# What makes someone a "bad" paramedic?



## mrhunt (Oct 10, 2019)

So Bit of specifics here.... i work in a county where private EMS is first in and County fire is Just BLS and assisting us. 

Alot of them dont like it. they're all EMT certified but just show up to open doors, maybe take vitals and carry our bags...Despite this, easily 50% think they're better than us an that they run the show. alot of Them like to loudly complain about staff members saying that were "incompetent" or something...

Mind you this hasnt happened to me YET but plenty of my co-workers who definitely are NOT incompetent. None of these guys are paramedics and hate running on medical calls anyways, Who are they to judge us? Takes one to know one. I dont show up to their Fire calls judging them cause im not a fire fighter!


So got me to thinking.....As a new medic.......What makes someone "bad" or incompetent or just like a "watch out for that guy" sorta thing?
Post your words of wisdom for me.


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## VentMonkey (Oct 10, 2019)

Eh, it’s all opinions and subjective, and we all know the saying about opinions. 

Honestly speaking, have you or any of your co-workers ever been guilty of criticizing what it is they do, like say?...


mrhunt said:


> i work in a county where private EMS is first in and *County fire is Just BLS and assisting us*.
> 
> Alot of them dont like it. they're all EMT certified but just show up to open doors, maybe take vitals and carry our bags...Despite this, easily 50% think they're better than us an that they run the show.
> 
> None of these guys are paramedics and hate running on medical calls anyways, Who are they to judge us?


I’d advise against getting sucked too far into that rabbit hole, especially as a newer provider.

As an aside, based off of another recent thread of yours, I think we work in the same county.


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## DesertMedic66 (Oct 10, 2019)

There is not one simple answer as it will change based on your own personal opinion. Some are labeled bad because they are hard to get along with, others because they are always negative, others because they aren’t good at leading, and others because they are not good clinicians.

For my own personal opinions, I base it off their clinical abilities and patient advocacy. If you are a poor clinician then I label you a bad medic. If you do not advocate for your patient and their wishes then I will probably label you as a bad medic. I don’t have to like you or get along with you to view you as a decent or good medic.


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## ghost02 (Oct 10, 2019)

It's a small world sometimes, I think Ventmonkey is right about being in similar areas.

Have you ever gone to discuss things with the Fire crews? Is it possible that a crew with a very high level of experience may seen things you don't? The times that I've had issues, they were resolved after talking to that specific crew and keeping an open mind. Do they feel you're incompetent just based of presentation? An untucked shirt goes a long way towards thinking other things are sloppy as well.

Consider talking to the crew, I'd imagine you have the time just need to find the inclination. Dont view things as us vs them.


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## NPO (Oct 10, 2019)

If I worked for a BLS fire department and had to work with an ALS transport agency that viewed us as "just BLS" I probably wouldn't try to hard to help them either.

Maybe the problem isn't the fire department.


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## mgr22 (Oct 10, 2019)

mrhunt, since you're asking for advice, I'll note that you're presenting only your opinions to make your argument about firefighters behaving badly. When you say "a lot of them don't like it" and "easily 50% think they're better than us," but "none of this has happened to me yet," you sound bitter and pretty far from objective.

As for incompetence, ideally, each agency would have objective ways of determining it, but I realize that's not the case. I think the best performance measures would be comparisons between prehospital care and hospital diagnoses. Some systems do that, but it's still not mainstream. There are other approaches, too, that are fairer than unsubstantiated opinions about people being good or bad at what they do.

What do you think makes someone incompetent?


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## Summit (Oct 10, 2019)

Any of the following could make you a "bad" paramedic:
1. Inflating the BP cuff around the patient's neck
2. Acting like a paragod
3. Fast push the zofram


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## mrhunt (Oct 10, 2019)

I fully agree with you guys that i presented that a bit poorly. So id agree with mgr22 that i AM bitter......No denying it. 

I DO want a team approach and an idea that we all work together but it comes to a point where your side is constantly criticized we end up doing some back. 

