# Is there something I should do??



## Phlier (Dec 21, 2008)

I have been out in the field on a BLS unit for about a month now. Ran into a situation this weekend I am uncomfortable with Looking for some advice If the uncomfortableness is founded or if i am over reacting. 

My partner and I got  called out on change in LOC in east jesus nowhere. This older guy had been discharged from a care facility earlier that day and his family belived he was surrering from a drug over dose. He had been vomiting since about 1230 that mornig. We roll on scene get vitals. A/Ox0 BP initaly at 88/67 pulse at 168 ish (can't remender the exact number) Reps where at 24 and labored. While my partner and I were gradding the gurney from outside the room I asked him if we should get medics involved. Either I missed his answer or he just ignored the question but we continued on with loading this guy up and get him into the back of the ambulance. I start getting another set of vital once in the unit. I got the BP at 68/47. At this point my partner is standing at the back doors watching me get the vitals. I say again to him. I think we should get medics here. Now he takes out his phone and proceeds to call for them.

My problem with all this is He been an EMT for 9-10 years (far too long if you ask me). If someones vitals are as crappy as this guys was should medics have been called alot sooner(like after the first set of vitals). I feel that I shouldn't have had to ask/suggest twice that this is more than we can handle before he does call for assistance. Plus the hospital that this guy's family wanted him to go to was a HOUR away (it was rush hour) according to the medic that did show up. I think I would have put up a fuss if he did try to transport but should some one who has been here as long as he has not be putting me ( a newbie) in that kind of situation. 

Should I bring this up to some one or am i just over reacting????


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## firecoins (Dec 21, 2008)

Yes medics should have been called sooner.  

Why couldn't you call for medics?


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## artman17847 (Dec 21, 2008)

This is a tough position to be in.

From your discription your pt. was in need of ALS. 

Now first thing is to always do what is best for your pt. Remember #1 do no harm. 

Was it possible for you to get to an ER faster than ALS could reach you. If that could be argued maybe rapid transport was approriate. If not the ALS intercept would be a good idea.

As far as you and your partner go you could try to discuss the call in a non confrontational way. If you respect your partner I think its best not to argue about the call. 

 I think you were thinking correctly.


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## MMiz (Dec 21, 2008)

After I noted the vitals I would have called for ALS, but that's just me.  Our service had a policy that unless there was a valid reason to cancel ALS, any BLS unit transporting a non-stable patient with lights/siren automatically required an ALS intercept.

The issue with your partner is something that was the leading cause for airline disasters in the past.  Crew Resource Management equals the playing field, no matter one's seniority, and makes both EMTs equally responsible for patient care and safety.


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## aidan (Dec 21, 2008)

I don't think that there's any concrete actions you can take at this point..however, you may know your partner a little better from this experience, and the next time your gut tells you that ALS should be called.. it shouldn't be a deliberation, but rather..you can call them instead of waiting for your partner to. You are responsible to be the advocate of your patient if it's in his/her best interest, whether your partner is being stubborn or not..


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## marineman (Dec 21, 2008)

Phlier said:


> BP initaly at 88/67



Please see the BP thread for info about that but it should always be even numbers. 

As far as your partner calling for paramedics, I don't know the time delay between when you first asked him and when you told him to call but look at the outcome of what happened. 

The first time you asked it as a question which is respectable since you're new and looking to the senior partner for guidance but I think he did a good job in teaching you something whether intended or not. The second time you told your partner to call the medics and he did it right away, this time by telling him what needs to be done you acted as a competent EMT that knew what was best for your patient. I bet the next time you're in this situation you will not ask the first time you will tell your partner to call the medics right off the bat, if so did your partner not teach you a valuable lesson in being confident and making decisions on your own based on your assessment findings?


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## mycrofft (Dec 21, 2008)

*Automated VDS monitors give odd numbers, manual BP cuffs even ones.*

Seems clearcut to me, needed ALS. The dynamic between "partners" (coworkers) seems strained, especially that 'too long an EMT' dig, and potentially very injurious charge that the "partner" blew the ALS question off. Get another partner.


