Bad Blood between the emt and the p all input is appreciated

[sinthia]

My guess is you are insecure regarding your own level of competence as a medic.

I absolutely agree. As an IFT unit we don't see much that requires acute care and so I am worried that I'm going to miss something.

 

[squirrel15]

I absolutely agree. As an IFT unit we don't see much that requires acute care and so I am worried that I'm going to miss something.

So you dont listen to your EMT no matter their experience, who may or may not be correct in something they see and you have missed?

 

[gotbeerz001]

I absolutely agree. As an IFT unit we don't see much that requires acute care and so I am worried that I'm going to miss something.

I have had some great EMTs shed light on an unusual presentation that they had seen before.

 

[sinthia]

So you dont listen to your EMT no matter their experience, who may or may not be correct in something they see and you have missed?

I never said that. I've worked with some great B's whom I would trust with my life, and some others who can do their job with their eyes closed and working with them is refreshing, being able to have confidence in them however that is not the caliber of EMT I'm working with now and it really doesn't necessarily have to do with experience.

My 8 year veteran Basic never takes vitals and makes them up on the report.
My 12 year veteran Basic thinks I should asses my ALS transfer pt in the back of the truck so that we can get on the road quicker because checking orders and meds and attatchments should be done enroute.
My old <1 year Basic could anticipate what I needed as well as handle any situation until someone got there to help (she saved a staff memerbers life in a NH who coded while the other staff stood around scared)

My problem is I don't know how to have peace of mind, making sure something isn't missed without coming across as being condescending.

Should I just chill out? Calm down. And whatever will be will be?

 

[sinthia]

I'd make the 3 year old joke but I think I'm late to the party. I'd also give input but I got lost in what exactly you were trying to say... Mostly what I gathered was you have no trust in EMT-Bs because they are a lower level provider than you. I understand double checking your equipment on a rig, or reassessing what came as a BLS call, to make sure it shouldn't be run ALS, but your distrust sounds like an issue as well as whatever it is being directed to you from the EMT-Bs.

And how does an EMT-B not have a medical director and operate under your license? As far as I'm aware it doesn't work that way, we have protocols and work under medical direction as well...

If you could clarify some of your rambling I will gladly give more input, but what you said is confusing.

I am sorry for the rambling, I did get a little carried away.
I don't have trust in my B's because they continually show their incompetence. Most of which can be pointed out as their laziness or them taking on the mind set that this is just IFT stuff so it isn't important.

My double checking as you say is what causes the animosity. I have never told any of my B's that I don't trust them, nor have I yelled at or called them out. I simply want to know what's going on so that hopefully nothing is missed. (When they ask to see my pt chart or step in to ask my pt questions I have no problem with it, after all that is technically our pt and there is information that they need to know, and truly we are working together so it shouldn't matter.) When I ask their pt a question, or confirm something with the nurse concerning their pt they feel as if I am undermining them. That is what I don't know how to get around. How to check in order to be confident that nothing is being missed without them feeling like I'm being condescending.

As far as them working under my license. Where I work basics cant operate without a paramedic present, their protocols simply list what certain things they can do on the P's call ie; 12lead EKG (they can perform the skill, where the P interprets), administer 4 baby aspirin, (after being instructed to do so my the P with the paramedic at bedside double checking), Set up and administer an albuterol treatment (again after being instructed and observed by P)

A basic cannot be an attendant for anything acute. They operate under borrowed servant. I don't understand it much myself, but under these rules they can actually perform more skills than I could as an EMT it just all has to be on scene.

 

[Brandon O]

http://www.amazon.com/How-Win-Friends-Influence-People/dp/B008GAT3BI/ref=sr_1_2?ie=UTF8

 

[squirrel15]

@sinthia so the same system that allows a B to administer drugs is now extremely restrictive and they can only work if a paramedic authorizes it? If you don't mind me asking, where is it you work? And how much of this is company policy?

And if everything is done under you, why is there such a thing as BLS under what you're describing? Because even if its not an acute call, my understanding of what you said is an EMT cant even administer O2 in the back without the paramedic present in the back. It sounds like everything should be run ALS and the EMT shouldn't be doing an assessment anyways.

And as for the saying you don't listen to your EMTs that's just how it came across in your first post, I apologize if I misinterpreted that.

