# Any interesting anecdotes about interference with patient care from a CNA, lifegurad, etc.?



## Tachy55 (Mar 15, 2017)

Wondering if any members had any appealing stories about lower level healthcare providers such as lifeguards, CNAs, etc. trying to interfere or take over patient care during EMS's assessment/treatment. One of my buddies is a certified lifeguard at a community pool and thinks he knows everything when it comes to emergency medical care despite only having a four hourish long CPR/AED and basic first aid course...


----------



## NomadicMedic (Mar 15, 2017)

I just thank them and get them away as soon as possible. 

Unless it's CPR, in which case, they do compressions.


----------



## Summit (Mar 15, 2017)

No... usually its an bystander with a higher level like MD, RN or Paramedic that needs a moment to realize it isn't their scene and they don't really want the responsibility. But even that is rare.


----------



## GMCmedic (Mar 15, 2017)

Usually Nurses or Doctors in my experience. There is always the occasional paramedic or former combat lifesaver

Sent from my SAMSUNG-SM-G920A using Tapatalk


----------



## VentMonkey (Mar 15, 2017)

NomadicMedic said:


> I just thank them and get them away as soon as possible.
> 
> Unless it's CPR, in which case, they do compressions.


This, OP. Also, for being 18, and (presumably) new you seem pretty focused on the status of this job. Would you care to elaborate?


----------



## EpiEMS (Mar 15, 2017)

I've gotten great help from:
 1) ED physicians
 2) Current EMTs and medics
 3) Younger cops
 4) Younger firefighters
 5) ED nurses

I've gotten terrible help from:
 1) Internal medicine physicians
 2) Older firefighters
 3) Older cops
 4) Nurses generally
 5) CNAs...oh, CNAs...

As always, n = 1, anecdotes =/= evidence.


----------



## StCEMT (Mar 15, 2017)

I've had a doc help with bagging once, she backed off once we had enough hands. No lower levels trying to take over. They would be told to piss off if they did anyway.


----------



## VentMonkey (Mar 15, 2017)

StCEMT said:


> They would-*kindly with my waymegasuperdope verbal judo skills-*be told to piss off if they did anyway.


----------



## EpiEMS (Mar 15, 2017)

Old school NYC*EMS had a great little p*ss off card at one point...gonna find that and hand it out


----------



## Tachy55 (Mar 15, 2017)

VentMonkey said:


> This, OP. Also, for being 18, and (presumably) new you seem pretty focused on the status of this job. Would you care to elaborate?



My friend's behavior triggered my curiosity into this topic. Nothing to do with status or glamour of being an EMT (I'm proud but I don't brag about being an "expert" in Emergency Medicine because I'm not, I am just a basic..). My other post pertaining to a career in EMS being looked down upon was triggered by incidents I have witnessed whether in the ER between nurses or MDs directed towards EMS, or talking with individuals about my future career path as a firefighter/paramedic and being encouraged to dream bigger in the field of healthcare... I just wanted some input from other people's beliefs or experiences.


----------



## StCEMT (Mar 15, 2017)

VentMonkey said:


>


The first time, of course. I'm just not a fan of repeating myself for these types of things. #2 is where politeness goes bye bye. (Insert a I am becoming my parents type thing here).


----------



## VentMonkey (Mar 15, 2017)

Tachy55 said:


> My friend's behavior triggered my curiosity into this topic. Nothing to do with status or glamour of being an EMT (I'm proud but* I don't brag about being an "expert" in* *Emergency Medicine because I'm not, I am just a basic*..). My other post pertaining to a career in EMS being looked down upon was triggered by incidents I have witnessed whether in the ER between nurses or MDs directed towards EMS, or talking with individuals about my future career path as a firefighter/paramedic and being encouraged to dream bigger in the field of healthcare... I just wanted some input from other people's beliefs or experiences.


Ah, fair enough. Well then as a bit of friendly advice from someone who's done it slightly longer, it's best not to worry about how others seem to portray you (us); it won't harbor anything positive. My direct advice to you is: 
do your job, do it well, don't let it define you, then go home at the end of the day. 

