# Rubberneckers, Lookie Loos, and other Civilian Interference Stories



## Mountain Res-Q

After Hockey’s recent thread, I was wondering if any of you have any stories regarding passerby’s, family, or friends interjecting themselves (in an inappropriate fashion) into a scene?  They can be about whackers on scene (I’m a lifeguard, and you should do this…) or just people who want to see what’s going on that get in the way or well meaning  family and friends that feel helpless and don’t understand the need to let you do your job… but I really like the rubbernecker stories about people who jump into the scene and start asking FFs, Medics, and LEOs questions about what is going on.

Right now, about 800 FFs are fighting a 700 acre fire 10 miles north of my place, and despite the deputies shutting down all the forest roads, people are still finding their way into the fire lines to check it out.  We have all had those in EMS… how did you handle specific instances of that?


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## Medic744

Last week I had a sorta interference on a CPR.  We got toned out at the start of a shift for unknown major or minor MVA and about 2 min later they tell us its CPR in progress for approx 2 min.  We arrive on scene (the side of a major highway during am workday rush hour) to see a cop doing compressions, and 2 women in scrubs bagging and checking pulses/BP.  Sounds great right?  Except there were about 6 other officers standing around talking and the 3 people working on the patient were passerbys.  My partner and I jump in and start giving directions and doing our thing (intubating, line, drugs)  when I swear one of the RNs (saw her name badge) starts to tell us what to do.  She starts giving contradicting directions to the cop doing compressions and just generally in our way.  Good thing for us one of the off going crew stopped to help out, along with a local wrecker driver, and the fire department.  When we got the patient in the back of the truck the RN tried to get in with us and when my partner told her to get out she made a snotty comment about how the patient had no chance with us and was promptly escorted away by one of the local officers.  Not sure what happened to her after that, I was a little busy.


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## timmy84

A few years ago I was at the gym when a man collapsed on the treadmill next to mine.  I instinctively jumped off and pulled the safety key from his to stop it (and as a side not I always keep mine clipped to my shirt now), and put him on his back.  He has a carotid pulse, and was breathing adequately, but was not responsive.  I looked up and told the guy standing next to me to call 9-11, and just as he runs off this woman comes up and says she is a nurse.  Being a good follower of my AHA BLS training I turned the situation over to her more capable hands.  Unfortunately she immediately began doing chest compressions on the poor man (which fortunately were inadequate as she did not push down very hard).  I shouted at her to stop, and just then he started to come to.  She then told the man she saved his life by doing CPR (she maybe did 10 compressions at the most).  When the paramedics arrived they asked what happened of the bystanders and the "nurse" went on and on, but one of the medics saw me roll my eyes and took me aside and I told them what happened.  Once they were gone I asked the lady where she was a nurse at, she said a local nursing home, but before I could probe her more there were tons of people waiting to congratulate her on a job well done, the manager of the club even gave her 6 months of free dues.  The man ended up at the hospital where I work, where it was determined to be a vasovagal episode, from his extreme dehydration.  I met the nurse over a year later at the nursing home she stated she worked in while my grandma was in the rehab section of the place.  Turns out she was a QMA (qualified medication aide, a CNA who take an 80 hour course to be able to pass meds in a nursing home).  Well that is my story.


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## redcrossemt

Bad wreck with two engines, two rescues, three ambulances, lots of police cars. Freeway is down to one lane.

Guy stops in his Suburu, wearing shorts/t-shirt, runs up to us... "I'M IN A FIRST RESPONDER CLASS. WHAT CAN I DO?"


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## Mountain Res-Q

redcrossemt said:


> Bad wreck with two engines, two rescues, three ambulances, lots of police cars. Freeway is down to one lane.
> 
> Guy stops in his Suburu, wearing shorts/t-shirt, runs up to us... "I'M IN A FIRST RESPONDER CLASS. WHAT CAN I DO?"



Reply, "Thank God you are here.  Here's what I need from you.  Turn around... do you see that Subaru over there that is contributing to this congestion?  I was rumored that the driver is interferring with Emergency Personel in the act of performing their duties.  If you could find that guy for us, the cops here would really like to tazer him..."


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## Summit

Mountain Res-Q said:


> Reply, "Thank God you are here.  Here's what I need from you.  Turn around... do you see that Subaru over there that is contributing to this congestion?  I was rumored that the driver is interferring with Emergency Personel in the act of performing their duties.  If you could find that guy for us, the cops here would really like to tazer him..."



I just laughed out loud in class and am getting funny looks.

That said, we do encourage firm but professional dissuasion of overzelous good samaratins before resorting to being a smartass. These are the people most likely to speak of us to the community because they view themselves as a part of the actionor wish to be part of it. They can speak well of us or say "those guys are a bunch of arrogant rude asses." That said, sometimes you have to be extremely :censored::censored::censored::censored:ing blunt and funny helps.


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## Hockey

Not a negative incident but rather a positive

I had an anesthesiologist (patients wife) who just finished her ACLS stuff a week prior doing compressions when we walked in.  She witnessed the arrest and started CPR immediately.  First full arrest I was on so wasn't as useful as I should have been.

My partner took over compressions as I was readying up BVM and all that other good stuff.

I gave it to her and she took over that.  She told me "Alright, get the Combi-Tube and lets go"

She knew her stuff and was damn good at directing orders.  She knew we knew too but was just helping.

When our medic arrived, she was helping her with the drugs and all that good stuff (had a bunch of problems on that call)

The guy was a save.  PD beat us on scene (was right down the street) (so were we) and they were on scene in under a minute of 911 being called.  Shocked him.

Talked to the guy a few weeks ago and is back out being his normal self.  Had a central mi, and pe and still survived.  Hot damn


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## redcrossemt

Mountain Res-Q said:


> Reply, "Thank God you are here.  Here's what I need from you.  Turn around... do you see that Subaru over there that is contributing to this congestion?  I was rumored that the driver is interferring with Emergency Personel in the act of performing their duties.  If you could find that guy for us, the cops here would really like to tazer him..."



We were less sarcastic, but I didn't laugh like I just did either. I need to interject more humor into my work.


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## timmy84

redcrossemt said:


> We were less sarcastic, but I didn't laugh like I just did either. I need to interject more humor into my work.



My instructor once told me that that a man of Romani (more commonly known as a 'Gypsy') descent pulled a knife out on him and told him to deliver his baby, but not to look at his wife's vagina.  Fortunately another unit was dispatched with a female medic.


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## usafmedic45

Mountain Res-Q said:


> Reply, "Thank God you are here.  Here's what I need from you.  Turn around... do you see that Subaru over there that is contributing to this congestion?  I was rumored that the driver is interferring with Emergency Personel in the act of performing their duties.  If you could find that guy for us, the cops here would really like to tazer him..."


That gets my vote for the best post EVER on this forum.  Well done sir, well done.


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## usafmedic45

One of my personal favorite calls was the guy who decided we were taking too long getting the motorcyclist who was run over (and I mean that literally, he was pinned uder the SUV) out of the way and traffic flowing again.  Sheriff's deputies and state police were on their way but had not got there yet.   So here we are trying to work on this guy with the road completely blocked by the SUV and our rescue truck and the idiot (a 20 something guy dressed like your stereotypical frat boy in a Mazda Miata) starts honking and screaming obscenities at us.  That's when I noticed that behind him was a group of bikers- like Hell's Angels bikers, not like "Wild Hogs" bikers- and one of them apparently got tired of hearing this tirade and walks up to the driver's window.  Mind you, the biker was roughly 6'2" and probably 300 lbs (to quote _Boondock Saints_, "One huge ****ing guy").  He reached in, grabs the driver by his shirt and pulls him out the seatbelt (it was still fastened) and out of the car and goes "SHUT THE **** UP.  NOW.  If I hear another word out of your ****ing mouth I will feed your balls.  Those guys are trying to help a fallen biker and I don't like that you're being disrespectful.  Do I make myself clear?"  

I think the guy promptly ****ing AND ****ing his pants could be taken as a definite "Yes, I heard you and plan on complying."   The biker dropped him on the ground and stood over him until the ambulance crew left the scene.   The state trooper got there and asked what the angry looking biker and the scared "frat boy" (exact words from the trooper) was all all about and one of my coworkers goes "Oh, our big friend there was nice enough to give the kid a very eloquent lecture of proper respect for EMTs and firefighters."  The trooper seemed quite confused by all of this.


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## Hal9000

*Car vs tree with ejection at night.*

Pt. is bleeding and not doing as well as we would have liked.  He kept asking about his dog.  Of course, we didn't know how his dog was doing.  Out of the dark a lady runs up and throws down a mass of fur and blood and yells, "HIS DOG IS DEAD!  IT'S DEAD!"

I don't know what we'd have done if she hadn't thrown the carcass at our feet. :glare:


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## Sasha

Nothing too terrible... I've had a family member (This is one of the "OH THANK GOD YOU ARE HERE!!!!" patients) insist the patient could walk to the stretcher (She didn't want us to "drop him" so wanted him to walk, probably because we were both small looking females.) That's all well and good, BUT the patient had multiple fx and according to their charts and orders was non weight bearing AND if they walked they were going to foot the bill because medicare would reject the claim. We tried to reassure her and such but eventually just found two strong looking males, one tech one nurse, to sheet lift him over.


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## Sail195

I wish I had a good story for this thread but i am too new lol but this has just made my morning!!!!!!!!


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## Fireguy

Well they really didnt interfere but it bothered the crap out of me.   Cardiac arrest inside a resturant.  I was on the first arrival piece(rescue-engine), and we walk in and start CPR and prep for the AED. These two guys are sitting at the table right next to us, watching and still enjoying thier meal like they were watching TBS "Dinner & a Movie". 

