There is a saying that you can’t teach an old dog new tricks, and it got me to wondering if the converse was true, can an old dog leave behind a couple of tricks for the young dogs. Call it a self-conducted exit interview. I thought I would attempt to summarize some key points I have learned over the years and pass them one to the next generation of EMS providers, those who may one day need to take care of me.

One uncomfortable realization I came to early in my schooling was looking at what constituted a “passing” test score, often falling into the 75% range. What that suggested to me was that I could pass a test and yet 25% of the time a mistake was going to happen. One fourth of my patients, who have no choice of selecting their care-giver in an emergency situation, was a one in four chance away from potential disaster. This realization pushed me to embrace being a life long learner. My concept of responsibility to my future patients was validated when I ran across a quote from a medical journal, Circa 1878:

IF YOU DON’T KNOW A THING, YOU ARE QUITE CERTAIN NOT TO SUSPECT IT…
AND IF YOU DON’T SUSPECT AT THING, YOU ARE CERTAIN NOT TO LOOK FOR IT…
AND IF YOU DON’T LOOK FOR IT, YOU ARE CERTAIN NOT TO FIND IT…
AND IF YOU DON’T FIND IT, YOU ARE CERTAIN NOT TO TREAT IT.

The wisdom of those words spoke volumes to me that I first must know things, as much as I possibly could. What I now find fascinating is as I learned more; I was able to condense my list of critical considerations. Spending time learning did not make my job more difficult with more paths to travel, it made it easier and let me focus on what mattered. Here is where I ended up in my top five concepts every emergency medicine provider should learn:

1. WE WILL ALL DIE OF BRAIN ANOXIA

I took great pains to ensure all my students understood the pathophysiology necessary to track one red blood cell through the process of offloading and onloading oxygen. I figured if they could trouble shoot their patient with the objective of keeping that process supported, they had a better chance of delivering a salvageable patient to the ED.

2. TREAT ABNORMAL VITAL SIGNS-WORRY ABOUT DIAGNOSIS LATER

I enjoy a good diagnosis as much as anyone, but one doesn’t want to lose sight of the need to fix some critical problems in the carrying and offloading of oxygen first and worry about the why when time and opportunity presents itself as things stabilize.

3. IF IT WORKS, KEEP DOING IT EVEN IF YOU DON’T KNOW WHY IT’S WORKING

I was always a firm believer in getting gravity to help me maintain cerebral perfusion when I needed it, as well as other simple ideas designed to keep that one red cell functioning properly. Sometimes an intervention may seem counter intuitive, but if it’s helping to stabilize my critical patient, I’m a happy person.

4. ERRORS IN COMMISSION ARE WORSE THAN ERRORS IN OMISSION UNLESS VITAL SIGN INVOLVEMENT.

I was always what I consider a non-glamorous paramedic, going for the simple over the complex and appreciating basic skills are what the majority of my patients required. I was never one of those who succumbed to the temptation of having a skill set in my arsenal that I just couldn’t wait to try out on the next patient marginally appropriate. I do admit to being a bit of an airway fanatic and honed my skills as best possible. I also figured everything I did in the field had an impact on the ED doc’s course of assessment and treatment and so I would tend to defer playing and deliver as untampered a patient as I could.

5. BLUE IS BAD, OXYGEN IS GOOD and the AIR SHOULD GO IN AND OUT.

What can I say, I already admitted to being a boring medic? Picture1__2__bigger

I encourage readers, those providers long in the tooth and those still cutting teeth to join the discussion and help the next generation of emergency care providers. Feel free to take a look at my offering of classes and presentations if I might be able to help stimulate some discussion or learning within your agency.