There really are some good threads on that topic, but this early in your career you're doing yourself a _huge _disservice by even concerning yourself with such matters. Worry about being a proficient provider, respect is earned in life, and status and wealth are what you make of it.

As far as the highlighted remark, you're sort of right, and I'm sorta "_just_ a paramedic". I'll let you figure out how I mean...

-VM


----------



## StCEMT (Mar 15, 2017)

Wise words as always.


----------



## gonefishing (Mar 15, 2017)

I actually one time had a cna claim she was a nurse.  I had a full arrest, my partner was off at the nursing station on the other side of the complex thinking things were peachy.  I walk in, no breathing, no pulse, holy snickers so I see the nurse aka cna I start compressions, she freaks out, I ask if she can bag, I finish off my compressions she attempts to bag she has no idea what shes doing, thank god my partner shows up, she breaks down crying admits to being a cna.  
Oi vey.  Plenty more where that came from.

Sent from my SM-G920P using Tapatalk


----------



## EpiEMS (Mar 15, 2017)

gonefishing said:


> I finish off my compressions she attempts to bag she has no idea what shes doing, thank god my partner shows up, she breaks down crying admits to being a cna.



Doesn't she have to take HCP CPR...? If so, no excuse.


----------



## gonefishing (Mar 15, 2017)

EpiEMS said:


> Doesn't she have to take HCP CPR...? If so, no excuse.


You would be surprised.  I've seen many fumble when it comes down to doing.

Sent from my SM-G920P using Tapatalk


----------



## StCEMT (Mar 15, 2017)

EpiEMS said:


> Doesn't she have to take HCP CPR...? If so, no excuse.


Think about how often (pre)hospital folks don't bag well. She probably hasn't touched one since CPR class, it's not that surprising.


----------



## VentMonkey (Mar 15, 2017)

EpiEMS said:


> Doesn't she have to take HCP CPR...? If so, no excuse.


Yes, they do. 

Anecdotally speaking you'll run into many "stereotypical" events at SNF's and con-homes in your career.

The story fish told is by no means new, or shocking. With that, when my wife and I first started dating she was in the midst of doing a CNA course (always knew she wanted to go RN). It was about equivalent to most EMT courses, and yes they require CPR cards like pretty much any healthcare provider.

Fast forward a few years later and she's working at a SNF. These "nurse assistants" are often left with 20-30?ish patients at a time on a given shift for 8-12 hours at a time. The LVN's are typically the highest qualified staff (particularly at night); you may have a pencil-pushing DON/ RN during the day. They're often subjected to the same type of injuries EMS providers are (try lifting a s/p CVA patient by yourself? She did.), and get the same crap pay in hopes of either bringing home the bacon to their families, or moving up the nursing ladder.

Many of these CNA's develop a fond, loving, and close bond with the patients they care for daily; they become like their own family members with names and such (every see the demented elderly SNF patient with the ragdoll babies, or the mind of a 3 year old?), and may even be "working" what they believe to be a person near and dear to them when we walk in the room. 

Sure, I've rolled mt eyes, snapped, snickered and judged like most of us, but it doesn't make it right. Try keeping up with all the grunt work of 30 bedpans, urinals, and daily turns only to have to EMS-ers give you attitude because you're surprised, or freaked out by the code in the room next door when you may literally have "just talked to them".

All these threads about how to better our profession blah blah blah. Why don't we start by giving out pointers we've missed to our future providers? Maybe then we won't continue the "tradition" of what it is we all find so frustrating: ourselves.

They have jobs to do just like us. These days more often than not I guide them if they're nervous (I do need/ use them for CPR), and walk them through or encourage their technique; isn't that what we learn in the basics of any AHA provider course anyhow? Nah, easier to turn around and poke fun.

...rant over (for now).


----------



## gonefishing (Mar 15, 2017)

VentMonkey said:


> Yes, they do.
> 
> Anecdotally speaking you'll run into many "stereotypical" events at SNF's and con-homes in your career.
> 
> ...


