Anyone ever been denied an intubation during clinicals?

[EMTBHillbilly]

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?



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.

Of course you don't and I'm not arguing what the doctor intended, it was the way it was done in an arrogant, snotty manner. Again "yes I do mind" and then walks away. It's so easy to be nice when you are talking to someone in a professional situation rather than being harsh and insensitive.

I'm also not arguing that paramedics aren't that way. They are some of the most insecure people with working class chips on their shoulders that I've ever worked with. . . but that's not the topic here. The topic was to give the paramedic student input about the snide remark he received from a doctor.
Follow along.

As for "little world." The hospital is a little world. It all happens inside one place. In EMS we deal with the whole rest of the world outside the hospital. It's a big place with a lot of crazy situations. we don't have millions of dollars worth of equipment, security and a team of experts in every body system behind us.
g'night.

 

[usalsfyre]

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.

Crawfishing doesn't get you anywhere.

Our job is very, very dissimilar from ED or med surg nursing. It's far closer to a mid-level (NP or PA) or physician. If it's over your head, perhaps it's time you up the level of your head.

As far as the 10+ year medics being lost? I'm not surprised. Homeostasing for 10 years with a patch on your arm doesn't mean a whole lot.

 

[socalmedic]

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.

so in summary, you walked around all day starting IVs and doing 12 lead ECGs. you did this because someone else told you that you dont need to know about the "advanced medical issues" like when CPAP is appropriate verses RSI. or lasix isnt the best treatment for this patient with CHF...

your saying that the MD teaching your class was teaching you to one level but the "ancillary instructors" are telling you that being sub par is OK because they are too lazy to learn it as well. this attitude is why we cant make any advancements. we have too many people who are lazy and settle for just enough. you are being lazy by not going forth and asking for clarification. you are lazy for not trying to be the best you can be. I do not want you or anyone like you ever touching me or my family. Please do us all a favor and either give paramedic school everything you have or dont finish. if this hurts your feelings it should. I tried being nice in the beginning but it obviously didnt work.

I hope you know that sometime in your first year on your own there will be a call which makes you question why you are a paramedic, you will watch someone die and have no idea what to do or you are going to do something that speed up the process. I hope you think back to this.

moderators, I tried to be nice at first but I couldnt stand by idly and let this attitude go un-checked.

 

[EMTBHillbilly]

You guys are rough, but I agree. The more you learn about the body and it's various states, the better you will be as a medic. If the instructor is teaching over your head, you're lucky. Resources are easily acquired these days. Use them and get the information you need to understand this instructor.

 

[EMTBHillbilly]

"As a PARAMEDIC STUDENT you need to learn the basics of being a PARAMEDIC not a Medical Student"

I'm thinking that if you work as an EMT-B for a while before going to medic school, you'll know the basics.

 

[Handsome Robb]

"As a PARAMEDIC STUDENT you need to learn the basics of being a PARAMEDIC not a Medical Student"

I'm thinking that if you work as an EMT-B for a while before going to medic school, you'll know the basics.

Fair argument. However I never worked as an EMT on an ambulance and would like to think I have the basics down pretty well.

I did work in an EMT capacity in other work environments though.

It sucks you got denied a tube but like everyone said, you had built absolutely no report with that MD, I completely understand why she did what she did. Could she have had more tact? Probably but again we don't have both sides to this story. When you're upset often times you hear inflections in statements that you don't like because of the simple fact that you are unhappy about what is being said to you.

 

[Smash]

As a paramedic student, you need to learn the art and science of practising medicine. Who better to teach that than Doctors?

 

[Handsome Robb]

As a paramedic student, you need to learn the art and science of practising medicine. Who better to teach that than Doctors?

Quoted for truth.

 

[RocketMedic]

Agreed, with a caveat.

In the military, I've seen a lot of 'new' doctors. Clinicians with little business in emergency medicine thrust into it. I've been blessed by not having to deal with the stereotypical horrible Army docs, and our unit's never been seriously challenged by casualties. Yes, they are fountains of knowledge, and yes, they do usually like to teach. However, sometimes I find that we need to remind them what's relevant to the task at hand. This isn't the mark of a bad clinician, its the mark of an inexperienced clinician.

As paramedics, we have a role. As students, we need to understand that role well enough to do it on our own. There are some advanced topics that are not well grasped at 2am in an ER if poorly taught, but we do need to be able to take that bit of knowledge, research it, and learn.

If your instructor (be they paramedic, CNA, nurse, RT, or MD) tells you something and you don't understand, tell them. If you still don't get it, take more notes and study it.

 

[Shishkabob]

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.

Point still stands.