Hal9000, we had the same kind of thing. PT in bad condition but refused care until we found her dog who ran away after the crash.  Luckily for us it had just snowed so we just had to follow the paw prints.


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## NC13

Working up at the local ski area as a ski patroller on a teenage kid who had a snowboarder vs. tree head on collison (literally head first into the tree) no major trauma but a good size knot on his forehead (no helmet ofcourse) and was AOCX3. We were getting him on the backboard and all that and out of nowhere this middle aged man skis by an says "Do you need a Doctor? Im a doctor." We politley refused and said we could handle it.  After getting the pt down and handing him off to the medic, I was walking to the locker room and saw the doctor. He recognizes me and explains that hes a gynecologist.:unsure: Not sure what he could have done for a teenage boy w/ a head injury.


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## NJN

NC13 said:


> After getting the pt down and handing him off to the medic, I was walking to the locker room and saw the doctor. He recognizes me and explains that hes a gynecologist.:unsure:



I can't quote the exact rule # but one of the rules of EMS is that every doctor on scene is assumed to be a gynecologist until proven otherwise.


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## Mzcr

Because obviously gynecologists never learn anything about medicine beyond looking at vaginas. I don't even know what they do the other 9 years of school.


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## Mountain Res-Q

Mzcr said:


> Because obviously gynecologists never learn anything about medicine beyond looking at vaginas. I don't even know what they do the other 9 years of school.



Not saying they don't know anything about medicine, but how much do they know about street EMS?  A Dentist gets called "Doctor" same as a Trauma Surgeon does, but who should be trying to put you back together after a MVA?  If it is a childbirth call, then I defer all pt. care to the first Doctor who identifies themself as a OB and wants to assume pt. care.  If this OB had demanded that NC13 reliquish pt. care to him, then fine... he has that legal right.  But, I too have experienced those people who show up on your scene and identify themselves as Doctors who turn out to be Dentists... great... his teeth are fine... Sure he has medical knowledge that is superior (in some areas) abd different to mine; but I train and work in Field Emergency Medicine, a setting that differs from what s/he does.  In most cases, people who identify themselves on scene and try to assume pt care are more of a hinderence who are only there becasue they have some medical liscence.  A phyciatrist is a Doctor, but I would rather have a Paramedic working on me on scene of an accident... wouldn't you?  Cae in point... at the snow park 2 years ago we had a midshaft humerous fracture on a 40ish female.  As we are treating, she identifies hereself as a Doctor.  To which we said to lighten the mood, "Oh, well then you should tell us what to do."  (Tone was conversational.  She was nice an we were bring good providers - physically and emotionally.)  To which she said, "Im and OB/GYN.  I would have no clue how to handle this.  You guys know what you are doing."  Bingo!  Thanks!  Yes, her knowledge is far superior to mine, but I know EMS and have been doing it in that environment for years... something she acknowledge and let me treat her.


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## NC13

I agree that an ob/gyn has far superior knowledge to myself, but as MtnResQ said its completely different performing emergency medecine in a tree well at dusk compared to a comfortable office where you get a lollipop after your done. Theres a reason that our patrol requires everyone to go through their medical course (OEC-Outdoor Emergency Care). This has included in the past, doctors, firefighters and emt's. its a whole different ballgame out in the cold and snow. Its pretty hard backboarding someone as your slipping down the snow.


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## Bloom-IUEMT

Let's see what can a doctor do:
Take BP and vitals
hold c-spine
help backboard
help to lift the backboard
determine LOC
determine medical hx
Trauma assessment (yes believe it or not even an OB/Gyn can see bruising and deformities)
Cranial nerve assessment (are paramedics even trained to do this?)
treat for shock
splint (really its not brain surgery)
start on IV/venupuncture
setup an IV
obtain lung sounds
put on a NRB or NC
BVM if needed
intubate if needed
ACLS is required for most if not all OB/GYN's
Interpret arrhythmias
CPR
manually stabilizing a fx
prescribe medication if patient refused transport (that's a big one! )
 I'm sure there is more I'm neglecting but the idea that a physician can't help in an emergency situation is ridiculous.  Emergency medicine is required by all physicians (even psychiatrists).

I am disappointed because this statement bespeaks the attitude some paramedics have that they are Jesus incarnate and that no medical authority can match wits and knowledge.  
And if a dentist comes to a scene and says that s/he is "doctor" that is bordering on criminal misrepresentation of licensure.  That person was announcing his or herself as a "physician."


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## usafmedic45

> And if a dentist comes to a scene and says that s/he is "doctor" that is bordering on criminal misrepresentation of licensure. That person was announcing his or herself as a "physician."



I've had several dentists offer assistance in restaurants, on golf courses and in other public settings over the years .  Normally it's "I'm Dr. Soandso, a dentist.....can I help in some way?"  That's not criminal misrepresentation.  It's just the fact that on these forums people seem to leave out the key bit of how most introduce themselves that leads to assumptions like you have made.   



> prescribe medication if patient refused transport (that's a big one! )



Which I have never seen nor heard of happening.  Many docs are so risk averse that they would not do it unless the patient was one of theirs before the call.  I don't know many docs who carry a prescription pad around with them while off duty and don't think many are prone to just randomly calling in scripts for people they meet and don't know. 



> I'm sure there is more I'm neglecting but the idea that a physician can't help in an emergency situation is ridiculous.



But it is often the case.  On several occasions, I've seen docs pressured into assisting by their wifes, friends or other bystanders who know their occupation.  It's not uncommon to hear comments like "I'm out of my element and don't have any experience at this....what do you want me to do?".  In fact, that's probably the most common first question I've heard out of doctors on scenes in my decade or so of experience.   The ones who tend to overestimate their abilities in my experience are nurses and off-duty EMS personnel.  



> Emergency medicine is required by all physicians (even psychiatrists).


No, actually it's an _elective_ at most medical schools and even during residencies that require ED rotations (which not all do) there is a big difference between rotating through an ED and actually becoming competent.  Even then, would you want someone who hasn't seen an emergency patient in years telling you what to do?   Most docs know when they are in over their heads and are the first to say so (often quietly so as to save face).  Why should we assume they are medical supermen who trump our skills when many don't simply because they have more generalized education? 



> Cranial nerve assessment (are paramedics even trained to do this?)



Better question: does it really have the much utility in the field?  

BTW, yes, most of the paramedics I know can tell you how to do a basic cranial nerve exam as would be needed for the prehospital assessment of a patient with possible deficits. 



> start on IV/venupuncture



Ever heard the phrase "perishable skill"?  Even a lot of EM docs I work with are rusty on their IV skills.  Outside of anesthesiologists, I don't know many docs who start their own IVs very often.  



> BVM if needed



See above.  It's a hard skill to master, one that fades rapidly when not used and one I would hesitate to put in the hands of someone I did not know was recently practiced at it.  



> intubate if needed



Definitely see above under "BVM if needed".  You're talking one of the most danger laden skills in EM/CCM.  Not something you want to let a family practice doctor try since he probably hasn't tubed anyone since his internship.  Actually a lot of new residents I have met say they've never tubed anyone because the anesthesiologists they rotate under are not willing to let them do it and force them to simply observe or use things like LMAs because of the better safety profile.  



> ACLS is required for most if not all OB/GYN's



That does not mean that anyone who passes it is the best qualified person to run the show.  Ever seen the studies showing how fast ACLS and similar knowledge fades without review or application?  



> Interpret arrhythmias



Once again, something that your skills at fade very quickly without practice. 

Just because someone is a doctor (without regard to specialty) does not mean they know more than an EMS provider anymore having an EMT-P implies they know more about managing asthma than say a respiratory therapist as an example.


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## EMS49393

I work in an urban arena.  Most of my interference is from family members screaming "Oh Lord, Oh Lord, Oh Jesus, Oh Lord Jesus, help them Lord" over and over again.  They also tend to place their big rear ends right in my way when I'm dealing with the patient.  Mind you, these are normally patients that have little more wrong with them then a bruise from falling off the couch in a drunken oblivion.  

My favorite though... a minor MVC, not even any damage to the cars, and perfect do-gooder strangers tell everyone inside the vehicles "you need to go to the ER and get checked out since they're (us) here anyway."  No, you really don't have to, hell you don't even need anything more than some strong turtle wax to buff the scratch out of your bumper.


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## kecpercussion

Haha sounds typical of most people


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## Mountain Res-Q

Bloom-IUEMT said:


> Let's see what can a doctor do:
> Take BP and vitals
> hold c-spine
> help backboard
> help to lift the backboard
> determine LOC
> determine medical hx
> Trauma assessment (yes believe it or not even an OB/Gyn can see bruising and deformities)
> Cranial nerve assessment (are paramedics even trained to do this?)
> treat for shock
> splint (really its not brain surgery)
> start on IV/venupuncture
> setup an IV
> obtain lung sounds
> put on a NRB or NC
> BVM if needed
> intubate if needed
> ACLS is required for most if not all OB/GYN's
> Interpret arrhythmias
> CPR
> manually stabilizing a fx
> prescribe medication if patient refused transport (that's a big one! )
> I'm sure there is more I'm neglecting but the idea that a physician can't help in an emergency situation is ridiculous.  Emergency medicine is required by all physicians (even psychiatrists).
> 
> I am disappointed because this statement bespeaks the attitude some paramedics have that they are Jesus incarnate and that no medical authority can match wits and knowledge.
> And if a dentist comes to a scene and says that s/he is "doctor" that is bordering on criminal misrepresentation of licensure.  That person was announcing his or herself as a "physician."