Yes encourage and walk through.  I never snapped but have always tried to be the calm reassuring voice.   I remember cracking ribs for the first time.  I'll never ever forget it.  I try to make it an enjoyable experience. 

Sent from my SM-G920P using Tapatalk


----------



## VentMonkey (Mar 15, 2017)

gonefishing said:


> I try to make it an enjoyable experience.


So would you say doing CPR on a loved one is/ was enjoyable?


----------



## gonefishing (Mar 15, 2017)

VentMonkey said:


> So would you say doing CPR on a loved one is/ was enjoyable?


Not in a million years.  Way to hit close to home there.  What I ment was keep everyone on the same page and like the fonz.  Whats the fonz like? Cool! Everyones gonna be cool!

Sent from my SM-G920P using Tapatalk


----------



## EpiEMS (Mar 15, 2017)

@VentMonkey You're totally right about their workload - and you're also absolutely right about being non-judgemental. I try to keep the chortling for the truck (only snapped once - 20 minutes ago he was at an SPo2 of 96%? Come on, this guy is satting at 70% on 6 lpm.)


----------



## Tachy55 (Mar 15, 2017)

VentMonkey said:


> Yes, they do.
> 
> Anecdotally speaking you'll run into many "stereotypical" events at SNF's and con-homes in your career.
> 
> ...


Very respectable rhetoric. Thanks for that.


----------



## VentMonkey (Mar 15, 2017)

gonefishing said:


> Not in a million years.  Way to hit close to home there.


My point remains. I had to watch the matriarch of our family die a slow miserable death; finally coded and died...Thanksgiving day the year I was in didactic, so yes it sucks, anyhow... 

Some of these workers are hard working, sure they may not be up to par on what we do, but it isn't their specialty. They really do grow to bond with their patients, and for some of them, it's all they have; I've seen it. 

I'm just trying to open up young impressionable minds to insight perhaps they never thought of; won't that do more good than poking fun at what we may not understand?


----------



## gonefishing (Mar 15, 2017)

VentMonkey said:


> My point remains. I had to watch the matriarch of our family die a slow miserable death; finally coded and died...Thanksgiving day the year I was in didactic, so yes it sucks, anyhow...
> 
> Some of these workers are hard working, sure they may not be up to par on what we do, but it isn't their specialty. They really do grow to bond with their patients, and for some of them, it's all they have; I've seen it.
> 
> I'm just trying to open up young impressionable minds to insight perhaps they never thought of; won't that do more good than poking fun at what we may not understand?


Yes I see your point.  They are with these people day and day out and form a bond and thats my point try to keep everything smooth and cool.

Sent from my SM-G920P using Tapatalk


----------



## VentMonkey (Mar 15, 2017)

gonefishing said:


> Yes I see your point.  They are with these people day and day out and form a bond and thats my point try to keep everything smooth and cool.


Sooo, just like any code, right??


----------



## gonefishing (Mar 15, 2017)

VentMonkey said:


> Sooo, just like any code, right??


Of couse lol

Sent from my SM-G920P using Tapatalk


----------



## MMohler (Mar 15, 2017)

gonefishing said:


> I remember cracking ribs for the first time. I'll never ever forget it. I try to make it an enjoyable experience.



I will forever remember this when it happens.


----------



## Bullets (Mar 15, 2017)

Thankfully, last year our lifeguards were transitioned into the newly created municipal "department of EMS" So they get training from us at the beginning of the season and are encouraged to ride out with us once or twice. This helped greatly when we go to the beach for calls.

SNFs, just smile and wave....


----------



## EpiEMS (Mar 15, 2017)

@Bullets, are they under medical control? What's their cert level, EMR?


----------



## Tigger (Mar 15, 2017)

It's weird, most around here don't really have an issue with "lower certifications." I mean, they called us after all, most are happy we're there.


