Dear EMT

[8jimi8]

I work at a teaching hospital. I question doctors regularly. I also refuse to follow orders.

Sure could get my *** in trouble, but. I have'nt made the wrong judgement call yet.

 

[Sassafras]

Hmmm....few things...
Our transports are normally about 45+ minutes...COPDers will never get highflow O2 for an entire transport here.

And I do question all the time who I am assisting. It's how I learn. "Why'd you make that call?" "What would happen if we did it this way?" I ask later of course, but I'm not here to let my education stop at the state exam and a good crew cheif will understand that.

And I'm a little concerned with the "I'm the medic. Never question me" mantra. It sounds like a god complex and last I checked, none of us were perfect. Is there a time a place for questioning? Yes, and I agree not in front of the patient, but that patient is my responsibility as well and if I feel a different treatment may be in order I have a responsibility to speak up for my patient. I may still be wrong, and that's where the medics expertise comes into play, however, I may also be right and have actually saved a situation or two asking a well placed question of a crew chief who should have known more than me. Newbies aren't all stupidity. We are a lot of stupidity, I'll give you that, but occasionally we make a valid point or two.

 

[JPINFV]

So, I suppose this boils down to hierarchy. Don't question the choices of the person you're assigned to assist, UNLESS you are absolutely clear the consequences would be dire. Why would that be any different in a case of Nurse and Doctor?

Emphasis added.

That's the ideal point that every working relationship needs to get to. However, what I don't want to have happen is the relationship to get to the point where the lower provided is trained to keep their mouth shut 'or else' and not bring something critical to light. The problem is, how do you get to the point where critical oversights are brought to light, however issues of style or personal preference that doesn't affect outcome are let go? Especially when the fact that new providers don't necessarily understand the difference between textbooks and real situations where everything might not be black and white or where best practices have advanced past what is written in the text. This is especially true when everything in EMS training is, "THIS IS AN EMERGENCY AND EVERYONE WILL DIE IF NOT TREATED NOW NOW NOW!"

 

[JPINFV]

And I do question all the time who I am assisting. It's how I learn. "Why'd you make that call?" "What would happen if we did it this way?" I ask later of course, but I'm not here to let my education stop at the state exam and a good crew cheif will understand that.

And I'm a little concerned with the "I'm the medic. Never question me" mantra. It sounds like a god complex and last I checked, none of us were perfect. Is there a time a place for questioning? Yes, and I agree not in front of the patient, but that patient is my responsibility as well and if I feel a different treatment may be in order I have a responsibility to speak up for my patient. I may still be wrong, and that's where the medics expertise comes into play, however, I may also be right and have actually saved a situation or two asking a well placed question of a crew chief who should have known more than me. Newbies aren't all stupidity. We are a lot of stupidity, I'll give you that, but occasionally we make a valid point or two.

The issue comes down to having the right time and place as well as ignorance (note: ignorance is the lack of knowledge and completely different from stupidity. I'm very ignorant in lots of things, including underwater basket weaving). What is not an emergency to one person may be an emergency to someone else because of ignorance on either side. As such, I don't think anyone is saying don't question after a call, but tread carefully when questioning during a call.

 

[firetender]

The problem is, how do you get to the point where critical oversights are brought to light, however issues of style or personal preference that doesn't affect outcome are let go?

As a sympathetic Mentor, I would hope that the relationship I would build with my partner would be a MUTUAL exploration of the Work. Sometimes you can do this, especially when you have steady partners assigned you. I can honestly say it was always something I hoped to do with each partner, short or long-term.

Still, I often found there were, let's say, periods of adjustment where we each assessed the others strengths, weaknesses and where we needed to just take over. Sometimes, there were clashes. Sometimes, individual style differences could not be worked with, but had to be worked around!

"personal preference that doesn't affect outcome" is what it's all about. Bottom line, it's about building trust in your partner's judgment or discretion; trusting that even though his/her approach may not be the same as yours, it won't hurt anybody. But it's a two way street that takes a shared willingness to communicate and then work through the stylistic differences.

That's where you need to start, but it's just as important to recognize when you've got a partner that isn't going to bend. Sometimes, unfortunately, it does become necessary to be very selective in how much energy you want to spend defending petty differences. That's where your letting go is a positive move you can make for the patient.

