Contempt of EMT

[CANDawg]

I dont see why people would waste the energy having a verbal pissing match with a patient.

Patients have every right to refuse interventions. However, I also have every right to refuse to provide interventions that I don't feel are medically appropriate. If they're insistent, they are more than welcome to take a trip to the hospital and argue it out with the ER doc.

If they are doing something that interferes or prevents you from providing care, or that puts me, my partner's, or a bystander's safety at risk, they will get one warning that I will stop care and leave. If they don't heed it, I will cease care and leave. (Or depending on the situation, delay care until LEO has control of the patient.)

End of story.

 

[DT4EMS]

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.
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.

The reason for the big, biker comment...... people act differently when they feel they will be injured by someone. However, even the officer must have "legal" authority to modify a person's behavior.

Then you mention the cop dumps out the beer.......... yes......... they are the cops....... jeesh........ we must have CONSENT to treat people. Not COMPLIANCE.......

I am sure your administration would have a different view of your opinion of "control" of a scene.

You are helping make my point brilliantly. We have been convinced over the years that we in EMS "control" more than what we do. This unwritten policy has helped many get fired, injured and some in in jail. Because when do you stop trying to be in control? At what point to you say enough is enough?

You don't have the authority to ORDER anyone to put down a beer......... you may "request" he does...... so what happens if he doesn't? Is he in contempt of you now? Now will you order him? Then what? The situation has now been escalated.......

Let me scream this "GOOD CUSTOMER SERVICE IS A SCENE SAFETY TACTIC!"

Again, EMS have learned by osmosis......... not the best way to have learned certain things. Particularly when it comes to conflict dynamics. Stop thinking you have the authority like an officer does to control a persons behavior.

The only person you can control on a scene is yourself.

Addition* When it comes to who is in charge...... EMS is in charge of "patient" care. Not everyone we are called to is actually a "patient".

Maybe my response seems harsh......... but people view forums from all over the world. They read ridiculous crap about how a person does this or that with regards to Machismo........ well....... that is how those new to EMS get in trouble.

My battle is not with an individual........ it is with an idea. This misconception about who controls what. I learned years ago from a law enforcement DT instructor who said "No man can control another man, unless he wants you to" meaning....... if the person didn't want to go into custody, we had to use PAIN to change his mind into complying.

 

[DT4EMS]

Here is an example: But I am sure they thought they were in control...........

CHICAGO (CN) - Paramedics may be liable for forcibly hospitalizing a man who refused medical attention.
http://www.courthousenews.com/2011/11/21/41620.htm

 

[mycrofft]

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.

And remember, even if the subject thinks (s)he's putting one over on you, there's less wear and tear and just as much time used to treat them as being legit.

 

[mycrofft]

"The reason for the big, biker comment...... people act differently when they feel they will be injured by someone. However, even the officer must have "legal" authority to modify a person's behavior.

...........

You are helping make my point brilliantly. We have been convinced over the years that we in EMS "control" more than what we do. This unwritten policy has helped many get fired, injured and some in in jail. Because when do you stop trying to be in control? At what point to you say enough is enough?

.........

Let me scream this "GOOD CUSTOMER SERVICE IS A SCENE SAFETY TACTIC!"

Again, EMS have learned by osmosis......... not the best way to have learned certain things. Particularly when it comes to conflict dynamics. Stop thinking you have the authority like an officer does to control a persons behavior.

The only person you can control on a scene is yourself".............

Amen your whole comment!

 

[Anjel]

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



+1

Nice them to death, it works!

Yea I have seen them start CPR. I'm sure they would hold pressure.

 

[DrParasite]

You are helping make my point brilliantly. We have been convinced over the years that we in EMS "control" more than what we do. This unwritten policy has helped many get fired, injured and some in in jail. Because when do you stop trying to be in control? At what point to you say enough is enough?

you might be right. maybe the cops in control of the scene. maybe the FD is in control of the scene. maybe the patient or their family is in control of the scene. maybe EMS should just get used to never being able to stand on their own two feet, and maybe EMS just always has to do what others want them to do. maybe that's the future of EMS?

You don't have the authority to ORDER anyone to put down a beer......... you may "request" he does...... so what happens if he doesn't? Is he in contempt of you now? Now will you order him? Then what? The situation has now been escalated.......

I'm curious, on what authority does a cop have to order anyone to put down a beer? Assuming they are of legal age and not breaking any laws. I'm not a cop, but you mentioned authority and ordering, so where does a cop get his authority to order someone from doing something that is legal?

