Practicing Fearless paramedicine

[Just Plain Ruff]

I was flying to Tampa today and saw a headline in Golf Digest that said "Learn to play Fearless Golf" and I said to myself, How does that translate to EMS?

So the question I have for the group today, How does one practice "Fearless Paramedicine or EMS"?

is there such a thing?

Can there be Fearless paramedicine?

I am planning on getting the definition of Fearless Golf and see if I cannot make it relate to EMS. More to follow.

Ruff

Edited February 21, 2011 by Ruffems

[paramedicmike]

I don't know. I'm speaking with a general "you" here... not referencing anyone in particular.

If you're fearless are you then reckless? If you're fearless do you have no respect for the potential damage you can cause with some of the interventions available? Are being fearless and practicing with confidence while retaining some fear (aka respect for the potentials) mutually exclusive?

From my own standpoint, I don't think I want to be fearless. Confident, yes. But fearless? When I RSI a patient, for example, I still get a pucker factor knowing that I'm actively removing someone's respiratory drive and that I had damn well better secure this airway or things can get really interesting really fast. Am I confident that I can do it? Yes. Do I still retain some fear of the potential for negative outcomes? You bet your ass.

This has the potential to be a great conversation. Good question, Michael.

[chbare]

How exactly does one define "fearless" paramedicine? Assuming a very broad and ambiguous interpretation, I would have to say such a concept should not exist. Fear is a natural concept, it is something we experience that ultimately ensures our safety and helps us make better judgment calls. A certain amount of fear should always be present during the patient care experience. We should experience fear and respect regarding our patients because ultimately things do not go well. Also, we need mechanisms in place that make us ponder our proposed actions prior to going down a certain treatment pathway. RSI anybody?

Take care,

chbare.

[crotchitymedic1986]

I imagine the reference is into not being so scared that you beat yourself in the game. In any sports, confidence makes a big difference. I can see the same in a Paramedic, after years of experience, IV attempts on kid, tough intubations, critical calls, don't scare you like they do the rookie. I do not think there is anything wrong with saying I am confident enough in my skills that I doubt there is a call that I am scared of.

[Just Plain Ruff]

I don't have a copy of golf Digest so I can't see what they were trying to talk about.

My opinion is that it's not to be fearless to do anything. I think it's more like having the fortitude to do what needs to be done yet taking into account the ramifications of what we are doing.

RSI terrifies me if you ask me. I consider myself a pretty good intubator but once you remove the ability of the patient to protect their airway, to breathe and to move then that gets my butt in a significant pucker factor.

I don't expect that "fearless" means to do things without fear. I look at it as knowing the consequences of my actions and being able to use that knowledge to be a better medic.

more to follow after I think on this more.

[paramedicmike]

I think it's more like having the fortitude to do what needs to be done yet taking into account the ramifications of what we are doing.

So you're thinking being competent and having confidence?

[kevkei]

I agree with what's been said so far. The day I become fearless is the day I need to find a new career. I think the challenge and the skill is learning how to control that fear, how to manage it, and how to apply it in a positive sense.

I try to be pragmatic wherever possible. In theory, I know I can RSI this inhalation injury but the pucker factor is huge because I am aware of the risks, complications and outcomes. The stark reality is it needs to be done to do my part to minimize morbidity and mortality. If I am fearless, I take too many risks (short cuts, no back-up plan, etc) and have a higher liklihood of being unsuccessful. If I am fearful, I fail to act and respond accordingly.

I think by not being fearful nor fearless, I can be aware of both extremes and it helps to keep me honest and patient focused. Everything I do is risk vs benefit based. In my example, failure to do anything obviously results in a poor outcome. If I am fearless, maybe I am lucky and I am successful with a positive outcome. The reality is, you're playing with fire and you will eventually be burned. It's not a matter of IF, rather, WHEN.

The other factor is if you are fearless, you are the 'I' of the 'team' (there is no 'I' in team) and you are probably a burden to the rest of your crew.

[FireMedic65]

I always considered being fearless with being ignorant. Once you stop fearing something you become ignorant to the dangers. You should always have a bit a fear in what you are doing. You might be thinking why.. because you get tunnel vision, you think you know it all.

You can be confident and educated and experienced and still have that fear in you. In my honest opinion, when you stop having that fear in you.. you are going to hurt someone or yourself.

[chbare]

The more experienced I become, the more thoughtful I am about aggressive interventions that are associated with high risks. I am in fact more fearful in some ways than I was as a neophyte provider.

Take care,

chbare.

[Chief1C]

I've always followed the self SOP, that doing something in fire, rescue, searches or EMS, with out human instinct and a little fear.. Is being complacent, and asking for trouble. "I ain't afraid of... ouch... medic.."