Using EMT Skills off-duty

[Handsome Robb]

That's also why a doctor in the ER will repeat every questions you ask in the ambulance, as well as why every nurse who examines the patients will reask every questions you asked, and gave them the answer when you gave the nurses your report. Same exact reason.

I agree 100%

Although we have a pretty good relationship with the nurses and physicians in our system. Many nurses won't re-ask questions if we've built a good rapport with them, provide them with an excellent hand off report and have proven ourselves competent. If I give them a thorough report including vaccinations, height, weight, primary care physician and/or pertinent specialty physicians. They are busy and recognize that most of us are good at what we do and if we can make their job easier they take all the info they can get from us.

That's not to say that there aren't nurses out there that don't listen to a word we say when we give them a report and redo all the work that we did.

 

[JakeEMTP]

This shouldn't be just about you and how much the nurse likes you.

Those nurses also need to understand they must build a rapport with the patient and there are some things that they should document based on their own assessment. It sounds more like they are failing to do an important part of their assessment. Going to court with just documented hearsay without doing their own personal assessment gives another meaning to "WNL". For some this would be like writing down the last set of vitals from a patient's chart for a transfer and using them as if you just did them. Sometimes the timeline of when the questions were asked and re-asked is relevant. Some patients also don't like to be talked over and not given the opportunity to correct whatever information was given incorrectly. That is then in their record from which others might use to determine treatment. When the nurse is then questioned why it was documented as such it will then be known he or she didn't assess or ask any questions. That makes the nurse look incompetent.

Some patients may be asked the same questions over and over to establish a baseline and any deviation from it. Sometimes it is a good thing when a patient recalls being asked the same questions earlier and by who.

 

[Handsome Robb]

This shouldn't be just about you and how much the nurse likes you.

Those nurses also need to understand they must build a rapport with the patient and there are some things that they should document based on their own assessment. It sounds more like they are failing to do an important part of their assessment. Going to court with just documented hearsay without doing their own personal assessment gives another meaning to "WNL". For some this would be like writing down the last set of vitals from a patient's chart for a transfer and using them as if you just did them. Sometimes the timeline of when the questions were asked and re-asked is relevant. Some patients also don't like to be talked over and not given the opportunity to correct whatever information was given incorrectly. That is then in their record from which others might use to determine treatment. When the nurse is then questioned why it was documented as such it will then be known he or she didn't assess or ask any questions. That makes the nurse look incompetent.

Some patients may be asked the same questions over and over to establish a baseline and any deviation from it. Sometimes it is a good thing when a patient recalls being asked the same questions earlier and by who.

Out of that entire post that's what you picked out?

Agreed they should do their own assessment but there are things that I can pass along that don't need to be asked again. Do you know how frustrating it is to be asked the exact same set of questions over and over again? It can be misconstrued as demeaning to the patient, "why isn't anyone listening to me" comes to mind. What's the point of doing an assessment and passing finding along if those findings are going to be completely disregarded?

If you don't like it then that's your choice.

 

[DrankTheKoolaid]

Thats exactly why I tell my patient's to expect to have the exact same questions asked over again in the ED at least once maybe twice more. That way they at least can expect it and not think nobody is paying attention to them.

 

[JakeEMTP]

Agreed they should do their own assessment but there are things that I can pass along that don't need to be asked again. Do you know how frustrating it is to be asked the exact same set of questions over and over again? It can be misconstrued as demeaning to the patient, "why isn't anyone listening to me" comes to mind. What's the point of doing an assessment and passing finding along if those findings are going to be completely disregarded?

If you don't like it then that's your choice.

Can you give an example of what they don't need to be asked again?

Besides just the assessment questions there are other things the patient will be asked over and over. You might even have noticed there are sometimes signs posted in the patient rooms, that is if you go past the ED, which inform the patient for their safety they will be asked the same questions over and over. These include personal identifiers such as name and birthdate. Every health care worker from the phlebotomist, RN, LPN, Radiology Technician, ECG Technician, CT Scan Technician, Respiratory Technician, Admitting clerk and so on will ask that patient for their name and birthdate even if they just saw the patient a few hours before and know who they are. That is a policy in probably every hospital in the United States.

Also, as part of the patient education and re-education process, they may be asked to give the names of their medications, dosages and indications several times. Repetition is sometimes a good enforcer and patients won't be so ignorant of what their are taking and why. Again that is a good safety tool.

