenario at that time and decided that we really needed to break this down to find out what made this young man think that the interventions he was calling for were appropriate.
To our surprise, he actually had a great answer as to why he wanted to use epinephrine on this patient. It was wrong and he was confused, but in the end, we had an idea of what was on his mind.
For this student’s clinical experience, he did 24 hours of ride along time on an ambulance in the San Fernando Valley in which he was pared with 2 paramedics. During his ride along, he was on the scene of a few MI’s in which the paramedic AHA protocols were in play. He heard, Lidocaine, Atropine, Dopamine and of course, Epinephrine. In his mind, according to him, it was something that I forgot to tell him he could use so there-fore, he was thinking that he was being aggressive and going above and beyond the call here. Not knowing the pharmacology, pathophysiology issues, and concerns with administering an EPI-Pen on an alert and oriented cardiac patient. What a shock!
In the end I was able to get through to this student the right and correct methods for dealing with a scenario such as this but more importantly, as an instructor I learned a very valuable lesson. Afterwards, no student was allowed to do their ride-alongs with paramedics only and as a matter of fact, to this day, I make it very clear that as basic EMT’s in training, they should be doing all their ride along experiences on EMT basic rigs only. That way they don’t get confused, they get much more practice with their assessments and skills and have a keen understanding of exactly what a basic EMT on an ambulance does.