Anyone ever been denied an intubation during clinicals?

usalsfyre said:
I agree, but the OP described an ETOH female post head-on MVC presenting as combative. I saw nothing inappropriate there, rather I saw an OP that didn't understand the risk associated with not performing the procedure.

I've gone toe-to-toe with physicians and nurses over crappy medicine on more than one occasion. Agreed we can't knock people out over emotions or bad behavior...to a point. If they present a danger to themselves or others to the point the amount of chemical sedation required endangers their airway, they still buy a tube.

If anything I've seen far less inappropriate intubations by physicians than paramedics.
Click to expand...

+1

I am a firm believer in prophylactic RSI, especially with this particular presentation. An altered individual, regardless of origin (alcohol or CHI), that is acting inappropriate after being involved in a head on collision will be getting intubated until fully evaluated by a trauma team. I'm not even too concerned about the injury to self aspect, but they are not going to injure me, nor are they going to injure the rest of the crew. Our helicopter, our rules. If you don't want to play by them, you have analgesia, sedation, paralytics, and plastic coming your way. Period.

OP, it sounds as if there was some communication that was lost in translation. Regardless, you cannot allow the physician refusal to bother you. There are patients that are appropriate for you to practice on and there patients that are no appropriate for you to practice on. Perhaps the situation and severity of the patient were the determining factors here and not the perceived attitude of the physician?

I am curious though, a lot of the responses have hit on the point of who the student should be shadowing. Does your program not have a Paramedic preceptor that is with you in the ER? Most of the hospitals around Houston require it as part of the contractural agreement.
 
To the OP -

Next time you're in clinicals and you see a doctor make a thought-provoking decision, try to find the appropriate time to ask them about their decision-making at that moment. Probably far more important than learning the mechanical skill is learning to judge WHEN you should deploy a skill. So many factors...

It's a great opportunity to initiate a dialogue with a doctor. Plus, it sends the message that you aren't just focused on "the tube," but that you are sincerely interested in their experience and viewpoint. Heck, everyone likes to talk about themselves. It's also a great way to lay the groundwork for getting procedures in the future.

It's fine to ask an RN, but you are going to get an incomplete perspective from them, since they rarely have to make decisions about airway management. Just a different mindset, not bad.

Clinicals are tough - hang in there!
 
Last edited by a moderator:
JPINFV said:
Of course this is also why I think EMS student need to be shadowing physicians in the ED and not nurses.
Click to expand...

They need to shadow both. There are aspects of medicine that they will learn from each provider that the other can't teach them.

Sit a few shifts with a triage nurse, and you start to understand the method behind their madness. When you are bringing a patient in, this will come in handy.

Nurses do a lot of things that paramedics need to be really proficient with. IVs and medication administrations are at the top of the list, but you can put any skill in there. A good nurse can also teach you a fair amount about sick patients. One of the big reasons that paramedic students do hospital time is that they don't get the exposure to the volume of skills in the field.

Physicians have a different perspective, and one that we also need to understand. At the program where I teach, most of the ED time performed by paramedic students is under the supervision of an RN. But they also have 5 (I believe) shifts throughout the class where they are assigned to a specific, EMS oriented physician 1:1. They round on interesting cases, they talk theory, they perform skills. They are meant to be spaced out so that they can see them progress. I think it actually works pretty well.

And FWIW, there are things to be learned from almost any medical provider, if a student wants to, other than RNs and physicians. Some of the providers when I was a paramedic student that I happened to run across and were willing to teach were a couple PAs, a respiratory therapist, a pharmacist, and a CRNA. I got a lot out of spending time with these particular people.
 
I would second the suggestion of having the students work with the RTs. Most of us genuinely like teaching especially when we don't get to do it that often.
 
to the OP in the original poster. the hospital I did my clinicals at, a level 2 trauma center, had a standing policy that only the attending trauma surgeon or anesthesia or ED doc in the absence of either where the only people allowed to intubate traumas. so you may have been denied strictly because it is even more impairative that is is done right the first time. there are alot more complications to trauma than medical intubation. ie, deformed anatomy, secretions/blood/vomit, increased ICP in head injuries made worse during laryngoscopy. further I didnot meet a single doctor that would let me do anything like intubation or central line prior to watching me do other procedures first.

I do feel that medic students need to learn from both RN and MD, I spent my first half of clinicals with the RNs then the second half with the MD. it gave my a well rounded education.
 