When that patient is transferred to another part of the hospital or even if another RN picks up that patient, the same questions and another thorough assessment will be done. At each shift change, the oncoming RN will again assess the patient. Your one time assessment is not the only one to be considered. Patients change. Even just while moving the patient from the ambulance to the ED, there can be a change in condition or mentation. If you are doing a CCT call, you should do your own assessment before assuming care for that patient and ask questions for clarification even if the RN just asked them.

If you work with patients and care about them, the choice is to do what you can to ensure safety rather than just copping an attitude and walking off pissed because you heard someone ask the same questions you just did. Again, it is not just about you. The whole patient care process and the plan of care must be considered with safety and the correct information provided for that care to continue beyond your ambulance.

 

[Handsome Robb]

I still want to know where I "copped an attitude" or made it "all about me".

I'll just go crawl back in my hole since I'm obviously a sub par provider who has no business caring for patients.

 

[atropine]

Don't use your skills off duty, that is what 911 is for. The only time I've seen my friends use their skill and I'am talking ALS stuff was for a syncope patient on a flight coming back from Hawaii, up in the air you can do what ever you need to do, and the flight attendents are very greatful.

 

[joezeeger]

A rare story where those on scene don't know what to do.

On a rock climbing trip in Southern Illinois, we were having lunch after a day of climbing when we heard a loud thump in the distance and then the sound of a girl screaming. We ran in the direction of the screaming and found a girl who had fallen 50 feet off a cliff screaming. She had a compound leg fracture. That wasn't the bad part. There was a paramedic lying next to her and a very nervous and panicky EMT who had no clue what to do.

The girl was trying to cross a stream at the top of the cliff and slipped and fell. Then the paramedic who responded did the same, but wasn't as fortunate. Seemed like he broke his neck. There were a lot of nervous people panicking and my brother took charge and told everyone an ER nurse is here (his girlfriend) and to back the hell off. (She wasn't too happy about that but went along with it)

In the end, she got the EMT to calm down and take her to his ambulance. They ended up retrieving a backboard from the ambulance and they all coordinated a heli transport for the injured medic. Whatever happened to the girl and when she finally received care, I don't know, but her condition was not as serious as the paramedic's.

 

[msaver]

It all depends on the situation, but you are very limited in what you can do. If it is possible, I would recommend acquiring a jump kit/trauma bag that you can carry in your vehicle. Your squad may furnish this for you, just ask your Lt. or Cpt. If it's a serious crash, do not try to extricate the person, for you may compromise the spine. However, if they are are at immediate risk of dying where they are have someone assist you, and very carefully move them paying close attention to their spine. Do not try to splint any injuries if a rig is on its way. More than likely it would be something makeshift and need to be redone by the arriving crew. When you're off-duty the only thing you can really treat is some life threatening situations.

 

[NYMedic828]

With great power comes great responsibility

-Uncle Ben

 

[Tigger]

If it is possible, I would recommend acquiring a jump kit/trauma bag that you can carry in your vehicle. Your squad may furnish this for you, just ask your Lt. or Cpt.

Things that I am not going to do, volume #1. If I asked my boss for a first in bag he'd laugh at me and then probably fire me.

 

[Veneficus]

Do not try to splint any injuries if a rig is on its way. More than likely it would be something makeshift and need to be redone by the arriving crew. When you're off-duty the only thing you can really treat is some life threatening situations.

If a splint is working why would a crew take it off?

 

[NomadicMedic]

If somebody had a patient splinted when I got there, I certainly wouldn't take off the splint… In fact, I probably would high-five the splinter.

 

[Martyn]

Some of you guys think wayyyyy too far into your capabilities as a rescue-randy passerby...

Stop, ask if everyone is alright, call 911, sit back and watch the show.

I like your line of thought NY lol

 

[chillybreeze]

me too! ^_^

 

[NYMedic828]

After reading through this entire thread again, I have outfitted my vehicle with a new jump bag in the event one of these off-duty situations should occur.

Here's what is inside it.


For calling people who can actually do something. (and playing games if I get bored waiting for them)

For enjoying the show

For making the popcorn

 

[Veneficus]

If you are going to carry around a grill like that, maybe replace the popcorn with a steak or something...

 

[MacrossForever]

Steaks? who the hell is he waiting for? I like the jiffypop idea, though that should be enough entertainment without the need for the phone to play games.

 

[Veneficus]

Steaks? who the hell is he waiting for? I like the jiffypop idea, though that should be enough entertainment without the need for the phone to play games.

steak should be rare, at room temperature about 1 minute or so on each side.

 

[STXmedic]

steak should be rare, at room temperature about 1 minute or so on each side.

Quoted for truth