Let me scream this "GOOD CUSTOMER SERVICE IS A SCENE SAFETY TACTIC!"

and I will agree with you 100%... but if you aren't in control of a situation, people will walk all over you, and you can be the smarted medic out there but if the patient doesn't think you know what is best, you won't be able to help him.

My battle is not with an individual........ it is with an idea. This misconception about who controls what. I learned years ago from a law enforcement DT instructor who said "No man can control another man, unless he wants you to" meaning....... if the person didn't want to go into custody, we had to use PAIN to change his mind into complying.

kind of like that unnamed city I mentioned used to operate..... and I still don't agree with their actions

 

[CANDawg]

EMS does not have the authority to control or command individuals directly. However, we DO have the ability to withhold our services and treatment unless those involved follow some essential guidelines of behaviour. Considering that EMS responds to situations that are deemed 'emergencies', this can be considered defacto control - people are usually willing to alter their behaviour in order to receive the care that we offer. The problem arises when practitioners confuse the two and think that it is who they are rather than what they do that makes most people follow our instructions.

 

[DT4EMS]

you might be right. maybe the cops in control of the scene. maybe the FD is in control of the scene. maybe the patient or their family is in control of the scene. maybe EMS should just get used to never being able to stand on their own two feet, and maybe EMS just always has to do what others want them to do. maybe that's the future of EMS?
I'm curious, on what authority does a cop have to order anyone to put down a beer? Assuming they are of legal age and not breaking any laws. I'm not a cop, but you mentioned authority and ordering, so where does a cop get his authority to order someone from doing something that is legal? and I will agree with you 100%... but if you aren't in control of a situation, people will walk all over you, and you can be the smarted medic out there but if the patient doesn't think you know what is best, you won't be able to help him.kind of like that unnamed city I mentioned used to operate..... and I still don't agree with their actions

Again, you make my point.

If an officer is taking legal "custody" of a person...... he can "order" the person to drop a beer, cigarette or anything else he/she may be holding. A police officer stirctly operates under the 4th Amendment. Any stop (seizure) of a private citizen is scrutinized.

Again, through osmosis (dang......how many times have I said this) EMS learn behavior traits from cops that EMS does not have the same authority to employ.

A Paramedic, who works off of "consent" may "request" a person drop something. So YES, we must do what others ask. We are still public servants, just not subservient!


Whatever you like. The point is.... I will continue to state....... EMS does not have the authority you "think" they do. I am here to do my best to keep people safe. Sometimes it doesn't sit well with some. I am good with that.

I am again, trying to keep people out of trouble....... and "control" of a person other than the provider on scene gets a lot of folks in trouble.

You are making it blatantly clear the you have a problem with the OP's subject of Contempt of EMT. I am stating good customer service is a great scene safety tactic.

I wish you the best and have no personal issue with you. I will state however that anyone reading my posts understand that EMS does not have authority to "order" anyone. We can and should "request" things.
If you want to "order" people......become a cop or a prison guard. But even seasoned cops/guards have learned that sometimes..... it is less dangerous to show a little respect......even to a dirtbag.

Funny...... my message has the backing of two different state EMS associations, I have trained thousands of EMS providers across the country........ was the Subject Matter Expert for this subject with the NAEMT's Safety course, had 9 published articles on scene safety tactics, I am a state and national level speaker, have 71 instructors teaching DT4EMS programs, have multiple EMS agencies and paramedic schools making my course mandatory for staff........ and I am debating a scene safety tactic on a forum with someone I don't even know.........

This is why I can't always take the time to write in forums much anymore. The emotion does not come across in type. I am here for EMS because not only was I a victim of violence on the EMS job.......but now that I have interviewed so many who were victims also...... it's personal. They tell me I am their voice.

So with that...... as far as this thread is concerned...... I'm out. If a person still thinks they can control/order someone to do something on a scene..... that's on them.

I stand by the fact that Good Customer Service will keep many in EMS from getting injured, losing their job and possibly their freedom.

 

[abckidsmom]

I totally agree with DT.

Leading people into doing what you want them to do by asking them, showing them, and guiding them is not being a pushover. I have truly come to believe that outright intimidation as a first round technique is a tool of the weak, the ones who lack social skills to communicate gently the best desired outcome.

Slow down, listen to the people. They want to be heard, the called for help. If they are in "contempt of EMT" it is usually a cry for another kind of help. People who are ok, people who have what they need, do not call for help and then yell at them or worse.

It's our JOB to assess the situation and determine what the needs are. That's what we do.

The trouble is that the real job looks so little like EMT class that we are so unprepared it's not funny.