 

[mycrofft]

5=4

:deadhorse:

 

[firemedic0227]

Trust me I have a thick skin, I have been out of Medic School since last month and I continue to study up on things that I am not really all the great at yet. With that said If I had questions I asked them or I find them out by getting into books and asking people like yourselves for input. I didn't have any EMT-B experience due to a DUI that I had almost 4 years ago and couldn't get a job, but I do feel as if my Basic Skills are pretty darn good without having been on an ambulance. I appreciate everything you guys do and everything you say to me on here it makes a better "medic" down the road. I was taught in my class differently from others have and that's whats wrong with classes there is no set standard on how to teach these classes. And no I didn't just go around and start IV's and do 12 Leads, I asked questions pushed Meds and if I didn't know how one worked or didn't know the dose I asked and told whoever I was following around I didn't feel comfortable about giving/doing something. I have already witnessed Death and dying in the field as a Ride A Long without any experience. I saw people murdered people dead from natural causes and Codes that ended up dying and I felt hopeless and all of those cases still bother me to this day.

 

[MNRescue]

Skill Denial

I can feel your pain, at least as a student you can expect douche docs like that. What happened to me, I was working as an EMT in the ER, as in I was a paid employee. We had a peds case come in with a fx'ed femur. As we all know, you put the leg into traction. This particular doc (fresh out of residency) wanted to transport the child handing weights off the end of the stretcher (we didn't have a peds unit, as the Children's Hospital was only five minutes away). I suggested to the doc a way to provide traction that would not move. Field traction using cravats and a cane. Would have made the trip to the Children's Hospital in which they could then put the leg into hare traction there. Or even hang weights. She totally blew me off and acted like I didn't know Sh**. The child waited 4 hours for the Ambulance Supervisor to come and deliver a peds traction device. The time it took the Supervisor to get the device there, she could have been out of surgery and recovering.

 

[Veneficus]

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 would just like to address this on several levels.

I doubt the RN or Medic in the ED is a better source of information for correlating what you learned in class.

One of the aspects of medical education is understanding “why.” I can say in my nearly 9 years of teaching medic class, less than 1% of all instructors I have ever met understand why beyond a few bullet points in the paramedic text.

The knowledge “why” helps you make better decisions about what treatments you choose for your patients as a paramedic. It also allows you to know what is going to come after your care, so you can set your patients up for success.

Perhaps the greatest information you can gain from following the doctor is thought process and critical reasoning.

Yet another benefit is learning how to differentiate what the most acute issue of a patient with multiple chronic pathologies. (aka, is one making the others worse, is it unrelated, or are the sum total effects of the other pathologies causing an acute issue?) Don’t you think in the modern world where people are not only living longer, but more active longer, with multifactorial causes of long term pathology starting prior to birth, that kind of information would be absolutely critical to your function?

But now I ask you to help me.

What is an advanced medical issue exactly? I have heard of complex ones, but never an advanced one. I would just offer what I can tell you about shock would probably make your head explode. Most doctors I know cannot reconcile the required balance of NF kB promotion of antiapoptosis, proinflammatory, and prothrombotic, effects in a clinical or lab environment. Do paramedics not treat shock? Do you think the information I described doesn’t directly apply to you?

If you think it doesn’t, you are wrong and your patients can suffer, even die from your lack of understanding.

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.

I will give you a break on this one for a couple of reasons.

You don’t know any better and doctors who by their very nature spent almost all of their waking hours in medicine sometimes forget other people don’t. They can easily assume that things they consider common knowledge or obvious that others do as well. That is the fault of the doctor and she should seek to remedy it.

As for your adjunct instructors, I am embarrassed for them. They are supposed to be experts at prehospital medicine and after 10+ years of experience and continuing education, they should be on par with just about any physician (I will accept there are some really exception physicians whom nobody will be able to match wits with, but they are few.) discussing the concepts of such.

As a PARAMEDIC STUDENT you need to learn the basics of being a PARAMEDIC not a Medical Student,

Could you tell me what the differences are?

I am not smart enough to figure the differences out on my own.

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.

Let me help you since you may not have understood my original comment.

If a doctor can, and everyday, educate patients with no medical accumen at all, surely they could teach you something useful to your job.

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.

I would say because the doctors were treating you like a capable professional and trying to discuss things with you as a peer.

Clearly from your statements here, they gave you and your adjunct instructors far more credit than you have earned.

I think it is probably better if the guys in your area just stick with driving the ambulance and stop "teaching".

