Mega Code Paramedic Training: Insights from Medical Directors and FTOs

In this episode of The Erik and Matt Show (EMS), Dr. Erik Axene and Matt Ball explore the crucial components of mega code paramedic training. From the perspective of a medical director and a seasoned FTO, they discuss the challenges and strategies for passing a mega code evaluation. Whether you're a new paramedic in training or an experienced first responder, this episode provides valuable insights into mastering EMS skills under pressure.

Transcript

Erik: [00:00:00] And then imagine, okay, now Matt Ball, would I feel comfortable with him treating my daughter? But when we went to do the mega code, they were just all thumbs.

Narrator: You're listening to EMS with your hosts, Erik Axene and Matt Ball. 

Matt: Well, this is, I always say, I feel like I always say that when we start a podcast, this, but this is a truly exciting day for ACE. 

Erik: [00:00:30] It is the studio 3.0. 

Matt: 3.0, not 2.0? 3.0.

Erik: Oh, that's 

Matt: right, 

Erik: because we started in the office. Well, initially, yeah. Yeah.

It was small, and then we, we built our office. Yep. And, or, built the studio. Built the studio, yeah. And now, our brand, we just got our CO here not too long ago, and we finished building the studio. 

Matt: In this amazing sound studio. And 

Erik: everything is foamed in. I mean, we even foamed the pipes. Yeah, some of them.

Matt: It's pretty cool. Very exciting. 

Erik: So we do that. So the sound is better, right? Yeah, sound. I think the sound. 

Matt: Does it make us look better? [00:01:00] 

Erik: Uh. 

Matt: I hope. 

Erik: For all of our cities. I don't think so. Well, actually, I thought that with the higher ceilings now, the light's coming at us from new angles. So I think maybe we do look a little better.

Matt: Good. Younger. 

Erik: Yeah. 

Matt: Yeah. 

Erik: That would be the goal. 

Matt: That's always the goal. 

Erik: So what are we going to talk about today? 

Matt: So today I was thinking we would talk about, uh, you know, as you know, I've been an FTO, uh, in my fire department for a long time. You're a medical director. So we [00:01:30] both have been very involved in the training of new paramedics specifically in our respective departments.

Um, and what it takes, um, To pass a megacode with a medical director. You come in. I'm usually sitting in there the way that we do it. Our process has actually changed in my department where the medical director actually isn't always doing it. Most of the time it's one of the FTOs that comes out to the station and does it.

And so every department does it a little bit different, but that is a big [00:02:00] kind of a rite of passage for a paramedic and EMT is going through their megacodes. I did not have to do that when I got hired on. Yeah. It was, you know, that was a long time ago and we didn't have to do megacodes. It was basically you got put with another firefighter, you rode 10 shifts on the ambulance and they said, bing, bang, bong, okay, you're good.

You know, we didn't have to do that. Now it's, they have to pass this megacode as you do with your guys. 

Erik: Uh huh. 

Matt: So I thought it'd be good to kind of give some advice to those new, [00:02:30] uh, paramedics. That's a good idea. that are approaching that or will be doing that if they're in paramedic school, kind of what to expect, what kind of a mindset to have from both the paramedic FTO perspective.

And then from the medical director, like what are you looking for in these mega codes? What are you watching out for? So if you like our podcast, you like our stuff, our new studio, Be sure to hit the like button, subscribe to our channel, follow our podcast, and we've been putting them out pretty consistently every Monday, so, [00:03:00] um, and if you have topics that you'd like us to talk about, let us know.

We'll certainly put that on the docket. Um, 

Erik: so, go ahead. Well, I was going to say, when you mentioned that this would be a topic, um, And we got a great list of things that we're going to be doing, but, but this, this particular subject is something I I've spent a lot of time preparing our process, which I don't think is too much different than most medical directors.

Um, it might be a little more involved than most places, but I think it's pretty similar. [00:03:30] Um, but what 

Matt: is your process? What is the process in your department? 

Erik: Yeah. So, uh, the, well, we have some things that don't involve me at all. I mean, They involve me direct indirectly, but as the protocol exam and then, uh, write outs, there's a certain amount of period, a period of time to a probationary period where they're not quite eligible yet for the mega code, we call it.

