Are most EMS personnel THIS unprofessional?

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zaboomafoozarg

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I recently completed my ride-along time for my EMT-B class. My knowledge is not that expansive, I will readily admit, (even though I am at the top of my class ^_^) but I was still absolutely shocked to see how the "real" medics behave.

Just to clarify, this is not a rant in any way, because I still had a good time: I just want to know if this is what I get to look forward to for the rest of my career. :wacko:

For starters, these folks' vocabulary appeared to consist only of the necessary medical terms, a few verbs, and primarily the F word.

Every other word, pretty much. Then, of course, there are the conversations. Horrible. Laughing, joking, and even just talking about absolutely inappropriate matters. You know what I mean.

Then there's the attitude. I got a sampling of more whiny drama, gossip, and downright nastiness in 6 hours in that EMS station than one should normally expect in... oh, I don't know, a month! This includes your typical backbiting sessions, and one woman becoming extremely angry and yelling because the kitchen was dirty and then basically stomping around from that point on. (Yes, I was hoping and praying for a call to come in so I could get out of there :ph34r: )

The standard professional behavior one would expect from trained medical personnel was nonexistent. This includes insulting the 96 year old verbally-responsive patient right beside her in the ambulance... "She BLEEPing reeks!" and ranting about how much of a %&*( @!)% )$(! ^&%* idiot her primary caregiver is because she was reluctant to send the DNR with them in the fear that it might get lost. Then relating the entire thing to the hospital staff as he wheeled her in on the cot, all the while ignoring the actual patient. :sad: Another squad exhibited the same type of behavior when we pulled up to a trailer park. The scorn was just seething from them.

Not only this, but the EMT/Patient communication one is taught in class to use was not displayed at all. Not once throughout the day did any of the medics I saw introduce themselves properly, ask consent to treat, or even really talk to the patient as a human being. If any actual addressing was done, it was in the form of, "Hun," "Old girl," or simply implied, "you." Then the patients just had to sit on the cot in the ambulance while the medics worked on them in virtual silence (save for the two standard questions, "how old are you? are you allergic to anything") all the way to the hospital. No reassuring, no explanation of procedures and treatment as administered.


And then, to top it off, the level of care seemed downright unprofessional even to my own inexperienced eyes. Not once did any of the shortness of breath or difficulty breathing calls receiving anything more than 3-4 liters of O2 via Nasal Cannula. What happened to the non-rebreathers that are supposed to be used? One woman who could hardly breathe and speak only 1 word per sentence was forced to walk to and climb into the ambulance by herself. A patient who fell and had severe left shoulder pain was mercilessly jostled by the medics manning the stretcher. Trust me, they could have been far more gentle.

These are just some of the things that took place, and let me tell you, it was not what I expected! :unsure:

I don't believe I saw even one good example during the entire time period.

So that's why I make this post here. Is this really the way things are? I understand the job can be stressful but come on, the people with whom I was acquainted there wouldn't have been able to hold a job as a gas station attendant acting like they did, let alone medical professionals. And I wouldn't be so concerned, except I saw the same thing in every case If this is the norm, then I guess I'm in for a fun ride. :excl:


Your thoughts and input be much appreciated.
 

Onceamedic

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Absolutely, totally and completely is NOT the norm. I would not tolerate anything less than a professional attitude on the ambulance and take exception to those that demonstrate lack of compassion, or are judgmental.

As far as conversations and behavior in the station - yes, there are the profanities and the "inappropriate" conversation occasionally. However, if anyone behaves like the woman you describe over the kitchen - well it just wouldn't happen. Kitchen cleanup is one of assigned PM duties and the crews enforce the completion of same amongst themselves. If a crew is on a transfer and unable to perform PM duties, others pitch in and get it done.

It sounds to me like you are with an agency/shift very far on the continuum of what is "typical" behavior. EMS varies company to company, area to area.

Just look at the variety of posts on this forum. They range from the illiterate and ill informed to amazing demonstrations of competence, maturity and commitment.

