PHECC Paramedic common mistakes
PHECC Paramedic · Understand the traps and how to avoid them.
Treating a casualty found in cardiac arrest by immediately intubating and gaining IV access before starting effective chest compressions and defibrillation.
Candidates over-value advanced procedures they have recently learned and deprioritise high-quality CPR and early defibrillation, which drive survival.
What to do instead
Commit to the sequence: recognise arrest, call for help, start compressions, attach and use the AED/defibrillator, and only then layer in airway and vascular access without interrupting compressions.
Choosing a supraglottic or advanced airway without confirming ongoing effective ventilation and without a plan for failed placement.
Skills drills reward successful insertion, so candidates fixate on the device rather than the outcome of oxygenation and ventilation.
What to do instead
State the indication, confirm placement with waveform capnography plus clinical signs, and always verbalise the failed-airway and rescue-ventilation plan before insertion.
Applying the adult drug dose or algorithm to a paediatric patient without recalculating weight-based doses and energy settings.
Adult cases dominate practice, so candidates default to memorised adult numbers under time pressure.
What to do instead
Use a length-based tape or estimated weight, calculate and state the weight-based dose aloud, and confirm defibrillation energy against a paediatric reference before delivery.
Reporting a full set of vital signs but failing to interpret trends or escalate when values are abnormal.
Candidates treat vital signs as a data-collection box to tick rather than a trigger for clinical decisions.
What to do instead
For every set of observations, state the trend, the clinical meaning, and the specific action or escalation it prompts.
Performing a secondary survey and reassessment without first controlling a catastrophic primary problem such as major haemorrhage or an obstructed airway.
Structured assessment sequences encourage rigid step-by-step completion rather than responding to what is immediately life-threatening.
What to do instead
Practise the primary survey as a loop: any life threat found is treated immediately and the survey restarts before progressing.
Using an AED on a casualty who has been moved out of water without first assessing and drying the chest.
Candidates focus on speed of defibrillation and overlook environmental hazards that affect pad adhesion and safety.
What to do instead
Follow a hazard check: move from water or metal, dry the chest, remove transdermal patches, then apply pads and follow the device prompts.
Giving a casualty with suspected stroke food, drink, or oral medication before swallowing has been assessed.
Candidates want to act and provide comfort, and oral routes feel like the default for medication.
What to do instead
Treat stroke with a nil-by-mouth approach, screen swallowing before anything oral, and use the FAST assessment to drive time-critical referral.
Advising a patient to attend the emergency department when the presentation is safely manageable in the community, or the reverse, without documenting the rationale.
Candidates lack confidence in risk stratification and default to the safest-seeming option rather than the most appropriate one.
What to do instead
Apply a structured disposition framework, document the reasoning and safety-netting advice, and state the specific red flags that would change the plan.
Making a referral without confirming the patient understands the plan and can actually access it.
Candidates treat the referral as the end of the encounter rather than the start of a care pathway.
What to do instead
Use teach-back to confirm understanding, check transport, cost, and access barriers, and record the agreed plan in the patient's own words.
Deviating from a clinical guideline without documenting the indication or the discussion that justified it.
Candidates fear being marked wrong for departures from protocol and so either follow it rigidly when it does not fit, or deviate silently.
What to do instead
When departing from a guideline, state the clinical justification, the risk-benefit reasoning, and the senior clinician consulted, and record it contemporaneously.