So that a mega code is after passing the protocol exam, after a certain number of write [00:04:00] outs and then a certain amount of time and a certain amount of supervised write outs. So I have some, some, um, nurses, nurse educators that work with me and I'll send them out on, on ride outs with, with the, um, the individual that's in the FTO process.

Matt: Interesting. So you have your educators come out and are they. Because your department has FTOs, do they not? 

Erik: They do. Yeah. That's correct. And so, my nurse educators, who we work with, it's with a system of, I work with a consortium of medical [00:04:30] directors. And we have a central location that has nurse educators.

Right. And as part of their contract with us is they'll, they'll send them out and we can utilize them in different ways. We've chosen to use them for part of the FTO process in doing a ride out. It's, it's, and I do ride outs too. And sometimes I, I'm on a ride out and that FTO is on shift. And then I will contact those nurse educators and say, Hey, you know what, Matt Ball, I got him.

We had some great cases together, some great trauma. He did a great job. [00:05:00] fantastic job. I think he's ready to move to the next step. So 

Matt: I've always found it interesting. We actually just had a meeting with a group of RNs nurses that are educated for paramedics. And I've always found that strange as a paramedic and a nurse.

I find that very, a very strange thing where you have nurses teaching paramedics, because I'll be honest with you, they are completely two different skill sets. As a guy that's been a paramedic and I've gone through nursing school, I've only done [00:05:30] nursing in a surgical environment, you know, if you're an ER nurse, I would say that, as you know, that's very applicable to a paramedic, but the scope of practice, the mindset of a nurse over a paramedic is totally different.

Totally different. 

Erik: Yeah, that's interesting. And 

Matt: so anyway, just kind of an interesting side note that you guys have them. 

Erik: Yeah, that's a good point because it's a different skill set and I know the nurse educators that I work with are ER nurses. Yeah. That also were flight nurses. Okay, then that's very 

Matt: applicable.

Yeah. They know what it takes to do pre [00:06:00] hospital medicine. Yeah. 

Erik: But just um, but that's, that's something that to me is, they've got a lot of experience doing it. Okay. But you're right though, I mean, a nurse perspective, or a paramedic perspective. They have in the hospital 

Matt: nurses coming teaching paramedics, and I'm like, they don't have any clue what we're, that would be like me as a, Just a paramedic going in to teach a med surg nurse.

Like, I don't have any idea what they do. 

Erik: And you, actually, we may have listeners right now in Arizona, for example. We have a lot of, uh, uh, [00:06:30] partners and customers out there in Arizona. Yeah. And all of the fire departments and EMS agencies have a base hospital. Yeah. And the base hospital is responsible for providing live education.

And those are usually nurses or ER nurses that will come out. 

Matt: Yeah, like I say, and again, this is not at all a knock on nurses. It's, it's. I can see where you 

Erik: are a nurse. I mean, well, yeah, that's why I got my 

Matt: nursing degree. I wouldn't go into ER. So yeah, I say when they're like, okay, ambulance drivers, whatever, Dr.

Helper. So the 

Erik: same thing with doctors [00:07:00] too, though. Like I have friends of mine that just assume I'm a surgeon. Oh, okay, yeah. Well, I mean, as an ER doctor, for the record, I do, I'm trained to do the most, I believe, invasive procedure that anybody can do, the thoracotomy. Yeah. But it's not in an OR. Right. It's right there in the ER trauma bay.

Right? Um, but I don't, I don't do appendectomies. I don't do cholecystectomy. I don't do hernias. I don't do I'd say that 

Matt: that You know, yeah, the full custom is a little bit more about it 

Erik: is, but I, but a lot of people think [00:07:30] doctors or surgeons or surgeons, you know, it's like we don't learn everything. 

Matt: Oh yeah.

Erik: Now, if there was a profession that did learn everything, it would be the ER. Exactly. We're like, you have 

Matt: to be able to deal with everything. Yes, absolutely. 

Erik: But we're not surgeons. Yeah. And uh, that's interesting, but no. 

Matt: Yeah. Get us back on track with the FTO. So you've got educated nurse educators. You have FTOs.

Erik: Yep. 

Matt: They have to write out. It's very similar to what we do. 

Erik: They've got to go through a process of different stages of, we have it all, actually, I don't know [00:08:00] if your department, whoever, when you're listening to this, if you have something, but we put together a manual almost, you know, and so we have different stages.