----------



## agregularguy (Mar 15, 2017)

VentMonkey said:


> Yes, they do.
> 
> Anecdotally speaking you'll run into many "stereotypical" events at SNF's and con-homes in your career.
> 
> ...



I know the rest of the thread has already kinda moved past this post, but I really wanted to highlight this post because I really like it. 
I know both I and my crew mates have previously **** on CNAs for their quality of care (which don't get me wrong, sometimes goes beyond the negligent scope) but your post really brought that into perspective. In the end, we both have jobs to do, and some of them take care of a lot more patients at once than I do most days! We all are trying to provide care for our patients, whether it be at the CNA level, EMT level, Medic level or one of those levels with aspirations to go higher. While yes, they are usually definitely lacking in certain parts of prehospital care, that's what we're there for, not them. So if they've never done CPR properly, teach them! Never bagged properly? Teach them! We get the opportunity to see and do a lot more emergent pre-hospital care than they do.. instead of being all pissy with them, take that time to teach them. That way, in the future, while they will still be calling you for emergent care, maybe they'll have made more of a difference than standing around doing inadequate CPR (if any)


----------



## hometownmedic5 (Mar 15, 2017)

I can't really say I've had trouble with lower level providers. As said, they called us and are usually pretty good about getting out of the way once we turn up. 

Now, higher level providers, that's another kettle of fish entirely. While not a daily occurrence, I think we've all come across a dr or nurse(more nurses in my experience) who hurts so much more than they help things. I try to get them to back off as professionally as possible, until it becomes a problem and then they get told point blank to get out of the way.


----------



## Bullets (Mar 16, 2017)

EpiEMS said:


> @Bullets, are they under medical control? What's their cert level, EMR?


No, but to be a Lt or Captain they require EMT. About half are EMTs who volunteer with a squad. Those who aren't get the Red Cross first aid class. NJ doesn't recognize EMR as a level of training


----------



## EpiEMS (Mar 16, 2017)

Just thinking out loud here...I have a lot of friends and family members who are physicians. Aside from the EM folks, they all tell me that they would be basically useless at an out of hospital emergency scene - so they'd rather leave it to us. The only one of them whom I think might be underrating his abilities is the critical care peds doc...



Bullets said:


> NJ doesn't recognize EMR as a level of training



Oh, NJ, magical NJ. So there is no oversight for providers below EMT?


----------



## Bullets (Mar 16, 2017)

EpiEMS said:


> Oh, NJ, magical NJ. So there is no oversight for providers below EMT?


For what? There is no level of care below EMT in the eyes of the state DOH. You could take ARCs First Aid Class but it's not a recognized certification. No one offers the national EMR class. Lifeguards etc are basically good Samaritans under the law.


----------



## EpiEMS (Mar 16, 2017)

Bullets said:


> For what? There is no level of care below EMT in the eyes of the state DOH. You could take ARCs First Aid Class but it's not a recognized certification. No one offers the national EMR class. Lifeguards etc are basically good Samaritans under the law.



That's interesting - just kinda strange that there is no EMR level. Don't NJ volley services often have "driver only" members? So wouldn't you want them to be at least EMRs?


----------



## Bullets (Mar 16, 2017)

EpiEMS said:


> That's interesting - just kinda strange that there is no EMR level. Don't NJ volley services often have "driver only" members? So wouldn't you want them to be at least EMRs?


No, i want them to be EMTs. In this state, there is no need for EMR. We have to many hospitals and are too densely populated to warrant EMRs. EMT is 120 hours of class, how much more watered down can you make it? Just give everyone the Boy Scout merit badge at that point. Even PDs encourage their officers to go to EMT class


----------



## SAREMT (Apr 18, 2017)

I have no idea what this person's certification was or where she worked, but I one time was screamed at by a "nurse" that I didn't know what I was doing and that I couldn't possibly be getting a blood pressure without a stethoscope while I palpated a blood pressure in the middle of a crowd at a large music festival (only BLS gear). I found that to be pretty humorous.


