Contempt of EMT

[Veneficus]

As I sit today with my newfound freedom of free time, I read through some of the threads that ordinarily I would not glance at in the interest of time.

However, I have noticed another common theme forming in a couple of them.

Let us call it: "contempt of EMT"

Not to be confused with "contempt of cop" which is a very serious issue that plagues law enforcement.

Because EMS in sometimes associated as a public safety service (which it really isn't, but that is a different post) I can see where wearing a uniform and having protected status in society can cause providers to see themselves as an authority figure.

In my observation it is a distinct shift in culture from the pre Sept 11 days when most public safety forces I was involved with (fire based EMS) saw themselves more as servants than authorities.

Whether it is psych patients, smoking patients, or patients some see as "system abusers," what is it that triggers the attitude of "I will help you whether you like it or not and I will do it my way, when I feel you deserve it."

When the patient doesn't readilt submit and cooperate, responses from apathy to "mechanical" (thanks firetender for this term) care, to punitive "treatment ensues.

I will even admit that in my time I have taken part in this as well.

So what causes it?

What do we do about it?

Is it a problem of the system?

An individual problem or providers?

How should we respond to it?

What can we do to avoid it?

Perhaps some of our Law enforcement collegues could give us considerable insight as well as solutions?

 

[mycrofft]

I saw it plenty before the WTC attack. Often it was simply that the patient wasn't served at all so it didn't get far into the system.

Individual issues which are seen repeatedly are cultural issues. Question is, are these cultural mores corporate, local, regional, or of a larger problem?

I think that many people who want to exercise derived authority (wear a badge or uniform) get into prehospital EMS because the threshold is so low and it is associated with a paramilitary structure, either as part of or derived from firefighting. As these sorts of people fill the system, so the system becomes.

Also, it is a defensive measure against micromanagement from above which can represent unreasonable client and political demands versus the reality of the interface between care and client (limits of assets and people causing pinches in time, task loading, and being forced to treat or transport when the real signs to do it are not there).

 

[DT4EMS]

As I sit today with my newfound freedom of free time, I read through some of the threads that ordinarily I would not glance at in the interest of time.

However, I have noticed another common theme forming in a couple of them.

Let us call it: "contempt of EMT"

Not to be confused with "contempt of cop" which is a very serious issue that plagues law enforcement.

Because EMS in sometimes associated as a public safety service (which it really isn't, but that is a different post) I can see where wearing a uniform and having protected status in society can cause providers to see themselves as an authority figure.

In my observation it is a distinct shift in culture from the pre Sept 11 days when most public safety forces I was involved with (fire based EMS) saw themselves more as servants than authorities.

Whether it is psych patients, smoking patients, or patients some see as "system abusers," what is it that triggers the attitude of "I will help you whether you like it or not and I will do it my way, when I feel you deserve it."

When the patient doesn't readilt submit and cooperate, responses from apathy to "mechanical" (thanks firetender for this term) care, to punitive "treatment ensues.

I will even admit that in my time I have taken part in this as well.

So what causes it?

What do we do about it?

Is it a problem of the system?

An individual problem or providers?

How should we respond to it?

What can we do to avoid it?

Perhaps some of our Law enforcement collegues could give us considerable insight as well as solutions?

Absolutely a FANTASTIC topic!

Here is a couple of points I usually try to make with this very subject. Although I word it different, the meaning is the same as what you are getting at:

1) Machismo- The tough-guy approach. This is a problem with many in EMS. The reason... they are taught in class "You are in control of the scene". Sometimes this is true, but not always. (hence the pi$$ing matches between EMS/Fire and LEO on scenes) each is told in their respective schools they are in charge.

Then there is a sub-topic to Machismo..... EMS eat their young. As a whole, if a person works for agency A, everyone else sucks. However, if he leaves agency A for agency B, agency A is now the craphole and everyone there is an idiot. This causes divides within our profession.

Since EMS is still "new" as a profession........ we have learned a lot of "tactics" for scene/person control via osmosis through our brethren police officers. The problem...... we ain't cops!

Then I make the point of customer service as a "tactic". Be nice. It is hard to sue someone that was nice to you. Plus.....You are protecting others in EMS in the long run.

Force comes into play with "Contempt of EMT" because sometimes the provider believes that "must" do something or it is abandonment. Not always true........

Then we have the abuse of the system issue-makes the average provider callus pretty quick. So customer service is no longer seen as important.