No one is disputing these facts.  However, dispite the fact that a Doctor can do everything an EMT and Medic can do, several points stand out:

1.  If the Doctor can do perform procedures, the equipment must be on scene.  If it is on scene, it is being carried by the EMTs or Medics.  If they are carrying it, they must be able to use it... so why do you need the Doctor to do it?  In the case mentioned we are talking about ski patrollers trained to a OEC-BLS level... what are they carrying that only a Doctor could use?

2.  We are talking about Prehospital Emergency Medicine, something few Doctors are truely familiar with.  Largely Doctors work in Hospitals and Offices, most do no realize what needs to be done in the prehospital world to get them to the Hospital.  In this case we are talking about a Frozen Mountain at 7,000 feet.  The Ski Patrollers have the training, experience, and familiarity with the protocols to get eh job done every other day of the week... what realisticly does the OB have to offer that the Patrollers do without every other day of the week?

3.  No one is saying they are better than the Doctors who offer help, but we know our job better than they know our job.  I have no issue accepting help when needed or accepoting it when forced upon me by law, but do I or the pt. really need it?  If the Doctor feels that the pt. does, then it is within their ability to insist and take the scene.  However, having an MD after your name doesn't make you an expert on everything.  On SAR we get Paramedics, EMTs, and Doctors joining up.  I'd rather have OEC or other wilderness certified people on medical calls with me... why?  They understand the environment. and the application of even their lower version of medicine in those unique circumstances.

If a Doctor wants to take the scene from me... hey whatever... it is their right, but from that moment onward than responsibilty lies on them (ALL OF IT).  But in my experience, how ofter is that needed... and how often do the Docs really want to go that route?  Just like a good EMT or Medic will acknowledge that the Docotr has supperior medical knowledge, a good Doctor will recognize the fact that the field personel are not just trained monkeys and allow them to do the job they are trained and experienced to handle.  IMHO.


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## amberdt03

Sasha said:


> Nothing too terrible... I've had a family member (This is one of the "OH THANK GOD YOU ARE HERE!!!!" patients) insist the patient could walk to the stretcher (She didn't want us to "drop him" so wanted him to walk, probably because we were both small looking females.) That's all well and good, BUT the patient had multiple fx and according to their charts and orders was non weight bearing AND if they walked they were going to foot the bill because medicare would reject the claim. We tried to reassure her and such but eventually just found two strong looking males, one tech one nurse, to sheet lift him over.



i once had a family member ask if we could just take the hospital bed to transport her mother........female crew and we were taking her back to a nursing home with a hip fracture......we were like no maam it won't fit in our ambulance, and i don't think the hospital would be to happy with us taking one of their er beds with us.


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## silver

FYI before you blow off OB/GYN docs, in most residency programs they do internal medicine, and intensive care rotations and a lot elect for emergency medicine rotations. So someone fresh out of their residency should know there stuff. Of course they don't work in the field, but don't blow them off like they only know OB/GYN. Use them as a resource when needed (which isn't often that we need help, but it does occur).


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## Bloom-IUEMT

To be clear I never the doc should take control of the scene---I said they can assist. An ob taking over an emergency scene is an ego move, just like saying an ob doc can only be involved in babies and vaginas. 

I apologize because I assumed ER is a requirement for all schools.  Though it is a requirement for MANY schools and chances are (especially an ob) has been trained to do it.  
And let me be clear----did you in fact say using a BVM is a difficult skill to master? Putting a mask on someone's face and squeezing a bag every 5 seconds......In my state, well I guess your state too, BVM is a BLS skill   We even let lay responders do it if we need an extra set of hands.


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## Rob123

HEY... Wait-a-minute, I was one of those Civilian Rubbernecking Lookie Loos.

Background:
I am a Volunteer EMT and was having lunch from my paying job.
We were at an extremely large dairy supermarket with picnic tables and a petting zoo that was closed for the season.

I overheard the two-way radio of security guard indicating a "Confirmed unconscious female behind the petting zoo."

I walked towards the scene and a guard stopped me.

I explained that I was an off-duty EMT from New York City and wondered if there was anything I could do. He smirked and said everything was under control.  *He then stepped aside allowing me to see that somebody was placing an AED on... Rescue Anne!!!!

*I was so embarrassed.
Apparently they were performing a mock-rescue, drill or something similar.


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## ffemt8978

BVM is an easy skill to learn, but is not so easy to master.  I think that's the point he was trying to make.


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## silver

Rob123 said:


> We were at an extremely large dairy supermarket with picnic tables and a petting zoo that was closed for the season.



Stew Leonards?

stew's is awesome...


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## Dominion

I don't know if I would feel comfortable letting a doctor take over the scene at all.  There is only two docs I would feel comfortable turning the scene over to around here and one is a medical director for many EMS agencies who really knows his crap, the other is a friend of mines dad who happens to be an ER doc with alot of experience and also really knows his crap, pre hospital and otherwise.  Unless I knew the doc to be an active ER doc I probably would not turn over the scene but would ask them to step back.

At the most I was told in my last job that if an active ER doc showed up on scene requesting control, I was to contact the hospital he claimed to be afiliated with, ask for ID, and then confirm with that hospitals on call MC if it was ok to defer the scene to that doc.  Then my *** was covered and I would assist him into the hospital (which had to be his hospital or hospital group)


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## Rob123

silver said:


> Stew Leonards?
> 
> stew's is awesome...



Yes, Stew's in Yonkers, NY.
And they are awesome in many respects.
(I have actually seen several documentaries about the company)


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## usafmedic45

> An ob taking over an emergency scene is an ego move,



...except that an OB is about the 4th most experienced field in terms of resuscitation you're going to find in a hospital (behind EM, anesthesia, and surgery).



> Though it is a requirement for MANY schools



Actually according to the numbers given at the AAEM meeting last year on the state of EM education, it's a _requirement_ at <20% of schools. 



> did you in fact say using a BVM is a difficult skill to master?



Yes, I did.  



> BVM is an easy skill to learn, but is not so easy to master. I think that's the point he was trying to make.



What he said.  

Almost anyone who has a decent amount of experience and doesn't have a narcissistic streak a mile wide will tend to say pretty much the same thing.  It's arguably the skill people have more trouble with in EMS than probably any other....you just don't hear it discussed as such since it is considered a "low level" or BLS skill and there is a pervasive attitude of "Well, if I can't ventilate, I'll just tube 'em" which is a mistaken and very misguided belief that gets a lot of people into a lot of trouble.  



> Putting a mask on someone's face and squeezing a bag every 5 seconds......In my state, well I guess your state too, BVM is a BLS skill



BLS =/= simple.  The fact that you made such a statement with the implications you've given it means you're either _really_ ignorant, _really_ inexperienced or both.



> We even let lay responders do it if we need an extra set of hands.



I think your medical director and likely the state EMS commission would have a serious problem with that.   

Seriously....stop and think for a second about what you just said.  Any competent attorney- hell an incompetent one on a bad day after a few drinks- would hand you your *** on a platter if such a case wound up going to court (don't laugh, more EMS cases go to court than people seem to think) and that little bit of trivia came to light.  Just because it's a "BLS skill" does not imply you can put a BVM into the hands of an untrained civilian because you need a spare set of hands.   We don't "battlefield commission" people to practice our skills because we need extra help.  

If you don't have enough people to do what you need to do beyond the airway, nothing gets done beyond the airway.  I mean what else are you doing as an EMT-B that is so important that you're going to hand the airway (the thing that if you screw it up will kill the patient faster than pretty much anything else) off to someone with zero training?


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## GR1N53N

On the (already beaten to death) subject of efficacy of doctors in the pre-hospital care scenario:
I was with an ER nurse in a BTLS class (along with a bunch of fresh-from-school paramedics), and we were supposed to be quickly demonstrating that we could size and collar a patient, so that the instructor could sign us of on that banal (or so he thought) skill.  He turned to the nurse, and she immediately said, "I've never put one on before, all I do is take them off!"  Which got a good chuckle, and made us all realize that while this RN probably knew more than all of us about emergency medicine, that did not necessarily translate into knowledge of pre-hospital care skills or protocols.
Just something to note in regards to having allied health professionals on scene.


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## Melclin

+1 on the already +453266236 subject.

Aside from the issue of forgetting stuff they learn't years ago,

1. They're not up to date. Esp not with pre-hospital stuff. How many OBGYNs/shrinks/GPs/nephrologists...etc would know not to give fluids to penetrating thoracic trauma, or be familiar with the latest guidelines for o2 admin in stroke pts? Bugger all.

2. Most doctors, even the ones familiar with emerg medicine will have trouble in the pre-hospital setting. It's so much different when you are not in the controlled, familiar environment of the hospital...All the nurses doing my degree say that. 

3. With less gear, less help, less technology, the approach is different. I just started volunteering for a bit of experience and fun with St. John's ambulance (volly organisation, provides first aid/AED at events, first aid training to public etc). So I'm doing their scenarios and training stuff, and I find that without what I thought were basic tools: stethoscope, BP cuffs, cardiac monitors, pulse ox, thermometer, BGL and our normal array of VSS assessments, I feel quite hamstrung. Another eg: doing CPR with an AED... I didn't know that I had to keep doing compressions until it decides it wants to analyze again...here I am pressing buttons after my 5 cycles trying to get it to analyse the rhythm. How do u go about relieving pain when you can't use drugs? Its not rocket science, but I have to take a step back and think, where as a first aider  who has trained specifically in that lower level, doesn't. 