----------



## rescue1 (Apr 21, 2017)

SAREMT said:


> I have no idea what this person's certification was or where she worked, but I one time was screamed at by a "nurse" that I didn't know what I was doing and that I couldn't possibly be getting a blood pressure without a stethoscope while I palpated a blood pressure in the middle of a crowd at a large music festival (only BLS gear). I found that to be pretty humorous.



I remember blowing the minds of upper year medical students when I demonstrated how to palp a BP at a clinic event. It's not really something docs would learn until intern year and beyond, but at the time it was pretty funny.


----------



## Summit (Apr 21, 2017)

rescue1 said:


> I remember blowing the minds of upper year medical students when I demonstrated how to palp a BP at a clinic event. It's not really something docs would learn until intern year and beyond, but at the time it was pretty funny.


I remember bugging the eyes out of some residents when I had them palp the pulse on an ICU pt... monitor read 50s but they were palping about 15 because he had bigeminal couplet/triplets.


----------



## DrParasite (Apr 24, 2017)

Bullets said:


> EMT is 120 hours of class, how much more watered down can you make it?


your information is outdated...... Current standards for classes in NJ is 250 hrs of education, although many places are transitioning to the hybrid format so there is a lot of online studying, so not all of the time is spent in the classroom.

As for the driver/only thing, that's a topic and argument for another day.


----------



## Summit (Apr 24, 2017)

DrParasite said:


> your information is outdated...... Current standards for classes in NJ is 250 hrs of education



Is there a source for that? I found some sites saying 120, 140, 200, and "250 including clinical rotations"?


----------



## DrParasite (Apr 24, 2017)

http://www.trinitashospital.org/emt_training.asp I picked up the phone and made a phone call to the guy who runs the program.  He told me the class was 168 hours of classroom time, supplemented by online content.  I asked if there was a statewide standard and he said it was 250, including clinical time.

I called two other hospital based training sites, and got answers between 200 and 220, with other materials.

Unfortunately, the state EMS page is sorely lacking in content about the program.


----------



## Bullets (Apr 25, 2017)

JSUMC is like 160 hours of in class work plus 10 hours of clinical. I didnt think that there was a specific requirement for the length of the program, hence the wide variation. 

Either way, 120, 160, 200hrs, its something that can be done in 2-3 weeks if you do long days. I know our site runs an accelerated course for lifeguards, cops and college kids. It basically 1 month.


----------



## DrParasite (Apr 25, 2017)

So I just called the NJ Department of health, and spoke to one of their education coordinators....... He told me the minimum number of hours is 180, and the maximum number of hours is 250, and each program create's their own schedule, as long as it covers all the required topics.

In theory, all the content is covered, and regardless of how many hours the course is, the content should all be the same..... that being said, it boils down to a statement that I made in another thread, as long as the information is enough for them to pass the final exam (which is designed to judge baseline competency, and evaluated on a pass/fail level), are the hours involved really that important?  and if more hours is better, wouldn't they have better retention and first time pass rates?

BTW, we have one of those boot camp EMT classes (https://ncoae.org/trainings/19-day-intensive-emt-basic-emt-b/ ) where after less than 3 weeks time, you can take the NREMT exam.... personally, I don't see how you can keep up with the reading requirements,  but apparently students have been successful at it......  I am curious how much content they actually retained 2 weeks, 2 months, and 2 years later.


----------



## EpiEMS (Apr 25, 2017)

DrParasite said:


> personally, I don't see how you can keep up with the reading requirements, but apparently students have been successful at it...... I am curious how much content they actually retained 2 weeks, 2 months, and 2 years later.


It's really not so bad...2 hours a night or so of reading on top of 8-10 hours per weekday of class. If you have the time and a solid background in basic math & English skills, I highly recommend it.


