# I don't trust him



## Sassafras (Feb 14, 2011)

I realize the anser may only be "suck it up and deal", but here is my issue...

My volly unit only runs as BLS.  We have a transplant from another state who hasn't run as a paramedic in a few years, but was assisted in gaining reciprocity here and went through all the steps and recertifications to do such.

He likes to take over calls refusing to allow EMT-B's to tech.  On one level I understand this.  He feels ultimately responsible as the highest trained provider.  On the other hand, I've gotten into many an argument with him over things where he refuses to admit he's wrong, even when I pull out the text books showing him that yes in fact you can not give D-50 to a hypERglycemic patient and expect good results.  He pawns it off as "such and such unit would" and I've rolled my eyes and thought "no, you just said you'd provide this treatment".  We've had multiple discussions such as this, and frankly, I know my training is lower than his, but I think my college level biology class educated me more in anatomy than his paramedic course did.

The fact is, as a provider, I don't know if I could trust this guy and I'm not sure how to deal with this fact.  If I'm stuck up front driving because he's pulled the "higher trained" card and jumps in back, I am afraid of not being able to advocate for a patient if he pulls one of these stunts on call.  Luckily our arguments have been off the clock, and I've not run a single call with him yet, but it's only a matter of time and I need to figure out what to do with my personal feelings about this guy before it happens.


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## JPINFV (Feb 14, 2011)

Sassafras said:


> On the other hand, I've gotten into many an argument with him over things where he refuses to admit he's wrong, even when I pull out the text books showing him that yes in fact you can not give D-50 to a hypERglycemic patient and expect good results.  He pawns it off as "such and such unit would" and I've rolled my eyes and thought "no, you just said you'd provide this treatment".  We've had multiple discussions such as this, and frankly, I know my training is lower than his, but I think my college level biology class educated me more in anatomy than his paramedic course did.



[sarcasm]Well, you see, the problem is that the dextrose isn't dilute enough for a homeopathic treatment. [/sarcasm]


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## Sassafras (Feb 14, 2011)

I should have added my anatomy comment was in reference to other arguments we've had over where specific areas were in the body as he reprimanded me to go back to anatomy class (only to pull the A/P book I have on my bookshelf and point out that I was again correct).


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## Chimpie (Feb 14, 2011)

It's time to chat with your boss/supervisor/mentor, letting them know what's going on, and taking their recommendation and moving forward.


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## 8jimi8 (Feb 14, 2011)

If you don't trust him, don't go out on calls with him.  Let your supervisor know that you refuse to work with him.


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## Sassafras (Feb 14, 2011)

Is it really as simple as that? I'm not being snarkey.  It just seems as though it could create a lot of waves within the politics of volley service. Know what I mean?  How do you even approach the cheif about that when this person goes on a good portion of calls?


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## 8jimi8 (Feb 14, 2011)

Do you not have direct evidence that he is a subpar provider who is often wrong about FACTUAL knowledge. 

I don't understand how ANYONE can earn their Paramedic if they don't understand such a simple concept as not administering dextrose to someone with hyperglycemia.  

Pull your supervisor to the side and tell him that this guy is dangerous.

Maybe everyone else is also intimidated by this charlatan, but not strong enough to stand up and say something.

What if you two get on a bad scene and he tells you to do something contra-indicated, and you hurt someone?

Sure the vollies all have terrible politics, but that isn't an excuse that should permit bad medicine to be practiced.  

Tell you supervisor that you do not trust his clinical judgement and you don't feel comfortable with his as your team lead on calls.


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## lampnyter (Feb 14, 2011)

Your lucky. If the Medic ever gets in the back of the truck at my agency its a good day lol.


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## zmedic (Feb 14, 2011)

I think the real question is does someone with more training get to pull rank on scene if the service only runs BLS? It's a good question and I think you need to look at the bylaws of your unit. It may be a situation where you can say "I was first on scene, we are BLS, I'm running this." But better to have the leadership of your organization spell it out.


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## MrBrown (Feb 14, 2011)

Talk to your supervisor, clinical standards officer, medical director or PADOH


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## 46Young (Feb 14, 2011)

Back in the day, in NYC, we would give the unresponsive cocktail. It was D50, 2 mg of narcan, and 100 mg of thiamine. It mattered not if the pt's BGL was over 70, 400, or whatever. The reasoning was that the glucometer could be malfunctioning, and that if their sugar is already high, a little more isn't going to make much of a difference in the short term. We all knew this protocol was flat out stupid, but we had to follow it anyway. 

You said that this medic was from another state, and that they hadn't practiced as an ALS provider for a few years? It sounds like he had a lousy, quickie mill type of education, is stuck on doing things the old school way, and hasn't bothered to supplement his original knowledge base from back when pterodactyls were flying. I see this problem where I work now. We have a mix of old timers who were originally certified around 1985-1990 or so, and us younger medics, a good number of which actually hold EMS degrees (degrees help with promotion in the fire service; some figured out that they might as well get their P-card through a degree program, and kill two birds with one stone). It seems to me that some of these old timers think they're still back in 1990, and their pt care decisions and knowledge base reflect that. They have no clue how to read a 12 lead, and you have to force them to use CPAP, since they don't understand it, and just think it's a PITA, much like cracking open the narc pouch for pain management.