Stepping down from paramedic to first aid, caused me quite a few troubles. I would imagine that a doctor stepping down to first aid would have even more.


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## FFMckenzie

I have one from a few years ago. The dispatch was tour bus vs vehicle no further information. The engine I was on was first at scene.

I was assigned to the vehicle a honda accord the bus had minimal damage so the captain went to asses the bus and occupants. There were no injuries.

The left side (drivers) of the vehicle had over 24 inches of intrusion the right side of the vehicle was un damaged. I went through the right rear door to find one patient in the passengers seat. 

Did my initial and by that time the medic showed up to pick up because I was stuck holding manual c-spine. Also I forgot to mention this was during the end of a marathon run so there were 30-40 bystanders.

 It hits me then, why do we have one patient and she is in the passenger seat. Im asking her if she was driving she says she does not know. She was AOx3 did not know what happened. 

Captain comes over asks "where is the driver?" I answer, "I have no idea she has no idea" he walks to the drivers side of the vehicle to find the seatbelt cut clean. 

We get her on the board the medic is exposing and Im still holding manual. I hear the captain yelling at the crowd "did anyone see where the driver of this vehicle went".  

We get her in the ambulance they take off.

 I go back to the captain   to see what he wants to do about finding the driver he is standing with a civ off to the side and he says "forget it she was the driver go ahead and start cleaning up". 

Now I can hear some yelling I cant make certain what exactly is being said but its between the captain and they guy that I did happen too see standing in the back of the crowd of onlookers as we extricated her from the vehicle. 

I find out the guy was a doctor and for what ever reason (none of us could ever come up with one) he cut her seatbelt and moved her to the passengers side of the vehicle and slipped back into the crowd, when the captain was yelling for some information on the driver another onlooker pointed to the doctor. Needless to say the captain was very angry with this "doctor".

I know it was not a very exciting story but it proved to be a somewhat confusing call. Ironic but the doctor turned out to be a chiropractor.


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## WolfmanHarris

I have allowed one bystander to BVM a patient for me. They were an RRT attending for homecare when the pt. arrested. I was still a student and decided she'd be more competent to bag at this point then me. My preceptor gave me the nod and I continued to run the arrest while he confirmed the circumstances with the family and got the pronouncement. (N-stage lung CA, no DNR but had only be diagnosed the day before. Give no more then a month and had come home to die. RRT was there as part of palliative care plan.)


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## usafmedic45

> They were an RRT attending for homecare when the pt. arrested.



Exactly.  If they have their license and can prove their credentials, I have no problem with them offering assistance.  As for handing the BVM to a drunk frat boy like the IU campus EMT suggested and going "Here...have fun"....totally different ball game.


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## Bloom-IUEMT

YES YES YES I am inexperienced.  No need for name calling though, you may leave your ego intact.  
Why is BVM difficult skill to master?? What about it makes it difficult, I'm curious because I've only done a couple of times.  There is not many components to it.  Do people find it difficult to obtain a tight seal on the face because Ive had difficulty with that.
But seriously, check the ego.  I've never would have believed I would be scolded so much as I am by paramedics---many "old dogs" (and I am referring mostly to the service I work for) seem to forget they were new once and don't realize all the knowledge they have I won't obtain in a week of working EMS.  "OH my god!! you don't how to do that!! What the hell!! You are stupid/ignorant/incompetent and you will never be as brilliant as me!"  It makes me wonder why anyone would want to continue being an EMT.  But I suppose that's another thread--


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## Bloom-IUEMT

Another question-- I was taught, and I'm sure this never happens, that if we happen upon a scene where someone is doing CPR and its pretty much you and them---you set up the AED and instruct them how to use the BVM.  Is this not correct or practical?


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## usafmedic45

> Is this not correct or practical?



Not under any training program I am familiar with and I've been an EMS clinical and adjunct classroom instructor (with a focus on airway management), CPR and first aid instructor, ACLS instructor, PALS instructor and NONE of those courses have ever suggested (so far as I am aware): 


> you set up the AED and instruct them how to use the BVM.





> I was taught, and I'm sure this never happens,



Are you sure you're not confusing what you were taught in preparation for your practical skills exam (where you are pretty much assuming they are trained in the use of the equipment....the "ghost" helper scenario as we called it)  and what is taught to actually be done in real life?  I know in many of the cardiac stations I've precepted, the scenario involved responding to a situation where another EMS provider was doing CPR awaiting the arrival of the AED and additional equipment.  Normally the "instruct them" clause was taken to mean "How many compressions to ventilations do you want?  What's the proper rate of ventilation?", etc.  It is more a way of measuring the ability of the  person being tested to rapidly recall the basics of cardiac resuscitation rather than being an indication you should be "instructing" in the literal sense. 

An emergency is not the situation to be teaching an unskilled bystander to bag someone with an unprotected airway.  That is really about all I should have to say.  It's not exactly a complicated concept.



> Why is BVM difficult skill to master?? What about it makes it difficult, I'm curious because I've only done a couple of times. There is not many components to it. Do people find it difficult to obtain a tight seal on the face because Ive had difficulty with that.



It has to do mostly with several common errors and the limited amount of time people spend practicing BVM ventilation.   The fact that they view it as a "simple" technique without a lot of "components" is the main reason for this and the attitude that causes such overzealous underestimations of the procedure and its permutations is something to definitely avoid. 

The mistaken belief that you push the mask onto the face is a major reason why people- of all training levels and often experienced providers- fail to achieve good ventilation.  The trick is to pull the face into the mask.  This is where the C-E clamp technique (it's described in most EMS textbooks and the ACLS manual) comes in handy.  Also keep your fingers on the edge of the mandible and not the soft part of the neck under the jaw to avoid shoving the tongue up and back thereby occluding the airway.   Those are the two main problems (along with poor head positioning or inadequate jaw thrust) that I've seen causing issues with BVM ventilation both in-hospital and out of hospital. 



> But seriously, check the ego



No ego....just being blunt.  I see no point in trying to make it "nicer" which would have just made the points less clear.  This is a technical and professional discussion and it gets a little pointed at times.  That doesn't mean "ego" is at play.  It's just how things come across when explained bluntly without the body language to imply that the person posting is not being a jerk but rather just firm with the reader.  I'm sorry if I offended you.  That wasn't my intention...



> many "old dogs" (and I am referring mostly to the service I work for) seem to forget they were new once and don't realize all the knowledge they have I won't obtain in a week of working EMS



Not many of us truly forget it, but we do become particularly aggressive in correcting the same mistakes we see time and again (often the same ones we ourselves made as rookies).  How do you think most of us obtained that knowledge?  We screwed up, made the same mistakes or were misguided in the same way you are and someone chewed on our a** for it.  We're all adults, we should be able to handle a little criticism and even a little browbeating should it become absolutely necessary without pulling a Cartman ("Screw you guys, I'm taking my ball and going home!").  



> "OH my god!! you don't how to do that!! What the hell!! You are stupid/ignorant/incompetent and you will never be as brilliant as me!"



I've had all of those yelled at me at one point or another (actually I've had most of those said to me by rookies on this forum who think their excrement is not particularly odorous)....and so has just about every veteran member of this forum.  What's your point?  



> It makes me wonder why anyone would want to continue being an EMT.



Because we realize the criticism is not usually directly personal (it could be just as easily aimed at anyone who makes the same mistake, and not just at you)  and take it for what it is:  An indication that we need to work on something, be it a skill, our attitude, our knowledge of the science underpinning our practice.  Instead of being a sore-tailed cat in a room full of rocking chairs looking for the way out, how about taking the criticism as an impetus to become the best damn EMT in Monroe County?  If you have any questions and don't feel like airing them publicly, PM me and I'll be happy to help or to direct you to someone on here who can.


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## Melclin

usafmedic45 said:


> No ego....just being blunt.  I see no point in trying to make it "nicer" which would have just made the points less clear.  This is a technical and professional discussion and it gets a little pointed at times.  That doesn't mean "ego" is at play.  It's just how things come across when explained bluntly without the body language to imply that the person posting is not being a jerk but rather just firm with the reader.  I'm sorry if I offended you.  That wasn't my intention...
> 
> Not many of us truly forget it, but we do become particularly aggressive in correcting the same mistakes we see time and again (often the same ones we ourselves made as rookies).
> 
> PM me and I'll be happy to help or to direct you to someone on here who can



Honestly, this is how half the arguments on this forum start. I know from experience how people can _seem_ when you're new to the forum. It would be nice if more of the forums veterans would explain that easy little mistake like this.  

.


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## WuLabsWuTecH

Bloom-IUEMT said:


> Another question-- I was taught, and I'm sure this never happens, that if we happen upon a scene where someone is doing CPR and its pretty much you and them---you set up the AED and instruct them how to use the BVM.  Is this not correct or practical?


Where's your partner?

Running Medic-Basic, Medic is on the ACLS and defib, Basic is on the airway, bystander is thumping, once LEO or engine gets there, change in LEO or FF for bystander.

Running basic-basic, one guy on AED, one guy on airway, bystander is thumping.  You uh... just might wanna call for ALS though!


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## Bloom-IUEMT

At risk of  getting the thread off topic I'll say thanks for the advice.  JUst pushing the mask down and not getting a good seal was the problem I had with my first instance of CPR.  You are correct in assuming that I am referring to the practical skills test when it says *instructs first person on proper rate and ventilation of BVM* or something to that affect.  
But before I started in EMS I made a pact with myself not to take it personally if my partner scolds me for an improper technique.  The problem though is I am not being scolded on patient care, I'm being scolded on some bs things I shouldn't be scolded on.  Like:  this is how *I* want you to do paperwork because my old partner did it this way and all other medics want it done this way (which is not true).  Or:  *YOU* forgot to hook up the R Arm 4-lead even though we were both hooking up 4-leads.  My favorite is when a medic mumbles something and says "why don't you listen when I talk"  But I suppose that is because I'm new.  