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## mycrofft (Dec 21, 2008)

*Automated VS monitors give odd numbers, manual BP cuffs even ones.*

Seems clearcut to me, needed ALS. The dynamic between "partners" (co-workers) seems strained, especially that 'too long an EMT' dig, and potentially very injurious charge that the "partner" blew the ALS question off. Get another partner.


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## Code 3 (Dec 21, 2008)

As stated above, this is an ALS patient. Out of curiosity, what interventions did you do for this patient while waiting for medics?


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## aidan (Dec 21, 2008)

marineman said:


> Please see the BP thread for info about that but it should always be even numbers.
> 
> As far as your partner calling for paramedics, I don't know the time delay between when you first asked him and when you told him to call but look at the outcome of what happened.
> 
> The first time you asked it as a question which is respectable since you're new and looking to the senior partner for guidance but I think he did a good job in teaching you something whether intended or not. The second time you told your partner to call the medics and he did it right away, this time by telling him what needs to be done you acted as a competent EMT that knew what was best for your patient. I bet the next time you're in this situation you will not ask the first time you will tell your partner to call the medics right off the bat, if so did your partner not teach you a valuable lesson in being confident and making decisions on your own based on your assessment findings?



Very optimist of you  it's a great quality to be able to pull a valuable lesson out of an otherwise bad situation.. his partner may have taught him a lesson, but did it at the expense of the patient's health.


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## marineman (Dec 22, 2008)

aidan said:


> Very optimist of you  it's a great quality to be able to pull a valuable lesson out of an otherwise bad situation.. his partner may have taught him a lesson, but did it at the expense of the patient's health.



Yes I tend to look at any situation as an opportunity to learn and better my skills for the future. Yes his partners actions could have had a negative impact on the patients health so for that reason I do not agree 100% with the timing of the lesson but if you look at how we learn in the field 95% of the time we learn by making a mistake as we don't reflect on situations enough to pull lessons from them when everything goes to plan. Look at most studies done in any medical arena, any of them could be said to come at the expense of a patients health. The service I ride with is a part of Zoll's Autopulse study, half of the patients in the study area get the autopulse and half don't. Could you not say that not using the autopulse on some patients could potentially be detrimental to their outcome?


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## FF894 (Dec 22, 2008)

Agree with everyone that ALS should have been called.  

How long have you worked with this partner?  Did you discuss it after the call?  Was there any exmplination.  Did you end up going to a closer hospital?


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## Sasha (Dec 22, 2008)

Why couldn't you have called ALS? Once you decide a patient needs ALS, you call them even if your partner doesn't respond to their question. If you need constant direction or reassurance, EMS isn't the field to get into, you're expected to be the leader, not a follower.


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## vquintessence (Dec 22, 2008)

I wouldn't throw your partner under the bus so quickly.  A lot could have been running through his mind, and it's not like you had to argue to get him to agree.  Also like somebody else mentioned, you were the lead EMT in that situation because you took on pt care, so you should be the one to take initiative.

Don't be the new guy/virgin EMT and start throwing people under the bus, especially seasoned providers.  The obvious exceptions being if you see gross negligence or malicous actions.  Just talk with em and find out what his/her thinking was.

Food for thought, if you were so far out (1/2 hour from hospital on a priority response?) and the pt wasn't alert at all (you said CAOx0?) why did you all get vitals on scene then again in the truck before taking off?  My service would have had an EMT:
package - give a diesel bolus - call intercept.
You'll have plenty of time to get vitals, glucose, etc. with such a long transport.

I'm not trying to be overly critical.  You seem to have handled the situation and are astute to detail.  What was the end outcome for this pt?  What did you do for him during transport prior ALS?

Good luck in the future.


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## JPINFV (Dec 22, 2008)

aidan said:


> it shouldn't be a deliberation, but rather..



It shouldn't be a deliberation because both *partners* should be on the same page anyways. In a situation like this (it sound's like the type of patient that would get a doorway triage to ALS/immediate transport depending on ETA), I'd probably turn to my partner and say something along the lines of "Hmm, paramedics? Yea, let's call paramedics." By phrasing it like that, I'm consulting my *partner* put pushing him towards a specific treatment. Similarly, if I get an extremely low blood pressure like you posted, I'll probably have my partner take an additional one to confirm. Now we're both on the same page and he should have the same concerns that I have regarding the patient's status.


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