The Good, The Bad and The Ugly Paramedic is written by Tammie Bullard, a practising paramedic, lecturer and author from Australia. Published in 2020, this book aims to help us look at ourselves in a friendly, non-critical way and decide where we sit on the scale—are we a good, bad or an ugly paramedic?
Being a paramedic is a job that generally holds us in high regard by the public. We are the ones that come when a person is having the worst day of their lives and we are seen as the calm in the storm. Over time, after bad calls, the pressure of shift work and the complexities of being a paramedic, we can all become a bit lackadaisical in how we behave or how we speak.
By reflecting on how we act and behave, we can see where we might need to make change. From the outset, the author takes a team-based approach. All of the scenarios look at how ‘we’ handle the situation or behave, taking a collaborative ‘we're in this together’ approach. As such, the book never looks to chastise the reader.
While paramedic practice in Ireland and Australia differ slightly, I resonated with so many of the scenarios—from the good, the bad and the downright ugly. The book asks the question, ‘are you the paramedic you hoped to be on your first day on the ambulance?’. When we start our careers as paramedics, we are often eager to work hard and do everything by the book. As time passes, we all change and sometimes bad habits can set in.
Each chapter deals with one general theme, and various scenarios that outline how the good, the bad or the ugly paramedic might behave and handle each scenario. These are all real-life examples from the hundreds of paramedics and health professionals that Tammie has spoken with over her years of practice and during her time writing this book. The chapters cover subjects such as safety, preceptorship, public perception, working within a multidisciplinary team and leadership. The final chapter brings all of these themes together and shows us how to reflect on where we stand on the sliding scale of the Good, the Bad and the Ugly, and what we can do to improve our position on the scale.
A key theme in the book is the practice of reflection. Tammie has lectured and written about paramedic reflection extensively. Reflective practice is now a key component of many continuing professional development (CPD) portfolios across paramedic services. In July 2020, Tammie hosted an online course called ‘Taking the Pain out of Reflective Practice’ with the Australasian College of Paramedicine (ACP). This event is available on the ACP website and I highly recommend it for anyone that is new to reflective practice (Bullard, 2020).
The book is designed for people of all clinical grades, from someone just starting out, to the more seasoned paramedic. We all—at least I hope—want to do right by our patients, cause no harm or put ourselves or our colleagues in a situation where our job or livelihood is at stake. By regularly engaging with the practice of self-reflection, we can see where we might need to make some changes, or reach out for help.
Each chapter ends with a series of reflective questions that are based on the theme of the chapter. The questions help the reader to understand ‘why it matters’ and how to ‘put yourself in the picture’, helping us to process the chapter from our own perspective.
This book is not a clinical one, as the author states in the introduction. It was written by a practising paramedic, for paramedics, to help us manage our attitudes over our professional careers. This line in particular reminded me of the book by Astronaut, Chris Hadfield, An Astronaut's Guide to Life on Earth, where attitude in terms of space flight refers to the vehicle's orientation towards the sun. If we lose control of our attitude, we lose control of our vehicle, and this could be a matter of life and death (Hadfield, 2015). We must never lose control of our attitude, since the right attitude is fundamental to success.
Two chapters in the book that I particularly enjoyed were the chapter on preceptorship and the chapter on safety. When starting my career as a paramedic, I was fortunate to have been paired with a phenomenal preceptor. This positive influence early on in my career has been invaluable to me and it goes to show how much of an effect we can have on new paramedics starting out in their careers. As a preceptor, or in a less formal role of meeting students at the ambulance base or hospital, we can have a huge impact on the development of new entrants. As such, it is vital that preceptors have the skills and training to encourage and help paramedic students flourish rather than fail, and not to dismiss and discourage the motivation (or keenness) of new people in this highly rewarding career.
The second chapter that resonated with me was the discussion on safety. In the working environment of a paramedic, there are so many variables at play. Not only do we drive a big vehicle, but we also deal with medications, the public, different equipment and often very sick patients. Add in unpredictable weather conditions, working at the side of the road and the unknown that comes with responding to 999 calls, and we can sometimes find ourselves feeling overwhelmed. This is where safety can make or break us, and in stressful situations, adherence to safety guidelines can sometimes go out the window. However, as the Bad and Ugly examples in this chapter show, ‘cutting corners’ can put us all in harm's way. By practising reflection, we can learn from our mistakes, and those of others, to avoid repeating them and prevent the precipitation of more problematic errors.
The final chapter includes three thought-provoking questions with the potential to truly change our perspectives and outlook as paramedics. The book is one that allows readers to dip in and out, helping us to take in the content, even for the most time-poor paramedic. Also, each chapter is a single topic, making it a very easy read. I highly recommend this book to every prehospitalist, from the new student to the seasoned paramedic and those who have moved into management and leadership roles. The book is available to order at your local bookstore, or online at the usual suspects (e.g. Book Depository, Amazon).