Do not allow these people to color your entire view of the industry, and if you can, find someplace else to get your ride time.
 

Linuss

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Couple of things I'll comment on real fast:

the "innappropiate" humor is a part of EMS, and medicine in general, for better or worse. Google "Gallows humor" and you'll understand why.


As for the sob getting an NC instead of a NRB, as you hopefully continue on in your career and get higher education, and more tools to use, you'll realize very few people get the EMT-student blanket treatment of "15lpm NRB", sob or not.
 

exodus

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Speak to some of the superiors at your school and let them know what happened on the ride-along and they should know how to follow up with it. And you can probably request another ride-along with someone else too..
 

Foxbat

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Is this really the way things are?
Some of them are.
Dark and/or politically incorrect humor, profanities and gossip are very common in EMS. As far of the use of NC instead of NRB, it depends on the situation.
The way they talked to pts. sounds very inappropriate and not typical. Making pt. who had difficulty breathing to walk and climb into ambulance definitely does not sound right.
I would find a different place to do ride-alongs...
 

mycrofft

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zaboomafoozgard, what do YOU think?

Gresham's Law as applies to EMS: crummy attitudes drive off good ones.
 

Luno

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Hmmmm....

Your thoughts and input be much appreciated.[/QUOTE]

Wow, sounds like you got your eyes opened to the good, the bad, and the absurd of the profession. So we'll just handle this piece by piece...

For starters, these folks' vocabulary appeared to consist only of the necessary medical terms, a few verbs, and primarily the F word.

Every other word, pretty much. Then, of course, there are the conversations. Horrible. Laughing, joking, and even just talking about absolutely inappropriate matters. You know what I mean.

This should of been curtailed especially with a rider, however, if there were ever a microphone in my rig while it's just me and my partner the conversation would probably be similar. Understand that you are an outsider looking in. In our station, there's the young kid, the gay guy (not actually homosexual), the old guy (me) and another guy named after a cartoon character. The topics range from jokes about kids vs cars and SIDS (coping mechanisms through humor) to evaluating cardiac arrythmias and or symptoms from previous calls that our crew or the other crew can't figure out. The key is that it is a closed society with it's given rules accepted by all members of the society. You were an outsider, and they probably should of censored themselves accordingly. The topics of discussion aren't really yours to critique as you have no bearing or reference to the appropriateness in a closed society, so take that advice for what you paid for it. And yes, absolutely inappropriate things are discussed, and often laughed at. I'd also be cautious, as I've seen crews exaggerate things and do things to make someone feel uncomfortable... i.e. you...

Then there's the attitude. I got a sampling of more whiny drama, gossip, and downright nastiness in 6 hours in that EMS station than one should normally expect in... oh, I don't know, a month! This includes your typical backbiting sessions, and one woman becoming extremely angry and yelling because the kitchen was dirty and then basically stomping around from that point on. (Yes, I was hoping and praying for a call to come in so I could get out of there :ph34r: )

This will happen with any crew that you live with, it happens in the military, it happens in the private sector, it even happens in the public sector, gossip and interpersonal conflicts will happen, and need to be dealt with. Yes, occasionally people explode. The upside is these circumstances rarely last, as you can only live with conflict for so long...

The standard professional behavior one would expect from trained medical personnel was nonexistent. This includes insulting the 96 year old verbally-responsive patient right beside her in the ambulance... "She BLEEPing reeks!" and ranting about how much of a %&*( @!)% )$(! ^&%* idiot her primary caregiver is because she was reluctant to send the DNR with them in the fear that it might get lost. Then relating the entire thing to the hospital staff as he wheeled her in on the cot, all the while ignoring the actual patient. :sad: Another squad exhibited the same type of behavior when we pulled up to a trailer park. The scorn was just seething from them.

Not only this, but the EMT/Patient communication one is taught in class to use was not displayed at all. Not once throughout the day did any of the medics I saw introduce themselves properly, ask consent to treat, or even really talk to the patient as a human being. If any actual addressing was done, it was in the form of, "Hun," "Old girl," or simply implied, "you." Then the patients just had to sit on the cot in the ambulance while the medics worked on them in virtual silence (save for the two standard questions, "how old are you? are you allergic to anything") all the way to the hospital. No reassuring, no explanation of procedures and treatment as administered.