 

[Shishkabob]

Case in point: My partner took Wednesday off so I got partnered up with another medic. (FYI working dual medic is a completely different experience)

Both the other medic and I got our certs at the same time, have spent the same length of time in the field (well, techinically me more because I'm FT and he's PT) yet on calls that he was running, HE was running, and I didn't question his choices during a call.


Even when he put someone satting 97% RA on an NRB at 10lpm...just to placebo the guy with 'sob' (per the pt) so he'd quiet down.



But it's called professional courtesy.

 

[wyoskibum]

There is no I in TEAM

Hmmm....few things...
Our transports are normally about 45+ minutes...COPDers will never get highflow O2 for an entire transport here.

And I do question all the time who I am assisting. It's how I learn. "Why'd you make that call?" "What would happen if we did it this way?" I ask later of course, but I'm not here to let my education stop at the state exam and a good crew cheif will understand that.

And I'm a little concerned with the "I'm the medic. Never question me" mantra. It sounds like a god complex and last I checked, none of us were perfect. Is there a time a place for questioning? Yes, and I agree not in front of the patient, but that patient is my responsibility as well and if I feel a different treatment may be in order I have a responsibility to speak up for my patient. I may still be wrong, and that's where the medics expertise comes into play, however, I may also be right and have actually saved a situation or two asking a well placed question of a crew chief who should have known more than me. Newbies aren't all stupidity. We are a lot of stupidity, I'll give you that, but occasionally we make a valid point or two.

I have to agree with Sassafras. I encourage all of my partners to speak up if they see something I'm not and to make suggestions. I'm human just like everyone else and I can sometimes get focused on one thing and miss something else.

It should be worded like a question. EMT: "What do you think about about a Non-Rebreather?" Medic: "The patient's oxygen saturation is great on the cannula, we can switch to the NRB if it drops".

 

[medic417]

When asked a question whether it is the basic trying to act like a know it all or actually wanting to learn I find that by telling the patient they are new and I am helping to educate them so some day they can become a Paramedic. This puts the patient back at ease and puts the know it all back in their place. Basics actually request to be my partner as I look to teach. New Paramedics also request me as a partner for the same reasons.

 

[Shishkabob]

I have to agree with Sassafras. I encourage all of my partners to speak up if they see something I'm not and to make suggestions.

It should be worded like a question. EMT: "What do you think about about a Non-Rebreather?" Medic: "The patient's oxygen saturation is great on the cannula, we can switch to the NRB if it drops".

When I first work with an Basic or Intermediate, and they ask the "What would you like me to do on the call" question, I always tell them the same thing:

They have their cert, they can do whatever is within their scope and protocols without asking me first as they've proven their knowledge to their level. The only exception, I tell them, is giving nitro before I have a chance to check some things.

If my EMT had just slapped an NRB on, that'd be one thing, and I probably would have left it on for a little bit... but that's not what happened.

When asked a question whether it is the basic trying to act like a know it all or actually wanting to learn I find that by telling the patient they are new and I am helping to educate them so some day they can become a Paramedic.

Here's the problem: He's in medic school, so not only does he think he knows more than he does (we've all been there. Heck, I'm still there, but I'm a certified know-it-all!), but he has a nasty habit of telling patients he "has more relevant experience" than me, as one year as an IFT EMT, compared to my 7 months as a PT EMT and 5 months as a Medic... even after I've told him that EMT experience does NOT compare to Paramedic experience, two different mindsets.

 

[piranah]

pull out the bottle.... powder up and start slappin'...lol jk

 

[CAOX3]

Here's the problem: He's in medic school, so not only does he think he knows more than he does (we've all been there. Heck, I'm still there, but I'm a certified know-it-all!), but he has a nasty habit of telling patients he "has more relevant experience" than me, as one year as an IFT EMT, compared to my 7 months as a PT EMT and 5 months as a Medic... even after I've told him that EMT experience does NOT compare to Paramedic experience, two different mindsets.

This seems like it could present a problem, maybe a backhand when you get back in the truck will correct that problem and restore some order.

I will speak up if the need arises it usually doesnt, but a hushed "you might want to connect the IV before the patient bleeds out on the floor" or "you been digging in that airway now for around a minute we should bag him and you can try again in a minute" is usually sufficient.