 

[sinthia]

Maybe try stop being so condescending?

Maybe you have ****ty partners, maybe you don't, I don't know all I'm getting is your side of the story. But if I had a newly minted paramedic come in to my service where I have been working for years as a basic and order me around and give me the attitude you have in your post, I would not be all nice and cheery for you.

There is a difference between bossing and educating. There is a difference between being friends and treating someone with dignity and respect.

Also, where do you work that basics can give benedryl without medical direction?

I get what you mean by the newby coming in being bossy, but how do I not come across as bossy or condescending but still be able to feel comfortable with the level of care provided?

I've tried educating, I was told that if the company didn't make it mandatory then they weren't going to do it, and besides they didn't need to know it, they were on the ALS truck, I would always be there.

And I have a really hard time giving respect where none is earnd. I have had some fantastic Basics but I am currently stuck with some seriously bad apples. Who constantly go to management calling me a bully for not having confidence in them.

NC I was extremely surprised my self at the extent of the basics scope. Like California every county is different. Where in one county you have basic units running around with Epi ampules to give IM injections, PO Benadryl, Ibuprofen, and Tylenol as well as nitro albuterol and narcan in other countys they can do so but not without a P present. We actually had a B unit with a monitor so they could obtain a 12 lead and Bluetooth it to the hospital.

 

[sinthia]

Just reading your post...you sound hostile, and angry and i probably wouldnt want to listen to you either.
You say you saw nearly everything as an EMT which is fine and dandy, but at 3 years of being a medic, I reckon you still have a lot to see, care for and manage as far as patients go, and if for NO other reason than to make your life easier, get a long with your EMT.
Its not that hard, and yes you probably are taking yourself too seriously.

"Theyre just IFT"---and so are you...so??

Take a chill pill

I was angry in my post... but I don't talk to my partners like that. I was frustrated.
I do have a lot to learn, and my emt career is all I have to compare my B's with. I was trying to show how I was support for my partner and so not having partners now that support me is a little uncomfortable.

I absolutely agree that I need to get along with my emt , that's my problem, I don't know how. Should I make all the concessions and bend to them, and let them do as they will and not worry that they apply the same mindset to their pt care as they do with their ideas about cleaning the station (if I don't do it someone else will) that's what I feel they want.

I'f I take a chill pill and relax am I not being to blasé about paramedicine?
Am I taking everything to seriously? Can I calm down without compromising pt care?

Maybe my perception of my paramedic partners is skewed, I honestly thought they had one eye on the patient and one eye on everything else.

 

[Brandon O]

I think this comes down to people skills, not medicine. Handling this kind of issue is one of the fun little challenges of any clinical role. And I'm not sure how teachable it is, especially over the internet. (Double especially not by me.)

 

[Kevinf]

Faking vitals is creating a fraudulent legal document / medical record and would likely result in serious repercussions if reported to overseeing authorities of any stripe. Not to mention potentially endangering the patient. This should be reported immediately if you have knowledge of it happening. I caught one of our newer hires doing this as it turned out his patient was very hypotensive, enough so to warrant a trip to the ED for evaluation. He charted 120/80 yet the patient had a systolic in the mid 60's. Chart review turned up an impossible pattern of 120/80's and he was terminated.

That said, you need to learn how to influence your peers without coming off as condescending or uptight. If you truly can't get along with someone you need to request not to be partnered with them. If the problem looks endemic that's either a sign that you are the problem or that it's time to abandon ship.

 

[Brandon O]

^ what he said.

 

[sinthia]

Me and all of my partners have always had an understanding.

1) Truck is the basics responsibility. If the basic thinks there is an issue with it mechanically or otherwise it's not questioned as the basic knows how it should operate normally.
2) Everything in the back is both our responsibility. We work together to make sure it's properly stocked.
3) Patient care is first and if the basic feels the medic missed something the basic can speak up without fear of the medic being a ****.
4) If one of us doesn't know a piece of equipment on our rig we work together and learn.
5) You can discuss freely any issues without fear of reprisals.
6) We are a team and not working against one another.
7) Before any administrative punishment is pursued we talk about our issues and if all else fails then write ups are a last resort.