And to keep this post on topic--- This didn't happen to me but to my instructor and its one of my favorite stories and I don't have one of my own yet.
He came upon a MVC that was pretty bad and he goes to a car that was damaged pretty bad that was leaking gasoline all over the road.  So he's trying to get a patient out and he's standing in a puddle of gas holding c-spine and a person who sees the wreck goes up and stands in the puddle of gas puffing away on a cigarette saying "what can I do to help?"  So my instructor tells to back away, back away until he's out of the puddle and says to him to put the cig out.  Haha, my instructor says he was afraid to say put out the cigarette because the guy might've thrown it down in the puddle.


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## rescuepoppy

Bloom-IUEMT;168127.

And to keep this post on topic--- This didn't happen to me but to my instructor and its one of my favorite stories and I don't have one of my own yet.
He came upon a MVC that was pretty bad and he goes to a car that was damaged pretty bad that was leaking gasoline all over the road.  So he's trying to get a patient out and he's standing in a puddle of gas holding c-spine and a person who sees the wreck goes up and stands in the puddle of gas puffing away on a cigarette saying "what can I do to help?"  So my instructor tells to back away said:
			
		

> If someone gets that close to a wreck with a fuel leak with a cigarette while i am in the hot zone. he will get some less than friendly advice that he has somewhere else he needs to be.


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## HokieEMT

Fireguy said:


> Well they really didnt interfere but it bothered the crap out of me.   Cardiac arrest inside a resturant.  I was on the first arrival piece(rescue-engine), and we walk in and start CPR and prep for the AED. These two guys are sitting at the table right next to us, watching and still enjoying thier meal like they were watching TBS "Dinner & a Movie".
> 
> Hal9000, we had the same kind of thing. PT in bad condition but refused care until we found her dog who ran away after the crash.  Luckily for us it had just snowed so we just had to follow the paw prints.



My dad has too many of the same story.  There is a reason he won't eat at Double T Diner(local place), Golden Corral, and many other buffet styles places.  He has even had ones where the pts friends pick up what the pt was eating and eat it.


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## HokieEMT

I had one this summer not too long after i got home from college.  IT was a difficulty breathing pt and we were dispatched with the next closest career medic so we were basically the 1st Responder.  We walk in and we havent even talked to the Pt when her friend is already asking "Where are you guys gonna take her" (there are multiple hospitals that we can transport to in the Baltimore Metro Area).  She gives us like two bits of info on the Pt and then goes and gets the kids and comes back out and is like "I have to know right now where you're taking her," at this point the medic is there and he kinda shoves her of on us lol.  He makes his decision from his first impression and that was that.

Its kinda funny because I play this "lookie loo" role a lot due to my job in our Corps of Cadets.  Im the Regimental Medcial Officer so im in charge of the medical care and the EMTs within the Corps.  We are basically Pre-EMS so were always there with a set of vitals and write up waiting for VT Rescue lol.  Unless the situation dictates we are hands off once Rescue shows up except for maybe helping with the stretcher or movement.


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## Seaglass

Apparently we have some old civilian in the area that will lecture crews on our gas-guzzling vehicles and money-wasting ways. I thought he was an urban legend, but he struck again at dinner at last night.


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## Mountain Res-Q

Last night there was a fire down the road from me about a mile.  Fully involved structure fire and was dispatched out as "explosions in the house and one victim trapped inside".  Deputies were requested to respond from the word GO or 2 reasons: 1. There were people that were trying to reenter the houes to look for the missing person, which would have been futile and even more deadly as the house was already starting to collapse when the first Fire units arrive on scene (3 minute response time)... and 2. The (and I quote the Battalion Chief over the Radio) "Lookie Loos that are cloggin' up the streets (gosh)".  Roads in my area are barely 2 lane, with no shoulders or sidewalks, with driveways that can have quite an angle...  Space is always at a premiumm but everyone wanted to come on down and watch, thereby making it hard for the 8 engines, 3 water tenders, 3 chiefs, 2 ambulances, and other support vehicles to get in.  I tell my Father what is going on, because he has friends that live right in that stretch of road, and based on the address, it was possible it was their house (actually next door neighbor, but they witnessed the explosians and were holding back family fro reentering the house)... after calling them on the phone and getting no response, he turns to me and wants me to drive with him to the fire to "check it out" (he wanted me because of my badge and connection to the Deputies and FFs)...    I had to convince him that "maybe" it is a bad idea to do exactely what the Chiefs are complaining about (hence the deputies that would have no issue forcably removing people) and thereby hindering the FFs ability to stay safe while trying their hardest to save lives...

After my fathers preasure washer incident yesterday, this story, and his insistance that I don't really need rescue rated 10,000 lbs static rappelling rope when doing technical training (utility line from Lowes or Home Depot will do)... I feel like banging my head against a wall for an hour...


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## usafmedic45

> After my fathers preasure washer incident yesterday, this story, and his insistance that I don't really need rescue rated 10,000 lbs static rappelling rope when doing technical training (utility line from Lowes or Home Depot will do)... I feel like banging my head against a wall for an hour...



Reminds me of the argument I had with my grandmother after the Columbine shooting.  She claimed the blood of the kids in the library was on the hands of the "cops who hid like cowards behind their cars for an hour before going in".   Sometimes even the brightest people can hold some truly boneheaded notions....


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## fiddlesticks

when a bystander pisses me off i just say hold this iv bag or carry this back to the ambulance they feel like they helped and made medics look good in the public eye. as for students that are eager and  want to help their first day of class were all there at one point and we need to show them how to treat the public and by being asses that dosnt make us look good. and it just makes them think thats its ok to treat bystanders like that. i admit there is a time and a place to be and *** but for the most part they just want to help.


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## skivail

*Theme Park VSA*

I had been working a VSA at a local theme park when I happened to look up and notice that a group from a religious school had circled around us and started to pray.  One of the group leaders then decided she wanted to place a cross on the womans chest. Fortunately police had just arived on scene and were able to talk the woman out of that idea.  Nice idea, just a little creapy in my mind.


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## mycrofft

*Maw Barker and her boys*

A middle aged woman and her two late-twenties boys took an EMT-Ambulance class, painted their station wagon utility yellow, joined a vollie outfit so they could mount a yellow light bar and siren, and installed a scanner. They eventually wound up with their own spineboard, stokes litter, oxygen, and trauma bag (probably all stolen) and would beat local FD's to accidents at night. I never saw them in action, but they would do this and that (no drugs or IV's), then take the mask, spine board etc off when actual crews showed up, and leave. Finally a state trooper arrested them; rumor had been she was sister of a state senator in the Unicameral.


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## ceej

Bloom-IUEMT said:


> But seriously, check the ego.  I've never would have believed I would be scolded so much as I am by paramedics---many "old dogs" (and I am referring mostly to the service I work for) seem to forget they were new once and don't realize all the knowledge they have I won't obtain in a week of working EMS.  "OH my god!! you don't how to do that!! What the hell!! You are stupid/ignorant/incompetent and you will never be as brilliant as me!"  It makes me wonder why anyone would want to continue being an EMT.  But I suppose that's another thread--



I wouldn't take it personally. BHAS medics aren't highly regarded amongst their peers, you know .


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## hjp31bravoMP

*They just don't know when to stand back*

In the military almost everyone is CLS (Combat Life-Saver) certified. They can start a saline lock/IV do a need le chest decompression, secure nasal airways...etc. When the Medics and Military Police roll out to respond to a casualty, everybody and their brother wants to "help." The MPs are supposed to be pulling security, but are so occupied keeping looky-loos back that it actually endangers the Medics. The worst are the Army photographers. They'll walk right into the middle of the scene and actually block the Medics' path to get "their shot."

I wish they'd let us cuff 'um!


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## wvditchdoc

usafmedic45 said:


> ... *If you don't have enough people to do what you need to do beyond the airway, nothing gets done beyond the airway.* I mean what else are you doing as an EMT-B that is so important that you're going to hand the airway (the thing that if you screw it up will kill the patient faster than pretty much anything else) off to someone with zero training?


 
I do believe I will have this put on a T-Shirt, after 15 years as a Medic it absolutely floors me the amount of people that don't get this. As a sidenote, this would apply to all providers, not just EMT-B's. ABC's are done in order of importance, if A cannot be positively controlled...you stop at A. That would include the lack of manpower to progress any further. :glare:

I have had more "I am a nurse/Doctor/X Ray Tech, can I help?" stories than I could ever remember. I live and work in a rual area back home in WV. 

The thing to remember is to treat them as a professional at all times, but get your point across to get the H:censored::censored:L outta the way and let you do your job!


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## dragonjbynight

One of my first calls was to a MVA with ejection, though I was on the fire side and not rescue, we responded for traffic and scene safety (very small department) On my way to scene running lights in my POV, A young kid decides to play reverse chicken, slows down to 20 miles an hour on a 55mph stretch and swerves in front of me every time i attempted a pass. Another car came up on my rear and Ill be Da*&ed, turns on his lights. A LEO in the right place at the right time. I pulled over and he in turn pulled the car in front of me over, I continued on to scene just wondering what he said (and swearing the other driver out for being a complete moron) . I was working traffic and warning as the scene was on a particularly steep curved hill when the LEO arrived, I told him what had happened with that particular vehicle and he mentioned had pretty much berated the young man to no end, not to mention a few large fines. 