Anyway, how about you just give him rope and let him hang himself? If he's a tool, and consistently disrespects you, just throw him under the bus when he inevitably commits a serious pt care error.


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## firetender (Feb 15, 2011)

Sassafras said:


> ... and I've not run a single call with him yet, but it's only a matter of time and I need to figure out what to do with my personal feelings about this guy before it happens.



You're condemning the guy before you have any real experience with him. YOUR suspicion could be the most toxic thing here as right now, all this is in your head.

In this moment, YES your personal feelings could interfere with good patient care. He apparently didn't pass muster with you in conversation. Maybe he's resistant some. But you DON'T know how he responds during calls and wouldn't it be fair to be the best EMT with him you can be without being his watchdog? Start there first, that's your job.

Then come back and talk to us!

Your job right now is to not let your personal feelings impinge on your job right now.


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## tazman7 (Feb 16, 2011)

Sounds like the critical care medic we just hired that gave me a pt from a BAD accident placed on the backboard on her stomach. And couldnt give me a reason why she put her like that.


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## abckidsmom (Feb 16, 2011)

In a vollie situation, I wouldn't ride with him.  As a volunteer, I reserve the right to only ride with people who make the job fun.  You'll need to pay me to deal with people who in any way make the situation more difficult.

At my vollie agency:


I will not ride with people who scare me with their driving
I will not ride with people who mouth off to the patients
I will not ride with people who embarass me in the hospitals
I will not ride with people who are resistant to learning new things

I love to teach, and I love to help people become a better provider, but if they chose to wallow in ignorance, I don't want to be around them.


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## Sassafras (Feb 16, 2011)

firetender said:


> Your job right now is to not let your personal feelings impinge on your job right now.


You're right.  I'm trying here.  Really.  I've had way too many off the clock convos with this guy (and a personal run in that Brown can attest had me upset for days since he got to hear me rant about it in chat for a while). It may just be tainting my impression of him as a provider.  I may simply just not want to be alone with this guy at all.  But I have to figure it all out in my brain.  Mayhaps deal with things as they come. I suspected someone may give this opinion.  Part of me holds the same.  I think I'm really just trying to talk myself down and thinking the entire process aloud.


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## emt seeking first job (Feb 18, 2011)

In your vollie on a rig is someone designated crew chief ?

In my vollie, there are working medics, RNs, and a few PA's. There is an indisputed chain of command. Someone on every crew is designated crew chief and he or she has the final say. Even if someone on the crew is a medic or an officer in another organization.

Of course, an on duty medic from another organization can take over the scene and our crew chief is outranked, but it is his or her position in the other organization as a medic that gives them the authority, not their education, training or experience alone.

IMHO, you said you have never riden with him but argue about patient care? Do you have a position of authority to question what goes on at calls you were not at ? Q/A, and officer or board member? If not , IMHO, better to be silent.


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## rescue99 (Feb 18, 2011)

:blink:





tazman7 said:


> Sounds like the critical care medic we just hired that gave me a pt from a BAD accident placed on the backboard on her stomach. And couldnt give me a reason why she put her like that.



:blink: confuzzled...very, very confuzzled.


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## yotam (Feb 19, 2011)

"...I am afraid of not being able to advocate for a patient if he pulls one of these stunts on call"


Frankly, in my opinion that pretty much raps it up. If you're in any way accountable for his actions on a ride, and you're afraid you can't legitimize his actions should you ever face court you shouldn't ride with him and explain that to your supervisor. EMT providers are susceptible to law suits even when they do their best, so you should have the right to minimize damage as much as you can.


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## emt seeking first job (Feb 19, 2011)

If this person is that bad isnt anyone else saying anything about it ?


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## Madmedic780 (Feb 20, 2011)

Talk to your EMS Director for a "surprise" protocol test?


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## DFW333 (Feb 20, 2011)

Im kinda confused as how he can pull the rank card in a BLS only service. What good is paramedic training if you cant do ALS interventions? Tell him you're both Basics and he's driving.

Sounds like he's just an uneducated bully. Im kinda curious as to why this guy had to flee to another state and go vollie in order to stay in EMS....


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## JPINFV (Feb 20, 2011)

DFW333 said:


> Im kinda confused as how he can pull the rank card in a BLS only service. What good is paramedic training if you cant do ALS interventions? Tell him you're both Basics and he's driving.



There's an entire thing before treatment dealing with a history and physical exam and coming up with a working diagnosis.


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## DFW333 (Feb 20, 2011)

JPINFV said:


> There's an entire thing before treatment dealing with a history and physical exam and coming up with a working diagnosis.



So your EMT-Bs are not able to listen to lung sounds, palpate for tenderness, obtain a pulse rate, or review history? When it comes to examining patients the EMT can do everything the medic can except interpret the EKG.


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## JPINFV (Feb 20, 2011)

Are you arguing that the only difference between an EMT and a paramedic are assessment tools and treatment options? There's no difference in either foundational education (anatomy, physiology, etc) or applied science (pathology, pharmacology, etc)?