I see a lot of these "Students" talking about following a DR around in the ED. When I did my clinical times I NEVER followed a DR around because they would give information that would be way over our head as a PARAMEDIC Student. Instead we were told to follow RN's and Paramedics around in the ED and I did ALL of my Clinical Times at Creighton University Medical Center which is a "teaching hospital" with a Level 1 Trauma Center with possibly one of the Best ED's in the entire midwest. We also did ALL of our Intubations in the OR where there are more Intubations to do and we didn't even do it with the DR's we did it with Nurse Anethesist (SP)
 
Last edited by a moderator:
arharris83 said:
I see a lot of these "Students" talking about following a DR around in the ED. When I did my clinical times I NEVER followed a DR around because they would give information that would be way over our head as a PARAMEDIC Student. Instead we were told to follow RN's and Paramedics around in the ED and I did ALL of my Clinical Times at Creighton University Medical Center which is a "teaching hospital" with a Level 1 Trauma Center with possibly one of the Best ED's in the entire midwest. We also did ALL of our Intubations in the OR where there are more Intubations to do and we didn't even do it with the DR's we did it with Nurse Anethesist (SP)
Click to expand...

so what your saying is that the doctors were trying to teach you...

IT IS YOUR RESPONSIBILITY AS A STUDENT TO ASK FOR CLARIFICATION IF THE TOPIC IS OVER YOUR HEAD.

nobody is going to spoon feed you. as a paramedic you are responsible for interviewing your patient and developing a patient care plan which includes treatments to correct the problem or alleviate the symptoms, which is exactly what a doctor does. nurses do not, they carry out the doctors orders and take care of the patients basic needs.
 
socalmedic said:
so what your saying is that the doctors were trying to teach you...

IT IS YOUR RESPONSIBILITY AS A STUDENT TO ASK FOR CLARIFICATION IF THE TOPIC IS OVER YOUR HEAD.

nobody is going to spoon feed you. as a paramedic you are responsible for interviewing your patient and developing a patient care plan which includes treatments to correct the problem or alleviate the symptoms, which is exactly what a doctor does. nurses do not, they carry out the doctors orders and take care of the patients basic needs.
Click to expand...

Thank you. That would have sounded much nastier coming out from me.
 
arharris83 said:
I see a lot of these "Students" talking about following a DR around in the ED. When I did my clinical times I NEVER followed a DR around because they would give information that would be way over our head as a PARAMEDIC Student. Instead we were told to follow RN's and Paramedics around in the ED and I did ALL of my Clinical Times at Creighton University Medical Center which is a "teaching hospital" with a Level 1 Trauma Center with possibly one of the Best ED's in the entire midwest. We also did ALL of our Intubations in the OR where there are more Intubations to do and we didn't even do it with the DR's we did it with Nurse Anethesist (SP)
Click to expand...

Your basically saying your not smart enough to understand advanced assessment.

Way to advance paramedic education there. Which FD or low level private do you want to work for?
 
arharris83 said:
I see a lot of these "Students" talking about following a DR around in the ED. When I did my clinical times I NEVER followed a DR around because they would give information that would be way over our head as a PARAMEDIC Student. Instead we were told to follow RN's and Paramedics around in the ED and I did ALL of my Clinical Times at Creighton University Medical Center which is a "teaching hospital" with a Level 1 Trauma Center with possibly one of the Best ED's in the entire midwest. We also did ALL of our Intubations in the OR where there are more Intubations to do and we didn't even do it with the DR's we did it with Nurse Anethesist (SP)
Click to expand...

???

You are telling me that a doctor cannot give you information that is usable to your career and practice?

That sounds to me like a failure of the doctor.

Since the original founding of medicine in ancient times, doctors have been instructing non medical providers in health knowledge and practice.

Any doctor should be able to teach a patient with no medical background and even the most minimal of education how to apply home treatments and make better choices regarding their health.

If they can't... well... They may have a medical degree, but they are not doctors.
 
Well imagine that: an MD acting like an arrogant snob wad. Who would have ever thought. . . forget about it and move on. oh, and get used to it.
Yea, it's frustrating dealing with doctors and nurses who have no clue what it's like outside their little world, but you've got to learn to deal with it without letting it get to you. It's not about you, it's about them and their bs and insecurities.
 
EMTBHillbilly said:
Well imagine that: an MD acting like an arrogant snob wad. Who would have ever thought. . . forget about it and move on. oh, and get used to it.
Yea, it's frustrating dealing with doctors and nurses who have no clue what it's like outside their little world, but you've got to learn to deal with it without letting it get to you. It's not about you, it's about them and their bs and insecurities.
Click to expand...