Mind you it was MUCH MUCH worse as an emt working with fire where they will COMPLETELY Dismiss our bls crews, over-run them and loudly be like "oh , your JUST bls?!, Wheres als?" With paramedics they're actually alot more respectfuly

And yes.......Due to the local departments general attitude ive gotten a bad taste in my mouth for them. on scene im super polite and respectful and always thanking them for their help (and they are typically very helpful) 

But honestly......Like my Fake stemi i flew out.... does that make me a bad paramedic? Would i have been a bad paramedic if i DIDNT fly her out or just let her AMA like she wanted to? or taken her to the local NON-stemi hospital 5 mins away which would have been out of protocol and they wouldnt have been able to help her?


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## mrhunt (Oct 10, 2019)

And also.....i definitely do NOT act like a paragod . Hopefully i dont come off that way here. I know for a fact how little i know. i try to show confidence on scene but im the first one to ask for opinions or advice on things.


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## mgr22 (Oct 10, 2019)

mrhunt, I'm not sure what you mean by the "fake STEMI," but I wouldn't automatically think you're a bad paramedic because you took a conservative approach with an ambiguous presentation that turned out to be something minor. I must have done that hundreds of times.


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## DrParasite (Oct 10, 2019)

Lets be honest: they are bad EMTs, bad paramedics, on both the ambulances and the fire trucks. Poor clinical providers, poor interpersonal skills, and massive (undeserved) egos all around.

I will also openly say that before I moved to NC,  I didn't trust the majority of EMS providers who ride fire trucks, unless I knew first hand that they had worked in a busy 911 systems on an ambulance previously.  I still wouldn't trust many fire engine riding EMS providers to treat me (and yes, this includes several of my coworkers), but I will acknowledge that there are a few very competent EMS providers, even though they don't ride the ambulance regularly.

OK, that all being said:

You're a newbie medic, with minimal experience.... Who are you to discount these fire based providers experiences?  Maybe they have seen more than you, and know the difference between a good paramedic and a bad paramedic, because they have been doing it long enough?

I don't know anything about your system, but if all the fire crews do is carry your bags, take vitals for you and open doors, than I think that's a waste of a fire crew.  a "first responder" who shows up after ALS is a waste of a "first responder" because they aren't "first."  But if that's how your system is set up, so be it.

We all make mistakes.  The important thing is that you learned from your mistakes, and don't repeat them.  This includes flying out the fake stemi and calling a trauma alert or going to a trauma center with a questionable trauma.  don't worry about it, and if you make a mistake, learn how not to make it in the future.

As a fire-based first responder, I know what my job is, and I know what the ambulance people's job is.  Do I know all the details, all their protocols, and all their procedures?  not really.  but if my paramedic crew regularly showed up without their bags or other equipment, without their stretcher or carrying device, and expected me to get all that stuff for them, then I wouldn't have a very high view of them.  But I do know that my job is to treat the patient to the best of my ability, get information for the ambulance crew, and when they arrive, give a report and let them do their job, as well as stick around helping out until they tell me they no longer need my crew.  Oh, and I also have to make sure the patient is as comfortable with the ambulance crew treating them as they are with me (that transferring of the provider/patient relationship is a lot more important than people realize).

When I was first on the ambulance down here, I was told I should have been thanking the FD for coming out to calls.  Being a yankee, this was a foreign concept to me, as I always pictured it as them doing their job.  different cultures I guess, but I don't expect to be thanked (other than the basic here is my report to you, thanks for the info).  But that's just me.

Another thing: you are too new to be bitter, especially if you are bitter because of what you have heard from others.  you're a newbie medic; just because they aren't paramedics doesn't mean they don't know what a paramedic is supposed to do (and based on your initial post, you seem to think just because they aren't paramedics they don't know anything, because they are _just _BLS).  I knew some very questionable paramedics when I was just an EMT, especially ones who had less EMS experience than I did.

Sometimes, my delivery isn't the most tactful (as I'm sure many on here will attest to), but I'm working on it.  Sometimes I've made the error of assuming someone is being rude or disrespectful, when that wasn't their intent.  One time I can remember (back when I was on the BLS ambulance) I had a paramedic fly car assist us, and the paramedic's first words to me were "why are we here?"  Suffice it to say, I took offense to that, and after we transported the patient, we had a chat about it.  Her intent was not to imply that she didn't want to be there but wanted to know what was going on with the patient, and my response back to her had been perfect.  Again, minor communication issues.