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## MrBrown (Feb 20, 2011)

Oh dear Brown's Parathinktheyare detector is going off


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## jjesusfreak01 (Feb 20, 2011)

MrBrown said:


> Oh dear Brown's Parathinktheyare detector is going off



In this case however, it seems the Parathinktheyare is the Paramedic.


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## DFW333 (Feb 20, 2011)

JPINFV said:


> Are you arguing that the only difference between an EMT and a paramedic are assessment tools and treatment options? There's no difference in either foundational education (anatomy, physiology, etc) or applied science (pathology, pharmacology, etc)?



In a BLS only service like the one in question there are NO differences in treatment options and tools. BLS means EVERYONE is limited to BLS all the way around. What is the medic going to have on him that will enable him to assess the patient any better that he can use without exceeding protocol? His knowledge has already been brought into doubt by the original poster...doesnt leave much else.

And it is entirely possible that the EMT-B's knowledge, training and experience could vastly exceed the medic. I can name 20 people right off the top of my head who are medics with 0 experience cause they went straight to medic school from basic school. I can name just as many EMTs who have been EMTs for over 20 years, and it aint cause they failed medic school.


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## usalsfyre (Feb 20, 2011)

jjesusfreak01 said:


> In this case however, it seems the Parathinktheyare is the Paramedic.


If I understand Brown's thinking on this subject, most parathinktheyares have a valid EMT-P card in their pocket.


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## usalsfyre (Feb 20, 2011)

DFW333 said:


> In a BLS only service like the one in question there are NO differences in treatment options and tools. BLS means EVERYONE is limited to BLS all the way around. What is the medic going to have on him that will enable him to assess the patient any better that he can use without exceeding protocol? His knowledge has already been brought into doubt by the original poster...doesnt leave much else.
> 
> And it is entirely possible that the EMT-B's knowledge, training and experience could vastly exceed the medic. I can name 20 people right off the top of my head who are medics with 0 experience cause they went straight to medic school from basic school. I can name just as many EMTs who have been EMTs for over 20 years, and it aint cause they failed medic school.



Half the battle is getting the patient to the right facility and pointing the next set of providers down the right treatment path. So yes, a Basic can do just about any physical assessment I can. If they have no clue why the information means, it's an exercise in pointlessness. To put on my "arrogant @ss" hat for a second, I'm fairly certain I and most other halfway decent paramedics can run circles around even 20 year basics in this regard. Your right, someones not an EMT-Basic for 20 years without a reason.

It's not all about needles, tubes and drugs folks....

That is not to say with the stupidity that the OP says is on display I consider this clown to be a halfway decent paramedic.


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## DFW333 (Feb 20, 2011)

usalsfyre said:


> Half the battle is getting the patient to the right facility and pointing the next set of providers down the right treatment path. So yes, a Basic can do just about any physical assessment I can. If they have no clue why the information means, it's an exercise in pointlessness. To put on my "arrogant @ss" hat for a second, I'm fairly certain I and most other halfway decent paramedics can run circles around even 20 year basics in this regard. Your right, someones not an EMT-Basic for 20 years without a reason.
> 
> It's not all about needles, tubes and drugs folks....
> 
> That is not to say with the stupidity that the OP says is on display I consider this clown to be a halfway decent paramedic.



Again, in a BLS only service why does it matter if you know what the information means? Tell the hospital (Im assuming there's only one in the area in the case in question) what the patient has, what the patient's history is, and let them make the decision what's going on.

If you're going to be starting ALS interventions, giving cardiac drugs and all that other good stuff, then yeah you damn well better have that education and know what's going on.

Every service is different, some might have an ALS agreement with mutual aide, some might have 30 hospitals to choose from. I was drawing my conclusions based solely off what I saw from the circumstances outlined by the OP.

Now to jump to a far-fetched conclusion not based on anything, whatcha wanna bet the guy always insists on jumping in the back so he can sleep rather than drive?


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## JPINFV (Feb 20, 2011)

DFW333 said:


> In a BLS only service like the one in question there are NO differences in treatment options and tools.


Agreed, to an extent. 



> BLS means EVERYONE is limited to BLS all the way around. What is the medic going to have on him that will enable him to assess the patient any better that he can use without exceeding protocol? His knowledge has already been brought into doubt by the original poster...doesnt leave much else.



Knowledge is pretty darn important. Heck, if I was to go work on an ambulance tomorrow, I wouldn't be able to  just turn off the assessment tools and medical knowledge I've learned so far in medical school. Just because a medical condition (more differential diagnoses to consider) or manual assessment technique (e.g. dermatomes, muscle strength beyond grips, cranial nerves, and many more) that wasn't taught to me in EMT school doesn't mean I could be expected to turn it off on the ambulance. 



> And it is entirely possible that the EMT-B's knowledge, training and experience could vastly exceed the medic. I can name 20 people right off the top of my head who are medics with 0 experience cause they went straight to medic school from basic school. I can name just as many EMTs who have been EMTs for over 20 years, and it aint cause they failed medic school.