 

[Veneficus]

I can feel your pain, at least as a student you can expect douche docs like that. What happened to me, I was working as an EMT in the ER, as in I was a paid employee. We had a peds case come in with a fx'ed femur. As we all know, you put the leg into traction. This particular doc (fresh out of residency) wanted to transport the child handing weights off the end of the stretcher (we didn't have a peds unit, as the Children's Hospital was only five minutes away). I suggested to the doc a way to provide traction that would not move. Field traction using cravats and a cane. Would have made the trip to the Children's Hospital in which they could then put the leg into hare traction there. Or even hang weights. She totally blew me off and acted like I didn't know Sh**. The child waited 4 hours for the Ambulance Supervisor to come and deliver a peds traction device. The time it took the Supervisor to get the device there, she could have been out of surgery and recovering.

:rofl:

Sorry, but that doc was right.

 

[MNRescue]

:rofl:

Sorry, but that doc was right.

Would you like to ride in the back of an ambulance with a broken femur with 20 lb weights bouncing up and down over every bump not to mention the risk of a severed artery? And in regards to the wait time, how do you make a 3yr old child wait that long, sedate them? That opens a whole new can of worms as well, especially considering the lack of any peds experts onsite. BTW, it took my complaining to the Charge Nurse to stop the doc from wanting to transport. I guess better to wait four hours than have weights bouncing.

 

[Veneficus]

I accept your challenge

Would you like to ride in the back of an ambulance with a broken femur with 20 lb weights bouncing up and down over every bump not to mention the risk of a severed artery? And in regards to the wait time, how do you make a 3yr old child wait that long, sedate them? That opens a whole new can of worms as well, especially considering the lack of any peds experts onsite. BTW, it took my complaining to the Charge Nurse to stop the doc from wanting to transport. I guess better to wait four hours than have weights bouncing.

The purpose of applying traction is to elongate the distance between the opposing ends of the fracture to mitigate the pain and other injurious complications when the musculature of the proximal lower limb contract and “over approximate.”

The reason it is the treatment of choice for the femur is because the fracture cannot be immobilized in the acetabular joint. (allowing the joint above and below to be splinted)

Weights were the method of choice before traction splints were developed. (more useless EMS gadgets) With external fixation being the alternative.

As long as the weights are secured from swinging or overly bouncing around (like setting them on the ambulance floor and driving slowly and carefully or simply tying them under tension to the stretcher) they would work fine.

Moreover, if you actually understand the principles of lower limb anatomy and orthopaedic pathology, you can apply traction with a simple roll of gauze or triangular bandage and secure it under tension to the bottom of the stretcher.

The waiting/suffering the child did was because of the insistence on the use of the manufactured traction device by a provider who didn’t understand traction.

 

[usalsfyre]

Would you like to ride in the back of an ambulance with a broken femur with 20 lb weights bouncing up and down over every bump not to mention the risk of a severed artery? And in regards to the wait time, how do you make a 3yr old child wait that long, sedate them? That opens a whole new can of worms as well, especially considering the lack of any peds experts onsite. BTW, it took my complaining to the Charge Nurse to stop the doc from wanting to transport. I guess better to wait four hours than have weights bouncing.

Which was it, a horrible, dangerous, long, bouncy transport? Or a five minute ride?

How about securing the weights to the stretcher with the cravats so they didn't bounce and swing?

The big place where paramedics have an independent body of knowledge is the transport aspect of medicine. In this case, you failed in that regard.

 

[MNRescue]

The purpose of applying traction is to elongate the distance between the opposing ends of the fracture to mitigate the pain and other injurious complications when the musculature of the proximal lower limb contract and “over approximate.”

The reason it is the treatment of choice for the femur is because the fracture cannot be immobilized in the acetabular joint. (allowing the joint above and below to be splinted)

Weights were the method of choice before traction splints were developed. (more useless EMS gadgets) With external fixation being the alternative.

As long as the weights are secured from swinging or overly bouncing around (like setting them on the ambulance floor and driving slowly and carefully or simply tying them under tension to the stretcher) they would work fine.

Moreover, if you actually understand the principles of lower limb anatomy and orthopaedic pathology, you can apply traction with a simple roll of gauze or triangular bandage and secure it under tension to the bottom of the stretcher.

The waiting/suffering the child did was because of the insistence on the use of the manufactured traction device by a provider who didn’t understand traction.

That's the point I was trying to make, the fact that this Doc wanted to hang weights without knowing that the slower routes were the most unstable roads. We are known for our pot holes in MN. Short of air lifting the child for a 10 mile ride distance. (BTW, I worked in house, not the street and the crew that originally was to transport didn't give much feedback either.)

 

[RocketMedic]

From my perspective, I'd pick a tied or 'field' traction splint over weights any time. I can control tension a lot more easily with a traction splint (manufactured or improvised) then I can with weights.

Keep it simple. Applies to a lot of stuff.