----------



## NysEms2117 (Apr 25, 2017)

yikes... 2 grand for a class. Thats quite a financial hit


----------



## BobBarker (Apr 25, 2017)

This thread kind of reminds me of an episode of "Bondi Beach Rescue" in Australia. Lifeguards pulled a man out of the water in full arrest, started compressions and bagging. An anestheiologist happened to be watching, identified himself and told them politely to bag a bit slower (he was 8ft away, not interfering at all). The lifeguard took offense to it and told him they knew what they were doing as they have done it for awhile. I believe later in the episode the lifeguards talked to their medical director about the case who confirmed what the anesthesiologist was saying was correct. I'm pretty sure the patient still made it.


----------



## EMS HOT BOX (Apr 29, 2017)

Working the streets of The Rotten Apple while BLS with a good partner, a 70 pound FW Mdl. 8 stretcher & a half broke bus gave me more real world education & a healthy respect for all things on all skill levels EMS then Maspeth could ever give me. L4 training gave me a skill set beyond compare but the BLS survival mode mindset always worked, when an external factor enters your equation, then make lemonade, make that individuals competence or incompetence or even threat status work for you, hold some innocuous item for you, listen for our bus number on the portable, look down the street for whoever is responding & flag them down, etc, etc, etc. Even perps that jacked our patient were elicited to help lest they decide to jack us too. Back in the day we didn't have the luxury of staging like the kids today enjoy. Any L4 that looks down on what they consider lesser people in the profession are usually found out to "be" themselves the lesser person because esteem lacking individuals depend wholly on objects to boost their self image & when equipment fails & it does, the lesser man mentally malfunctions while the greater man works the call in BLS mode.


----------



## MonkeyArrow (Apr 29, 2017)

EMS HOT BOX said:


> Working the streets of The Rotten Apple while BLS with a good partner, a 70 pound FW Mdl. 8 stretcher & a half broke bus gave me more real world education & a healthy respect for all things on all skill levels EMS then Maspeth could ever give me. L4 training gave me a skill set beyond compare but the BLS survival mode mindset always worked, when an external factor enters your equation, then make lemonade, make that individuals competence or incompetence or even threat status work for you, hold some innocuous item for you, listen for our bus number on the portable, look down the street for whoever is responding & flag them down, etc, etc, etc. Even perps that jacked our patient were elicited to help lest they decide to jack us too. Back in the day we didn't have the luxury of staging like the kids today enjoy. Any L4 that looks down on what they consider lesser people in the profession are usually found out to "be" themselves the lesser person because esteem lacking individuals depend wholly on objects to boost their self image & when equipment fails & it does, the lesser man mentally malfunctions while the greater man works the call in BLS mode.


I really didn't want to engage, but I can't let this one go. What does this even mean?????


----------



## EMS HOT BOX (Apr 29, 2017)

Tachy55 said:


> Wondering if any members had any appealing stories about lower level healthcare providers such as lifeguards, CNAs, etc. trying to interfere or take over patient care during EMS's assessment/treatment. One of my buddies is a certified lifeguard at a community pool and thinks he knows everything when it comes to emergency medical care despite only having a four hourish long CPR/AED and basic first aid course...



My take on what I'd do when running interference when incompetents try to overrule my patient care. Try to keep up.


----------



## NomadicMedic (Apr 29, 2017)

#TYFYS







EMS HOT BOX said:


> My take on what I'd do when running interference when incompetents try to overrule my patient care. Try to keep up.


----------



## StCEMT (Apr 29, 2017)

MonkeyArrow said:


> I really didn't want to engage, but I can't let this one go. What does this even mean?????


I've read it three times and I don't think I found a direct point anywhere in there....


----------



## Summit (Apr 29, 2017)

I am exceptionally skilled at jargon...  But that was a bit much


----------



## akflightmedic (Apr 29, 2017)




----------



## DrParasite (Apr 29, 2017)

I think he's saying he used to work bls in New York City back in the 80s...... Bringing out the dead style....

But i can't make heads or tails out of the rest of the word jumble or the major run-on sentences


----------



## StCEMT (Apr 29, 2017)

DrParasite said:


> I think he's saying he used to work bls in New York City back in the 80s...... Bringing out the dead style....
> 
> But i can't make heads or tails out of the rest of the word jumble or the major run-on sentences


Us young whippersnappers are spoiled because we get to stage for pd?


