# Help or hinderance?



## MedikErik (Sep 5, 2007)

Was going to post this in BLS discussion, but decided to try it here as I'm looking for ALS opinions. At one of my old firehouses, either I was loved or hated. Some loved what I did, some couldn't stand it. Here's the scoop:

For those of you unfamiliar with me, I was in P school and made it most of the way through clinicals. I was dropping tubes, reading 12 leads, etc. If I'm on scene of a call and SHTF, I revert to what, for lack of a better term, I'll call "advanced BLS". I take the concept of spiking a bag, and run with it. I remember a shooting call I was on; there were plenty of BLS providers on scene doing BLS skills while waiting for ALS to arrive, so I got to work doing my thing. I had two 1L bags spiked and hanging, two sixteen gauge needles and all the other misc. IV stuff spread out on the bench seat, a tube holder under the patients neck ready to go, a 7.5 ET tube with a Mac 3 set up, a 4 lead was on the patient, yada yada yada. The two medics jumped in back, saw everything was good to go, started the lines, dropped the tube, and transported. Lead medic asked me to be one of the providers in back. Made me feel good inside, and the compliment I got has still lasted me.

Some medics, however, act as if I were TCPing patients on my own, starting EJs, and dropping drugs down a tube. I see nothing in my protocols saying that getting stuff prepped is ALS; I make sure to not do the procedures myself, just to get things ready. If a medic doesn't like what I have set up for him (he'd rather use a 14/18 gauge needle instead of a 16, etc.) then he just sets it up himself and is no worse for the wear than if I hadn't done anything at all. Opinions/comments/questions?


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## chico.medic (Sep 6, 2007)

Just curious, but if your on a BLS rig, w/ no ALS provider, why do you have all of that stuff with you?  :huh:

Now if we were partnered on an ALS rig, and you set up all that stuff w/ out me asking, I'd have to give you props!  (Except, do they make tubes smaller than an 8.5?  lol.)B)


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## akflightmedic (Sep 6, 2007)

Ok, I will give a POSSIBLE reason why some medics may be bent out of shape when everything is prepped for them.

It has nothing to do with you being BLS and anticipating my needs, its not an ego thing by any means.

Having everything set up would also screw me up a little as well.

It is human nature..we are CREATURES OF HABIT.

We have our routines and thought processes that we have fine tuned over the years and after each call. I like going through certain motions, it is my thinking time, my prep time, etc. Its getting my head in the game, so to speak.

Therefore, if I jump in back and all is laid out, yes I can perform, but I have skipped several steps and routines that are my coping mechanisms.

In addition, I have to also trust that you did not make a mistake and forget to lay something out as well. Therefore, I also have to review all you prepped as well. Its just as fast and easy for me to do it myself or have it handed to me or performed in front of me when I ask for it.

My old service, all ambos were set up identical. I could jump in any truck on any scene and find exactly what I needed. I felt comfy no matter what unit it was.

If you do not believe any of this, when you wake up in the morning, get out of bed on the other side and brush your teeth with your other hand. See how awkward it is when you dont have routine and feel like you have missed a step. For some, it can screw up their whole day.


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## MedikErik (Sep 6, 2007)

Chico: All our rigs are fully ALS equipped. Several quick scenarios which have proven why I like it. Full code's especially: medic jumps on, doesn't have to worry about carrying stuff over from the engine. That, and we carry more supplies than an engine.

Akflight: That makes perfect sense, actually. I guess its like when a probie puts the BP cuff on someones arm and hands me a stethescope.


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## MedikErik (Sep 6, 2007)

chico.medic said:


> Just curious, but if your on a BLS rig, w/ no ALS provider, why do you have all of that stuff with you?  :huh:
> 
> Now if we were partnered on an ALS rig, and you set up all that stuff w/ out me asking, I'd have to give you props!  (Except, do they make tubes smaller than an 8.5?  lol.)B)



Keep it up wiseguy and I'll leave you with either a 3.5 or a 10.5 :-D. Have fun trying to get an initial tube with that


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## Airwaygoddess (Sep 6, 2007)

I think that Flightmedic summed it up pretty well, I have worked with different medics and all of them have a certain way of doing things, and if you are the new kid on the block, they have to get to know you and gain their trust.  I am a creature of habit, and I too need to see people's work habits in order develop trust.


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## Ridryder911 (Sep 6, 2007)

At my service, if the basic or first responder does not have things awaiting for me .... someone is going to have a long talk to. 

It all depends upon the service and the medics. Personally, I have other important things to do than tear the tape, spike the bag, etc. It is not going to hurt to prepare and assist the medics. 

R/r 911


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## MedikErik (Sep 6, 2007)

Been doing this about 5 years... to give you an idea of call volume, I'd have months where I'd run 200 calls, easy. When I was working private ambulance and 911, I think I was topping 300.


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## ccfems540 (Sep 6, 2007)

I would love if my EMT's would take more initiative in the back of the ambulance.  I don't like having to tell EMT's to place the patient on the monitor, get a blood pressure and place on pulse oximetry etc. on every call.  Having a good EMT makes you a much better Paramedic.  As for being creatures of habit, I pride myself in being very flexible with the EMT's that I work with.  I let them know what I want and then I expect that everytime I work with them from then on.


