Dear EMT

"Is there anything you'd like me to help you with?"

"Would you like me to put the pt on 15lpm/NRB?"

I've seen some ignorant EMT's act like the medic was hindering their assessment. I've also seen some EMT's that have taken the "ALS Assistant" Course offered in PA that would get the LifePak up and running, get a BP, a SP02 and the 4 or 12 lead put together and ready for the Medic so he could perform interventions. I don't feel that having a medic on hand means I'm to sit back and observe, I'll act in my own scope of practise, working around him if he's performing interventions or assessment, and I'll follow any direction or lead that he offers.

I know that the medic will want basic vital signs, I can do that even if he's doing medic-y IV/EKG type stuff that I can't help with. I can also ask questions and he'll hear the answers. I basically follow the lead of my medics and stay the heck out of their way. After the call, when we're driving back to the chase vehicle, I'll usually ask what was going on, what they did and how changes in the patient would have changed their treatments and interventions.
 
Just one more addition to the "nanananananan I'm not listening *plugs ears* " file.


Got in an argument yesterday when my partner, who is 2 class days from his Paramedic school final and starting his internship, was adamant in the fact that Narcan reversed the effects of marijuana...



*sigh*


I will pay big bucks to get videos of him during his internship on calls.
 
Linuss said:
Got in an argument yesterday when my partner, who is 2 class days from his Paramedic school final and starting his internship, was adamant in the fact that Narcan reversed the effects of marijuana...
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Gosh really?! That's good to know. We run on people suffering life threatening respiratory depression from marijuana overdose all the time out here. And here we just thought it was only good for opiods... so good to know there's a drug to stop the rampant problem of fatal marijuana OD.
 
Linuss said:
Just one more addition to the "nanananananan I'm not listening *plugs ears* " file.


Got in an argument yesterday when my partner, who is 2 class days from his Paramedic school final and starting his internship, was adamant in the fact that Narcan reversed the effects of marijuana...



*sigh*


I will pay big bucks to get videos of him during his internship on calls.
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Sally you are just bitter because Paramedic schools are so much better than they were back in the day when you were a student. :P
 
medic417 said:
Sally you are just bitter because Paramedic schools are so much better than they were back in the day when you were a student. :P
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Atleast paper had been invented by the time I was in Paramedic school, gramps. ^_^
 
Linuss said:
Atleast paper had been invented by the time I was in Paramedic school, gramps. ^_^
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Hey if you had to chisel your notes on stone you would never forget the information. B)
 
Let me guess, the pterodactyl ate your homework?
 
Sorry but many of the replies on here are completely ignorant. First, if the EMT was taught something different than what you are doing, it is your responsibility to help further their education by explaining why you are doing something. Yes, that means you might have to explain yourself.

And you should be greatful for a partner who will question what they are seeing. Now, if they ask questions in a demeaning way, then yes it needs to be worked out so that they are being respectful.

But it is crucial that if someone sees something that might be being missed they speak up. The concept is called crew resource management. It means they don't just shut it and follow your orders, but point out potential problems they see.
 
jms81 said:
Sorry but many of the replies on here are completely ignorant. First, if the EMT was taught something different than what you are doing, it is your responsibility to help further their education by explaining why you are doing something. Yes, that means you might have to explain yourself.

...

But it is crucial that if someone sees something that might be being missed they speak up. The concept is called crew resource management. It means they don't just shut it and follow your orders, but point out potential problems they see.
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There's a time, a place, and a method, though, to bringing up concerns. For something moderate-ish (like oxygen therapy) where I might have an understanding of what's going on, personal preferred method if I'm not sure why someone is doing something is to ask it as a question. "Just curious, why are you doing X instead of Y?" This allows the other provider to cure my curiosity while having to reexamine what they are doing with the seed my my preference planted inside their brain. I'm not calling them out, I'm educating myself.

If it's something where I'm fairly sure I'm missing something, then I can easily use the exact same line after a call. As such, unless it's something that will kill the patient, I'm not going to make a stink on scene.

As to a quick note about CRM, that evolved from the aviation industry, which has the benefit of most cases having a fairly solid and functionally sound proof (for normal conversations) door. If there's a dispute between the pilot and first officer, then it's resolved between them, not over the plane's PA system. EMS doesn't have that luxury since when decisions are being made, at a minimum the patient is present, if not a larger crowd.
 
Linuss said:
Got in an argument yesterday when my partner, who is 2 class days from his Paramedic school final and starting his internship, was adamant in the fact that Narcan reversed the effects of marijuana...
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I can't imagine a situation in which you would want to reverse the effects of marijuana on a patient...
 
JPINFV said:
There's a time, a place, and a method, though, to bringing up concerns. For something moderate-ish (like oxygen therapy) where I might have an understanding of what's going on, personal preferred method if I'm not sure why someone is doing something is to ask it as a question. "Just curious, why are you doing X instead of Y?" This allows the other provider to cure my curiosity while having to reexamine what they are doing with the seed my my preference planted inside their brain. I'm not calling them out, I'm educating myself.