----------



## VentMonkey (Apr 29, 2017)

This is a perfect example of why I don't poke my head in on that FDNY thread; the one or two times I have in the past it's left me scratching it.


----------



## hops19 (May 1, 2017)

Nurses seem to be the worst about trying to butt in... We see it fairly often in the Athletic Training world too. I had one last year insist that a kid go to the ER for a CT scan for a concussion. I tried to explain to her (and to the kid's dad) why that wasn't necessary. But she had scared him enough to go. Guess what... CT didn't show anything! (Just like I told them it wouldn't).


----------



## VentMonkey (May 1, 2017)

hops19 said:


> Nurses seem to be the worst about trying to butt in... We see it fairly often in the Athletic Training world too. I had one last year insist that a kid go to the ER for a CT scan for a concussion. I tried to explain to her (and to the kid's dad) why that wasn't necessary. But she had scared him enough to go. Guess what... CT didn't show anything! (Just like I told them it wouldn't).


And this means what? I get that most athletic trainers, particularly those in the full-contact sports realm are pretty squared away with the different types/ grades of concussions, but I'm just curious how you knew that is "wasn't necessary"?

Certainly, I get your point of view re: scare tactics; we've all had that pleasure. I'm just curious as to how you just knew without CT there were no further indicators ruling out a more acute TBI? Do you guys have guidelines?


----------



## hops19 (May 3, 2017)

VentMonkey said:


> And this means what? I get that most athletic trainers, particularly those in the full-contact sports realm are pretty squared away with the different types/ grades of concussions, but I'm just curious how you knew that is "wasn't necessary"?
> 
> Certainly, I get your point of view re: scare tactics; we've all had that pleasure. I'm just curious as to how you just knew without CT there were no further indicators ruling out a more acute TBI? Do you guys have guidelines?



Of course we have guidelines. First of all, let me say this: We don't grade concussions. That's a thing of the past. A concussion is a concussion. But a concussion itself is not grounds for a CT scan. Certain signs and symptoms would warrant referral to the ER for a CT scan. Those would include repeated vomiting, slurred speech, deterioration of symptoms. This kid never displayed any of these signs or complained of any "red flag" symptoms. Had he done so, I probably wouldn't have let him leave with dad.. I'd be calling for an ambulance. I've seen somewhere in the range of probably about 150 concussions in my career (~7 years) and less than 10 of them have been referred to the ER. Only two that I can remember did I send to the ER strictly for concerns about a brain bleed. The remainder were sent by EMS to rule out a neck injury.

Any time I have a kid suffer a concussion, the parents are given instructions for that night. Signs and symptoms to be looking for, and when is it time to head to the ER. What they should do that night (get a little food and get some sleep). And they are always referred to a concussion specialist, who typically sees them in the 24-72 hour range.


----------



## VentMonkey (May 3, 2017)

@hops19 I'd love to hear your take on CTE, but alas, perhaps another time, and in another thread.


----------



## Akulahawk (May 3, 2017)

hops19 said:


> Nurses seem to be the worst about trying to butt in... We see it fairly often in the Athletic Training world too. I had one last year insist that a kid go to the ER for a CT scan for a concussion. I tried to explain to her (and to the kid's dad) why that wasn't necessary. But she had scared him enough to go. Guess what... CT didn't show anything! (Just like I told them it wouldn't).





VentMonkey said:


> And this means what? I get that most athletic trainers, particularly those in the full-contact sports realm are pretty squared away with the different types/ grades of concussions, but I'm just curious how you knew that is "wasn't necessary"?
> 
> Certainly, I get your point of view re: scare tactics; we've all had that pleasure. I'm just curious as to how you just knew without CT there were no further indicators ruling out a more acute TBI? Do you guys have guidelines?