Act confidently (you are the highest training medical provider), but if you treat the FD like stretcher fetchers, and bag carriers, they aren't going to have a high opinion of you.  But if you do have an issue with a FD crew, after the call is over, have a chat with the Lt or Captain about it.  See what was going on, because your new, so maybe you missed something, or did something that they didn't agree with.   Or maybe you were unintentionally disrespectful, and didn't thank them for their service (who knows).  But don't look down on the FD just because they aren't all knowing paramedics like you are.


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## mrhunt (Oct 10, 2019)

Excellent post. Great insight, I know fire despite being bls has been doing this a long time. And I've been an EMT for 6+ years so I'm well aware of their positions as well. 

I wouldn't say I'm burnt out. Just tired of multiple different engines in multiple different areas initially acting like im a hindrance to them when were all on the same team.

If that makes sense.


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## Summit (Oct 10, 2019)

mrhunt said:


> And also.....i definitely do NOT act like a paragod . Hopefully i dont come off that way here. I know for a fact how little i know. i try to show confidence on scene but im the first one to ask for opinions or advice on things.


Just for clarity because online it is easy to misinterpret, I was not accusing. My post was mean to be lighthearted and general.


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## mrhunt (Oct 10, 2019)

I didn't think u were. I was just trying to make sure I didn't come off that way in my posts. Your good sir. ☺️


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## VentMonkey (Oct 10, 2019)

Also, many of the FF’s in my—our?—area who are _just_ EMT first responders are actually paramedics. Many of them with equal, if not more experience than myself, to include the flight paramedic gamut.

When I first came here I was in LaLa land because of the fact that they actually did help.

I did have a fire captain have a “discussion” with me once about my candor (ironically as one of my first shifts as a supervisor). I could have taken it only one of two ways.

Turns out, as @DrParasite points out—much is lost in translation. We were, and have been squared away on many-a calls since and look forward to running with one another as well when we do catch up. Oh yeah, and he’s also a PM who’s _just_ a (BLS) fire captain.

Guess the point is, as a provider this should be such a non-issue at any level. You know? The whole “who says what to whom about so and so...” Respect goes both ways and that badge or title mean nothing unless you show, and yes sometimes repeatedly, competency.

Coming from any area where the shoe was on the other foot I’ve always tried to keep that in mind. It’s what drives me to tidy up the ambulance in the back before every call (different story for another time) without assuming it’s the EMT’s job; including trash.

Did I always? No. But somehow I always managed to remember at some point after the fact what it felt/ feels like to have your credibility discounted because of a silly title.

Also, sounds to me like there are some overall cultural issues between your agency and your first responders you all may need to address on a larger scale.


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## mrhunt (Oct 10, 2019)

I agree with you. And I'm also aware of who are paramedics who work in the fire department and those guys are typically an obvious step above.


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## VentMonkey (Oct 10, 2019)

mrhunt said:


> I agree with you. And I'm also aware of who are paramedics who work in the fire department and those guys are typically an obvious step above.


Not always. I think you’re missing the point still, and perhaps caught up on the title itself. 

And to add to the above post (was mid-edit when I saw this, lol), I’ve also had excellent career BLS firefighters provide better reports, handoffs, and care than some of their co-workers with more “experience”.

TLDR: back to my original post- it is all subjective...and should not be a big deal.

You asked for advice, you’re getting it.


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## KingCountyMedic (Oct 10, 2019)

Not recognizing the value of BLS providers would make you a bad Paramedic all day, every day. Public, Private, or Fire. EMT's are the single most important role in the chain of survival with the exception of bystander CPR. Listening to opinions of coworkers who have bad attitudes and then making those your opinions would make you a bad Paramedic. 

You're a new Medic. Establish your own relationship with your BLS crews. This whole ALS/BLS, Private vs. Fire is like the Hatfield - McCoy War. Treat your patients like you would want your family treated, be conservative, do what's best for the patient. Communicate with everyone on the call, whether you pull up in a Engine or a Private AMB I consider them all as my brothers and sisters and treat them as such. I work in a service full of Para-Gods that have a long reputation for being A-holes to patients and providers. Change starts with YOU in this business. 

