There exists an invisible phenomenon in paramedicine, along with many other professions, that whilst it's absolutely essential, it can quickly become debilitating if we don’t keep watch over its sneaky and pervasive nature.
In trying to quantify this unspoken “thing" that we develop, with time and experience, in order to write about it in The Good, The Bad & The Ugly Paramedic, it took days and days of mind mapping, scribbling and drawing before it began to make any sense.
Finally, describing it as “The Bluff” in the form of a coat that we wear when necessary, seemed to fit, and it is reportedly now a favourite chapter for many readers. Most commonly those with several years of experience, who tend to truly appreciate the potential benefit and, more importantly, the harm that can come from wearing it often.
Finally, describing it as “The Bluff” in the form of a coat that we wear when necessary, seemed to fit, and it is reportedly now a favourite chapter for many readers. Most commonly those with several years of experience, who tend to truly appreciate the potential benefit and, more importantly, the harm that can come from wearing it often.
We absolutely have to step up on so many occasions, so that we can meet the needs and expectations of patients, their loved ones, bystanders, our colleagues and inter-agency personnel. We literally have no choice. If we have signed up to step into first responder shoes, we quickly realise, right at the beginning of our careers, that we must fill them.
The reality is that we are human and, like all the humans we see before us on each call, situations can be challenging, stressful, chaotic, tragic, graphic, revolting and downright terrifying. The expectation, however, is that we will manage, de-escalate, organise, fix, sort and soothe the situation as soon as we arrive, and most of the time, we actually do. Remarkably enough, but not without the help of our good old bluff, after all, what else do we have to rely upon?
In order to turn up at confronting scenes and instil calm, controlled and safe surroundings immediately, was there a special school or university course that taught us how to keep our own feelings and fears in check?
For re-certification, with that irrational fear that makes live assessments more terrifying than the real calls themselves, who patiently instructed us in tried and tested methods, to prevent us from losing our minds in the midst of the pressure we find (and put) ourselves under?
When calls escalate, or suddenly become chaotic and unspeakably graphic, what stops us from listening to that overwhelming gut instinct to just turn around, start running and go home right away?
Mid-way through a night shift with a brand new intern and no back up available, which training certification provides us with the tools to support them confidently, on a gruesome multiple casualty trauma job, even though our own brains are struggling to keep up with demand?
During a paediatric resuscitation, when sadness drenches the room like a heavy fog, how did we learn to distance ourselves enough from the tragedy we’re right at the centre of, in order to maintain our composure so that we can perform challenging interventions and reassure our patient’s family?
Most of the time, the answers to these questions will be “No.” “No-one.” “Who knows?” “None” and “No idea!” And herein lies the bluff.
We mentally don that bluff coat just as we step out of our emergency vehicles. It protects us as much as it protects others. It provides us with just enough confidence to carry out the job, no matter how much stress we may secretly feel deep inside. The old adage of the graceful swan gliding around above water, whilst it’s feet paddle furiously beneath the surface. Without the bluff, would we be able to put our bravest of faces on? Possibly not.
For me personally, I am one hundred percent positive that I would never be able to drive up to a scary looking house, with people crying out and waving me over, in the middle of the night, in my own car, dressed in my favourite jeans and t-shirt and walk in with a friend, calling out casually “Hi there, my name’s Tammie and this is [insert friend’s name].” I can do it in uniform, however, but how? The only difference is my clothing and my vehicle. They, in themselves, start to form my bluff. Yes, I look more purposeful, the assumption of callers is that I’m well trained and qualified, I’ve also been tasked to attend, but even still, it’s that bluff that quashes most of the unsettled feeling in my gut as I walk in. Without it, I couldn’t keep doing my job. It keeps me going. It helps me to feel braver and more in control. It lends me the strength I need to look calm and settled enough that an intern or a colleague feels stronger too.
So how can this possibly be dangerous, learning to wear such a beautiful coat, that makes us feel so good? Sometimes, it feels too good, like eating too many cupcakes at a birthday party, rather than a delicious treat, it becomes a heavy, sickly feeling in our stomachs. The extra half hour in the gym, where we feel great, so we stay longer, but end up overdoing it and become sore for days. That extra couple of beers, because we’re having so much fun, that take us from feeling warm and fuzzy before bed, to suffering a monstrous hangover the next day. We need to know when to stop, when to take the coat off and remove the bluff, before it swallows us up.
If we wear it too often, how can we stay in touch with those true gut feelings that keep us safe? Are we at risk of getting so comfortable in that coat, that we forget how to keep ourselves open to learning new things? Do we become so complacent when we’re wrapped up in the bluff, that we may forget the importance of ensuring safety measures are in place every step of the way? Can the bluff make us arrogant enough that our peers refuse to communicate openly with us, for fear of us passing comment just to outsmart them? Is it possible that our families become less able and willing to connect with us, because our comfortable coat creates a barrier between our open, vulnerable, human selves and the bluff version that we begin to favour more often?
It may be a complicated concept to get our heads around as it’s something that we learn and develop individually, inside our own heads, rather than being taught in the usual paramedic or EMS based systematic methods. From reader feedback, however, it sounds like it's definitely worth taking a little time to pay attention to your bluff. Let me know what you come up with, I’d love to hear your thoughts on the subject either in the comments below, or on Facebook, Twitter or Instagram.
Tammie
Tammie
Interested In Reading More?
Check out Chapter 3 “Beware The Bluff, But Wear It Well” for yourself.
The Good, The Bad & The Ugly Paramedic is available in paperback, hardcover, eBook and audiobook formats at all major retailers or direct from the GBU Paramedic website.
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As a current, practising paramedic in Australia, Tammie Bullard is passionate about prehospital care. With a background in metropolitan and country ambulance, academic study, clinical training, precepting and lecturing, she aims to put it to good use. Through the shared experiences of countless students, colleagues and mentors, her first book is designed to encourage effortless and ongoing self-reflection in every paramedic that strives to excel in their rewarding choice of career. Find out more about the author and the book through any of the links included below.
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