I think we call them phases that we go through and then the final phase would be the mega code. That's the same thing. And so with the mega code, what I do, um, is the first thing. Um, and as an educator, I understand how there's, I have to be an educator to understand this, but there's a lot of anxiety.

Matt: Absolutely. 

Erik: Uh, we've, I, along with my FTOs, we put [00:08:30] together a process that is pretty rigorous. 

Matt: Mm-Hmm. . 

Erik: And you gotta have your ducks in the line and know what you're doing Is this, or you won pass you. That's for the megacode, right? And I would say that, I don't know that we've done this so many times, but I would say there's a certain percentage, significant percent of, you know, less than a quarter, I would say, but a significant percent of, of, uh, FTOs, FTOs of, of guys in the FTO process won't, they won't pass.

Yeah. And they have to do it again. Yeah. And, uh, I [00:09:00] remember one case in particular, um, where the, uh, the individual in the FTO process. Um, I could see that, and I knew they knew their protocols. They went through all the process, and they had experience working in a, with a private ambulance company. So I knew they'd had a lot of patient contact.

But when we went to do the megacode, they were just all thumbs. And it didn't, it didn't go well. And so I said, you know, with certain procedures, [00:09:30] I'm going to take you to the cadaver lab and we'll give you a conditional pass, basically, until you can demonstrate, uh, mastery of these skills that you kind of flubbed up in the megacode.

Matt: So you actually had them do skills. 

Erik: Yes. And so I brought him with me to the cadaver lab and he did these skills on a cadaver with me. And he had opportunity to practice. We worked with his FTO and he, you know, he, I knew he knew how to do it 

Matt: because 

Erik: [00:10:00] there's always a context with my students or I call them students, but the individuals in the process, some are fresh out of school and they're 19.

I mean, really young. And some of them have come from another, worked for a decade in a private ambulance company, and they became a firefighter, and now they're working to become that paramedic. And, and they're, yes, super experienced. And so when they don't do well, I kind of look at myself as like, well, how have I failed a student?

Or what could I have done [00:10:30] to, To have made this an environment where they can display what they know, because I know they know it, and when they don't pass, sometimes I got to look at myself. 

Matt: Yeah, but on the other side of the coin is the FTO. I don't think that's your failure, because it's not your job to prepare them for the megacode, in my opinion, 

Erik: in my department.

I agree. I hear what you're saying. I guess as an educator for me, the way I was trained, is when my students failed, like when I was teaching chemistry, right? And a student failed my chemistry exam. I have to think to [00:11:00] myself first, well, what have I done that may have not met that need for that student? But you're not teaching the 

Matt: guy every day.

That's my point. True, 

Erik: true. You're 

Matt: just coming in to do the megacode. The FTO is the chemistry teacher. He's the guy that's there every day, running them through megacodes, making sure, like, when I would have new people, I mean, I would explain the whole process to them on day one. We would sit down and have a long conversation about, here's the expectation, this is what you can Yeah.

Expect to happen, so on and so forth. And I [00:11:30] would start off with very easy megacodes and explain to them the beauty of a megacode for those new paramedics that are out there. And like with my department, we started doing skills, but most of the time, like you're not actually having to innovate a real patient.

You know, you're innovating a dummy, it's going to be super easy if skills are a part of it. True. You're doing, you're going to get all your skills. Like ours used to be totally verbal. And so I'd be like, You have a huge stress relief because you just have to say, Yep, we're going to crack this [00:12:00] guy. You don't actually have to do it.

You just have to say, Yep, it's indicated we need to crack him. Okay, you've just cracked him. They're going to give it to you. 

Erik: Yeah. So 

Matt: that's if you do a mega code where it's just verbal, that's a super easy part. Yeah. If you're a new person, I get that it's still stressful, but you're not having to, okay, I've made this decision that I have to do this extremely difficult skill.

Now I've got to actually do it on a live patient. You talk about stress. 

Erik: And that's 

Matt: why we put for, for those people that don't understand, well, why do we have the [00:12:30] doctor come in? That's part of it, to have me as the FTO sitting there, maybe an EMS captain in there, the medical director in there, maybe the EMS chief in there.

That's part of it is to see, can this new guy perform under pressure? Because again, when you've got somebody's life in your hands and you're having to make critical decisions and do the skills, you have to be able to perform under pressure. That's the entire point of the mega code, right? Like you said, most guys know their mega code.

