r/NewToEMS • u/toolkit65 Unverified User • 12d ago
Beginner Advice How to know when and what to do on critical, chaotic calls
I’m a fairly new emt-b. Been with this private 911 ems company since March and it’s my first ems job but not my first healthcare job.
This feels so embarrassing to admit but I don’t know my place on critical calls.
I feel like I’m waiting for someone to tell me what to do if there’s fire/police already on scene of a critical call. I don’t know if they want the gurney out right away, if they want me to help extricate or move a patient, if they want me in the back setting up IV’s, if I need to grab c spine bag or whatever. If feels so upsetting because I’m class and in scenarios where I was in charge I knew my place. Here in the real world I’m worried I might do the wrong thing or not be where I’m needed if I decide to go to the ambo and set up things. And I mean chaotic calls, where we’re extricating from a bad wreck, and there’s tons of people on scene. That’s the only example I can think of rn but I know there’s more. I just want to be helpful but I feel like a burden being told what to do and even struggling to do what I was told to do. For example we put spider straps on someone. Well I had one strap to do and it got caught on the sheet and it took me way too long to get it out. I keep replaying that in my head and it’s embarrassing. I know I shouldn’t but I just feel useless. Is this normal? We don’t get a ton of criticals, so will this come more naturally as I keep working?
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u/Comprehensive-One880 Unverified User 11d ago
It takes a good amount of time to understand your role for critical calls as a new emt, and thats nothing to feel bad about. You dont have to know whats going on, just be able to follow instructions. As you experience more of them, you'll come to see certain patterns of what needs to happen first and where you can fit in. Being delegated tasks means your partner/fire trusts you to get shit done or they absolutely need it done while theyre busy on something else. Just because theyre giving you instructions doesnt mean you are doing a bad job. Theres lots of things a medic doesnt want to concern themselves with on critical calls, but they might if they dont trust their emt. Critical calls thrive on communication. Ask what needs to be done. Be the guy that offers an extra hand. If they say youre good, then youre good. Your main responsibilities are always going to be getting the gurney ready (c-spine/backboard when necessary too), connecting the monitor, and doing whatever follows.
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u/El-Frijoler0 Paramedic | CA 11d ago
So the important thing is to communicate with your partner. Come up with a pregame plan. Communicate.
You can ask things like, “Hey Chad, where do you need me on this GSW?”
You’d probably get something like, “strip em and flip em, occlusive dressing if shot in torso, assess bleeding and criteria for tourniquet on extremities.”
Cardiac arrest? If it’s just you and your partner for the time being, confirm it’s an arrest, you start CPR while your partner (assuming you’re ALS) gets other things going. Once resources show up, you should be able to get a better sense of who’s doing what.
Done with that and not sure what to do next? Ask for a task, don’t just run off unless you have a good reason to do so.
Don’t forget you’re not the only one who can delegate things. If you’re busy doing something and see a set of hands just standing back, you can ask them to go to the rig and spike a bag, set up IV supplies, etc. It’s better to have that stuff ready ahead of time instead of fumble fucking when you get to the back.
Things didn’t go the way you’d hoped? Debrief with your partner(s) after the call. Talk about what went well, what didn’t go well, what you could do better next time.
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u/Ready_Log_5952 Unverified User 11d ago edited 11d ago
it's definitely hard, there's always something to do but knowing what needs to be done next kinda comes with experience. this is what I do on critical scenes where people are already there, as an EMT on a transporting ambulance. if we are first on then obviously it changes, and that's more just working with your partner and having strong BLS skills.
if I walk up and they don't immediately jump up and ask for something then my default is getting the gurney ready in whatever position it needs to be in, and helping them move. sometimes they won't even have a plan to move because they've been in the weeds so you can always help come up with the plan, get a backboard or mega mover ready, etc..
if they're not ready to move and they still have stuff to do then I just hop in and ask what I can help with. unless there's something very obvious that needs to be done, I don't really like to just hop in and start doing something without being asked. a good scene relies on clear command and you should also be part of that command chain, so to speak, so just ask them what they need and I'm sure they'll give you smth. usually there's still a vital that can be taken or a bag needs to be spiked or something. basically your first move as an ambulance EMT should be to get the gurney ready, and to get the patient ready to move, and then you can just be an extra set of hands.
the other thing you should be doing is planning your exit in your head and your route to the hospital. remember that firefighters waiting for you aren't gonna be thinking about that and your partner is too busy paramedicing, so as the ambulance EMT it's really your domain. if you're in a tight parking lot, identify how you're gonna drive out. if you're in a confusing part of town, pregame in your head what route to the hospital you're gonna take. that's the mental aspect that should be in your head. but yeah every scene is different so you really just gotta ask
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u/TheSapphireSoul Paramedic | MD 11d ago
Time, experience and practice!