Across the country, I get a few minutes to "soapbox" about this very topic. I ask people not to "pee in the pool". It is a way of saying -- everyone in your community is a potential member of a jury pool. Someday you may be sitting in court and someone who an EMSer was a jerk to is sitting in the jury box. So, be nice.........you never know "who" you are being nice to.

 

[Doczilla]

very well put.

 

[DrParasite]

I must admit, I am unsure what you are asking.

Should we, the EMT, not be in control of the scene? If a patient wants pain meds, should we just give it to them because they ask, regardless of it it is clinically indicated or not?

if they are smoking, and continue to smoke, should they be permitted to do so while we are assessing and treating them? or should they be forced to put it out prior to us getting involved?

What about if they are drunk? should they finish that last beer before we treat them?

If a drunk punches you while on the job, should you not defend yourself? yes, call LEO, but what if they aren't available or have a 25 minute ETA? yes, leave the scene, I do that too, and when the drunk goes after two kids and really hurts them, then what is going to happen?

Not for nothing, but when you call for my help, than yes, I do expect you to do what I say. that can mean put out the cigarette, stop drinking alcohol, and don't touch me unless I give you consent. I expect you to let me do my job to the best of my ability, and not interfere when I am doing it.

If you punch me, will I hit you back? no. will I do what I need to to ensure my safety, which may include restraining that limb so I don't get hit again? probably.

There is a city in NJ, that I don't work for, and never worked for, that in the 90s and early 2000s, had the reputation for being worse to people who harmed them than the cops. right or wrong, people were more afraid of the EMS crew than the PD crew, esp if they were giving someone a hard time or if they had hurt someone. I don't condone it, don't think it was right, but it did happen.

BTW, I am 100% in favor of leaving unsafe scenes. they don't want my help, no worries, I'm out of there. you want to fight, fine, me and my partner are leaving, let the cops deal with you. But I also think EMS should be able to deal with the EMS emergencies on their own, and not have to rely on the FD or PD for routine operations.

 

[Jambi]

I can see where wearing a uniform and having protected status in society can cause providers to see themselves as an authority figure.

This. many people want to be "badass" and in charge. Many want to be the image he or she has in his or her heads as opposed to what the job really entails.

...saw themselves more as servants than authorities.

Yup. It's a culture thing. People like to through around the sheepdog mentality which just sets up for the above problems. When we start seeing people/patients as sheep that need protecting instead of as patients that are unable to adequately make decisions independently, providers shift into taking on a paternal role. It's a for-your-own-good-mentality.

the system and culture must not be tolerant of such things for change to occur. Perhaps medical directors have a role to play here, but it's more likely to rest with the initial training and education process, and the culture that's allowed to persist at a particular agency/company.

 

[Wheel]

I must admit, I am unsure what you are asking.

Should we, the EMT, not be in control of the scene? If a patient wants pain meds, should we just give it to them because they ask, regardless of it it is clinically indicated or not?

if they are smoking, and continue to smoke, should they be permitted to do so while we are assessing and treating them? or should they be forced to put it out prior to us getting involved?

What about if they are drunk? should they finish that last beer before we treat them?

If a drunk punches you while on the job, should you not defend yourself? yes, call LEO, but what if they aren't available or have a 25 minute ETA? yes, leave the scene, I do that too, and when the drunk goes after two kids and really hurts them, then what is going to happen?

Not for nothing, but when you call for my help, than yes, I do expect you to do what I say. that can mean put out the cigarette, stop drinking alcohol, and don't touch me unless I give you consent. I expect you to let me do my job to the best of my ability, and not interfere when I am doing it.

If you punch me, will I hit you back? no. will I do what I need to to ensure my safety, which may include restraining that limb so I don't get hit again? probably.

There is a city in NJ, that I don't work for, and never worked for, that in the 90s and early 2000s, had the reputation for being worse to people who harmed them than the cops. right or wrong, people were more afraid of the EMS crew than the PD crew, esp if they were giving someone a hard time or if they had hurt someone. I don't condone it, don't think it was right, but it did happen.

BTW, I am 100% in favor of leaving unsafe scenes. they don't want my help, no worries, I'm out of there. you want to fight, fine, me and my partner are leaving, let the cops deal with you. But I also think EMS should be able to deal with the EMS emergencies on their own, and not have to rely on the FD or PD for routine operations.

I think he is referring less to scene safety than to an attitude problem that he sees in ems. Correct me if I'm wrong though.

 

[Jambi]

I must admit, I am unsure what you are asking.

Should we, the EMT, not be in control of the scene? If a patient wants pain meds, should we just give it to them because they ask, regardless of it it is clinically indicated or not?

if they are smoking, and continue to smoke, should they be permitted to do so while we are assessing and treating them? or should they be forced to put it out prior to us getting involved?