They know their protocols. They can regurgitate them to you verbatim, but when you put [00:13:00] them in a stressful scenario, can they perform? And that's what it's all about. 

Erik: And the, and uh, well, we'll get into the specifics of what I've built, but. The, the, the, the, the way you set it up though, I think going back to myself, reevaluating when I have somebody that doesn't pass it Mm-Hmm.

I gotta check myself just to make sure that what I've built was fair, right. And equitable. 

Matt: Yeah. Or my questions. Yeah. 

Erik: Right. Because it, when I have somebody fail that I know is ex, you know. You know, really, this is 

Matt: a knowledgeable guy. Like, why did this [00:13:30] guy fail? Yeah. 

Erik: And I also recognize too, and we talk about this before we start our mega codes is that, uh, you know, I remember one guy from a big department locally who came over to our department and I knew this guy was a former FTO in his department.

Yeah. This guy was going to pass. No problem. And he actually didn't pass one of my cases. So when he didn't pass one of my cases, I, I, I went back and looked really hard at that case to see if there's something confusing about it and we talked about it and he just was off a little bit, but he knows his [00:14:00] stuff and, and it's, and no matter how hard I work to set up a situation, I know it's still artificial.

Matt: Yeah, 

Erik: it's not a real patient, right? 

Matt: And honestly, they probably perform better on a real patient. And you also have the crew. There are supporting. Yeah, exactly. Because he's kind of on 

Erik: an island. Exactly. In a megacode, 

Matt: it's all you. 

Erik: And I want it that way. Yes, 

Matt: and that's the way it's designed. You know, like I say, the stress is designed to do it.

Erik: So, I'm going to take you through a megacode. 

Matt: Okay. 

Erik: We're not really going to do it, but the first case. So, when I set it up, it's not just you and me. [00:14:30] Um, I have a score card, so it's objective. We take score. 

Matt: Oh, you did. Okay. That's 

Erik: right. And so, and I think you actually were one of my evaluators, right? Yeah.

So we have three evaluators myself. It's usually the FTO and maybe an EMS chief or maybe the shift captain, or maybe the battalion chief, whoever's available. Um, sometimes some of my nurse educators are available too. Um, and they come in and there's three of us in a panel and there's usually a fourth person observing us.

Yeah. Because of, we just want to be held accountable, right, [00:15:00] and make sure that if the, in the event that somebody didn't pass. It's not just me saying, I don't think you passed, because there's always subjectivity to it. We have a panel, and sometimes we're split. And then it's nice to be able to go to that other person observing, and then imagine, okay, now, Matt Ball, would I feel comfortable with him treating my daughter?

And that's 

Matt: ultimately what you just said. A lot of people, you know, it's so hard to put into words what is the standard we're looking for, because it is very [00:15:30] subjective. Yeah. But that's the exact same thing that we say is it's it's a level it's is the FTO Are the people that have experience Seeing firefighters and paramedics grow up It's it's kind of an unspoken thing that you can see like, yeah, this guy's got it.

This girl's got it Like they got it. I'm not gonna know you just know and and that but that is like what I feel comfortable with Erik, xe responding to a member of my family and treating them. That's my mindset as an FTO and All of our FTOs. [00:16:00] And 

Erik: at the beginning, I share that too. It's like, this is my barometer.

Say the same thing. And when they walk out at the end of the mega code, that's what we as evaluators discuss. And you experienced it. It's like, would we feel comfortable with, you know, paramedic Smith? Right. Evaluating your wife or, or transporting your wife. Yeah. Yeah. So, so, um, those things are kind of set ahead of time and, and I do, when you're sitting there in front of all the evaluators and you saw this, is I, I just take a moment to set the stage and say, Hey, listen, I know [00:16:30] this is artificial.

It's going to feel, uh, a little awkward sometimes because you're talking to me as the wife or the police officer. That's the way I have it set up anyway. Do you go 

Matt: into a girl voice when it's 

Erik: Sometimes, sometimes. 

Matt: Well, 

Erik: sometimes you gotta 

Matt: talk a little. Well, and two, that kind of helps break the tension a little bit.

Like it kind of, okay, this is kind of funny, you know. 