If you have an issue with the crew, talk to the crew. Don't go to their supervisor or officer, handle it at the lowest level possible if at all possible.


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## DrParasite (Oct 10, 2019)

mrhunt said:


> Great insight, I know fire despite being bls has been doing this a long time. And I've been an EMT for 6+ years so I'm well aware of their positions as well.


6 years as an EMT working on an EMT/EMT ambulances handling 911 calls without a medic to hold your hand, working  in an IFT truck only, or an EMT on an engine company?


mrhunt said:


> I wouldn't say I'm burnt out. Just tired of multiple different engines in multiple different areas initially acting like im a hindrance to them when were all on the same team.


It's your patient.  you're the paramedic.  when you show up, it's your patient, and you direct the scene, as you are the most knowledgeable person in prehospital care, in the role you are in.  How are you a hindrance?  Are you not moving fast enough with sick patients, do you always look confused, do you have trouble when you encounter a patient who is circling the drain?  Do THEY know your in charge, and if so, how do they know it without you sounding like a paragod?

Here is the TLDR message:
1) stop thinking of the FD as _just _BLS, and thinking paramedics are obviously better than those dumb EMT firemen
2) sound confident, act competent, and do your job, while recognizing the limitation of prehospital care
3) mistakes will happen.  Anyone who tells you otherwise is a damn liar.  the important part is to learn from then and not repeat them
4) you're a new medic, and a new face to all these engine crews.  when they get more familiar with you, even if it's just your face not your name, your interactions will improve.
5) don't lose sleep over subjective descriptions of you.  if someone says your a bad paramedic, ask for concrete examples and reasons why they think so.  The rumor mill will often run rampant, and people can base their opinion of you on 2nd/3rd/4th hand information.  don' t lose sleep over it, but don't go out of your way to piss people off.
6) work on your communication skills; sometimes people receive a different message than what you are sending.


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## mrhunt (Oct 10, 2019)

Well put. This might as well be a thread of what not to do to be a ****ty provider. And so far I'm avoiding that.

Privately I might have a worse opinion but I keep it private. Thanks everyone.


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## VentMonkey (Oct 10, 2019)

KingCountyMedic said:


> Not recognizing the value of BLS providers would make you a bad Paramedic all day, every day. Public, Private, or Fire.
> 
> Listening to opinions of coworkers who have bad attitudes and then making those your opinions would make you a bad Paramedic.


Slow down, Cochise. While I don’t disagree with most of your post, we’ve all had growing pains.  

Many of us have had a paragod/ EMT moment or 10. This doesn’t make the OP a “bad” paramedic. Least the guy recognizes the need for input outside of his own work place.

Honestly, I think the biggest takeaway is try and avoid most, if not all water cooler talk buy in. Don’t worry about the what the “cool kids” think, do the damn job, do it well, and everything else will eventually fall into place for you individually.*

*The caveat being you may feel like an outlier. But then you wouldn’t be the first or only provider to feel like one at their agency either.


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## mrhunt (Oct 10, 2019)

I've been an EMT doing everything actually. 911 on bls, als , a sprinkling of ift and also in the e.r. as a tech with an advanced scope and also a military medic... so I consider myself fairly well rounded.

Fire doesn't have a REASON to act like our bls crews are a hindrance. They act that way simply because it's a bls crew arriving to scene. To clarify.... Als ambulances aren't treated this way and neither am I.


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## Carlos Danger (Oct 10, 2019)

My first EMS job was with a private 911 agency that covered numerous municipalities. One of them was a very small (few thousand residents) city with a non-transporting BLS fire department that responded to every medical call in a squad truck.

Per our contract with the city, we couldn't respond to any call until the FD requested us. Didn't matter the nature or urgency of the call, or even whether we were closer, or that we went to every call they went to anyway because we transported every one of their patients. We'd hear them get toned out by the county for an obvious ALS complaint (asthma attack, chest pain, etc) and have to sit on our thumbs until the FD EMT-B's got on scene, assessed the patient, confirmed whether ALS was actually needed, and then requested an "ALS transport" or "BLS transport" as well as the response mode. They would tell the patient which hospital they were going to and what interventions, if any, they would have performed enroute.

