I worked with a newly cleared paramedic the other day. We started to check out the truck and I asked her how it was going.

“I’m scared shitless on every call.” came her reply. “It’s much different than it was during training when I had an FTO there to back me up on every call. I have the feeling that I’m clueless on every call”.

I reassured her that what she was feeling was normal. Even though she’d done well during her training and received good reviews from her FTOs’ it is different when you are out on your own. She had strong BLS skills, which is always helpful. I’ve never seen a good medic who wasn’t a good EMT first.

Even though we have a two medic system, a new medic has to learn how to run a call and not depend on his or her partner to make decisions for them. It’s not an easy thing to learn, and some medics never quite figure it all out. One of my co workers, known for being brutally snarky, refers to them as “Paramedic Assistants”. Some go on that way for years, moving around from unit to unit and partner to partner. A friend of mine who is a retired public school teacher told me that they have the same type of thing in teaching. An inept teacher will move from school to school throughout his or her career as successive principals dump them on unsuspecting principals encourage them to share their wisdom at a new venue. It’s known as “The Dance of the Lemons”, which I think is apt.

Back to the new medic. She will do well, but as with all good medics it will take some time. Any medic who tells you that he was comfortable his first few months out of training is lying to you. One of the best medics I ever knew told me much the same as I told my partner that day. The good part of that is that you will notice that you gradually are getting more confident and more comfortable. Calls, such as CHFers in the middle of the night that once made YOU 4+ diaphoretic now seem almost routine. Almost instinctively you will look at a patient and just know what the diagnosis is and your treatment plan will flow effortlessly into your brain.

You’ll be a rock star, like Sir Robin, you’ll stride confidently up to the “Bridge of Death” only to be tossed over the edge of the precipice.

Then there are the weak BLS crews that just make every call tougher. That’s part of scene management too. Some EMTs need to be watched every second lest they snag your hard won 22ga IV out of the thumb of that 90 year old lady in CHF, or dislodge the tube that you worked oh so hard to get. Or they’ll give you a story that makes no sense of leave out the little detail such as that the 65 year old man with chest pain also has Aortic Stenosis. Even the EMT or first responder screws up, you know who is going to have to explain that to the QA person or worse, the medical director.

Which is to say there will be bumps in the road of your progression to confident, self assured, but never cocky paramedic. Your progress is likely to be a bit, shall we say, uneven. Some days you’ll be great, others you’ll think you wasted your time going to paramedic school.

Just remember that a bad call never gets better, it only gets worse. Get through it as quickly as possible and move on.

One day you’ll finish up a very challenging call and realize that it was challenging, but not terrifying. That’s when you’ll know that you really are competent. Of course that’s when a new procedure, drug, or piece of equipment will be thrown at you and you’ll have to learn a whole new protocol or skill.

That’s the funny thing about medicine, it never really stands still.