 

[mycrofft]

If a patient is trying to manipulate you into doing something dangerous, illegal, or medically questionable, just say no. Fall back on the truth: if you do not see objectively that something is medically indicated and/or it falls outside your scope or company rules, you can't. Don't argue, reiterate your stance once, then offer them an AMA or let them stalk off stripping off the nasal cannula and IV saying "Sheeeeeeuht!".

 

[DrParasite]

I wish you the best and have no personal issue with you. I will state however that anyone reading my posts understand that EMS does not have authority to "order" anyone. We can and should "request" things.

If you want to "order" people......become a cop or a prison guard. But even seasoned cops/guards have learned that sometimes..... it is less dangerous to show a little respect......even to a dirtbag.

Funny...... my message has the backing of two different state EMS associations, I have trained thousands of EMS providers across the country........ was the Subject Matter Expert for this subject with the NAEMT's Safety course, had 9 published articles on scene safety tactics, I am a state and national level speaker, have 71 instructors teaching DT4EMS programs, have multiple EMS agencies and paramedic schools making my course mandatory for staff........ and I am debating a scene safety tactic on a forum with someone I don't even know.........

Ok, I'm not disagreeing with you about customer service, and your right, we can't order anyone to do anything.

I asked a couple questions, and you sidestepped them. You're the expert on this, and I don't disagree with your idea that "being nice can keep you safe." I do know quite a few "nice people" who were injured by others on the job, but I'm sure they are the vast minority.

I think another poster worded it better than I did

EMS does not have the authority to control or command individuals directly. However, we DO have the ability to withhold our services and treatment unless those involved follow some essential guidelines of behaviour. Considering that EMS responds to situations that are deemed 'emergencies', this can be considered defacto control - people are usually willing to alter their behaviour in order to receive the care that we offer.

 

[abckidsmom]

EMS does not have the authority to control or command individuals directly. However, we DO have the ability to withhold our services and treatment unless those involved follow some essential guidelines of behaviour. Considering that EMS responds to situations that are deemed 'emergencies', this can be considered defacto control -
people are usually willing to alter their behaviour in order to receive the care that we offer.

I was once certified as a Medical Priority EMD, and I learned a few skills that I still use constantly. One was that when we tell someone to do something, we give an action with a reason, for example "Please answer my questions so we can help your daughter."

That's an EMD example. Things I find myself saying all the time are, "Please sit down so we can check your blood pressure." (Puts an agitated person in a chair, which stops the walking and pacing, tells them that we are in the process of doing something for them, and if we successfully check their blood pressure, most of the time it stops the words coming out of their mouth long enough for me to turn the conversation back where I want it.)

"Please answer my questions so we can give you the best help." (Gives them ownership in the process, shows them that I want to do the best thing for them, etc.)

"Please put out the cigarette, we like to promote good health where-ever we go." (It's a joke, usually makes people smile, and I hate cigarette smoke.)

We do not have actual control over people, but with the right words and skills, we exercise a lot of control over the people.

 

[Sandog]

How about you say "Wow, that smoke is getting in my eyes, I hate to put this IV needle in the wrong place" :wacko:

 

[Shishkabob]

EMS does not have the authority to control or command individuals directly.

Sure we do. Look up "implied consent".

Let me scream this "GOOD CUSTOMER SERVICE IS A SCENE SAFETY TACTIC!"

I don't do customer service because I have no customers.

 

[abckidsmom]

How about you say "Wow, that smoke is getting in my eyes, I hate to put this IV needle in the wrong place" :wacko:

I don't do anything when the cigarette is still lit. Nothing.

I ran this by my hubby, who said that he tells people that he's carrying sensitive equipment that the smoke interferes with, and that the oxygen could explode.

I don't lie to people if I can avoid it.

 

[JPINFV]

Sure we do. Look up "implied consent".

Huh? Implied consent only works if the patient lacks capacity. Most of the scenarios presented do not reach that level.

 

[Shishkabob]

Huh? Implied consent only works if the patient lacks capacity. Most of the scenarios presented do not reach that level.

Most, not all, hence there are still times when we do 'control or command directly', for lack of a better way of saying it.

 

[JPINFV]

Most, not all, hence there are still times when we do 'control or command directly', for lack of a better way of saying it.

....and seconds can be the difference between life and death, therefore every patient should be driven to the hospital with lights and sirens with as aggressive driving as possible. After all, there is that rare time that transport time matters.

 

[Shishkabob]

....and seconds can be the difference between life and death, therefore every patient should be driven to the hospital with lights and sirens with as aggressive driving as possible. After all, there is that rare time that transport time matters.

What you said has really no relation to what I said...