On Being Prepared, Having No Regrets and Delivering Asymmetric Impact.

by Roland Paquette

I began my medical career as a first responder within the US Army. I was a US Army Special Forces Medical Sergeant or Green Beret Medic (18D). We received the civilian NREMT Emergency Medical Technician and Paramedic Training curriculums augmented with 3rd world-centric medicine and military trauma management training. The training provided to me was thorough and detailed. We were held to a high-performance standard, and patient care mistakes or oversights were unacceptable as our next patients would be in a combat zone.

Throughout my training, I was motivated by a desire never to be unprepared or to regret not studying or practicing hard enough as someone died in front of me. I felt as though I had applied myself and absorbed as much as I could. As I stepped off the plane, as mentally prepared as I could have been, I felt the hot climate and suddenly realized I didn’t feel ready at all. Questions raced through my mind.

US Army medics train on a simulated patient

Had I studied and practiced enough? Could I remember my treatment algorithms and sage advice my instructors had given me from their real-world experiences? Would I be able to be the medic my patients needed and deserved? The questions raced through my mind; I remember steeling my nerves as best I could and silently running through my trauma algorithm as I stepped off the plane. I knew that regardless of my feelings of readiness, patients would be coming and I would be called to perform.

I’ve only had a short period of insight into the civilian EMS system. During paramedic training, before certification, we worked with EMS crews and rode along for the requisite number of hours and encounters. During this time, I learned that EMTs, Paramedics, and military medics spend a limited amount of time with our patients, but often have a disproportionate impact on our patients’ lives. The split-second decisions made by Paramedics and EMTs in life and death situations and the time spent in patient care during the short transport time (hopefully!) to the Emergency Department have a HUGE impact on how patients will ultimately discharge from the Emergency Department.

I think about the discrepancy between the medical simulation available to Paramedics and EMTs in preparation for real patient care and the impact we have on patient care. This discrepancy confuses me. I understand why the disparity exists, high price simulators that are difficult to use and lack flexibility, but understanding doesn’t alleviate the worry this discrepancy creates amongst first responders as we prepare to step off the ambulance, helicopter, or plane and go to work.

Why do I feel medical simulation training is so necessary and why medical simulation is at the crux of this source of worry? Medical simulation training gives us the opportunity to immerse ourselves in realistic scenarios and apply real-world interventions without the consequences of a wrong decision. It allows learners to develop and grow in their training before looking down at a real patient’s eyes pleading for help. High fidelity simulation is the closest thing to that which we all know to be the ultimate teacher, experience.

Roland Paquette is  a former US Army Special Forces Medical Sergeant (18D) and currently a  practicing emergency medicine physician assistant.  He’s the Chief Operating Officer of MedCognition Inc, a professor teaching in a master’s degree physician assistant program, and an owner/instructor of a medical first responder training company.