What about if they are drunk? should they finish that last beer before we treat them?

If a drunk punches you while on the job, should you not defend yourself? yes, call LEO, but what if they aren't available or have a 25 minute ETA? yes, leave the scene, I do that too, and when the drunk goes after two kids and really hurts them, then what is going to happen?

Not for nothing, but when you call for my help, than yes, I do expect you to do what I say. that can mean put out the cigarette, stop drinking alcohol, and don't touch me unless I give you consent. I expect you to let me do my job to the best of my ability, and not interfere when I am doing it.

If you punch me, will I hit you back? no. will I do what I need to to ensure my safety, which may include restraining that limb so I don't get hit again? probably.

There is a city in NJ, that I don't work for, and never worked for, that in the 90s and early 2000s, had the reputation for being worse to people who harmed them than the cops. right or wrong, people were more afraid of the EMS crew than the PD crew, esp if they were giving someone a hard time or if they had hurt someone. I don't condone it, don't think it was right, but it did happen.

BTW, I am 100% in favor of leaving unsafe scenes. they don't want my help, no worries, I'm out of there. you want to fight, fine, me and my partner are leaving, let the cops deal with you. But I also think EMS should be able to deal with the EMS emergencies on their own, and not have to rely on the FD or PD for routine operations.

This is missing the point. Scene safety, appropriate restraining, preventing harm, etc are not what's in question. Rather, it's the approach and mindset providers have towards patients.

Many of my colleagues operate from the view point that patients owe providers something just for showing up when in reality it's the other way around. By calling 911, they're putting their heath, well being, and perhaps their lives into the hands of those that show up; i'm afraid that many providers have lost respect for the significance of such a relationship.

 

[EpiEMS]

We're public servants. Whether a paid or volunteer EMS provider, you are in uniform or on duty to serve the public. Act like it. Be courteous. I know, I'm just a volley, and I'm fairly new to EMS, but I know how I'd like to be treated if I called EMS for a serious problem. I'd expect expeditious, courteous treatment. If I called EMS for something minor, I expect to be evaluated, courteously.

EMS should be in control of any scene that is medical or trauma in nature, unless it involves, say, the potential for a HazMat or fire. If so, FD is in charge. If there's a chance that somebody is going to take potshots at EMS, PD is in charge. Most importantly, it should always be medical/patient well-being before all other concerns (after provider safety, of course). Medical BEFORE legal. Medical BEFORE property.

Nobody owes us anything for showing up. We are going to serve them. That should be emphasized in courses -- I was taught by providers who care. Everybody should be so fortunate. Nobody should be in a helping profession, whether it's medicine, public safety, law, social work, or anything of this sort, without understanding that you have a duty to the public and to your patient. Yes, sure, we have to be sheepdogs, but most certainly not in the "I'm here to tell you what to do." It should be "I'm here to serve you. Here are some resources I can help you get access to. Here's what I might suggest for management of your chronic condition."

 

[DT4EMS]

Attitude of EMS is exactly the point "I" was making.

On the scene safety issue, all you have to do is read one of my published articles, watch any of my videos, take the NAEMT Safety Course ( I was an SME on),read hundreds and hundreds of course evals to know my take on scene safety.

I say that to say...... in "MY" research, I have found attitude or EMS (right or wrong) to play a part in scene dynamics.

At no point have I ever said it was not OK to defend oneself. I am actually the loudest voice in the US at the present time on the ABILITY and NEED for EMS to do just that.

Plus, let me ask this....... since the beer and cigarette issue came up.....

If the guy is a pi$$ed off biker with shaved head, weighs 295 lbs and is telling you he wants to finish his beer....... are we as EMS supposed to "order" him to put it down? This is a situation EMS has NO control over........ LEAVE!

 

[EpiEMS]

At no point have I ever said it was not OK to defend oneself. I am actually the loudest voice in the US at the present time on the ABILITY and NEED for EMS to do just that.

Do you have a sense on how many systems deploy LEOs to every scene along with EMS? I ask because the service I work on does, and I find that it is a huge improvement on having to call for LEO assistance. Not to mention, a third pair of hands to, say, hold C-spine or do compressions never hurts.

 

[DT4EMS]

Do you have a sense on how many systems deploy LEOs to every scene along with EMS? I ask because the service I work on does, and I find that it is a huge improvement on having to call for LEO assistance. Not to mention, a third pair of hands to, say, hold C-spine or do compressions never hurts.