Not five minutes later the young mans vehicle pulls up to the stop, and he recognized one of the involved vehicles, It was his parents. I have never seen a face drain of all color as fast. I radioed for the LEO to come back up the hill and asked for some assistance in telling the kid what to do next ( I was still very new) The same LEO came back up the hill and told the kid where the parents were being taken to, luckily for him, they were not critical. 

I can't imagine the guilt that the boy would have had to have felt, after doing what he did. I know that several weeks later, the dept got a written apology from the boy and the parents had taken his car. But it just goes to show some of the complete lack of respect people have for VF/R.


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## nomofica

I felt like such a lookie loo this weekend.

I was working the Children of Bodom in my city as event security, working the barricade (pulling the crowd surfers off the crowd, making sure nobody jumps on stage, etc, etc. Near the end of the show an individual who was crowd surfing was hurled pretty far over the barricade and hit his head on the corner of the stage (causing a minor 2" lac and the usual looks-bad-but-isn't bleed that happens with scalp). Because I was the only one who is medically trained (other than CPR/standard first aid) and I witnessed it, I had to treat until EMS arrived.

Anyways, I had to go into the ambulance with EMS (which was already crowded... two medics and an EMT-A who was most likely doing training/practicum) and watch until the patient was released (chose no txp; went to hospital for sutures w/ his friends as we were right a couple blocks away from a hospital). Just standing there in the crowded box made made me feel like an annoyance, but I had to stay because I would I have to report what condition the pt was in/what treatment was needed for insurance/liability reasons.


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## WolfmanHarris

nomofica said:


> Just standing there in the crowded box made made me feel like an annoyance, but I had to stay because I would I have to report what condition the pt was in/what treatment was needed for insurance/liability reasons.



Did you ID yourself to the crew as a moonlighting Medic (or EMT-A)?

If it were me and you had I would have let you stay out of professional courtesy, but otherwise I would have asked you to stay out and just been sure to give you a quick run down before we left. That's what I do with PD (unless they're coming along), as well as foremans, security, teachers, etc. I don't mean shut them out as a snub, but I wouldn't want to be in the patient's shoes in a box that full.


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## nomofica

WolfmanHarris said:


> Did you ID yourself to the crew as a moonlighting Medic (or EMT-A)?
> 
> If it were me and you had I would have let you stay out of professional courtesy, but otherwise I would have asked you to stay out and just been sure to give you a quick run down before we left. That's what I do with PD (unless they're coming along), as well as foremans, security, teachers, etc. I don't mean shut them out as a snub, but I wouldn't want to be in the patient's shoes in a box that full.



No, it was the three (two medics and the EMT-A) and then me standing at the side door.

I asked them if I was in their way and if they'd like me to leave as I know that it can be very annoying. They said it was completely fine, though. It didn't feel right to me.


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## RESQ_5_1

We actually had Provincial Rounds on Monday covering a call involving a Physician on scene. Bear in mind, our Rounds are conducted by Physicians. Until the provincial takeover of EMS, it was primarily conducted by our Medical Director. 

The Physician brought up the subject of Physicians on scene and even admitted that he would not be much use above the EMS crews' level. As far as what can be done on scene with equipment available etc, a Physician cannot do any more than the crew that is responding. 

They can, however, assist the crew on scene. Also, if a Physician is willing to take pt care and attend all the way to the receiving, then they can have full control of the scene.

So, if a physician takes pt care from the crew, is it ethically responsible for them to hand down care to a lower training level? If so, then what use is it to have them in charge of the scene? They don't have the equipment necessary to do any interventions that my partner and I aren't capable of doing ourselves.


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## firetender

On scene, MVA car vs. travel trailer. Car driver, a young woman, impaled by a strip of fiberglass ripped from the sportscar she was in. WHILE I'm doing triage on passenger side (her husband with cervical fx), a passerby drunk leans in driver's window, sees the shard and PULLS IT OUT!

By the will of something other than me, they BOTH survived!


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## Onceamedic

firetender said:


> On scene, MVA car vs. travel trailer. Car driver, a young woman, impaled by a strip of fiberglass ripped from the sportscar she was in. WHILE I'm doing triage on passenger side (her husband with cervical fx), a passerby drunk leans in driver's window, sees the shard and PULLS IT OUT!
> 
> By the will of something other than me, they BOTH survived!



I hope the idiot was arrested, charged and convicted.  Assault and battery would be appropriate.


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## firetender

Funny you should mention that! Not ONCE did I even think of pursuing the guy. Sometimes, things like that happen as if a Devil were sent out of the ethers to ruin your best work. It's almost not even about the AGENT. But, looking back I can see I worked on keeping my focus on what I could do, rather than what was in the way. I'll never know if -- had she died -- I would have pressed to have the guy reamed.


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## sdaileyemt

*Me Being a Lookie Loo well really just trying to help*

Played lookie lue a few times, First time was last year first time I took the class. I was going through a parking lot and a female on a bicycle darted out in front of me I clipped her. I immediately jumped out and assisted. I put her back down on her back on a elevated side walk thing because she stood up did basic assessment for a trauma PT. Vitals were great ha a small abrasion on her left ankle.  a nurse showed up out of the starbucks so I turned care over to her. Cop said no ones fault on private property good to go don't bother with insurance. Me being a dumbass didn't. the nice female turned out to be just 18 and her mommy tried to sue me! Due to my awesome insurance agency and some good photography of the scene she was DENIED!

 Second time was recently on while I was in my refresher course. Driving up to my moms house in rural Calaveres County saw a car on side of the road MVA through a POWER POLE! So I drove up a qaurter mile turned into the ditch and drove up to her. Cleared power lines, She was ok 85 Y/O lucky women! After I sat her on my tail gate and got vitals and took over c spine, We chated. A double bypass a pace maker 2 heart attacks a stroke now this and she is still alive and well. The nicest most humble person i have personally met. All she could do is complain of what a hassle she was and I just insured her she was not a hassle and she could be seriously injured not know. Finnaly after 15 min Medics showed up and police and fire, I transfered care.  They said I did an awesome job and the women loved me, I even went back to the vehicle for her purse just cause I wanted to help and couldn't do much more


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## ceej

sdaileyemt said:


> After I sat her on my tail gate and got vitals and took over c spine



You walked her to your truck, climbed her up onto the tailgate then took cspine precautions?

She must have been up and walking already, because I can't imagine that an EMT would knowingly manipulate someone out of a vehicle with that MOI without cspine already in place


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## sdaileyemt

yes, someone had already pulled her out of the car. And my truck isn't high its a 05 ford escape suv the back is about 3 feet off the ground if that maybe 4. But I did take c-spine as I was walking her, Just because MOI I mean she was doing about 50-60 and went through a power poll into a ditch. No I would NEVER remove a PT like that from vehicle unfortunately I was not first on scene. Sorry i am bad at story telling


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## claty111

Correct me if i am wrong, but isn't any movement aside from placing the patient on a backboard contraindicated for suspected spinal injuries?  Being that you walked her to your truck, whether she had a C collar on or not, I would say that pretty much completely nulls the purpose of the backboard in the first place, and is a not good.


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## BossyCow

My favorite helpful bystander story is about a frequent flier. We've run a number of assault, drug ODs, trauma calls on this guy for many years. We get toned out to 'unconscious male/head injury'. We find the guy passed out in his own vomit on the living room floor. The whole family is there, camped out in chairs around the living room, watching. The guy is alert to pain only. No visible sign of trauma anywhere. I ask the family what happened and get the litany of "He's a good boy. He's been sober for the past 3 weeks, going to meetings, he's not drinking!" Again, I ask, so what happened tonight? I get a long story about how yesterday he fell down outside and they took him to the ER, the ER assumed that he was just drunk and sent him home with what was obviously an undiagnosed head injury from yesterday's fall, because look at him... and he was staggering and having some other cognitive issues related to that 'serious undiagnosed head injury' from his ground level fall the day before. Guy's vitals are all wnl. No sign of trauma anywhere. But the family is very insistant that he go in to get his 'head injury' treated. 

By now the guy is waking up a bit. His sister, who has been telling us how clean and sober her brother is, steps over to the pt and says to us... "It's Okay, I've had first aid training at work! I know what to do" and grabs him by the shirt front. Lifts him up with one hand and round house slaps him across the face twice! His head goes flying with each slap. I yelled "Stop That!!!" and said... "I don't know where you learned that as a skill for dealing with a potential head/c-spine injury, but I am documenting what you did in my report in case it just turned him into a quadraplegic." She started crying and saying we didn't care, we were just like the ER, we were treating him like he was drunk instead of injured... yadayada... turns out the guy had a Blood Alcohol about 4 times the legal limit and a body full of all kinds of recreational chemicals. Oh yeah.. and no trauma.


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## Fox800

I had a pt. with end-stage cancer who was experiencing moderate hemorrhage from a decubitus ulcer. The pt. was obviously in a lot of pain and needed to be transported for sutures/evaluation.