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## MedikErik (Sep 6, 2007)

My view: if no one's ever told you you're too aggressive, you're not being aggressive enough .

Then there's me... :-D.


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## GaEMT (Sep 7, 2007)

I have to agree with redryder   If the truck is not set up when I get there with the patient, someone hasn't done their job.    When I was an intermediate, I knew what had to be done and would do it with out being asked.    Having everything ready when you hit the truck saves minutes and minutes are a good thing!


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## FFMedic1911 (Sep 7, 2007)

Also agree with rid on this one. I think operating in this function would show your professionalism and commentment to the job. Please forgive if I misspelled:unsure:after all am from kentucky


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## BossyCow (Sep 7, 2007)

I've learned that different medics have different expectations.  There are some that I know will let me do anything I know how to do and appreciate it.  There are others that I need to wait until being asked for something.  Unless it's one of the few that I've established a working relationship with, I generally just offer "Would you like me to spike a bag?" "Do you want me to go ahead and set up the 12-lead?" or sometimes.... "What do you want first?"

I've had more issues with new medics who are still trying to find their feet in an organization.  I understand (having 20+ years of marriage to a medic) not to take this personally.


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## ResTech (Sep 12, 2007)

Most of the medics around here are like Rid.... they like when u anticipate their needs with tape, hanging fluid and running the line through, or priming the lock for em, doing the EKG, and glucometer... its not uncommon for BLS to be handed SL NTG to give or even put on nitro paste. 

I think their has to be a trust relationship between the medic and EMT. Dont know how often you run with the ALS unit that didnt like what u were doing for em, but if they trust you and run with you often it should be cool.


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## Rattletrap (Sep 12, 2007)

Ridryder911 said:


> At my service, if the basic or first responder does not have things awaiting for me .... someone is going to have a long talk to.
> 
> It all depends upon the service and the medics. Personally, I have other important things to do than tear the tape, spike the bag, etc. It is not going to hurt to prepare and assist the medics.
> 
> R/r 911



Do you check for goldfish before you hook the line to the cath?


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## Ridryder911 (Sep 12, 2007)

LOL!.. No but the EMT's know to read the bag three time (fluid, expiration date, and checking for cloudiness) This helps them prepare as they move up the levels.

Personally, I rarely hang fluids anymore, unless it is trauma or dehydration, etc.. rather saline locks. Anyone else? 

R/r 911


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## Rattletrap (Sep 12, 2007)

Ridryder911 said:


> LOL!.. No but the EMT's know to read the bag three time (fluid, expiration date, and checking for cloudiness) This helps them prepare as they move up the levels.
> 
> Personally, I rarely hang fluids anymore, unless it is trauma or dehydration, etc.. rather saline locks. Anyone else?
> 
> R/r 911



For the most part it is the same with me with one exception, Mercy and Aultman hospitals in Canton, Ohio hate saline locks. They want a bag hung every time. It gets insane for me at times. I have to know which regional protocols I am running under in Ohio and when in WV I have to use WV protocols and am now learning PA protocols.


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## MedikErik (Sep 23, 2007)

I prefer locks myself, but if a bag's already hung I'll use it.


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## Ridryder911 (Sep 24, 2007)

Rattletrap said:


> For the most part it is the same with me with one exception, Mercy and Aultman hospitals in Canton, Ohio hate saline locks. They want a bag hung every time. It gets insane for me at times. I have to know which regional protocols I am running under in Ohio and when in WV I have to use WV protocols and am now learning PA protocols.



That is why I hate State protocols and those that have to work under separate protocols. In my state, each service has its own, under the guidance of their own Medical Director. If they want to adopt the state's they can as a generic type. 

Fortunately we don't have to care what the hospitals want or prefer. They can do what ever they want to after they get them, otherwise they can't say anything. 

R/r 911


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## firetender (Sep 25, 2007)

If stuff was set up for me in anticipation of the work I'd be doing while the Basics were not being attended to, somebody'd catch hell.

If somebody set me up and then badgered me about how well he set me up and "I've got this ready, want to use it?" starts, that person gets tossed.

And if a hot dog would show up with his OWN equipment and try to set me up with that (when he couldn't use it himself legally) then, it's a call to the Cops!


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## eggshen (Sep 27, 2007)

We are an all ALS service. Soon I think we will be going to split cars. I do not care for the idea but if I have someone that is tight setting me up that would be nice at least. Unless you are racking the slide on the shotgun and getting everything out. Alas I would question why someone got the TV ready when it was a GSW.

Cheers
Egg


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## SC Bird (Sep 27, 2007)

I can only voice what I have heard other medics and instructors say.

They say it's all about the relationship between you (myself being a Basic student now) and the medic.  Our instructors are always talking about the great Basics they've worked with over the years who could anticipate their moves and both medic and Basic would work off of eachother really well.

While I can understand the frustration about routine, I can say that I would certainly not mind having things prepped for me when I got there....it's benefiting the patient in the end.

-Matt


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