Nurses don't usually get a really good and thorough education in evaluation of concussion. For that matter, neither do Paramedics. I am ATC trained, Paramedic trained, and RN trained. Nurses and Paramedics are basically taught to punt to the ED because of the possibility of various forms of ICH, some of which will be visible on CT, some require MRI. Concussions normally will not show any structural abnormality on CT. The CT scans aren't "fine" enough to be able to show any damage. The ATC knows how to test for concussion and knows the signs/symptoms to watch for if the athlete actually suffered a more severe CHI, and when to send the athlete to the ED. The ATC also has a very specific advantage that Nurses and Paramedics do NOT have: the ATC knows his/her athletes incredibly well and knows what's normal behavior for each athlete. The AT is very well educated in other areas as well. The minimum for entry into the field is a Bachelors and it's the reason why Paramedic and Nursing school didactics were seriously easy for me. While my knowledge base isn't as good as that of a PA, I do have to be quite cognizant of my limitations while working, particularly when answering questions that a patient may have.


----------



## ERDoc (May 6, 2017)

@Akulahawk, check out the PECARN head injury studies.  It sounds like something you might really be interested in, especially when you have to deal with the super nurses and MAs.


----------



## Akulahawk (May 7, 2017)

ERDoc said:


> @Akulahawk, check out the PECARN head injury studies.  It sounds like something you might really be interested in, especially when you have to deal with the super nurses and MAs.


@ERDoc Thanks for the reference! I will certainly take a better look at it when I have some time. Just a cursory look at the site showed that there's quite a bit of info available.


----------



## ERDoc (May 10, 2017)

The study is really more about who needs CT (and radiation) and who doesn't but it is very useful to help with discussion and you can shut those know it alls up when you ask them which PECARN criteria the meet.  It still annoys me when someone says that their relative who is a (insert alphabet soup here) sent them in for a head CT to see if they have a concussion.  You can't see concussions on CT, it's a clinical diagnosis.

I'm going to go against the grain and the intent of the OP and post about a time when another medical person was happy to turn over care.  I rolled up on a guy hit by a car in my POV when I was an EMT.  There is someone with obvious medical knowledge holding c-spine, I assumed another EMS type person.  I walk up, identify myself and ask what I can do to help.  She looks up and says, "You can tell me what to do.  I'm an RT.  I'm happy to help but this is above my paygrade."  She was great and really helped until EMS arrived.


----------



## Alan L Serve (May 11, 2017)

I've had EMTs from other fire depts stop at scenes soon after I arrived with me my FD and asked if we needed help. In the rural area I work we often tone out for mutual aid and it just so happens those off-duty EMTs were about to be toned out and be made on-duty. I've even heard for pagers sounding and the county dispatch speaking through the speaker just as they were asking if we needed help. 

I appreciated it every time, esp in the situation where we had more patients than on-duty providers.

Except for the guy who came up with his cat on a dog leash. That was just odd.


----------



## hops19 (May 11, 2017)

ERDoc said:


> I'm going to go against the grain and the intent of the OP and post about a time when another medical person was happy to turn over care.  I rolled up on a guy hit by a car in my POV when I was an EMT.  There is someone with obvious medical knowledge holding c-spine, I assumed another EMS type person.  I walk up, identify myself and ask what I can do to help.  She looks up and says, "You can tell me what to do.  I'm an RT.  I'm happy to help but this is above my paygrade."  She was great and really helped until EMS arrived.



I'll share. Again, Certified Athletic Trainer at a high school. We had an SCA event at an alumni baseball game this year. Nursing student and a nurse came out of the stands to perform CPR, one of our coaches is a retired FF/paramedic. The three of them handled CPR duties. Coach told me later that had the guy not responded, I would have been next on the chest. I applied the AED and ran that machine. When the engine and ambulance arrived about 8 minutes later, the man was conscious. You better believe I was happy to see that nurse and that nursing student come down to help!


----------



## NUEMT (May 31, 2017)

StCEMT said:


> Think about how often (pre)hospital folks don't bag well. She probably hasn't touched one since CPR class, it's not that surprising.



This is backed up by research. Bagging can be deceptively hard in reality.


----------