To be honest you sound like you have an ego problem and feel like you demand respect. Respect is earned not demanded.

I agree with your list. My day to day workings run like this.
1) If I ask my partner if they checked the oil and the O2. One will lie, two and three will actually do it and four will suggest I do it since hes washing the truck.
2) Only one of my 4 partners will help me check off the truck.
3) I have no problems with my partners speaking up, or suggesting something, I will be the first to admit that I don't catch everything. We are supposed to be a team. But none of them want me to speak up, if I do I'm being condescending.
4) There is no working together or learning together. One feels as if she knows enough to get by, two says his job is just to drive, three will actually pull up the owners manual and talk about it with me, four will suggest I do it my self since hes washing the truck.
5) I've suggested over and over that I am easy to talk to and non confrontational and if they have an issue with me that they can speak up and we will work it out. One is a drama queen and pathological liar and I have to let her have her drama moment and apologize that she didn't know that it was my job to make sure that she didn't do something that could hurt the patient as it is her job to do the same with me. And to either let her have her lie or argue until I'm blue in the face. Two will tell me his problems with me after his anger calms most of which revolve around him having issue taking direction from a girl who's young enough to be his daughter. (His words not mine.) Three will offer her opinion and listen to my reply but decide that her opinions on the matter are correct, but doesn't cause issue with me not doing it her way. Four offers no opinions about anything except to bad mouth any and all other Paramedics specifically, usually ones hes never worked with.
6) One Two and Four are just getting a pay check. Three is truly my only 'partner'
7) One will lie about anything to anyone, the more drama the better, tattling is one of her favorite past times if things are to quiet around the office she'll change that. Two gets angry and huffy and will go the entire shift without talking to you if you suggest that something could be done different. Three is all about talking it through (unless shes mad... then she requires at least 3 hours of quiet time first) Four is to busy complaining about what ever it is we should be discussing to actually have a conversation about it.


I am not sure why my post came across that way. I do not demand respect, and I am well aware it is earned. I also know that almost all things that happen at work are either individual situations (station duties, turning in completed paperwork on time etc.), or partner situations (checking off truck, providing prompt polite pt care, providing care period etc.) and almost never I'm the paramedic I'm in charge situations (informing my Basic that they are not allowed to do what they want to because that is battery). I am not arrogant nor do I think this is the paramedic show.


I do feel as if they should support me on my calls as I am there to support them on theirs. I get their vitals for them. I clean the stretcher and truck while they give report. If they want to do something different all they have to do is communicate what they want, and I will follow their direction without question. But get no support in return. If asked to get vitals they suggest I get them in the truck. If I start to make the stretcher after turning over pt care they want to know why I can't just wait until we get back to the office. If I ask them to wait before they place blankets and straps on the pt so that I can untangle the iv lines I get hands thrown in the air step back 3 steps and a declaration that they wont touch the pt unless asked to do so.


I am not super bubbly and friendly, nor do I know how to be fake and pretend to be interested in things they are interested in, I am by nature an introvert. I know this has me come across like a snob but pretending to be friends with them isn't going to fix any of my problems. I need to know how to get along with my partners and how to communicate with them so that I don't come off as condescending. Even if I need to calm down. (need some suggestions on how to do that, worrying about pt care and missing something is not something I know how to not do) I would prefer some suggestions on how I can come across as calm while still making sure the pt doesn't suffer from in attention.

 

[sinthia]

@sinthia so the same system that allows a B to administer drugs is now extremely restrictive and they can only work if a paramedic authorizes it? If you don't mind me asking, where is it you work? And how much of this is company policy?

And if everything is done under you, why is there such a thing as BLS under what you're describing? Because even if its not an acute call, my understanding of what you said is an EMT cant even administer O2 in the back without the paramedic present in the back. It sounds like everything should be run ALS and the EMT shouldn't be doing an assessment anyways.

And as for the saying you don't listen to your EMTs that's just how it came across in your first post, I apologize if I misinterpreted that.

I work in NC, every county has a different Medical Director (county based and system based)

The county I work does not allow for basic providers. Its a County thing, nothing acute. They can take discharges out of the hospital, or dialysis runs. However basics cannot attend an acute call if it originates in this county and terminates in this county. If it terminates in a different county (BLS long distance Hospital to Hospital transfer) then it falls under our systems medical director where they are allowed to operate at the basic level following State protocols (instead of County) but as an ALS truck we never take long distance BLS calls.