There were many times that ALS interventions were needlessly delayed by these guys arriving first and playing on scene (er, I mean, "assessing the patient") for 5 or 10 minutes before requesting us. Predictably, our paramedics often disagreed with the diagnosis and treatment plan decided on by these EMT-B's, and it was a constant source of friction between the two agencies. Things only got worse when the agency went "EMT-I", because now these guys REALLY thought they knew what they were doing, and the delay between them arriving and them requesting us got much longer because now every patient was "ALS" and they pretty much refused to allow us on scene until they had an IV started.

It was a terrible approach to EMS which put the well-being of the patient exactly last, and unfortunately it wasn't an uncommon set up in this region. I also worked a fly car for the same agency in a very rural area covering multiple rural municipalities with whom we had similar arrangements.

Point is, I wouldn't assume that just because a new paramedic says he's having trouble with a BLS fire department, that it's necessarily because of his attitude.


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## mrhunt (Oct 10, 2019)

Like point in case...Just showed up to a call......Here was my report:

"Yeah this is mary, she's having troubling breathing. We couldnt get a pulse ox reading. 
If its respiratory she needs to get going to the hospital right now" 

And then cleared themselves which is against policy. 

And mind you this pt was completely stable,a nd had no difficulty breathing, Chest pain, Clear airway, SP02 @ 98% first attempt, Skins pink/warm/dry with her only complaint being a productive cough X6 months with clear sputum.

And i just smiled and thanked them for all their hard work and continued on with my pt.


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## DrParasite (Oct 10, 2019)

Well, if they are clearing themselves which is against their policy, that's something for their admin to handle (and if you feel that strongly about it, ask your admin take it up with their admin).  to be honest, if that's all the report you are getting, than it doesn't seem like they would be all that useful, provided they were on scene for more than 2 minutes.  There are some departments that are known for not being good EMS providers, and some that provide amazing care.

I used to work in a county where one particular career FD would clear themselves after 10 or 15 minutes.  It could get a cardiac arrest, CHF, or the sniffles, but after their 10 or 15 minutes of being on scene, they were leaving, even if we were just walking in the door.  

Honestly, at least they gave you the patient's name, tried something, and transitioned the provider/patient relationship over to you.  that is more than what some departments would do.


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## SandpitMedic (Oct 11, 2019)

The simplest answer to how to be a bad anything is forgetting where you came from, failing to remain teachable, and letting your pride get in the way of making rational logical decisions.

That goes for firemen, paramedics, and pretty much every other profession out there.


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## RocketMedic (Oct 13, 2019)

I used to be a pretty good paramedic, but I fear I’ve lost some of the sharpness due to my stint in Transfer Heck and the Wheelchair Chariot.


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## RocketMedic (Oct 13, 2019)

On a serious note, you really can’t “win” an inter-agency spat or fix much, so the best answer is to do what you’re doing...be polite and just roll with the punches. Me personally, I let them do them and don’t worry about it unless it’s clearly dangerous, in which case I just politely assume command. I find a decent answer is to let the fire captain run his show and I run mine.
Also, it can be very easy to make competency assumptions. To the average 911 medic like I used to be and wish I was, the dudes on the wheelchair van looked like failures...but now that I’ve been humiliated and find myself at a job where I go from 911 to CCT to BLS to wheelchair in literally the same shift I have a different perspective. It’s really really hard to quantify what “good” means because there isn’t really an adequate or appropriate definition of “good”.
There are good jobs, good clinicians, good employees, good friends,  good coworkers, good paramedics, etc. There are bad ones. And good ones can have bad days and bad ones can have good days. Even attitude isn’t a constant.


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## MSDeltaFlt (Oct 29, 2019)

mrhunt said:


> So Bit of specifics here.... i work in a county where private EMS is first in and County fire is Just BLS and assisting us.
> 
> Alot of them dont like it. they're all EMT certified but just show up to open doors, maybe take vitals and carry our bags...Despite this, easily 50% think they're better than us an that they run the show. alot of Them like to loudly complain about staff members saying that were "incompetent" or something...
> 
> ...