Erik: And I think, I think they appreciate the fact that sometimes we don't take ourselves too seriously. Exactly. You know, and it lightens the [00:17:00] mood a little bit. For sure. Yeah. But it is also, the reality is, you know, sometimes their EMS division chief is sitting there with their medical director and their FTO and a battalion chief.

I mean, it can be stressful when you're a 19 year old fresh out of school. 

Matt: It's a little daunting, right? And it should be. I mean, and because again, when you think about it, at the end of the day, like your medical license, they're working under your medical license and you want to trust that when they go out in the field, they're not going to do something stupid.

That's going to jeopardize all of us. Right. Yep. [00:17:30] And And on top of that, you have, you literally have people's lives in your hand. If you make a bad decision, you pick the wrong medication, you do the wrong, the right procedure in the wrong way. There's a hundred things that could go wrong. It is a big responsibility.

I don't think people outside of this job realize the level of things that paramedics do. 

Erik: And that's why I built this mega code because I used to do it and you experienced this too. More conversational and go through, okay. You've gone through all the steps of the [00:18:00] process and you've passed the protocol exam.

So I was protocol light in my megacode. I've gone back now to more of a, I address protocol issues. And we go back and I'll talk about that in a second. But, um, I think it's so important to take it seriously. Because I want the megacode process to be something that you take seriously. means something. 

Matt: A hundred percent.

It shouldn't be easy to pass. 

Erik: Right. 

Matt: Yeah. It should be a rite of passage for every, every paramedic. But it has to be 

Erik: fair and equitable though. It's gotta be. A hundred [00:18:30] percent. Yeah. It has to be fair. If I can make something really hard, nobody can pass. So there used to be, 

Matt: we, we had a doctor formerly that would do our mega codes with us, and he had a case.

Erik: Is he the one that's coming to the studio later today? No. Uh uh. 

Matt: No. Um, uh, But he, this guy had a case that I didn't like. I didn't think it was a fair case for, for new paramedics because it was more, it more, uh, addressed a legal issue, not a treatment issue. And like the first time I heard that case, I'm like, no.[00:19:00] 

That's like, you could take a 10 year paramedic and they'd be like, I don't know what to do here. And I had a conversation with him about it. Like, I think this case is a little bit, and he was totally cool with it. And he's like, okay, that's a great perspective. And he took the case out. But now do you do, um, like in my department, typically there's.

Like four different scenarios, they have a medical, they have a trauma, usually they'll have some sort of a cardiac with a 12 lead interpretation, then you always have a pediatric scenario, and one of those obviously is going to be your four, full megacode. 

Erik: Good [00:19:30] question. So, um, I'm going to back up just a step.

So the first thing I will do just to get the, to get you feeling comfortable, is I have an interview that we do and we, we ask questions on, so what do you think are the most important traits in a, In a, in a highly effective paramedic. Yeah. And it gives them a chance to answer something subjective where there's no wrong answer.

Yeah. And then it gets them feeling comfortable. Yep. And you know, it's like, hey, you know, we're, again, get the, everybody wants you to be successful. Matt, all of us sitting here in this panel wants you to be successful. We want to get you to a [00:20:00] point where you can now demonstrate what you know. And I think, and I find that doing the interview, it's less for me, Yeah.

It's more for you. Yeah. To get you feeling comfortable. Yeah. And then, and then I, I will say, okay. Um, we're going to pick a protocol now, and so I have, uh, I'll, I'll, I make it kind of goofy where I say, okay, what's your birthday? You were, you were, you were born, uh, what's your birthday? Hold on. Hold on. I know.

Cause you just, is it, was it June? No, July. July [00:20:30] 4th? 8th. Okay. Sorry, man. 

Matt: I know yours is coming up. It's in October something. 

Erik: Yeah. Anyway. So eight. Thanks. Right, so I'll go to the 8th item on the table of contents in our protocols, in medical, or something like that. And I say, and so I'll click on, maybe it's OB GYN emergencies.

And they're all going, 

Matt: dang it, why didn't I have a different birthday? And 

Erik: then I'll say, what's your phone number? 

Matt: Yeah. And then you'll list 

Erik: off your phone number, and the last number was a 6. So then I'll go to the 6th item, and it's, you know, eclampsia or something like that. And [00:21:00] then I'll say, okay Matt, so tell me, take me through the protocols on an eclamtic patient.