I could have so much fun with this post... I really could. After all, imagine that, an EMT with a chip on his shoulders.
 
EMTBHillbilly said:
Well imagine that: an MD acting like an arrogant snob wad. Who would have ever thought. . . forget about it and move on. oh, and get used to it.
Yea, it's frustrating dealing with doctors and nurses who have no clue what it's like outside their little world, but you've got to learn to deal with it without letting it get to you. It's not about you, it's about them and their bs and insecurities.
Click to expand...

Hmmm, considering the OP was asking a physician he'd had no interaction with to perform a dangerous and possibly difficult procedure I'd say it was less "arrogant snobwad" and more "prudent clinician" I'd have done exactly the same thing. Guess I'm an arrogant snobwad...
 
JPINFV said:
I could have so much fun with this post... I really could. After all, imagine that, an EMT with a chip on his shoulders.
Click to expand...

Please, have fun. I sure don't take this stuff personal or care what some anonymous person thinks.

I only deal with reality.

1. The response and reaction that is the topic of this thread was arrogant and snotty. '"yes, as a matter of fact I do mind" and then walks away.'

2. Any EMT needs to learn to deal with that type of attitude from doctors and nurses with a smile. Most doctors and nurses are decent and helpful and treat us as fellow healthcare professionals with our own niche that overlaps theirs, but there is also the group that will inevitably treat the EMT like an ambulance driver who isn't worthy of their time and can offer them nothing in the chain of patient care.
 
EMTBHillbilly said:
1. The response and reaction that is the topic of this thread was arrogant and snotty. '"yes, as a matter of fact I do mind" and then walks away.'
Click to expand...

I'll pose the question again. You're on scene. An EMT student from a different ambulance on scene approaches you and asks if he can do a high risk procedure. Do you just let someone you don't know do a high risk procedure?

2. Any EMT needs to learn to deal with that type of attitude from doctors and nurses with a smile. Most doctors and nurses are decent and helpful and treat us as fellow healthcare professionals with our own niche that overlaps theirs, but there is also the group that will inevitably treat the EMT like an ambulance driver who isn't worthy of their time and can offer them nothing in the chain of patient care.
Click to expand...

I agree, however this has nothing to do with comments like, "Outside their little world" or "insecurities." I've seen more "little worlds" and "insecurities" from EMS providers than I have from physicians. Want to see "insecurity"? Look at the comments on Facebook when ever someone links to Kelly Grayson's "Day in the Life of an Ambulance Driver" blog.
 
Linuss said:
Devils advocate...


Don't our patients let us everyday?
Click to expand...

They either don't have the choice and there is implied consent, or they do and you gain informed consent.

Completely different scenario from the one posted.
 
Linuss said:
Devils advocate...


Don't our patients let us everyday?
Click to expand...

by virtue of me arriving in a marked ambulance and in an authoritative uniform exuding self confidence, our patient feel confidant that I know what I am doing. they feel safe in the fact that I have passed my training.

put me and a student in the same uniform and put us in front of the same patient and i can almost guarantee they will know off the bat who the student is.
 
Let me clear up what I was trying to say. I was just trying to say as a PARAMEDIC STUDENT, we were told to stick to a Register Nurse or the Paramedic that was working the ED at the time because we could closely correlate what we were learning in class to what they could teach us vs a DR. Yes Dr's know a lot and are a great bed of information at ADVANCED MEDICAL ISSUES, not necessarily the best for a PARAMEDIC STUDENT. I can tell you from personal experience (having a DR teach my Paramedic Class) there were lots of times that he spoke over our heads as PARAMEDIC STUDENTS that not only myself but my classmates needed clarification on. We had adjunct faculty that have been medics for 10+ years in the field that didn't know certain things that the DR that was teaching our class was talking about. As a PARAMEDIC STUDENT you need to learn the basics of being a PARAMEDIC not a Medical Student, after all if I wanted to go to school to be a DR I would have been a Medical Student not a Paramedic Student. With that said yes ED Docs and Docs over all are an awesome bed of information but not for someone just starting out in the field. I learned more from the Paramedics on the Ambulances than I did probably from any DR because they seemed to talk over our heads as Paramedic Students.
 
Last edited by a moderator:
You must log in or register to reply here.
Back
Top