The standard of care including the treatment of a patient is absolutely unacceptable, and is not standard. This kind of behavior needs to be corrected. EMT/Patient communication as taught is subjective at best. I've use "hun," "sweetie," "bud," "boss," "chief," and probably several others that are used to calm, reassure, and decrease the emotional distance between the patient and caregiver. However, it is just a tool in the box to calm and reassure the patient, and sometimes might be inappropriate.

And then, to top it off, the level of care seemed downright unprofessional even to my own inexperienced eyes. Not once did any of the shortness of breath or difficulty breathing calls receiving anything more than 3-4 liters of O2 via Nasal Cannula. What happened to the non-rebreathers that are supposed to be used? One woman who could hardly breathe and speak only 1 word per sentence was forced to walk to and climb into the ambulance by herself. A patient who fell and had severe left shoulder pain was mercilessly jostled by the medics manning the stretcher. Trust me, they could have been far more gentle.

I'm going to go out on a limb here, and state that your class hasn't prepared you to critique a practicing medic's calls. You will learn that you don't treat the book, you treat the patient, and not every SOB needs an NRB. The patient that had to walk, there may have been mitigating circumstances. The shoulder pain, there's potentially issues there that could go either way. I'd guess what I'm saying is that there might be more to the situations then meet your class trained eyes. When I joined the field, I felt the same way coming out of class, so do I empathize with you.

So that's why I make this post here. Is this really the way things are? I understand the job can be stressful but come on, the people with whom I was acquainted there wouldn't have been able to hold a job as a gas station attendant acting like they did, let alone medical professionals. And I wouldn't be so concerned, except I saw the same thing in every case If this is the norm, then I guess I'm in for a fun ride. :excl:
These are just some of the things that took place, and let me tell you, it was not what I expected! :unsure:

I don't believe I saw even one good example during the entire time period.

I guess the only thing I can say about this, is really what do you expect from a profession that requires less education than someone who cuts your hair? A profession is not built on a 120hr certificate... That also being said, these aren't the only shocks that you will experience if you decide to enter this field.

These are just my opinions from 6 years in prehospital medicine...
 
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Canoeman

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I still might encourage you to talk to their bosses. Something tells me this is not the first time that this behavior was presented. Just bad carma all the way around. And no this is not typical. Press on.
 

JonTullos

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Blue humor is just a part of how things are done sometimes. While it isn't "nice" it's just there. Plus some people cope with the stress of EMS and blow off steam by talking about sex or using profanity. While I choose not to participate, I'd rather they do that than bring an uzi in with them.

As far as how patients were talked to and about, that's totally wrong. At my services these medics would have lost their jobs post haste. I'm sorry you had to see that. Like it or not, though, there are some bad ones out there. Eventually they'll be caught and have to answer for it.
 
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zaboomafoozarg

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Well this much feedback is certainly nice. Thanks for the interest, everyone. And the advice. Fortunately I only had to do one ride along. And it was mandatory that it be this company. In November some insurance laws are changing and I will attempt to get permission to ride along at a much closer, local, and largely rural service (3 plus's right there) where a couple relatives work (also a plus.) So I'm not overly concerned about one bad experience. I just wanted to know if anyone else had noticed it as a trend in their experience, and I'm glad to see the general consensus is negative. :)


Most of what I said is subjective, I realize. Meaning, it wouldn't matter in the slightest to some people. But it's still a patient oriented field... where I would think propriety should be paramount.


I will clarify one thing: the nasal cannula was put on by the EMT. Medic didn't even say anything. But that might be their protocols, I don't know.



