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First day (to the power of infinity)

What’s wrong with my partner?

It was my first week off of orientation at my first EMS job. I was 18 years old, an EMT, but was already in paramedic school (I went straight from EMT to Paramedic). My partner? An individual about 25 years my elder, who had been working in EMS for over 20 years. They were nice to me, and they took me under their wing. I was glad they took interest in me because I had a lot to learn. What did they teach me?

They taught me how to navigate the response area, how to fill out the ambulance check-off form, how to use the radio, which hospitals had different specialties, and where the good (and quick) food was. They also taught me the phrase “we’re 10-42” (Which meant we were past the end of our shift and unavailable for another call). That last part came in handy for sure. But, something seemed to be missing from this individual's wealth of knowledge. What was it?

Being a paramedic student I had a lot of questions and ideas about medicine, and I was excited to bounce this mess of information in my head off of someone else. However, they didn’t bounce very well off of my new partner. I came to find out that talking to my new partner was basically like talking to a layperson who happened to have been around EMS for a long time. Don’t get me wrong, they were a great technician - they had the basic skills in their hands and a decent flow about them. They could get vitals, move the patient, obtain a 12 lead, start an IV, etc... They could also talk to the patients much better than I could - I didn’t know how to be conversational in an emergency yet. However, their clinical knowledge was almost nonexistent. As I would study my protocol book and talk about them, they had no idea what the protocols were. As time went on I realized they wouldn’t give medications when it was indicated because they didn’t understand the treatments. They would shy away from anything besides a non-rebreather mask for everyone. They almost never wanted to stay on scene and assess a patient or stabilize them. They always wanted to do the minimum (sometimes less) and transport quickly. I was so confused. What was going on with my new partner? Some of my thoughts about the situation went like this:

-How have they been doing this for so long but seem to know so little about treating a sick patient?

-How have they lasted this long in EMS when they rarely treat anyone?

-I’m pissed.

-This isn’t what I thought EMS would be like.

-Is this why people make jokes about ambulances being taxis?

I was slowly starting to doubt my new career direction.

Three distinctions

I didn’t quit, even though sometimes I wanted to. As time went on, I got pretty interested in observing people. I noticed that there was a clear distinction between those that I would want taking care of me if I was sick, and those that I would never want to come near me if I had an emergency. That was distinction number one - what was number two?

Distinction number two was realizing that time of service (years in EMS) had absolutely no correlation with someone’s ability to treat a patient well. You would think the graph would go like this:

But, it doesn’t. In my experience (and everyone else I’ve ever talked to about this topic) it goes more like this:

Even these graphs are misleading because they’re two dimensional. I think of actual experience as a three dimensional space. In this context, experience is just a line of how long you’ve been doing something, it’s also about what’s behind it.

So, there was distinction number one and two. What was number three?

Distinction number three was coming to the realization that some people have the ability to repeat their first day infinitely (day one to the power of infinity).

Don’t we all know this already?

At this point you might be thinking: ‘ yeah.... everyone already knows this and it’s true in every profession.’

I’m not sure what people know. So, maybe that’s true. Maybe not. But that’s not my point here. The purpose of this blog is not to point out that we have a problem with clinicians being outdated as time goes on. I’m not even trying to change these people with this blog (they aren’t reading it anyway). So, what is my point? I’ll tell you why I wrote this blog in the first place.

Last week, a friend came to me. I won’t say their gender or age or anything. You can use your imagination - maybe it was someone just like you. They feel as though they can’t educate, or write, or podcast. Why not? They told me it’s because they don’t feel like they have enough years under their belt in order to be taken seriously by the medical community. They’ve only been at their current level of practice for barely a couple years. Here’s the thing… They also:

Have an advanced degree in a medically related field.

Have obtained advanced certifications.

Read medical literature on a regular bases.

Strive to better themselves constantly.

I’m not saying that all of these things are a requirement for sharing in blogging, podcasting, or making videos. But what I am saying is that I don’t care how long this person has been in medicine. If they can take some knowledge from their degree area of study, or from studying for advanced certification classes, or anything else that they’ve read or learned, I’m not going to turn my nose up at good information. I don’t even care if they’ve personally seen the thing that they’re writing or speaking about. Why? Because our personal experiences will never measure up to the medical research performed by large studies. As long as what this individual is speaking about is scientifically accurate, I don’t care if they have some arbitrary number of years in medicine.

It’s all about how you frame it

If you’ve considered sharing some knowledge you've obtained, but don’t feel like you have enough experience, maybe your problem is that you’re thinking there is only one way to frame information. What is framing information? Framing a delivery is how you present the information and yourself. If you’ve been in medicine for one year and you’re using phrases like:

‘In my experience…”

“What I do is…”

“From what I’ve seen…”

“I always…”

That isn’t a good way to frame yourself or the material because you likely don’t have much exposure to the situation to have a meaningful amount of examples to draw from. This is a fast track to imposter syndrome if you build yourself up like this. Instead, you might frame yourself in a learners way and use phrases like:

‘I was confused so I researched…’

‘This was different than I learned in school so I researched it…’

‘I made a rookie mistake / error and here’s how I recovered…’

‘In the future I’m going to try to…’

See the difference? We’re not pretending to be the expert, but we are communicating something important and evidence-based. It’s all in how you frame the information and yourself.

Donkeys and Gold

I remember talking to my friend's dad when I was a teenager, and we were talking about taking advice about something. I barely remember the context of the conversation. But, my friend's dad said something pretty profound. Before I tell you what he said, I’ll tell you the point of what he said. He was trying to get us to understand that sometimes people we don’t like, or don’t trust, or don’t even respect will have valid points. He was trying to get us to understand that you should really listen to people no matter who they are and keep an open mind because the truth is we are never always right. We should stay humble, and be willing to learn from anyone. Everyone has something to offer, we just have to figure out what it is.

He said:

“If a donkey walked up to you one day with packs on its back, and they were filled with gold, would you accept the gold?”

Please don’t misunderstand me and think I’m comparing people with few years in medicine with donkeys. I’m sure you get the point. We might not think the person we’re receiving the information from is the be-all, end-all clinician the world has ever seen. However, did they present good information in a way that you learned from? Are you smarter after having received the information? Yes? Accept the gold.


Don’t let your short amount of time doing something stop you from sharing what you know could help other people. Start studying. Start creating. Start producing. Put yourself out there. As long as you study and work hard, you’ll figure out what it is you have to offer, and there is an audience out there that will connect with how you present it.

Most importantly, don’t let those who have been repeating their first day to infinity tell you that you haven’t been doing this long enough to teach someone else.


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