If it's something where I'm fairly sure I'm missing something, then I can easily use the exact same line after a call. As such, unless it's something that will kill the patient, I'm not going to make a stink on scene.

As to a quick note about CRM, that evolved from the aviation industry, which has the benefit of most cases having a fairly solid and functionally sound proof (for normal conversations) door. If there's a dispute between the pilot and first officer, then it's resolved between them, not over the plane's PA system. EMS doesn't have that luxury since when decisions are being made, at a minimum the patient is present, if not a larger crowd.
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I agree... the manner in which it is brought to attention should be appropriate. But some of the replies on here about telling him who's boss, etc are way out of line. I understand some people might be joking, but it's still completely inappropriate.

It might not be the best way, but certainly a partner saying "Are you sure? I'd do a non-rebreather" isn't a completely terrible way to state a concern. Again, depending on the tone.

And yes CRM comes from aviation, but the sound proofing doesn't really matter. When a patient's life is in your hands, if you're treatment isn't appropriate, I couldn't care less who hears.

FWIW I've been on all three sides of this situation (questioning someone else, being questioned, and suspending the licenses of those who's partner questioned a treatment and were right, but the partner "put him in his place"). The P after the EMT on your license doesn't make you infallible, or even signify you're the slightest bit exceptional.
 
If anyone one scene does anything to undermine the pt's trust in the providers that person is out of line, EMT or Paramedic. "Are you sure" is a poor way to double check how appropirate an intervention is. It absolutely undermines the pt's trust in the person who suggested the initial treatment. Lay people don't understand the difference between the two, and if an EMT asks "are you sure?" of a Paramedic all the pt sees is one guy in uniform questioning another guy in uniform. When that happens I then have to stop and explain at great length that yes, I am sure, and why I am sure while my partner is not. It can be embarassing for the person who was wrong and explaining education levels isn't how I like to spend my calls.
 
So a couple of months ago, I go on a call dispatched as a resp distress at the doctor's office. It's an elderly lady, and when we get there (a two EMT crew) we find her in no resp distress, so following an assessment which reveals no acute problems, we cancel the ALS.

Following a reassessment on scene of the patient, I develop this hunch that she is having a stroke, due to the fact that she keeps asking where her son is (who has been with her the entire time). Anyways, the patient is packaged, and ALS is rerequested, and not surprisingly, the original paramedic crew from before is sent out again. Sidenote: one of the paramedics happens to be my operations coordinator, with at least 10 years of experience as a medic.

We get the patient in our truck, and ALS is assessing her. one of the medics (my Ops coordinator) doesn't believe me when I think it's a stroke, while the other is unsure. They end up riding in with us to the Stroke center, with my coordinator's partners staying with us. about 3 minutes from the ER, he finally agrees that she might be having a stroke, and calls a Brain Attack.

I decided to follow up with the ER afterwards, to see how the patient was doing. She had a massive bleed, was to be admitted to the Neuro ICU, and had orders to be intubated if she got any worse. And the medic told me that I made a good call on pushing for the BAT team activation in the field.

Just remember, you have more education, and have been precepted more, but that doesn't mean you don't make mistakes, and sometimes the lowly 120 hour first aider can catch something that you miss. And also remember, the only medical providers that never make mistakes have M.D. after their name :rolleyes:
 
I think you need to look at the situation.

Linuss said:
Pt has no hx of COPD, no asthma, no respiratory diseases except for a recent bout of pneumonia. Non-smoker. No cyanosis, no obvious increase work of breathing, no accessory muscle use, nothing that would scream "SOB!", but has an SpO2 of 96%.

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."
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This doesnt seem like a life or death situation, hardly a reason to get into a discussion in front of the family and patient. Remeber the united front, the family and patient need to be confident they are in capable hands. Sounds like this kid is either looking for your acceptance or trying to undermine you.

Im all for being a patient advocate, this is simply ridiculous and if the kid new anything he would understand the woman probably lives at 96% and with the info provided has no signs of respiratory distress and blasting her with fifteen liters is completely inappropriate.
 
I'm thinking the kid didn't know any better. Most new EMT-Bs wanna just slap a NRB on every single patient. Linuss, does that EMT actually know how to read the SpO2?
 
He does, but he probably takes it at face value like many. But then again, he thinks narcan works to reverse marijuana.


Like I said...he's 2 class days from his Paramedic final....
 
Wow, The service I work for I AM the lead Medic, when I am on shift. I usually work with EMT-I or B's. I also am the Medic that responds, with a chase unit, into rural areas, that are in need of a Paramedic. I truely believe respect comes from both sides. If the need arises to correct someones rudeness on a scene, I will tell them that this is something that can and will be discussed later, after the call. It takes a long time to EARN the respect of others in this business, but it does come. I am treated with the utmost respect on all my calls, because I respect them back and because of my experience. I am also looked to for the answers, on the call. I do Not ever lose my temper. It is always the way handle yourself and your tone of voice.
 
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