I'm not sure that the education level (I assume you're referring to EMT and not Paramedic too, by the way) has that much to do with it, because... much of what I heard and saw would not be even close to tolerated in a minimum wage entry level position! Let alone a job of this importance. Furthermore, who would you rather have be a compassionate, helpful and, if at all possible, remotely pleasant person of character: your barber or the person responsible for saving your life? But, apparently being an untrained outsider, I do not have the keen eye or educational requirements for spotting blatant indecency. ;)
 
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daedalus

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Couple of things I'll comment on real fast:

the "innappropiate" humor is a part of EMS, and medicine in general, for better or worse. Google "Gallows humor" and you'll understand why.


As for the sob getting an NC instead of a NRB, as you hopefully continue on in your career and get higher education, and more tools to use, you'll realize very few people get the EMT-student blanket treatment of "15lpm NRB", sob or not.
I agree with Linuss's thoughts.

Be aware that these paramedics may know something you do not in regards to oxygen therapy. (http://www.bryanbledsoe.com/handouts). Like many things in school, you probably have not gotten the whole truth.

Also, if you stuck a recorder in my rig you would here some pretty nasty, perverted, and down right strange conversations. While it may have been nice to temper down normal partner communication for the ride along, be aware that some services have to deal with an EMT ride along every week and sometimes they just want to talk to their partners like normal.

BTW, if you think we are strange, try sitting in a police or correctional officer lounge or spend a few minutes in the living room of a fire station. Those guys are horrible.

Now, in regards to patient communication, I can't judge your preceptors based on second hand information. Just be aware that if you saw something that you wish to do differently when you become and EMT, make a mental note of it. However, you were invited onto the unit as a guest and it is a privilege for you to be there so it is not appropriate for you to challenge the crew or attempt to get them in trouble.

I hope that you will stay it through and find happiness where ever this field takes you.
 

HotelCo

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Gallows humor is very common in EMS. That's for around the station, not around patients though.

daedalus: Some of the best laughs I've gotten have been in the PD. Those are some crazy guys. You're right, EMS humor is pretty tame compared to some of their humor.
 
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Miss Xina

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I know what you mean, I was actually told NOT to get too involved with the patients.

The reason for this is because we had a suicidal patient and when we arrived at the hospital, they told us to put her in the room. My team mates left to do other things, but none of the nurses came in to sort out the patient.

I may be new to all of this, but if I am told the patient is suicidal, I am not going to leave him/her alone in an unlocked room with a plastic bag, shoelaces, whatever.

I am a patient advocate and I do not believe in just dumping the patient as soon as we enter the hospital.

Another example was a patient being brought in completely unresponsive to painful stimuli, a head injury that happened a few days previously and NO OXYGEN! When I blatantly asked the crew why there was no o2, they said "this is an alcoholic who comes in every week"

I was not impressed by this response and even more disgusted when the drs found that the patient's blood alcohol level was significantly lower than normal and Cat Scans were performed to check for brain damage.

I know we can't do a whole lot, but I think we should always do what we can to the best of our abilities. I don't know what happened with this patient, but the fact that he was not unconscious because of alcohol intoxication and the crew assumed that was the reason is unacceptable.

If it gets to a point where you can't even be bothered to administer oxygen, you shouldn't be in this job. This is when people die unnecessarily!
 
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zaboomafoozarg

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P.s., another fun tidbit I just remembered is that we didn't even get full vitals on all the patients. On one of them I was told to take a shot at getting the vitals, but I couldn't get an accurate blood pressure (not good at that yet, plus the lady's sleeve could not be rolled up enough) and informed the EMT that I was unable to, and asked him if he could do it on this patient. He responded, "Nah, whatever" and promptly slid her out of the ambulance and took her into the hospital. -- And on another squad, The EMT-Intermediate reported the vitals en route to the hospital, but forgot to take a pulse ox reading, and when the hospital asked for it after she was done reporting, she said a less than pleasant word off the mic and ignored the question.

Daedalus said:
However, you were invited onto the unit as a guest and it is a privilege for you to be there so it is not appropriate for you to challenge the crew or attempt to get them in trouble.

