My Board

A time I was playing in the top left box was the first time I had to use ketamine to sedate a combative patient with a serious head injury that resulted from falling off a hover board while intoxicated. He had a blown pupil, was posturing, abnormal breathing, and combative. We were trying to maintain his airway and also get him sedated. The use of Ketamine was newly added to the GMVEMSC protocol and the crew I was working with at the time, along with myself was unsure of the dose needed in relation to the different methods of administration. The patient was a large male that was very difficult to physically restrain. Careflight was en route to the scene, one of the firefighters was constantly updating me on the status of Careflight, and PD was climbing into the medic to help restrain our patient. While all of this was going on some of the crew members were shouting out what they though was the correct dose/route which only added to the confusion because all the doses were different. Needless to say, it was a chaotic scene in the back of the medic.

I finally found a moment to get the protocol book open and double check the dose needed. One crew member was able to obtain IV access, so we drew up the IV dose. Just prior to administering it the patient was able to pull his arm away and the IV came out. Ultimately this patient ended up getting two IM doses of Ketamine before Careflight arrived on scene and used their medications to sedate him since the patient was still being combative.

Something we could have done differently was to review the new protocol a little more thoroughly when it first came out. It is not a good time to try and look up drug doses in the protocol book when trying to restrain someone. There was a lot going on at the same time on this call which only added to the confusion and hectic atmosphere. As the PMIC, I should have taken more control of the scene.

What have I learned...When you find yourself unsure and falling behind, stop and take a time out. Reassess the situation and see what you have in front of you. Make sure everyone has clear defined roles and make sure everyone knows the protocol. Although we always learn as we go, the best time to learn is before the call, not during it.   

Sounds like you did the right thing. You stopped and took the time to find the answer. Doing that saved you time when you had to go to the IM rout. You already had all the information.

The problem:  under performer.
When I was a first line supervisor at another department the job performance of a 3rd year firefighter was brought into question.  His performance was described as slow and unenergetic.  He required to be told when, where and how to preform day to day tasks.  Now his fire and EMS skills were on par with his peers and as a person he was a good guy.  The Chiefs were considering terminating his employment but first wanted to give him a chance to improve.  At the time I was not his supervisor, so I volunteered to take him as my firefighter.  I called him in to my office and had a very frank discussion on how the Chiefs felt and what could happen if things didn’t change.  At the end of our meeting he told me he had no idea that he was doing anything wrong, or was in need of any improvement.  He was honest in his regret and wanted to work towards positive change. 
The solution: 
He and I worked on forming a 90 day improvement plan.  He was given small goals each shift to meet and larger goals to meet by the end of each 30 days.   Before the end of the 90 days he had made great improvements and was taken off the plan early. 

What I learned:
While I was working with him it became very clear that no one had ever informed him of the department’s expectations.  He came to work and took calls, and that was it.  He felt if something needed done, someone would tell him.  He wasn’t undermanaged, he was over managed.  He had his hand held and was never encouraged to take the initiative.   

I use these strategies to manage my time, both personally and professionally:  I prioritize tasks based on the necessity and how critical they are to operations or people.  I make sure the most important things come before everything else.   I use my calendar to schedule things at work and at home.  I have a separate work and personal calendar.  I make lists.  I have a daily list and a separate list for long term items.  My daily list may include long term items, but I make one list every day.  If something is not complete, I carry that over to the next day, or I reschedule that task.  I look ahead to forecast and plan.  I get help or delegate items that people can assist me with.  I make sure I have time to take on any task that I accept.  I get assignments like everyone else, but I have to watch how much extra stuff I take on. 

Some obstacles I face in time management, and how I remove them:  I let myself get distracted.  I have to focus and decide how much time to spend on a task.  I will also get up and take a break to get refocused.  My mind will wander, and I won’t get work done.  I can get frustrated when multi-tasking.  I will schedule time in the day to do individual things.  I will set self-imposed deadlines.  I will force myself to eliminate time wasting activities, because I use these to avoid doing what I need to do.  Sometimes, I have to close the door and dedicate time to finishing a specific activity and eliminate all distractions.  I also find that sometimes the best solution is to just go ahead and do something right now, to ensure it is completed. 

As simple as many of these things sound, it can be difficult to manage time to accomplish tasks.  Always being prepared for an emergency call, along with the amount of distractions, whether from people, email, electronic devices, phones, or whatever else, it is important to find a way to manage time effectively.

It's funny that technology is your best and worst friend in keeping you focused i.e. calendar vs. e-mail