And then we'll have a conversation, and we'll keep going until you don't know something. So you know you're going to get to they go all 

Matt: the way through the Acclaim system. Yeah, 

Erik: and, and if, and if they don't know something on the protocol, then they would fail that, and then we would do a new one, and get another, give them a second chance in finding another protocol.

Matt: So they have to, they have to have to 

Erik: know it all, and I know they usually do because they usually score very high on our [00:21:30] protocol exam, but, but what I do though is I dig deeper. Yeah. So. What is it specifically about, you know, we go through all the eclampsia Why does mag work? What is it like on the cellular level?

What is it about mag? 

Matt: Why would you give mag as opposed to a benzo and an eclampsia? Yeah. 

Erik: Right. And then they have no idea. And then we're done. It's a teachable moment. It's a teachable moment. We find, we get to a level. I want to know how much they know. And so we get to a moment where they don't know something.

Now you 

Matt: don't fail them if they don't know. No, 

Erik: no, no. I just [00:22:00] go, I just keep digging deeper and deeper and deeper until they don't know something. And so they know that ahead of time. So I say, you're not failing. Right. Uh, uh, But, you know, like the basic protocols for eclampsia, for example, is, you know, you got a pregnant patient, and you got the vitals you need to add, and, and then, you know, giving mag in, you know, a situation where you're concerned about eclampsia, or maybe an eclamptic seizure.

So those are the basics, right? Our protocols are pretty bread and butter with each one, but then we have below them [00:22:30] pearls. Some of the pearls of management that, that, and I'll draw from those and see how deep I can dig. 

Matt: One piece of wisdom that I would give to any EMT paramedic that's taking their megacode, is you should be allowed to take in a piece of paper and a pen, typically.

Oh yeah, 

Erik: absolutely, you should. 

Matt: And I tell every single one of the people that I've trained, I tell them this, and I bet less than 10 percent of them listen to it, and they screw up because they didn't follow this simple advice. [00:23:00] When you get in there, write down, first off, ask for every single vital sign possible.

Why would you want to limit your intake of information because you're being judged on your decision? I want every single bit of information I can get. Because again, this is a fictitious world, so I want to know everything I can possibly know, right, before I'm making a decision that I am being graded on.

So I would tell them, when you [00:23:30] get in there, write on your piece of paper all the vital signs you want and write down everything. I want to know heart rate, blood pressure, SpO2, N Title, blood sugar, temp, GCS, A and O status. I mean, I want to know everything. And I write it down because I tell them, you're going to go in there, you're going to be super nervous, and you're going to forget to get a blood sugar.

And you're going to have to Just get them all 

Erik: right away. 

Matt: Get them all right away. Great advice. And then you go in, and that unresponsive patient And you forget to get a blood sugar and now you're RSI'ing this patient because you're thinking it's an altered mental status [00:24:00] and the doctor looks at you like you're an idiot and goes, well their blood sugar is 20.

Erik: Yeah. 

Matt: I didn't get a blood sugar. If you write it on your paper. Or maybe the sepsis 

Erik: patient. Or the sepsis patient. Get a 

Matt: temperature. Yeah, exactly. So write all those vitals down. That's great advice. And just write that on the piece of paper, ask for everything before you make that decision. 

Erik: You know, I tell it, you know, when I do have somebody who maybe needs some extra help, uh, I'll go and try to help them build a, uh, like a framework where they collect the data and write it down.

There's no magic way to do [00:24:30] it, but have a system that you use. It's your 

Matt: assessment, doing a proper assessment. Use your sample, use your OPQRST. Whatever 

Erik: you're comfortable with. 

Matt: And that's what the FTOs should be teaching them before they get with you. They 

Erik: do. 

Matt: Yes. Ours do as well. We sit down at our smoking table in the bay and I would go over two or three and like I said, I would usually start off with pretty simple ones and then they would get progressively more difficult as their training went on.

And by the end, I mean, I'm giving them full on like, okay, here you go. You got to figure this out. Prep them as much as I can, because I [00:25:00] know that I can't. I can't replicate that nervousness that they're going to feel. And so I make sure that they have all the protocol knowledge, all the didactic knowledge that they need before they go into that thing.