The pt.'s spouse was interfering with care, to the point of being a hindrance. He was attempting to administer high doses of narcotic analgesics with EMS on scene. Obviously, not a great thing to do, especially since we were planning to administer our own analgesics.. Then the spourse attempted to move me out of the way to move the pt. himself while loaded on a "Mega-Mover". After asking, then telling the spouse to move out of the way so EMS and fire could move the pt., the spouse became irate. He refuse to disclose the pt.'s medical history or medications, and would not retrieve medical records for us to examine. Told EMS & fire to "go to hell" and could not understand why we wanted such information. My partner was called a "jerk" and much worse for refusing to allow the spouse to administer morphine and dilaudid with EMS on scene, and for asking simple questions about the pt.'s medical history. With that, we exited the house with the pt. and transported her to the ER. She was upset with what had happened, obviously embarrassed, and in a great deal of pain from terminal cancer. Treated with fentanyl en route to the hospital. That call was just frustrating through and through.


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## Mountain Res-Q

BossyCow said:


> Oh yeah.. and no trauma.



Really?  How do you explain the two red marks across the face?  

Sounds like an EMS technique one might find on Trauma.    "Don't you die on me... <SLAP> <SLAP>!!!"


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## Scottpre

*Dumb**s public....*



HokieEMT said:


> My dad has too many of the same story.  There is a reason he won't eat at Double T Diner(local place), Golden Corral, and many other buffet styles places.  He has even had ones where the pts friends pick up what the pt was eating and eat it.



Try working EMS in a Casino. Typical scenario: 72 y/o woman unconcious on the floor, we start the assessment and ask the other Casino patrons to move to make room. Most common response I used to hear "...but I'm winning...."

Another one that is fun is any half-decent medical at a heavy-crowd special event. All of a sudden, we're far more interesting than whatever it was the crowd paid to watch. 

I got so fed up being bumped and bothered one time that I actually yelled at a security supervisor and a cop who were watching us to "Give me a f***ing perimiter and protect it!". That was out of character for me- I'm usually really easy-going. 

After the call, my partner looked over at me she notices I'm was still pissed about it. What good are cops and security if they are lookey-loo's too?


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## dragonjbynight

Mountain Res-Q said:


> Really?  How do you explain the two red marks across the face?
> 
> Sounds like an EMS technique one might find on Trauma.    "Don't you die on me... <SLAP> <SLAP>!!!"



Oh crap, you mean thats not the way to deal with drunks:excl:


B)


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## absolutesteve81

Scottpre said:


> Try working EMS in a Casino. Typical scenario: 72 y/o woman unconcious on the floor, we start the assessment and ask the other Casino patrons to move to make room. Most common response I used to hear "...but I'm winning...."



Been there, done that lol.  When I first got my EMT-B, I worked privately for a casino while PRN at another service awaiting a full-time position and *HATED* it.  Most of the "calls" were where patrons would sit 10-20 hours in front of a slot machine, their sugar would bottom out, and down they go.  Had a few that would bump another patron on their way down and as soon as we show up, the patron 'bumped' will still be playing their machine while yelling that they want the first (unconscious) patient removed for disturbing their play.


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## ChicagolandIFT

I do love walking into a nursing home room and seeing a nurse doing compressions on an air bed and and aide using a BVM without holding it to the patients face... got so bad at one nursing home we offered to do their CPR class for one dollar a participant... they turned it down.


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## Seaglass

Scottpre said:


> Another one that is fun is any half-decent medical at a heavy-crowd special event. All of a sudden, we're far more interesting than whatever it was the crowd paid to watch.
> 
> I got so fed up being bumped and bothered one time that I actually yelled at a security supervisor and a cop who were watching us to "Give me a f***ing perimiter and protect it!". That was out of character for me- I'm usually really easy-going.



At two places I work that do event standby, we actually have several people attached to a crew whose sole job is to clear a path and keep us from interference while we assess and move patients. Security may or may not be there, and they're sometimes really helpful, but we don't count on them. 

At the third, our event standbys are pretty tame. When you ask bystanders to clear off, they do. But we always have a ton of staff in attendance anyways, and if anything were to go wrong, we'd have a lot of support very quickly.


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## trevor1189

Had an incident recently. Responded to an MVA, 1 motorcyclist down in the roadway. Arrived on scene. Pt. lying supine in the road, motorcycle into the guardrail. When we went to remove the Pt.'s helmit for backboard purposes the whole group of people on motorcycles freaked out screaming what are you doing you can't take the helmit off. I tried to assure them that we were trained to remove helmits and we knew what we were doing. That didn't work. Luckily one of the Pt.'s fellow riders is an EMT instructor and assured them that it was ok and we wouldn't be able to assess and treat the Pt. properly without taking it off. (It also helped that we had an off duty Paramedic Supervisor there to set the crowd straight ;-) ).

Also before anyone goes too crazy, this was a Class II pt. with obvious elbow fracture, pain 10/10, object impaled in lower leg and had so much protective clothing on we couldn't get the C-Collar on without removing the helmit. That is why we did it. No airway compromise.


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## WolfmanHarris

trevor1189 said:


> Also before anyone goes too crazy, this was a Class II pt. with obvious elbow fracture, pain 10/10, object impaled in lower leg and had so much protective clothing on we couldn't get the C-Collar on without removing the helmit. That is why we did it. No airway compromise.



Wasn't going to get crazy. We remove helmets as a matter of course here. I'd imagine a crew would need a damn good reason not to bring a true trauma pt. in who wasn't damn near naked.


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## brice

very interesting-


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## Trauma's Mistress

*Its on Fire !*

OK  I have to share  this one. 

  I was coming home from work  and two cars  one tried to make the left at the last second, well he went into the embankment  to avoid the incoming traffic.  He by the way  gets out of his car and  was like 
" wow  that was fun ... " 
he was funny  and OK.  The  oncoming car  swerved and  slammed himself into  the telephone pole. He  was thrown from the drivers seat into the  passengers foot space. - yet, up and talking.  Anyways  I come on scene and  this one lady is cause more drama to the scene than is needed by screaming 
 " don't go near the car, its on fire" 
I am no fire fighter, but it was clearly not on fire at all.  she  yells
 " its coming from the middle of the steering wheel"  
I take a look from a bit away,and not even remotely close to  being on fire.  So she is yelling again, " its on fire"  She is in my way from trying to figure out how to gain access to the car to get to the other patient.  Squad shows up and I have  Cspine held for the patient and the lady is still yelling !!!  ... 
 " why are  you going to the car?! - Its on fire"  I finally yell back. 
 " Mam! Its not on fire or I wouldn't be in it !"
  The squad member turns to me as she is assessing the  lac across the guys face  asks me " who is that lady??"  
 The patient   responds saying .. 
" The hell if I know but that moron needs to shut the hell up"  

 Hahaha  It was a good call I would say  but   bystanders sometimes drive me crazy  who try to cause  drama  in an already  dramatic situation.


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## Dudester

Okay, so I've only had a first responder certification for 35 years now. This was 15 years ago and I was working an extra job as Security at a Six Flags park (at the time I also had a Peace Officer and Firefighter certification, and was working both-one part time). On this particular evening, they had closed part of the park due to electrical problems. I had a trainee with me and we recived a call of an unknown problem on one of the closed rides. 

We arrived and one of the kids tells us a girl is stuck and he points at a spot about fifty feet off the ground. We climb the track and find a girl laying on the track. Her body is bent, mid body, pretty much at a forty five degree angle. As I survey the scene, she says "I can't feel anything". 

I squat down and immobilize her neck/head. I then give the trainee instructions on how to radio in for the right kind of equipment/personnel-because this is going to be a very tricky extraction. Meanwhile, I keep the girl calm and keep a steady conversation with her to keep her from freaking out.

After a while, we had probably six EMT's on scene as well as the head of the EMT program and a whole slew of park managers. We were all trying to figure out the best way to do this extraction. Just as we get ready to make the move, the park safety director bellows out to me "Do you have a level one EMT certification?" 

"You know I'm just a first responder" (I had known this uppity jerk about a year).

"Well then, get out of the way and let someone who knows what they're doing do the job." (way to bolster the patient's confidence).

I moved and the senior EMT took my spot.


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## reaper

Would have been better to get someone who knew how to deal with the problem and treat the pt!


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## Trauma's Mistress

Ya  Know, I have to agree.  Its nothing against  first responders,  nothing at all. you do  fine work. but when someone with higher training shows up, they really should ( int he best interest of the patient)  take  over  care.  same  with  emts  and medics  show up.  Its not to say you  go away , or  leave,. but  just assist them.  Because as  an  emt,  there might be something that might be so slight that we notice, that  maybe  someone else might not  pick  up on.   Happens  all the times  with the medics  i work with. They   are great  they teach me a lot,    the ones  who  dont think they are  god, the others  really like to teach  stuff when the  drama is  over.  Thats  always  helpful


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## s4l

Trauma's Mistress said:


> Ya  Know, I have to agree.  Its nothing against  first responders,  nothing at all. you do  fine work. but when someone with higher training shows up, they really should ( int he best interest of the patient)  take  over  care.  same  with  emts  and medics  show up.  Its not to say you  go away , or  leave,. but  just assist them.  Because as  an  emt,  there might be something that might be so slight that we notice, that  maybe  someone else might not  pick  up on.   Happens  all the times  with the medics  i work with. They   are great  they teach me a lot,    the ones  who  dont think they are  god, the others  really like to teach  stuff when the  drama is  over.  Thats  always  helpful



I have to disagree.  In most situations I would rather have a FR with 20 years experience overn a greenhorn EMT fresh out of training.