In part of our presentation where we cover the Six Dangerous D's, we suggest asking for LEO response to those scenes.

Very few agencies that I personally know of have LEO all or even "most" of the time. Many get LEO regularly in the nicer suburbs. But many rural and urban agencies don't have it. It is something I did daily, without request when I was full-time LEO because I know how much of a blessing it is to have an officer show up.

The reason I say that......... If staging for unsafe scenes was the answer....... and so many people in EMS are still being assaulted...... where are they being assaulted? Yup, scenes that were originally deemed "safe".

 

[JPINFV]

I must admit, I am unsure what you are asking.

Should we, the EMT, not be in control of the scene? If a patient wants pain meds, should we just give it to them because they ask, regardless of it it is clinically indicated or not?

There's give and take. No, you shouldn't provide an unnecessary intervention. However sometimes the patient knows what works for them and that should be considered... heavily. Additionally and assuming capacity, the patient can refuse any intervention they want.

if they are smoking, and continue to smoke, should they be permitted to do so while we are assessing and treating them? or should they be forced to put it out prior to us getting involved?

What about if they are drunk? should they finish that last beer before we treat them?

At least with smoking you have a second hand smoke issue. Besides that, it depends. Fighting over one last drag on a cigarette or one last chug of beer simply isn't worth the fight. If the patient is that stable, then a little bit more isn't going to seriously harm them.

Not for nothing, but when you call for my help, than yes, I do expect you to do what I say. that can mean put out the cigarette, stop drinking alcohol, and don't touch me unless I give you consent. I expect you to let me do my job to the best of my ability, and not interfere when I am doing it.

Sorry, the patient get's to interfer with what you do to them as much as they want. Just because you showed up doesn't mean you get to force them to be transported or to allow you to perform an assessment or any treatment. I'll state right here for the record that personally, anyone trying to get me into spinal immobilization is up for a fight. If you can't handle the patient refusing a part of the assessment or any or all interventions, then tough.

 

[Aidey]

A

Whether it is psych patients, smoking patients, or patients some see as "system abusers," what is it that triggers the attitude of "I will help you whether you like it or not and I will do it my way, when I feel you deserve it."

When the patient doesn't readilt submit and cooperate, responses from apathy to "mechanical" (thanks firetender for this term) care, to punitive "treatment ensues.

For the first part "I will help you whether you like it or not" I can give you a couple of reasons. First, a lot of people haven't switched from "Don't just stand there, do something" to "Don't just do something, stand there".

Second, at least in my area, it is my employer. The prime directive is "You will shut up and transport, period". Do not talk patients out of going via ambulance, do not question why facilities are sending someone in, just shut up and transport.

I think the various threats of abandonment and lawsuits also don't help. "If you don't transport and the patient dies it is your fault" ignoring that the patient may have been in their right mind and completely within their right to refuse.

There is also the issue of the idea that if we end up on scene, someone, somewhere is a patient. Just think of all of the drive by calls for a "man down" or MVCs, where the "patients" aren't the ones who called. My company policy still requires we get refusals on these "patients" even if they were not the one who called 911.

As for doing it "my way" I think there are tons of reasons for this. We have that whole previous experience bias. In some places there are very firm expectations from higher up/medical control about how things will be done and people fear getting in trouble.

 

[Shishkabob]

Not for nothing, but when you call for my help, than yes, I do expect you to do what I say. that can mean put out the cigarette, stop drinking alcohol, and don't touch me unless I give you consent. I expect you to let me do my job to the best of my ability, and not interfere when I am doing it.

And this is my view. If you call for my help, I expect you to let me do what you called me for. Sure, you can refuse but part of my job is informing the patient, so if you don't want something done, I will question why and, if I think it's in your best interest, do my part in persuading you with facts and reasoning. If you don't want an IV because we "Ambulance drivers always suck with IVs because they roll everywhere", I'll try to change that perception. If you call for something but refuse all parts of my job where it turns in to nothing more than a taxi, I WILL correct your views on the matter and ask why you didn't call a taxi instead of waste an ambulance for someone who actually could benefit from an ambulance and wants one.


If you're smoking, I'll ask you to put it out for respect, then I'll tell you for my health, then I'll just walk away saying let us know when you're ready for us to do what you called us for.


Contempt of EMS? No. I just learned long ago some people are much more, for lack of a better word, receptive when you act like you're the leader and they're the follower that needs to be helped along to do the right thing. Use the right attitude on the right person.