And hopefully, and some of them, you know, it's based on effort. If you study your protocols on your day off, if you're putting in the work, you're going to do fine. I've had guys absolutely kill it in there. And then I have guys that, one of the things that we look for, it's sharks in the water. If I'm doing a megacode with somebody and I'm like, okay, you're going on this patient, go.

[00:25:30] Yeah. Uh, well, um, first off, um, uh, dude, how do we, how's the practice like, okay, this guy's all over the place. Like what? And you tell me what you look for, but I know what I look for when I'm doing this is I want them to be confident. Fake it till you make it walk in. Okay. I'm going to walk in. How does my patient present your patient?

Sitting up and share. Okay. I'm going to go up and introduce myself. Hi, my name is Matt. What's going on today? Oh, I'm having some chest pain. Okay. He's having chest pain. How does my patient look? Is he paled? Like they're just, and then as soon as that. [00:26:00] Student, FT, uh, rookie, whatever, the guy taking the test, as soon as they're acting like that, it's like, Oh, this guy knows this stuff.

Like you can just tell the confidence is exuding and they're hitting all their benchmarks on top of that. But when you come in there, uh, 

Erik: I will say this though, too, is I've had guys that come in that are very, and girls too, that are very confident. And sometimes that hubris. Yeah, right. That's pride, 

Matt: not confidence.

Right, right. No, 

Erik: it's, I do, I would prefer to have somebody who's, [00:26:30] um, you know, well, ideally it would be nice to have somebody with the confidence and the knowledge, right? Yes. I feel like I can, I can build the knowledge, no problem. I can work with them. But I'm seeing more and more and more of my, uh, students, or, Potential FTO or paramedics come in lack of confidence.

I'm wondering if it's because of all the screen generation stuff where people just aren't used to talking to real people. I don't know, but these young kids [00:27:00] that are coming in, some of them just are all thumbs with just talking to me. 

Matt: Yeah, they're freaked out, right? Yes, that's a huge issue I've seen with patients, them on patients.

Uh, yeah, I don't know what the answer to that is. Confidence is a big deal. But I think Even when I think back to when I went through school and all the years that I've been training people, that's always been an issue. That I think that somebody either has confidence or they lack confidence. And I think that that's partially the FTO's job is to instill that confidence in them.

That's the medical [00:27:30] director's job. Practice. And it's their job. You know, you as the new person, you've got to be putting in that work. Your FTO, your medical director, your crew can only help you so much. And I basically have told my, my guys this. That I will climb the mountain with you, but I'm not going to put you on my shoulders and drag you up.

Erik: I've used that before. I remember you saying that. Like, 

Matt: I will be right here next to you, struggling with you, going all the way through it. But I am not going to carry you up this hill. You're going to have to put in your work. You're going to have to do your part. And if we both do that, you will [00:28:00] succeed.

Yep. But most of the time, because the FTOs have done it, they're so practiced in doing it, they can run up the mountain. It's the new hire that doesn't quit. 

Erik: Well, and I think, um, you know, the last part, again, as we finish up here, is, are the actual cases. So I have the FTO, or each member of the panel picks a case, and we make sure that there's a variety of cases, and each case has a set of critical actions.

So you, you, as we continue to, as we listen to [00:28:30] them, Take care of the case. We're adding points. It's all in the scorecard, and they have to get a 70 percent at least and hit all the critical actions. So if you miss a critical action, or if you miss Or if you get all the critical actions, but you're below 70, you don't pass.

Or if you get over like a hundred percent, but you missed a critical action, you didn't pass. And you don't have to pass all three. You got to pass two of the three. And even if you pass everything in flying colors, if there's something about that paramedic, Potential paramedic, you know, that we [00:29:00] feel uncomfortable treating a family member as a panel.

We will agree that there's some sort of a remediation like we, I mentioned that guy that had to go to the cadaver lab. That was just something we needed to see before we would pass them. So that's the process. I will share one thing though. And, uh, is that. But I'm excited to add a new variable to our, our, our mega code is I'm going to start doing time limits.

Matt: Oh, yeah. To 

Erik: add the pressure of time, uh, to make it even a little more realistic. Just add a little pressure. [00:29:30] So, 

Matt: so hardcore. 

Erik: Well, I want to make it as As helpful as I can. 

Matt: Yeah. No, that's good. That's good stuff. See you on the next one.

Narrator: Thanks for listening to EMS, the Erik and Matt Show.