What to Do on Your First Day as a Paramedic

You’ve gotten the job as the new medic on the ambulance, and it’s time for your first shift to begin.

Are you nervous yet? If so, good. Being nervous is fine, it means that you are aware of how interesting your job can be! Here, we’ve collected a few gems of information and reminders that might help to ease some of that nervousness.

When you arrive for your first shift on a new rig, go through and make sure you can find everything you need. Some agencies use inventory control system such as pre-wrapped bins or containers, which are often labelled and stored in convenient places, and other agencies use loose storage.

Also, do a complete check of any equipment bags or packs you may need to take with you to a scene, such as a jump bag, trauma bag, ALS bag, or pediatric bag. Familiarize yourself with what is in each pocket, and especially any items that might turn out to be time-critical, such as your cric kit (the kit used to perform an emergency cricothyrotomy).

Know where to find the length-based pediatric emergency tape, if your agency uses it, or the pediatric wheel or whatever other quick-calculation device your agency uses to calculate pediatric doses and equipment sizes.

Go through all of your ALS equipment, and make sure it works (you will have learned how to do most of this in your class, although specific makes and models of equipment like heart monitors will be agency-specific; your agency should train you how to check and use the specific model they have).

Some agencies have specific procedures or checklists to follow, make sure you ask if these exist and where to find them if they do.

You will be required to account for all of the medications assigned to your rig, so make sure you check them. In particular, any controlled substances such as morphine, diazepam, midazolam, and other such medications, will need to be accounted for by both the oncoming and offgoing paramedic.

Some agencies have boxes or bags for these medications, which are securely stored at the operations center or primary station, and you will need to verify that the security tags or other security devices have not been tampered with and are still in place. Keep in mind that you will be held responsible for those medications, including the controlled substances, so check them thoroughly, and report any discrepancies immediately.

You may be working on an ambulance which is in service 24 hours, such as a primary 9-1-1 ambulance. Since it is possible that you will get dispatched for a call while you are still in the process of checking your rig, it is important to communicate with the off-going crew about their previous shift, and ensure that any equipment or supplies they used were replaced. As you get to know your crews, and the rig (if you are assigned to a permanent or semi-permanent shift), it will get easier to do these early-shift calls and still be confident that you have the equipment you need.

Keep in mind that some of the things used in EMS can be re-purposed, and used for a task they were not necessarily intended to perform, and that there are certain things for which there are no substitutes.

A non-rebreather falls into both of these categories; if you find that you cannot use a nasal cannula for whatever reason, you can always deliver oxygen by non-rebreather mask, but you cannot provide high-flow oxygen through a nasal cannula. That makes non-rebreather masks a “must have,” and should be among the list of things you cannot live without on your rig.

Some other items in the “no-substitutes” list include filter needles (if you have any glass ampules, you must have a filter needle to draw the medications), large blades for your laryngoscope (in a pinch, a large blade can be inserted only partway during intubation, but a small blade cannot be inserted farther than the blade reaches), adult-sized defibrillation pads or paddles, and everything in your medication container.

Some common EMS slang:

ALS: noun phrase, “Advanced Life Support.” EMS service provided by those who are paramedics.

BLS: noun phrase, “Basic Life Support.” EMS service provided by those who are EMT-Basics.

Code: n, a cardiac arrest (adopted from the hospital phrase code blue, referring to a patient who has stopped breathing or has no pulse).

Commode code: n, a cardiac arrest that happens on the toilet; so-called because one cause of cardiac arrest is for a patient to bear down so hard during an attempt at a bowel movement that their vagus nerve is stimulated to slow down their heart rate.

Lividity: n, the tendency of blood to pool when not being circulated activly; usually used in EMS to describe the visible pooling of blood in the gravity-dependent parts of the body after a patient has been dead for a while. One of the presumptive criteria of death in many places.

PTA: adv. phrase, “Prior To Arrival.” Often used to describe a condition that existed before the ambulance crew arrived on scene. In some jurisdictions, may be an accepted abbreviation in documentation.

Rig: n, the ambulance or rescue apparatus to which a paramedic is assigned. A.K.A. the box, ambo.

Always remember that our paramedic school page provides you with a list of accredited programs you can apply to.