Experience is only important if the knowledge and training is there. Additionally, I'm not impressed with "experience" as being some sort of equalizer. If the EMT had the drive to provide good prehospital emergency care, they would advance well before they hit 20 years. Additionally, all too often in EMS it's 1 year of experience repeated 20 times than 20 years of experience. Personally, I'd take the EMT with 6 months of experience and a college degree in a biological science than an EMT with 20 "years of experience" (or 1 year repeated 20 times).


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## JPINFV (Feb 20, 2011)

DFW333 said:


> Again, in a BLS only service why does it matter if you know what the information means? Tell the hospital (Im assuming there's only one in the area in the case in question) what the patient has, what the patient's history is, and let them make the decision what's going on.



Reasons knowing "why" is important to an EMT.

1. Do I need to reroute?
2. Do I need to call paramedics?
3. Do I need to call medical control and request a variation? 
4. Do I need to turn on the flashy lights and woo woos and put everyone on board and around us at risk by engaging in one of the most risky interventions we have?


Yea, sure, if you're in BFE without paramedics, one hospital, and relatively no traffic, I guess it doesn't matter who's in the back. Heck, in that situation you don't even need an EMT. Anyone can throw a NRB on and drive with the woo woos to the hospital.


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## DFW333 (Feb 20, 2011)

Oh I see what you're doing. Taking it to the absolute extreme and saying basics have no knowledge whatsoever.

Here is the bottom line I was making with my original response because you clearly do not understand it:

IF YOU HAVE KNOWLEDGE USE IT. IF YOU HAVE A PARTNER WHO CLAIMS TO HAVE KNOWLEDGE BUT CLEARLY DOES NOT, THEN DO NOT LET HIM USE IT.

Are you really so dense as to think I was telling you to turn off your brain? :sad:


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## JPINFV (Feb 20, 2011)

I'm not the one making the claim that there's zero difference between an EMT and a paramedic working as an EMT.


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## DFW333 (Feb 20, 2011)

JPINFV said:


> I'm not the one making the claim that there's zero difference between an EMT and a paramedic working as an EMT.



In most instances there is a HUGE difference. Speaking strictly to the scenario at hand, it does not appear there is in this case.


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## JPINFV (Feb 20, 2011)

DFW333 said:


> In most instances there is a HUGE difference. Speaking strictly to the scenario at hand, it does not appear there is in this case.



Strictly speaking, the situation at hand appears to have an idiot who would ignore assessment tools and administer the wrong medications. However I think the issue of the functional difference of an EMT working as an EMT and a paramedic working as an EMT are separate from this case.


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## MrBrown (Feb 21, 2011)

If there is only sometimes a difference then why is that outside the US a 120 hour EMT would not be qualified to even set foot on an ambulance and it takes three to six years of education to become the equivalent of an American Paramedic?


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## FrostbiteMedic (Feb 21, 2011)

Now, to be fair, I am probably about to get yelled at for this, but please folks, hear me out. This guy might have a case of what my instructor, years ago, called the -P syndrome. The -P syndrome is where a Paramdic forgets that his licensure starts out with the letters EMT. I do not see it a lot in here, but I have seen it in the real world many times. He feels that since he is a -P, basic level interventions are completely below him. Just a thought.....


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## usalsfyre (Feb 21, 2011)

frostbiteEMT said:


> The -P syndrome is where a Paramdic forgets that his licensure starts out with the letters EMT.



I really, really, REALLY wish andecotes such as this would disappear...:glare:


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## emt seeking first job (Feb 21, 2011)

jjesusfreak01 said:


> In this case however, it seems the Parathinktheyare is the Paramedic.




I am not expert in EMS, however, I can understand the issue in this thread.

Somebody could have an MD from John Hopkins and be a working brain surgeon at a hospital.

However, if he or she joins a BLS volunteer ambulance as an EMT, neither the MD, other knowledge, other job position affect his or her position.

It is the same as an out of work finance position with a Wharton MBA getting a job as a cashier at Applebees. The manager has an AA in liberal arts. Because the cashier has a higher level of buisness training does nothing to put them in automatic authority above anyone else in the organization.

My questions to the OP remained unanswered.

1) who was the crew chief on the bus ? what was their angle on this ?

2) what is your services VPO angle on this ?

As far as the medicine goes, dont quote me, but in my b class, I rmemver the instructor staing in NYS the protocol is glucose regardless if they are hyper or hypo since more sugar will not make a difference..not sure on the full explanation.

As far as the administrative authority goes, I know I am right. If this person was designated crew chief, do what they say. If you know they are wrong 100% then refuse and report to your VPO.

Once again, there is no automatice authority granted to anyone with more education, training or experience in a BLS ambulance service if their position is EMT.


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## emt seeking first job (Feb 21, 2011)

JPINFV said:


> I'm not the one making the claim that there's zero difference between an EMT and a paramedic working as an EMT.




Once again, a paramedic working as an EMT has to follow EMT protocols.

There is a vollie in NYC, where an actual MD works. When he does so, he acts as an EMT, not an MD, he has not authority above anyone else or to do anything else.


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## JPINFV (Feb 21, 2011)

emt seeking first job said:


> Once again, a paramedic working as an EMT has to follow EMT protocols.


