Dear EMT

Shishkabob

Shishkabob

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I'm all for explaining why I did or did not do something to a patient AFTER a call.




But, don't ever challenge my patient care decision infront of said patient if you disagree with a decision, okie dokie?

(Exception to the rule is if it has the potential to cause harm to the patient [like giving morphine to someone who is allergic to it])




/rant (temporarily) over
 
+1

Hope things turned out ok for your patient and that the EMT in question didn't cause too many problems, Linuss.
 
To the SAME EMT....

Your time in the back of the ambulance with a medic is a continuation of your classroom. Take notice, learn, assist and as linus said... when the time is right ask your questions.
 
Don't make me shock you into compliance.
 
You don't scare me, jimi!




L4L-- I'll give just one example of a few.

"Respiratory distress" call at a rehab facility. Arrive for a patient in the 90's, family stating patient looked SOB. Nursing staff state they haven't noticed a change in the patient. (And it's actually a good rehab with nurses that tend to be knowledgeable)

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."

...



No, I'm not sure. I just randomly decide to do things without thinking them through, my 2 years of education in emergency medicine, clearance from my internship, passage of my certification exam, and freeing from FTO be damned, I obviously have learned NOTHING with how to treat patients.
 
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Now Sally don't get your panties in a wad. We edumacated Paramedics know all basics are told 15lpm for everything. If you had wasted a few years working as a basic you would know that. :wacko:
 
lol that was for your minion, not for you Linuss... but know I know you're scared since you had to publicly state that you weren't.
 
I have had a few of the reverse: when they will take High flow O2 off my patients, because the patient has COPD, and their instructor says that High Flow will stop their resp drive. 1 patient was cyanotic, and biox of 76%. Another time I had to have a police officer tell my student to leave patient care alone at the scene. and I left the student on the scene, (station was across the street).
 
johnrsemt said:
I have had a few of the reverse: when they will take High flow O2 off my patients, because the patient has COPD, and their instructor says that High Flow will stop their resp drive. 1 patient was cyanotic, and biox of 76%. Another time I had to have a police officer tell my student to leave patient care alone at the scene. and I left the student on the scene, (station was across the street).
Click to expand...

Yes, the hypoxic drive / COPD issue rears its ugly head again. It has been my general experience that EMS doesn't usually have the patient long enough for this to occur and therefore, Oxygen should be given as usual. It is in the hospital setting when we have the patient for days and maybe even weeks at a time when this can become an issue.
 
Having nothing to do with hypoxic drive or Loche Ness monster.

Oxygen is not a benign drug. There is very few conditions that require high flow o2 and way too many people relying on a spo2 number in the absence of clinical judgement.

In the next edition of NRP, it will be suggested that neonates are ventilated with a BVM without o2.

Many of the critical care circles I am involved in are also looking at reduction of high flow o2 with BVM and multiple medical schools in both US and EU have been preaching not to automatically use high flow o2 if ever at all.

I understand what EMTs are taught. I understand what the predominant prehospital dogma is. But it looks more and more like EMS dropped the ball on yet another unfounded treatment regime.

Just because "everyone is doing it" or "thats what was always done," doesn't make it right.

When the PE patient has an Spo2 of 60, what exactly is 100% o2 going to do?

Will the hemolytic anemia patient who has an o2 sat of 100% not have perfusion issues?
 
ya I've had to talk to a few EMT's I was a basic with who need to get used to the idea that its my treatment plan...
 
piranah said:
ya I've had to talk to a few EMT's I was a basic with who need to get used to the idea that its my treatment plan...
Click to expand...

If I ever ride with you, can I honk the horn?
 
Yes, that happens sometimes when an EMT sees something through the slit of the blinders of limited experience and is compelled to point it out.

It only takes a couple of "Who asked ya?"s in response before the partner learns to call his/her shots more carefully. And afterward, sure, explain why an abrupt cut-off can be expected if it interferes with the flow of treatment as you have decided.
 
firetender said:
Yes, that happens sometimes when an EMT sees something through the slit of the blinders of limited experience and is compelled to point it out.

It only takes a couple of "Who asked ya?"s in response before the partner learns to call his/her shots more carefully. And afterward, sure, explain why an abrupt cut-off can be expected if it interferes with the flow of treatment as you have decided.
Click to expand...
Emphasis added.

So if a nurse questions a physician's order in anything remotely public of a setting, the physician should respond, "Who asked you?"

I'm not saying that there isn't a time and a place to have the discussion about why things went the way things went, but that the words on scene need to be chosen... wisely. After all, why speak up and stop a rude partner from doing something stupid?
 
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If this person has a reoccuring problem with questioning your decisions, I would just tell them "If I want your opinion I'll ask for it". Then keep eye contact for several seconds for effect before returning to the pt. Tell them "When you get your P-card, I'll then be open to discussion regarding pt care".
 
JPINFV said:
Emphasis added.

So if a nurse questions a physician's order in anything remotely public of a setting, the physician should respond, "Who asked you?"
Click to expand...

I call that my "Inner Brooklyn"! It's a tool used to set limits and boundaries. My picture was the paramedic being pulled aside by the assistant, not in public view, offering advice clearly way beyond his experience. He needs to get that's a no-no because it interrupts the flow of the call.

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?

(Never mind, I know; Nurses have better Unions than Medics!)

If I were challenged publicly, I couldn't assure as tender a response as that!
 
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