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## medichopeful

Trauma's Mistress said:


> Ya  Know, I have to agree.  Its nothing against  first responders,  nothing at all. you do  fine work. but when someone with higher training shows up, they really should ( int he best interest of the patient)  take  over  care.  same  with  emts  and medics  show up.  Its not to say you  go away , or  leave,. but  just assist them.  Because as  an  emt,  there might be something that might be so slight that we notice, that  maybe  someone else might not  pick  up on.   Happens  all the times  with the medics  i work with. They   are great  they teach me a lot,    the ones  who  dont think they are  god, the others  really like to teach  stuff when the  drama is  over.  Thats  always  helpful



This is a tricky situation.  If the FR is doing a fairly good job, let them help.  If they are doing something wrong and can be corrected, do that.  If they have no idea what they are doing, take over from them.

But here is the thing.  All interaction with first responders HAVE to be professional and appropriate.  If I'm the EMT, and I come to a scene where a FR is doing something incorrectly, and I say "What the hell are you doing?  Get the hell out of the way!"  do you think I am going to instill confidence in my patient, any bystanders, and the FR themselves?  No!  But if I come on scene and say "Hello Sir/Ma'am, could you do this for me?" I've created a connection with them.  Even though they may not be doing a fantastic job, they are part of the team.  And as part of the team, they MUST be treated as such.

As an EMT, we need to realize that we are NOT just treating the patient.  Yes, they are the reason we're there, but there may be others on the scene as well.  And if these others have a connection to the patient, by "treating" them (which could be as easy as being polite) we could decrease the stress level of the situation, which could EASILY make a difference for the patient.


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## Trayos

*Why information is always good*

This is a story I heard from a local Search-and-Rescue ranger working out of the Appalachians. Keep in mind that this mountain has a 2 mile, winding+rocky trail on the ascent, and is roughly 35 miles from the nearest hospital.

A woman injures herself on the top of the mountain, and a bystander runs down and reports it as a "back injury". Since they have no idea what they will run into, they mobilize everything up to having an helicopter extraction team on standby.
They arrive at the base of the mountain and set up stretchers, gather materials, etc. At this point dusk is rapidly approaching, so they decide to call in the helicopter for rapid transport.
They arrive to find a 40-something women leaning against a tree, with a broken arm, having waited for 4 hours after slipping and falling. She reports a man stopped by, and asked what happened. She said "I fell", and he takes off down the mountain.
She was fined for the medical provisions, a sum probably in the $300-$800 range.

All because somebody took off without letting the pt. finish :mellow:


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## VentMedic

s4l said:


> I have to disagree. In most situations I would rather have a FR with 20 years experience overn a greenhorn EMT fresh out of training.


 
This is another sad statement about EMS education. The EMT is too short and the FR is only a few hours less.


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## LondonMedic

s4l said:


> I have to disagree.  In most situations I would rather have a FR with 20 years experience overn a greenhorn EMT fresh out of training.


We might, but doesn't it cause legal issues because the EMT (or paramedic) takes clinical responsibility regardless of who's doing what on scene?


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## CollegeBoy

s4l said:


> I have to disagree.  In most situations I would rather have a FR with 20 years experience overn a greenhorn EMT fresh out of training.



There are times on scene that I trust the department's first responders just as much or more than I would trust myself. Their experience makes up for what I have learned over them.

Its the same as the old arguement. Which doctor do you want? The old doctor that has years experience but may have forgotten a few things. Or the one fresh out of school that may know it all by the book, but has no practical experience.


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## WolfmanHarris

I had a bystander on new year's eve that were I not tied up w/ Pt. care I might have gotten into it with.

Bad MVC. Single 18y/o M pt. We've finally got him extricated and were finishing packaging when I see person dressed in a hi-vis shirt approach one of the LEO's and say "I'm not actually part of this scene, but my kids are in the car and I really need to get through."

In my fantasy world, my response goes like this:
"Oh, your kids are in the car?! I'm sorry. This is someone else's kids. We'll stop working on him and get all this crap out of the way for you. I mean if that was your kid there I'm sure you'd want us to stop so some a**hole can get through, right?"


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## njff/emt

*Where there's fire, the morons will follow*

About 3 years ago when I was still a probie FF, we were having our monthly drill., Next thing the buzzer goes off, the call is wires down sparking on the other side of town right behind the sub-station., We get on scene and we find that a tractor trailer tried to turn around and in the process snapped the pole and knocked down the wires right by the fuel tanks., And of course the trailer caught fire., I was on crowd/traffic control, not only did rubberneckers nearly causing accidents in front of them, I get this genius walking up to me asking when is the cable going to be fixed., Apparently he couldn't figure out what CFD on my coat meant., I simply told him that I don't know and to return to his house., About 15 minutes later guess who's back., This time I told him if he asks me again he'll have a good chat with my cop buddy., He didn't return so I figured he was smart enough to get the message.


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## Scottpre

njff/emt said:


> About 3 years ago when I was still a probie FF, we were having our monthly drill., Next thing the buzzer goes off, the call is wires down sparking on the other side of town right behind the sub-station., We get on scene and we find that a tractor trailer tried to turn around and in the process snapped the pole and knocked down the wires right by the fuel tanks., And of course the trailer caught fire., I was on crowd/traffic control, not only did rubberneckers nearly causing accidents in front of them, I get this genius walking up to me asking when is the cable going to be fixed., Apparently he couldn't figure out what CFD on my coat meant., I simply told him that I don't know and to return to his house., About 15 minutes later guess who's back., This time I told him if he asks me again he'll have a good chat with my cop buddy., He didn't return so I figured he was smart enough to get the message.



He probably had his 'World of Warcraft' session disrupted. Never get between an addict and their obsession!


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## feldy

RuralEMT said:


> There are times on scene that I trust the department's first responders just as much or more than I would trust myself. Their experience makes up for what I have learned over them.
> 
> Its the same as the old arguement. Which doctor do you want? The old doctor that has years experience but may have forgotten a few things. Or the one fresh out of school that may know it all by the book, but has no practical experience.



Although I am an EMT-B. i am fairly new (under a year). I was working as a first responder during a huge Mardi Gras parade and was called out with a first aider (under first responder) to a dislocated shoulder. I came to pt who wasnt in too much pain but who a bit to drink so i still believed he need O2 (pt was also very pale and his lips were blue. So i called in to the other first responder who has been doing this for about 10 years to bring in o2 and when he showed up he said the pt didnt need it. (the first responder o2 only flows at 6 lpm so it wouldnt even be nearly as effective and was really supposed to be used in respiratory emergencies) Although i disagreed he was senior on scene even though my training was more extensive I had to listen to him. I ended up dispatching EMS because he need to get his shoulder set as well as he needed o2.

I explained my reasoning to him after and he say that it wouldnt have hurt him but since EMS was 2 mins out, that it could wait and since he wasnt having any trouble breathing.

Did I do the right thing here regarding chain of command?


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## Scottpre

feldy said:


> Although I am an EMT-B. i am fairly new (under a year). I was working as a first responder during a huge Mardi Gras parade and was called out with a first aider (under first responder) to a dislocated shoulder. I came to pt who wasnt in too much pain but who a bit to drink so i still believed he need O2 (pt was also very pale and his lips were blue. So i called in to the other first responder who has been doing this for about 10 years to bring in o2 and when he showed up he said the pt didnt need it. (the first responder o2 only flows at 6 lpm so it wouldnt even be nearly as effective and was really supposed to be used in respiratory emergencies) Although i disagreed he was senior on scene even though my training was more extensive I had to listen to him. I ended up dispatching EMS because he need to get his shoulder set as well as he needed o2.
> 
> I explained my reasoning to him after and he say that it wouldnt have hurt him but since EMS was 2 mins out, that it could wait and since he wasnt having any trouble breathing.
> 
> Did I do the right thing here regarding chain of command?



That's a toughie. Part of it depends on your agency protocols. Are you in charge of the scene? If so, you do what you feel is best for the patient, so long as you stay within your local practice protocols. is these scene given over to a more epxerienced EMT or Medics when they arrive? If so, do waht you know is good for the patient, within the expectations of the arriving units. 

When in doubt, come back to the basics: ABC. Always protect ABC and your patient care will not do any harm and quite a bit of good. If you got O2 and you think the person needs it, give it. If you get barked at later, then you've learned something about how your agency wants you to operate in the field.

One of the things I had to learn to get over was always second-guessing myself after a call. One of my partners helped me get over that. You were there and made the call you felt needed to be made. Unless you really F*** up, and you'll know when you do, let it go. Don't dwell on it. Each call is an opportunity to learn and improve, but don't beat yourself up.


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## feldy

Scottpre said:


> That's a toughie. Part of it depends on your agency protocols. Are you in charge of the scene? If so, you do what you feel is best for the patient, so long as you stay within your local practice protocols. is these scene given over to a more epxerienced EMT or Medics when they arrive? If so, do waht you know is good for the patient, within the expectations of the arriving units.
> 
> When in doubt, come back to the basics: ABC. Always protect ABC and your patient care will not do any harm and quite a bit of good. If you got O2 and you think the person needs it, give it. If you get barked at later, then you've learned something about how your agency wants you to operate in the field.
> 
> One of the things I had to learn to get over was always second-guessing myself after a call. One of my partners helped me get over that. You were there and made the call you felt needed to be made. Unless you really F*** up, and you'll know when you do, let it go. Don't dwell on it. Each call is an opportunity to learn and improve, but don't beat yourself up.




Thanks...it came down to he didnt have trouble breathing and I had EMS in a QRV on their way. Monitored his resps mulitple times to make sure his breathing was okay, im still not sure why his lips were blue but I know EMS put him on o2 once i transferred care. Becuase (where i was working for the Red Cross, they didnt expect us to put any pts. on o2 so I wasnt that worried. Plus I has other pts to attend to afterward so I forgot about it until I read this thread. I would have been only as precaution, not a necessity.


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