Using California as an example (because that's where I'm most familiar with), an EMTs scope of practice includes the ability to "evaluate the ill and injured." If I deem that a cranial nerve exam, for example, is indicated. Please tell me how I would be violating my protocol by conducting a cranial nerve exam? How about percussion? Rinse, wash, repeat with essentially all manual exam techniques. In fact, I could argue that I could use a lot of exam tools. If I'm, as an EMT, am empowered to "evaluate the ill and injured" and am properly trained in using an otoscope, is it really against my scope of practice to use one?

Even with strict protocols, there's still a fair amount of judgment that can be utilized. How is using a paramedic level of knowledge violating EMT protocols? Alternatively, is every action where you work dictated by protocol?




> There is a vollie in NYC, where an actual MD works. When he does so, he acts as an EMT, not an MD, he has not authority above anyone else or to do anything else.



If he decides to go full physician, including taking on malpractice liability, there's absolutely nothing legally stopping him. If he wants to equip himself with a manual defibrillator, there's absolutely nothing stopping him. A license to practice medicine does not end at the hospital or ambulance's doors. I can, however, see liability and maintenance of drugs and equipment, and staffing concerns (if he is acting as a physician, then does he still count towards the minimum number of EMTs in states other than NJ?) as valid reasons to restrict the tools available. 

Additionally, ask him if he limits his differentials only to those listed in an EMT text book, or if he uses his medical education to help make judgment calls. I'm also willing to bet that, when push comes to shove, he would take charge in a second if another provider started to engage in malpractice. However there's very little to legitimately foul up on a BLS unit. Seriously, in the grand scheme of things, there's very little to screw up on most patients.

Finally, ask him what he'll do when presented with a field birth of a baby with shoulder dystocia. I'm willing to bet that he wouldn't blink at placing the patient in McRoberts, or applying suprapubic pressure or performing an episiotomy if need be. By virtue of being a licensed physician, he has the legal authority to do those. The only question is, will he and at what cost?


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## JPINFV (Feb 21, 2011)

emt seeking first job said:


> It is the same as an out of work finance position with a Wharton MBA getting a job as a cashier at Applebees. The manager has an AA in liberal arts. Because the cashier has a higher level of buisness training does nothing to put them in automatic authority above anyone else in the organization.


I didn't realize that the cashier was at risk of practicing accounting without a license. 

I didn't realize that cashiers had the potential to be in situations where they had to make life or death decisions. 



> As far as the medicine goes, dont quote me, but in my b class, I rmemver the instructor staing in NYS the protocol is glucose regardless if they are hyper or hypo since more sugar will not make a difference..not sure on the full explanation.



Anyone who administers glucose to a patient who is known to be hyperglycemia for the purposes of correcting ALOC due to diabetes is an idiot. 

Anyone who wrote that protocol is an idiot. 

Both are boarding on malpractice.

Now if you DO NOT know if a patient is hyper- or hypoglycemic, then I can agree with that argument.


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## emt seeking first job (Feb 21, 2011)

As I said, I really forget the hyper/hypo issue in its entiretity. At my level, if faced with that sitaution, I would defer to the crew chief to make the call.

As far as the MD on a BLS ambulance. If he kept playing MD card and took over the scene, in theory, the BLS service could remove him. Then he would be free to drive around in his POV, roll up, and tell ambulance crews what to do.

Getting back to the original post. The original poster never answered my questions:

1) was there a crew chief on the rig

2) did nayone else complain, was it formally?

Ambulance services have mechanisms to review calls and my question to the OP was whether she used any of them.


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## emt seeking first job (Feb 21, 2011)

MrBrown said:


> why is that outside the US a 120 hour EMT would not be qualified to even set foot on an ambulance




Then Brown better get over to wikipedia and make some edits.

http://en.wikipedia.org/wiki/Emergency_medical_services_in_New_Zealand

"Training occurs across a broad range in New Zealand, and the range of training varies considerably between volunteer and paid staff. As a result, it is permissible to work on an ambulance with only a first aid certificate, or with a university degree in paramedicine. To some extent, availability of training may be affected by the location of volunteers, and also by their time availability, given full-time employment and other life commitments. There are, in fact, eight levels of training available.[13] It is quite common for New Zealand EMS staff to begin their careers as volunteers, and to progress into paid positions."

"Basic and IntermediateBasic life support providers use the same skill set used by BLS providers around the world. With additional training, some BLS providers may operate at an Intermediate Life Support level, including IV starts, and some drugs.[17]"


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## emt seeking first job (Feb 21, 2011)

JPINFV said:


> I didn't realize that the cashier was at risk of practicing accounting without a license.
> 
> I didn't realize that cashiers had the potential to be in situations where they had to make life or death decisions.
> 
> ...




The issue was boiled down to authority on an BLS ambulance.

I was trying to keep morality, saving lives, etc,  out of it.


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## FrostbiteMedic (Feb 21, 2011)

usalsfyre said:


> I really, really, REALLY wish andecotes such as this would disappear...:glare:


Told ya'll I was gonna get yelled at for the post. Oh well....

Just a thought....


