By: Dave Kahat, BA, EMT
ER Tech & EMT Teaching Assistant
During any sort of employment orientation, one would expect that a more experienced employee would oversee the new employee for a set period of time. Once a certain set period of time is complete, the company expects the “greenie” to be oriented, and know how to complete daily tasks. Ta Da! Orientation is complete.
While orientation in an emergency room works in a similar fashion, there are new problems that face the traditional orientation strategy. Mainly, what if 2 weeks isn’t enough time to adequately see and prepare for all ER scenarios? What if there are no "true" emergencies during one's orientation period? Then how can the "greenie" learn?
During my orientation at Fairview Southdale, I was lucky enough to see all sorts of scenarios during my first two weeks. During these two weeks, I was paired with a preceptor who would walk me through various scenarios with patients, ranging from mundane walk tests to life and death scenarios in red rooms (where unstable patients are treated). I saw a patient who fell from a ladder and was classified as a multiple trauma victim, multiple heart attacks, cardiac arrests, strokes, broken bones etc..., all in my first two weeks! These scenarios allowed me to know what to expect for each case. For example, the goal for a STEMI heart attack scenario is to get the patient to cath lab as quickly as possible. The goal for a patient suffering stroke symptoms is to get to imaging as quickly as possible to know how to proceed with medications and diagnose the patient. While being guided by a preceptor, I was able to experience a lot of scenarios, and understand what to predict of them in the future. Ta Da! My orientation was complete.
My coworker was not so lucky. She was hired on only 3 weeks after me, but during her orientation time frame, she did not see any red rooms. No heart attacks, trauma scenarios, strokes or anything. The ER works in mysterious ways. Some weeks are filled with all sorts of adventures, while at other times, the ER might as well hold crickets instead of patients. My coworker's orientation might have been a little easier to complete, but it definitely did not prepare her as well as orientation was designed, which was evident as she was called in for a cardiac arrest. So as the doctor barked, "Prep for a central line and get the thermogaurd cooling!” she panicked.
While my orientation exposed me to more scenarios than my coworkers, I have still been completely unprepared in certain cases. And when you are unprepared in a room with an unstable patient, with a doctor shouting at you to complete an unfamiliar procedure, when it very well may be a life or death scenario, well, it isn't a good feeling. It isn't a good feeling at all.
Part of being a good EMT is knowing how to properly use equipment. But knowing how to use a C collar, Lucas device, or anything else is worthless if you don't know where to find it! This was one of my most important parts of orientation: knowing where to find equipment. With that being said, for any new ER orientation, it is absolutely vital to expose yourself to as many "true" emergencies as possible. Make this known to your supervisor and your pod or team. If there is a heart attack, cardiac arrest, stroke, or any other urgent scenario, don’t be afraid to ask the charge nurse or your supervisor if you can help or observe. Watch how other EMTs anticipate and prepare for procedures. See where equipment is stored, so if you're alone you can find it quickly.
Even though her orientation was over, my coworker did this. She observed red rooms whenever she could, to try and soak up more knowledge. She paid careful attention to where everything is stored, that way she won’t be lost when searching for equipment. She is now a great tech and able to remain composed and competent. Orienting in an ER is difficult, but it is important to get your feet wet with someone who can show you the ropes. No orientation can perfectly prepare any EMT for all scenarios, which is why it is important to continuously expose yourself to scenarios that way you're always prepared! Then you’ll be closer to saying, “Ta Da! Orientation complete!”