Musing about preceptors

I’ve been running a lot of clinical shifts with one paramedic. I started running with him at the beginning of class, and I realized that he walked the talk, and actually wanted me to succeed. It hasn’t been all sweetness and light, and we’ve had some rocky times. More than once I’ve had to explain ‘what the heck I was thinking’… but each case has held a lesson for me, and I’ve learned it. I had one shift where we ran back-to-back cardiac arrests… part of my “Angel of Death” period, where I attempted to intubate someone on every shift I ran for a week and a half. We’ve found things I’m good at, and some things I need to seriously improve at.

We’ve also had some rock-star moments. I’m still flying a little high from a call a few weeks ago, where we had a hypovolemic patient with a head injury. First thing he asks me: “Do you want a helicopter?” I hedged my answer and asked for one on standby – meaning I’d do a secondary assessment of the patient and talk with the command doc of the trauma center before I decided to fly the patient.
He tells me “You don’t have that choice – are you going to fly the patient or not!”
Not knowing what to say, I started running through the patient’s condition and verbally rattiling stuff off – he called to me from the other room “So you want to fly the patient!”
I agreed, and he says “Good. Next time, be faster.”
Aeromedical then advised us they were down due to weather, I pushed to go to the closest hospital, rather than drive an hour to a trauma center, because the more I looked at the patient, the more unstable they seemed, and I didn’t want to have them bleed out in our ambulance. I made the call to the Medical Command doc and sold them on it as he sat back and watched. As we were a minute out from the hospital, I couldn’t feel a radial pulse – MAJOR pucker factor. We got to the ED, handed over the patient, and as both my preceptor and I apologized to the doc for bringing them a train-wreck patient, the doc said I made the right call.

I think I’ve found a keeper of a preceptor – he gives me enough rope to let me learn and make mistakes, but he’s also running the show. He challenges me and makes me learn every shift I run with him, and I push myself to impress him whenever I can. I know that he doesn’t give out a lot of praise – and when he does, it is earned – and I get just enough praise to make me want to do better!

Did that just happen?

Dispatched to a local SNF (Skilled Nursing Facility) for "Respiratory Distress"

After we went responding, was advised by dispatch that the facility had called back, Pt. was an "Obvious DOA", they had a DNR, and they would not be needing our services after all.


Unresponsive Person --> DOA I can see
Change in mental status --> DOA I can see
But "Respiratory Distress" --> DOA? That means they determined the patient was having DIFFICULTY breathing and called 911... then realized they were dead.

WTF?