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## emt seeking first job (Feb 21, 2011)

Sassafras said:


> here is my issue...
> 
> My volly unit only runs as BLS.  We have a transplant from another state who  likes to take over calls refusing to allow EMT-B's to tech.
> 
> ...





GETTING BACK TO THE OP'S ISSUE:

If this were my service, each crew of up to four people has a role and a place:

1) crew chief
2) driver
3) emt

If someone is on the schedule to be the driver, they drive that shift. They assist but the EMT for that shift is the person making patient care decesions, based on the protocols. The driver has no authority to tell the tech to drive and take over patient care. Regardless of his or her training or authority in some other agency (and that happens in NYC).

If two or more emts have a disagreement the crew chief decides. If someone wants to go over the crew chiefs head, they call the medical director on the phone  or an FDNY conditions boss to the scene. If it was criminal, the NYPD.

If anyone does not like what went down on a run, they make an incident report and the board conducts a hearing.

The OP has never ridden with this person, but has all these issues? Did the other people on the crew take any action through proper channels?

An ambulance crew paid or volunteer is not just a bunchg of people showing up and then arguing about who has more authority based on external factors.


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## emt seeking first job (Feb 21, 2011)

*Regarding the treatment protocols:*

I may stand corrected, but in NYS:

http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols

M2- Page 2

A patient with AMS, history of diabetes controlled by medication, able to drink, administer oral glucose, transport, keep warm. Request ALS but do not delay transport.

In NYS BLS, we do not test blood sugar.

Again, I am new to EMS, so I may stand corrected on the protocols, however, I am not knew to the world, and I had a valid reply to the OP re: adressing her concerns through proper channels.


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## usalsfyre (Feb 21, 2011)

frostbiteEMT said:


> Told ya'll I was gonna get yelled at for the post. Oh well....
> 
> Just a thought....



Not yelling at you at all, just expressing my displeasure at that kind of quote. It shows a gross misunderstanding of the difference in thought processes. 

It's like me saying a physician has "MD syndrome"' when I don't have an effing clue about his thought process on a patient. 

Suffice to say if I'm skipping over EMT-B practice levels it's because the patient is better served by something more advanced NOT because it's beneath me. Some people can never be convinced of this (not saying your one of them).


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## JPINFV (Feb 21, 2011)

I'm also willing to bet that NYS EMTs don't administer 50% dextrose IV solutions either and the OP specifically mentioned "hypERglycemia."

As I said, administering glucose or dextrose to a patient known to be hyperglycemic due to ALOC due to diabetes is stupid and tantimount to malpractice. 

Administering glucose to a patinet who is altered, has a history of diabetes, and absent the ability for point of care blood glucose testing isn't ideal, but understandable. I would go further to say that an EMT at a health care facility for a patient who has had an immediately recent (pro-tip: Ask for an updated BGL at a nursing home and more often than not they'll get one in front of you. Document "BGL ____ at ____ Per RN") blood glucose measurment and that measurment is not low has strong standing to not administer a glucose product, regardless of the protocol.


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## JPINFV (Feb 21, 2011)

emt seeking first job said:


> If someone is on the schedule to be the driver, they drive that shift. They assist but the EMT for that shift is the person making patient care decesions, based on the protocols. The driver has no authority to tell the tech to drive and take over patient care. Regardless of his or her training or authority in some other agency (and that happens in NYC).


Assuming both providers are eligible to drive, does your system allow for a mutually agreed upon switch in positions? After all, if your personal interest is respiratory calls and mine is psych, it makes sense that I take psych patients and you take respiratory patients. 



> An ambulance crew paid or volunteer is not just a bunchg of people showing up and then arguing about who has more authority based on external factors.



There's never a place for arguing. However there is a place for collaboration, which is definitely enhanced by external factors.


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## emt seeking first job (Feb 21, 2011)

usalsfyre said:


> Suffice to say if I'm skipping over EMT-B practice levels it's because the patient is better served by something more advanced NOT because it's beneath me. Some people can never be convinced of this (not saying your one of them).




But if you are on a BLS unti and "skip over" BLS practice levels and things go wrong, you could get in a jam.

CYA stick to the protocol.


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## reaper (Feb 21, 2011)

emt seeking first job said:


> But if you are on a BLS unti and "skip over" BLS practice levels and things go wrong, you could get in a jam.
> 
> CYA stick to the protocol.



There is no such thing as BLS or ALS!!!

There is medical education and treatments. Most basics have minimal education and treatments. Most medics have a better education and treatments. You use the appropriate treatment for the assessed pt. That is all that should be done on any pt you see.

Do not live or die off protocols. They are *Guidelines* to let you know what should normally be done for a pt in that situation. Does not mean that they are the rules for every pt. That is the difference between cookbook medicine and critical thinking!


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## emt seeking first job (Feb 21, 2011)

Well, for example, a surgeon riding on a BLS ambulance, if he or she did an emergency trachetomy (sp?) in the field, he or she does so on their own, not as a member of that ambulance service......


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## emt seeking first job (Feb 21, 2011)

emt seeking first job said:


> GETTING BACK TO THE OP'S ISSUE:
> 
> If this were my service, each crew of up to four people has a role and a place:
> 
> ...