I dont need to question our medics treatment options rather a light reminder may be in order when they get caught up in the moment which is competely undestandable when dealing with a difficult case/patient. I also never do it within ear shot of family or patient. A cool, comptetent and united front assures the patient/family that they are in capable hands.

 

[Sasha]

but has an SpO2 of 96%.

That's high for a nursing home patient

Hate to break it to you, Linuss but because you are a medic does not make you God. And this "Ah ha I am almighty medic and I should never be questioned" mentality is absolute BS. You're not above learning, even something from a "measley EMT".

That is a dangerous thought process to adopt, especially so early in your career. Open your eyes and ears and start learning from everyone and any one you can (you know education doesn't end after medic) and you will find it a very humbling experience.

We should not look down on our partners for having less education. Weren't you the one campaigning before you passed medic that people aren't "JUST emts"?

 

[Shishkabob]

Actually, Sasha, I suggest re-reading my posts in this thread.


I never said don't question me. I said don't challenge my calls on a scene for things that are just a personal way with dealing with a call, and does NOT put the patient in danger. Where's the para-god mentality in that?

You don't freak out on a medic if they opt to do their own style that is not dangerous, do you? That's what I'm saying.





Plus, true or false--- The final decision for patient care in a B/P partnership is left to the medic.

(Or is that just my company's protocols?)

 

[Sasha]

You don't freak out on a medic if they opt to do their own style that is not dangerous, do you?

Sweets, I've worked medic/medic too, and I'll challenge their decision on scene if I don't agree that their treatment or lack thereof is in the best interest of the patient. Doesn't have to be dangerous, just not in the best interest of the patient.

 

[Sasha]

Patient was already on a nasal cannula at 3lpm. I opt to just keep the NC on. Partner goes "Are you sure? I'd do a non-rebreather."

Obviously your partner felt that the NC was not in the best interest of the patient. Correct or not, s/he was being a patient advocate the best way they knew how.

A doctor gives you an order you don't feel is in the best interest of your patient, do you try to discuss/inquire about it, or do you just blindly follow it?

 

[Shishkabob]

A doctor gives you an order you don't feel is in the best interest of your patient, do you try to discuss/inquire about it, or do you just blindly follow it?

Slight difference between "So why is this the best way" with an inquisitive tone and straight up going "Are you sure? I think we should do the EMT-Basic blanket treatment of high-flow O2"

 

[Aidey]

I like to use "What do you think about.....". It woks almost universally. "What do you think about this being a 3rd degree block?" "What do you think about starting with 2lpm and moving up?" etc. I allows me to make a suggestion while still leaving the decision making power in the other medic's hands.

To me it is all about middle ground. I expect my EMT to speak up if they see me doing something strange or something they think is wrong. However, I expect it to be done in a calm, non alarming way. My EMT uses the same "What do you think about...." as I do, and she will use it with me. So in this case it probably would have been something like "What do you think about a mask instead?" to which I could have replied "I think we'll start low and work our way up". Then later I can explain why.

It is professional, it doesn't undermine anyone, and it doesn't come off as arguing, which is a sure fire way to have pt or their family lose confidence in you.

I've also found its a good way to get medic students thinking without outright telling them what to do. I prefer to let students stumble onto the right answer themselves rather than hand feed them.

 

[Shishkabob]

See, that would work and be preferable.


I don't mind suggestions at all... it's just how it gets phrased.

 

[mcdonl]

Big difference between asking questions and questioning a decision.

 

[medic417]

I had a partner many years ago that was an ECA (Texas First Responder and yes they can count as the second person on the ambulance and two of them can staff an ambulance with no one else with them). He would ask would you like me to get the ....... ready for you? This allowed me to wake up and say yes please if was something I had forgotten, or say no because of ....... it is better that we do ...........

It kept the patient from wandering if I knew what I was doing, it preserved my paradork status, it allowed him to advocate for the patient. I will admit there were very few times that he was wrong. So never ignore what your partner says.

Perhaps you can discuss with your partner a way that you are more comfortable having them bring up something they feel should be done better. And if all else fails you can say hey you are just a student once you get your education you will understand how what you suggest could harm this patient. Patient sees that you know what you are doing and does not lose faith in you because of the questioning. Partner hopefully shuts up and learns to advocate for the patient in a better way.