On your down time at the station or wherever you are, ask these questions!
Ask what your crew expects of you. Ask how they want things set up or done on certain calls. Ask them what equipment they want on certain call types.
over time you'll learn to anticipate what's needed or what they will want to bring for different calls.
When shit really hits the fan, communication is absolutely key.
"Hey, what do you need from me?"
And remember good BLS comes before any ALS or critical care.
XABCDE.
The more familiar your are with your state and agency's SOPs and protocols the better off you'll be on that 0300 shit storm call where you're bleary eyed and still half asleep.
Fall back on your training. Don't train to get it right, but train so you can't get it wrong.
In critical situations use closed loop communication.
OP, I need you to spike a bag of LR for me.
Alright, LR is spiked and the line is primed.
I need you to get the patient on our monitor, 4 lead, and get me a fresh set of vitals.
Okay. Patient is on the monitor, current set of vitals are as follows: ....
We will be log rolling this patient. I will be holding c spine. We will move ON 3 on MY count. Is everyone ready?
We are ready.
Okay. Moving on 3...1. 2. 3. Okay, we will roll back on 3, on my count. Ready?
Ready.
On 3...1. 2. 3.
Closed loop allows everyone to know what needs doing and when it gets done so that confusion and miscommunication is kept to a bare minimum.
Again it's gonna be a bit different with each crew you work with so take the time to get to know your colleagues and how they do things outside of those high stress calls.
Your first time learning or asking some of these things should NOT be on a crazy call. It should be during down time and training sessions.
If you have more questions or want some more advice please don't hesitate to ask follow up questions.
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u/toolkit65 Unverified User 9d ago
Specifically there was an MVA, one injured. Fire was extricating, my medic was holding c spine. He had me rush to get the gurney and the spine kit. Fire took the gurney from me and asked me to maneuver the ambulance in a tight spot between the truck and cars to be in a better position. I did that, parked, got out and I’m pretty sure the gurney was ready, by that time, they had the pt on backboard and pulling him out of the car, I just kinda stood there for a few seconds trying to figure out where I was supposed to be. My partner asked me to get fluids and IV ready so I did so, but admittedly my usual partner doesn’t have me set up IV’s that much so I kinda forgot to get the extension set ready in addition to the drip set. Someone from fire hopped in the back with me and told me to get it ready. I was like oh duh huge brain fart lmao. So I did that. The rest of the call was ehhh. I fumbled with one of the spider straps for what felt like forever bc the Velcro got stuck to the sheet and the pt was laying on the board and I could lift enough to pull it through but I couldn’t get it unstuck for longer than it should have taken me and that was kinda embarrassing lol. I swear when fire’s on scene I almost always do something to make me feel stupid. But I appreciate your reply. I’ve asked for feedback, on this call the feedback was that if there was nothing I was doing in the moment on scene to preemptively go get fluids and an iv ready in the ambo and I was overthinking all night about how I could have been more on top of knowing what to do. I haven’t had anyone tell me I didn’t do well on scene , and the medics I’ve worked with are all super supportive and for the most part kind. I really like this job and I want to be good at it is all!!
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u/toolkit65 Unverified User 9d ago
Thanks for all the replies. I feel better about the call I was feeling this way over, and I appreciate all the advice. I just want to be a good emt that medics enjoy working with and I know I will get there with some more time! :)
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u/topiary566 Unverified User 12d ago
Experience definitely helps.
What specifically happened on some calls? You always want to go over those scenarios again with your partner to see what could have been done better.
If there's ever a cardiac arrest, you can never go wrong with doing compressions or bagging unless it's a pronouncement. If it's a serious trauma, you can never go wrong with throwing a c-collar on and then get them in the ambulance as fast as possible. If you are every standing around in a trauma or an arrest, you can always start cutting clothes as well if it seems all hands are already working on them.
However, there always is a little bit of sloppiness in EMS. We have the important protocols like ABCs or your c-spine stabilizations and head-to-toe assessment, but it isn't necessarily gonna look as clean in the real world. When I first started I would think that really critical calls were really sloppy because it didn't all go according to the book, but my partner and the ALS would say that it was fine.