I stand by this post as my reply.

I can empathize with the OP has I have known volunteer services to often  have more drama than paid jobs.

I would strongly urge her to reach out to other members in her service to build consensus and failing that, consider switching to another service....


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## usalsfyre (Feb 21, 2011)

emt seeking first job said:


> I stand by this post as my reply.
> 
> I can empathize with the OP has I have known volunteer services to often  have more drama than paid jobs.
> 
> I would strongly urge her to reach out to other members in her service to build consensus and failing that, consider switching to another service....



What If the "crew chief" is about to administer a treatment that will be a detriment to the patient or (GASP!) violate protocol? Does the rest the crew have no authority/is under no obligation to do everything in their power to prevent suboptimal care?


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## emt seeking first job (Feb 21, 2011)

usalsfyre said:


> What If the "crew chief" is about to administer a treatment that will be a detriment to the patient or (GASP!) violate protocol? Does the rest the crew have no authority/is under no obligation to do everything in their power to prevent suboptimal care?



Then the crew should muntiny and hog tie the crew chief to the brush bar and ride lights and siren through the perimeter of their chartered service area.

Are you happy?

There is always a medical director on call to contact for treatment issues. There is always an operations officer on call for administraive issues. In NYC the FDNY has conditions bosses.

What happens in an OR room if a surgeon does something wrong? What do the nurses and techs do ?

The point I was making was to bring other people in the issue at the scene..

You dont debate it with the person one on one and then go to an online forum to gain consenses by whose paramedic certificate is more valid than another persons. Or who has education extra and above the EMT certificate....

I thought I asked a logical follow up  question(s) to the OP.....


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## Jon (Feb 21, 2011)

PA State EMS requires each agency adopt a policy that provides for the highest certified provider on scene to be responsible for the ultimate care of the patient.

When I run BLS (Ambualnce or First Responder) I'm still under this, as I'm an active medic in PA (and even in my County/Region).

Here's a PA-specific thought (Not sure if it applies) Does this person have active medical command status as a paramedic within the Commonwealth? Within the Region? If not currently an active medic in the Commonwealth, then he isn't SUPPOSED to wear anything that says Paramedic, and he's limited to being an EMT-B.


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## emt seeking first job (Feb 21, 2011)

JPINFV said:


> does your system allow for a mutually agreed upon switch in positions? .



Yes, however, the switch is not agreed on by the OP

I am still unsure if she ever rode with him or she was projecting.


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## emt seeking first job (Feb 21, 2011)

JPINFV said:


> I'm also willing to bet that NYS EMTs don't administer 50% dextrose IV solutions




Its in a tube. The same little tubes one can get over the counter.

No IVs ever. Even if a paramedic or a nurse is in the bus. If an ALS buswith paramedics from another entity takes over, then yes.


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## EMSrush (Feb 21, 2011)

abckidsmom said:


> In a vollie situation, I wouldn't ride with him.  As a volunteer, I reserve the right to only ride with people who make the job fun.  You'll need to pay me to deal with people who in any way make the situation more difficult.
> 
> At my vollie agency:
> 
> ...



Very well said, ABCkidsmom! Bravo!


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## JPINFV (Feb 21, 2011)

emt seeking first job said:


> Well, for example, a surgeon riding on a BLS ambulance, if he or she did an emergency trachetomy (sp?) in the field, he or she does so on their own, not as a member of that ambulance service......



That is true, but there's a significant difference between a physician working as an "EMT" on an ambulance doing a trache and a paramedic working as an "EMT" on an ambulance doing a trache. One holds an unrestricted license to practice medicine and the other doesn't.


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## Mex EMT-I (Apr 15, 2011)

An advice from Mexico.

Do some oxygen therapy....

(Hit him with the O2 tank)



Very used here in my chaotic city


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## emt seeking first job (Apr 16, 2011)

abckidsmom said:


> In a vollie situation, I wouldn't ride with him.  As a volunteer, I reserve the right to only ride with people who make the job fun.  You'll need to pay me to deal with people who in any way make the situation more difficult.
> 
> At my vollie agency:
> 
> ...




If you would not ride with someone as a vollie, why would you as a paid EMT. An EMT is an EMT regardless. Nothing changes just by the mechanism of compensation.


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## abckidsmom (Apr 16, 2011)

emt seeking first job said:


> If you would not ride with someone as a vollie, why would you as a paid EMT. An EMT is an EMT regardless. Nothing changes just by the mechanism of compensation.



Except the crap-I-am-willing-to-put-up-with meter goes up commensurate with pay.  It would be the same with any job.  That's why the buck stops with the guy who gets the biggest paycheck.


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## JPINFV (Apr 16, 2011)

abckidsmom said:


> Except the crap-I-am-willing-to-put-up-with meter goes up commensurate with pay.  It would be the same with any job.  That's why the buck stops with the guy who gets the biggest paycheck.



Basically, this. If I'm going to do something for free, I'm going to have to derive some enjoyment out of it, even if said enjoyment comes from the satisfaction of helping out my community. Anything that needlessly detracts from said enjoyment is to be avoided. However, if I'm being paid, then it's a job and I have less of a choice of who I can work with or what I can refuse to put up with.