Not exactly true. I paid good tuition to get some hands on training. A scheduled ride-along was one of the learning tools that I paid to receive, and I expected the best from it.


I am not attempting to get anyone in to trouble at all. Just posting about my experience.




But this job, as with any job, involves some doggone common sense too. If you see a defense attorney standing there and badmouthing his client, are you going to say, "You know what, I have no right to critique his actions because I personally am not a lawyer, just a mere guest in the court room."? I think the answer to that is kind of obvious
 
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mct601

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As everyone has said, the style of humor you encountered is typical in EMS/medicine, and gets worse in fire (at least around here) and PD settings. Hell, in my EMT class there are two firefighters that talk about playing pranks on the local police officers, and getting tazed as the results... for fun. I've got alot of friends and family in the 911/medicine fields, so its normal to me. spend 12 hours at a nurses station and you'll know whos doing who and where at what time, what the nurse on floor 3 smells like, what the nurse in the other wing of the ER drives, who the doctor of ICU is having an affair with... etc etc.

This SHOULD stop in a public setting or on call. These people represent their occupation and agency, however I see some agencies very lax on their expectations of the workers (ex. one station has very poor ambulances along with no rules on tattoos, facial hair, and overall appearance. one man had a beard, "sleeved" forearms, and a mohawk that was not stood up). I wouldn't want this coming to my house, and if (in your case) someone said a family member of mine :censored::censored::censored::censored:ing stinks, there would be hell to pay. Completely uncalled for.


As far as NC @ 4lpm, like other people have said it may not have been the wrong call. It depends highly on the protocols of that station/agency. I've been told many times "learn everything you can in class, but expect to use only some of it in the actual field".
 
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zaboomafoozarg

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mct601 said:
As far as NC @ 4lpm, like other people have said it may not have been the wrong call. It depends highly on the protocols of that station/agency. I've been told many times "learn everything you can in class, but expect to use only some of it in the actual field".

Yea, I'm not sure. My EMT class instructor who is a firefighter paramedic has said, off record, that everyone gets as much oxygen as possible because it can only ever help. Judging by people's responses here that's obviously not standard, but it does make sense to me. I'll have to ask him about it.
 

mct601

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Yea, I'm not sure. My EMT class instructor who is a firefighter paramedic has said, off record, that everyone gets as much oxygen as possible because it can only ever help. Judging by people's responses here that's obviously not standard, but it does make sense to me. I'll have to ask him about it.

I am told the exact same thing, but like I said, not everything you learn in class will be applied in the field cut and dry like the curriculum makes it out (so I'm told :p). Hell, it could have been the wrong move, but I'm simply saying from what I've learned from EMS professionals is that protocols and what you really do in the field vs what the book says varies. If I were you, I'd give my instructor the situation and ask if it was the correct call. In the future, after the call, I'd ask the paramedic about a questionable or confusing action taken by them. You're there to learn and be exposed to the field, so nothing wrong with asking questions.
 

triemal04

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Luno really said it best, so I won't repeat too much (except to say to read his post again).

What you need to remember is that, given your situation, you may be misunderstanding some things you see, misinterpreting others, and overreacting somewhat. Not to everything, and not even necessarily to one thing, but it is something to consider.

For the most part, what you reported you saw was relatively accurate. Some wasn't, much was. That's not to say that everything you saw was acceptable, just that it often happens that way.

If it really bothered you that much, figure out why, and what you would rather have done, and, if you ever end up working in this profession, remember that and act accordingly. But don't let 1 single glimpse taint your entire view of EMS, or let it give you a chip on your shoulder and make you determined to change everything.

Of course, that being said, to be honest there are truly horrible services out there, in both their personal conduct and their practice of medicine. But there are plenty of excellent ones as well, and loads that are in between.
 
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zaboomafoozarg

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Just for some background, this service has about the worst reputation in the area. Privately owned, etc. So it's to be expected, I know. I just wondered how it was out in other situations too. That's all I'm asking.



I'm not bothered by it, and not trying to dramatize anything, but I would certainly be bothered if my career ends up looking like that.
 
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