 

[DrParasite]

If the guy is a pi$$ed off biker with shaved head, weighs 295 lbs and is telling you he wants to finish his beer....... are we as EMS supposed to "order" him to put it down? This is a situation EMS has NO control over........ LEAVE!

why does it have to be a 300 lb biker with a shaved head? what if it's a doctor with a shaved head and sleeves on both arms, who wants to finish his beer?

To answer your question, I might "order" him to put down the beer so I can do my job. if he doesn't want to, that's his choice, I'll leave and he can call me back when he is ready to let me do the job. or I may just let him finish it, if I don't think it will negatively affect him or my care of him. I can't answer definitely, but it will all depend on the situation.

I have seen LEOs dumping out beers of drunks on the grass who wanted to have another drink before we took them to the hospital.

Sorry, the patient get's to interfer with what you do to them as much as they want. Just because you showed up doesn't mean you get to force them to be transported or to allow you to perform an assessment or any treatment. I'll state right here for the record that personally, anyone trying to get me into spinal immobilization is up for a fight. If you can't handle the patient refusing a part of the assessment or any or all interventions, then tough.

I wasn't clear, or you misunderstood. either way, the patient can refuse any intervention I want to give.

you don't want me there? fine, sign my RMA form, and I will be on my way.

don't scream that the ambulance took FOREVER to get there, and then rush me out of the house before I have had a chance to assess the patient.

stop chatting on the cell phone with your bff, or your boy/girlfriend, or your neighbor, and let me do my job. once my job is done, you can chat all you want. Put the cigarette out, and stop blowing smoke in my face. turn the TV off and pay attention to me, answering my questions so I can get an idea of what is going on. It's a respect thing, I am treating you with respect by not doing any of those things while in your presence, is it that wrong to expect the same?

Maybe it's just my backwater thinking, but when there is an EMS emergency, I am the one in charge, as I am the expert in what the best thing to do for the patient is. Yes, the care of the patient is priority, but I'm the expert until someone with more medical training takes over. It's my scene, and I'm in charge.

If the patient doesn't want my help, he or she can refuse my care. I won't take it personally, and if you don't want to go to the ER, that's ok, I won't take it personally either. Nor will I force him to do either of those things if he is AOx3 and he doesn't want my assistance.

 

[Anjel]

Do you have a sense on how many systems deploy LEOs to every scene along with EMS? I ask because the service I work on does, and I find that it is a huge improvement on having to call for LEO assistance. Not to mention, a third pair of hands to, say, hold C-spine or do compressions never hurts.

For one of our cities we do. We usually beat them there first. Unless it is a possible suicide, OD, assault, or any other potentially dangerous scene. Then we stage.

 

[abckidsmom]

And this is my view. If you call for my help, I expect you to let me do what you called me for. Sure, you can refuse but part of my job is informing the patient, so if you don't want something done, I will question why and, if I think it's in your best interest, do my part in persuading you with facts and reasoning. If you don't want an IV because we "Ambulance drivers always suck with IVs because they roll everywhere", I'll try to change that perception. If you call for something but refuse all parts of my job where it turns in to nothing more than a taxi, I WILL correct your views on the matter and ask why you didn't call a taxi instead of waste an ambulance for someone who actually could benefit from an ambulance and wants one.


If you're smoking, I'll ask you to put it out for respect, then I'll tell you for my health, then I'll just walk away saying let us know when you're ready for us to do what you called us for.


Contempt of EMS? No. I just learned long ago some people are much more, for lack of a better word, receptive when you act like you're the leader and they're the follower that needs to be helped along to do the right thing. Use the right attitude on the right person.

I regularly work with one of the biggest jerks I've ever know. He has more complaints for being mean than any 10 other people. I sign up with him on purpose and then I tell him I am happy to do all the calls and he can have the day off and drive. He's happy, I'm happy.

We have run upset people, hurt people, BS people, psychs and drunks and even one legit call and I have never yelled at anyone not have we been afraid of any crazies.

You be nice to people. You find out what it is they really want or need, and you address that.

He's starting to notice that everybody does what I want them to do, when I want them to, and calmly without drama. He's actually commented on how people listen to me, and how do I get them to do that.

It's all in not being an ***.

Be nice. It's the most important rule on the playground. Every playground.

 

[lateralligator]

^^^^:wub::wub:

 

[EpiEMS]

For one of our cities we do. We usually beat them there first. Unless it is a possible suicide, OD, assault, or any other potentially dangerous scene. Then we stage.

Do the PD, when they are there first, start CPR, say, or apply direct pressure, etc.?

Be nice. It's the most important rule on the playground. Every playground.

+1

Nice them to death, it works!