If picking up a dialysis return they find the pt blood sugar is 69 or below they have to call for ALS intercept, even if their transport time to the ED will be only 2 minutes they still have to call for ALS and they can not divert from the ER and take the pt back to the nursing home even if the pt insists that their blood sugar is normal for them, they still have to call for ALS.


No they can not administer O2 unless the pt is on O2 at home. As far as I know this isn't the only county that is this restrictive but it is one of only a few.

 

[sinthia]

So you're writing up your partners for every little thing they mess up on? And you're wondering why theres bad blood?

I don't write them up, I was saying that was the only thing that I could think of to do, otherwise it is them writing me up and complaining about me being bossy and condescending without my side ever being heard. I'm anal, I like things a certain way and I'll do them that way myself without expecting my partner to do it my way but expecting them to do their job (either pt care or as my partner) is not in my opinion being bossy or condescending. I can occasionally be sarcastic, for example... “so you know how you said that our main O2 was good this morning... yeah well its actually empty.” and the response I get usually is something along the lines of “hehehe sorry, I didn't actually check. The crew we relieved didn't tell me it was empty so I assumed it was good.”

 

[Kevinf]

Sounds like a **** place to be a basic, I would not be surprised that they aren't attracting the best and brightest. I'd wager the basic pay is near minimum wage too?

If there is a culture of half-asking this stuff, nothing you are going to do will change it. It's gotta be top-down from the start. Talk to management, it's their job to sort it out. If there is no action taken, move along before it bites you in the ***.

 

[squirrel15]

I work in NC, every county has a different Medical Director (county based and system based)

The county I work does not allow for basic providers. Its a County thing, nothing acute. They can take discharges out of the hospital, or dialysis runs. However basics cannot attend an acute call if it originates in this county and terminates in this county. If it terminates in a different county (BLS long distance Hospital to Hospital transfer) then it falls under our systems medical director where they are allowed to operate at the basic level following State protocols (instead of County) but as an ALS truck we never take long distance BLS calls.

What? That means there are basic providers then....

 

[sinthia]

That said, you need to learn how to influence your peers without coming off as condescending or uptight.

That is what I am asking... I was hoping for some suggestions. Especially from EMT's as I'm sure you've run across a difficult partnership and there were things you wish you could ask your partners to do in order to make for a better partnership.

 

[sinthia]

What? That means there are basic providers then....

Not within the county we are based out of. But in other counties and with the company yes. There are even counties where I can only do CPR and AED as I am not approved to operate in that county as an ALS provider, and the good Samaritan law only applies to lay people, if you stop to render aid off the clock it is considered practicing medicine without a license.

 

[squirrel15]

Not within the county we are based out of. But in other counties and with the company yes. There are even counties where I can only do CPR and AED as I am not approved to operate in that county as an ALS provider, and the good Samaritan law only applies to lay people, if you stop to render aid off the clock it is considered practicing medicine without a license.

Your wording is extremely confusing then, sorry. If they are taking discharges, or even dialysis runs, they are acting as providers.

And I don't know about NC but if you originate in a county in CA, those are the protocols you follow, even if going out of county and therefor, basics could not originate a transport in your county. And as for only doing CPR or AED are you not considered an EMT in other counties? In CA to be a paramedic and work ALS you must be certified in each county, and be working under an ALS provider, and cant operate as a paramedic off duty, but you can work as an EMT in other counties.

But I'll back out of that conversation and address your main question because I'm lost as to how your county operates, because it sounds as if EMTS can't even assess.

The person lying on reports needs reported. Everyone else is either bad luck on partners you've been put with. Or you are overbearing. If you start a shift off and do nothing but make it obvious you think your better and your going to oversee everything because youre paramedic, I'd be annoyed too. You shouldn't be double checking everything your EMT does and should trust them to make the correct decisions, and trust their assessments. If I get an AO status and BP and you come in and recheck both, I'm going to be jaded towards. I understand if you point something out that I miss, but I don't want my partner double checking everything I do. And I doubt the patient wants that, and that's no longer great patient care when the patients annoyed at constantly being assessed