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## emt seeking first job (Apr 18, 2011)

abckidsmom said:


> Except the crap-I-am-willing-to-put-up-with meter goes up commensurate with pay.  It would be the same with any job.  That's why the buck stops with the guy who gets the biggest paycheck.



So for you, you tolerance of other people raises with the financial compensation.


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## emt seeking first job (Apr 18, 2011)

JPINFV said:


> Basically, this. If I'm going to do something for free, I'm going to have to derive some enjoyment out of it, even if said enjoyment comes from the satisfaction of helping out my community. Anything that needlessly detracts from said enjoyment is to be avoided. However, if I'm being paid, then it's a job and I have less of a choice of who I can work with or what I can refuse to put up with.



I need to enjoy what I do regardless of what I am paid.

I have left higher paying jobs for lower paying jobs becuase the higher paying jobs I had were very mentally uncomfortable.

Just going for EMS in general even the few top dogs position wise make very little compared to other jobs.

When I first started vollying I would go out with everyone and anyone. Now I am starting to not be around when certain people are. However, I have found certain people are ok in combination with other people and not OK with others. In fact in my service there are two people NOT allowed to be on duty at the same time.

Everyone is different.


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## abckidsmom (Apr 18, 2011)

emt seeking first job said:


> So for you, you tolerance of other people raises with the financial compensation.



My willingness to put up with discomfort of any kind raises with financial compensation.  I spent saturday in the driving rain, 50 degrees, fishing triathletes out of the lake during their swim.  That was fun, and I enjoyed it, but the misery of the thing was abated some by the $35/hr the company was paying me.


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## emt seeking first job (Apr 18, 2011)

abckidsmom said:


> My willingness to put up with discomfort of any kind raises with financial compensation.  I spent saturday in the driving rain, 50 degrees, fishing triathletes out of the lake during their swim.  That was fun, and I enjoyed it, but the misery of the thing was abated some by the $35/hr the company was paying me.



My problem is after my rent, utilities, food and hygiene supplies are covered, I am no longer able to get out of bed so easily.


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## emt seeking first job (Apr 18, 2011)

abckidsmom said:


> the $35/hr



Was that OT, holliday or special event pay ?


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## abckidsmom (Apr 18, 2011)

emt seeking first job said:


> Was that OT, holliday or special event pay ?



Special event.  The triathlon company was paying us.  I guess they were trying to beat the OT rate so they wouldn't struggle to have enough medics there.


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## emt seeking first job (Apr 18, 2011)

abckidsmom said:


> Special event.  The triathlon company was paying us.  I guess they were trying to beat the OT rate so they wouldn't struggle to have enough medics there.



Are you a -b or a -p ?


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## abckidsmom (Apr 18, 2011)

emt seeking first job said:


> Are you a -b or a -p ?



I am a paramedic.  There were basics there, though.  They needed 2 ALS units and a boat medic, and that turned out to be barely enough for what was going on.


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## emt seeking first job (Apr 18, 2011)

Your service runs a boat ?


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## abckidsmom (Apr 18, 2011)

emt seeking first job said:


> Your service runs a boat ?



In the county, which recently combined all agencies into one big agency, there are 2 boats, a double or triple handful of ambulances, a gator, a couple of golf carts, and a jeep wrangler or two for deep off road adventures. 

For a rural area, we have a number of high-turnout events, and tend to stay busy at the standbys.


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## emt seeking first job (Apr 18, 2011)

abckidsmom said:


> In the county, which recently combined all agencies into one big agency, there are 2 boats, a double or triple handful of ambulances, a gator, a couple of golf carts, and a jeep wrangler or two for deep off road adventures.
> 
> For a rural area, we have a number of high-turnout events, and tend to stay busy at the standbys.



Does the boat carry patients ?

In an enclosed space or in the open ?

Does your agemcy require training or certification to operate the boat ?

Your agency covers an entire county for 911 ?

Is your employer a private company or the county ?


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## paccookie (Apr 19, 2011)

lampnyter said:


> Your lucky. If the Medic ever gets in the back of the truck at my agency its a good day lol.



Am I the only one who finds it bizarre that the person who went through the extra schooling to become a paramedic doesn't want to be in the back?


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## abckidsmom (Apr 19, 2011)

emt seeking first job said:


> Does the boat carry patients ?
> 
> In an enclosed space or in the open ?
> 
> ...



One boat is the sheriff's office boat, the other is a licensed EMS vehicle, and a pontoon boat.  Both carry patients if they need medical attention on the lake, in the open on the deck of the boat.  There are public boat launches and marinas scattered around the 800 miles of shoreline that we take the person to meet the ambulance.  

The boats patrol on summer weekends.  This is what you call "working on a tan."  Most times, if someone needs EMS, they go to shore and call.

Boat operators go through the Coast Guard auxiliary operators class, and I think the sheriff's office just uses guys that are good as pilots, because my pilot the other day was better at controlling the boat and the people on and around it than any I'd seen.

Yep, the agency covers an entire county for 911, fire and EMS, with a combination of volunteers and career staff under the leadership of the county chief and a management group.


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