Before I begin please understand that I freely admit that I am not the sharpest tool in the shed.  I am not God.  I am not a god.  I do not walk on water.  I make mistakes, I have been wrong, and I will continue to do both.  And like everyone I strive to do both with decreasing frequency.  And being someone who is in his third decade of providing prehospital care I am still striving.

Now that's out of the way.

There are two different kinds of "bad" paramedics.  The least common "bad medic" I'll mention first.

First one:  Some people just aren't cut out for EMS.  Try as they might, they just simply keep making the wrong decisions utilizing the wrong algorithms in their patient care.  If you read their charts then it may seem that they are treating their patients just fine... until to also happen to be on scene and witness the fiasco first hand and you realize that what they might be saying what is going on with the patient is not what you are seeing is wrong with the patient.  These are the paramedics that are by far the worst ones and they probably don't realize just how dangerous they are.

The second and most common type of "bad medic" are the ones with delusions of grandeur who have forgotten that their sh@t still stinks.  These are the ones that emit the culture that can lead a new medic down the wrong type of personal path in their new career.  They  tend to be apathetic, judgmental, and self serving.

News flash.  I, myself, have seen the aforementioned character traits staring back at me in the mirror more times than I care to admit.  Do not let these descriptions become your descriptions.  Find you a mentor(s).  Those who have earned the respect of everyone around them.  Not just in knowledge and skills, but also in personal integrity.  Learn from them.  Learn how to own your career from them.  When I say "own your career", I mean own it: the good, the bad, and the ugly.  The good: when everything is going great.  The bad: when everything is going wrong.  And the ugly: when it's all your fault.


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## RedBlanketRunner (Oct 29, 2019)

@mrhunt One glaring little problem is it sounds like team effort is lacking. Out on scene every person can play a vital role in making the job safer, easier, and more effective. 
Where I was for quite some time we would periodically have meetings with all responders including S.O. and police, the focus usually being how can we better coordinate on scene. 
One outstanding lecture given by a fire chief of, no BS, 60 years in the FD delineated jobs by level of training. The weakest, most vulnerable persons were those of the highest level. They were total patient focus, handicapped to all else, unable to even get supplies very often. Then periphrial of the patient, foreseeing what the top level would need/require, then on down to situation then scene management and safety. Thus a trained EMT 1 was a critical component of an ACLS operation and the like. A non medical FD was a critical component in access, safety, watching walking wounded and on down the ladder. In a proper team operation, everyone is valuable.

So maybe some meeting are in order, hashing out how to work as a team most effectively?


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## mrhunt (Oct 29, 2019)

That would be an excellent idea. but unfortunately our company was just bought out and we've been in the midst of MASSIVE transitions for months now and this is the least of the issue on managements hands unfortunately.

Theres also the fact that it often falls down to certain crews only.....Some are EXCELLENT. Some show up and do literally nothing, and then i show up and They weakly say some excuse like "oh we just got here too" which i know is a lie..... Some crews dont want to be there and view medical aids as a hinderance that they HAVE to do and dont really want to.

Its obvious in their apathetic attitude and leads to me usually just clearing them pretty early and Working with my partner and thats it....


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## RedBlanketRunner (Oct 30, 2019)

@mrhunt Not good. Especially thinking of having a partner that may not be reliable. Just always remember the rule: CYA


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## mrhunt (Oct 30, 2019)

i know.....I know trust me. Luckily its a small enough company that i know exactly what partner i can rely on and who i cant. But regardless......I wish things were different but it'll just take time for now.


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## MackTheKnife (Nov 6, 2019)

mrhunt said:


> So Bit of specifics here.... i work in a county where private EMS is first in and County fire is Just BLS and assisting us.
> 
> Alot of them dont like it. they're all EMT certified but just show up to open doors, maybe take vitals and carry our bags...Despite this, easily 50% think they're better than us an that they run the show. alot of Them like to loudly complain about staff members saying that were "incompetent" or something...
> 
> ...


Perception of the wannabes, nothing more.


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## Frank frankerson ESQ (Dec 13, 2019)

MackTheKnife said:


> Perception of the wannabes, nothing more.


Most people are nice


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## Frank frankerson ESQ (Dec 13, 2019)

Frank frankerson ESQ said:


> Most people are nice


Do your homework while they have their day in the sun. You might win..


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