First responders not providing any Pt care

[BenndaleEMT]

I am an EMT-B, I work for an ambulance company part time, and I first respond with the local Vol FD. What can you do about other FR that love to respond in their POV with their lights flashing, only to get on scene and not do any Pt care? It seems they want to "be seen" and look all important to the community, but they are either not confident in their skills or they have other underlying issues. I have arrived on scene after one FR and he just stands there in the way, and one time he talked a Pt out of O2 when the CC was a 72 y/o fall with back and leg pain. Several of the Paramedics have had issues such as the FR not even opening an airway on a SOB Pt that was in the Tripod pos.

I have discussed this issue more than one time with the FR President with no reslove.

I feel if you respond to the call, at least take a BP, Pulse and SAMPLE/OPQRST so you can give the Paramedic a head start.
-Bandit

 

[Veneficus]

Is bad care better than no care?

It's probably best if you give this person way more lights on the POV and give him a fancy title like: chief of traffic control.

That way you still have a giant beacon that shows you where to go instead of squinting to read an address. (sometimes called the automatic scene locator)

by giving him this critical duty, it will help keep him away from a patient. In the interest of scene safety maybe encourage him to do a walk around the property looking for hazards before attending a patient.

If you are this concerned about his ability would you really trust any findings that he may present?

Might be good to leave your cot in the truck, that way you can also dub him: "chief stretcher fetcher" and keep sending him to the truck for stuff to keep him out of the way.

 

[Shishkabob]

If it's simply a matter of not comfortable with his skills, then have him get worked with to increase his confidence with his abilities.


If it's anything else, talk to your officer / Captain / Lt /Chief and let them know your concerns.

 

[BenndaleEMT]

You make some good, valid, and very funny comments... I like that!

Is bad care better than no care?

It's probably best if you give this person way more lights on the POV and give him a fancy title like: chief of traffic control.

Might be good to leave your cot in the truck, that way you can also dub him: "chief stretcher fetcher" and keep sending him to the truck for stuff to keep him out of the way.

That's quite ironic.... he is the CHIEF of the Vol FD!

 

[Veneficus]

You make some good, valid, and very funny comments... I like that!



That's quite ironic.... he is the CHIEF of the Vol FD!

why am I not surprised...

 

[Shishkabob]

Than you're sol.

 

[Veneficus]

you could always remind him that the fire chief is in charge of the scene and he should assume command, set up a command post at his car, and assign incoming resources.

getting involved with the grunt work aspect of emergency response is a terrible waste of his talents.

 

[BenndaleEMT]

Than you're sol.

That's what I'm affraid of.

 

[Hal9000]

Are you only FR? No medical director?

I once knew a place that had that sort of problem. A new medical director put the kibosh on it once he learned what was happening. He did not tolerate unprofessionalism, even from a volunteer service. It sounds like you don't have that avenue.

 

[MrBrown]

they are either not confident in their skills or they have other underlying issues.

Sounds like a training and development issue

I have arrived on scene after one FR and he just stands there in the way, and one time he talked a Pt out of O2 when the CC was a 72 y/o fall with back and leg pain.

Again, sounds like a training and development issue.

Once again .... (this is rhetorical and not aimed at you specifically) how exactly was O2 going to help this patient? There is nothing magic about oxygen and it is often given to people who do not require it, in quantities above what is prudent.

I feel if you respond to the call, at least take a BP, Pulse and SAMPLE/OPQRST so you can give the Paramedic a head start.
-Bandit

Again, sounds like a training and development issue.

 

[Jersey]

This is something that needs to be resolved from a medical control level. Most first response squads fall under the auspices of a medical director in order to provide "care" to the patient.

Remember that the first response squads are vital links in communities without timely access to a full BLS/ALS/CCT ambulance, and even though sometimes not up to our standards something is often better than nothing.

Not saying that they shouldn't be improved, trained, and advanced, but there is a fine line that we in the professional EMS systems have to walk.

On one side, we want better care, but on the other we run the risk of alienating these very valuable resources. A lot of first response squads and first responders are very "emotionally" involved in first response/vol fire and view their role as important in the community and in their lives.

If you cross the line and start ragging too hard on these squads, the members (from my experience) take the criticism as a very personal attack.

 

[46Young]

I once wanted to do volunteer firefighting, but I was quickly turned off. I ended a brief stint for a volunteer ambulance corps for the same reason. Too much with the office politics, egos, power trips, so on and so forth. Medics who "don't do sick calls" (don't respond to minor calls, but remain in station as others respond)), as if it's beneath them.

When someone tells me that they're a chief, I have to wonder if they're the real deal, or ifit's just a joke title; one vol FD had maybe 10 chiefs.

There are many fine vol ambulance squads, fire based and otherwise. Examples would be most companies in Loudon County, or Exchange of the Islips and Brentwood in Long Island, or Corona VAC, Forest Hills, GOVAC, and Queens Village VAC in Queens, NY.

As if dwindling participation, increasing population, unwillingness to txp to a hospital outside of district, and other factors aren't enough to phase out vollies, you have characters like this:

http://www.wusa9.com/news/columnist/blogs/2009/01/volunteer-fire-company-dissolved-in.html

I'm suprised that volunteer companies don't run things tighter since the trend is towards replacement by paid services.

The vol FD cronies are likely in favor with the district's supervisors. Going to local politicians won't do much if that's the case. If you want to play hardball, go to the media. Take note of any misuse/waste of donation and grant monies, such as trips on the dept's dime, parties for no reason, new equipment for no reason, ditto for station expansion/renovation, or a chief's take home vehicle that serves no useful purpose, especially for the financial layout involved.

Speaking of take home vehicles, here's some ideas to work with:

http://www.myfoxdc.com/dpp/news/033109_fox_5_investigation_prompts_audit

 

[Foxbat]

I have arrived on scene after one FR and he just stands there in the way, and one time he talked a Pt out of O2 when the CC was a 72 y/o fall with back and leg pain.

I really doubt that O2 would benefit this patient, based on the description, but it was not his place to talk pt. out of any treatment if there was a higher level provider on scene.

Several of the Paramedics have had issues such as the FR not even opening an airway on a SOB Pt that was in the Tripod pos.

How do you open an airway on this pt.? It sounds from the description like he was conscious, breathing, and sitting in a tripod position, which in his condition is probably the best.

I feel if you respond to the call, at least take a BP, Pulse and SAMPLE/OPQRST so you can give the Paramedic a head start.

I don't know if it's in FR's scope of practice, but if yes, than I agree.

 

[rhan101277]

Several of the Paramedics have had issues such as the FR not even opening an airway on a SOB Pt that was in the Tripod pos.

His airway is open, he needs some oxygen and assessment to figure out why he is SOB.

 

[41 Duck]

I feel your pain. We run into this ALL THE TIME. I've had our local volley FD "chief" (and I use the term loosely) cancel helicopters and ALS without an EMT number, intimidate (with local PD in tow) PTs to be transported that had already refused care/transport with EMS, and otherwise generally been a nuisance on-scene.

What you do? File the appropriate complaint paperwork that yields no results, do additional care to counteract the little they provide, smile, nod as they give report, then immediately start your own line of questioning and retake the vitals. Do the call, do the PCR, get a cup of coffee and go home at the end of your shift and try not to let it get to you TOO much.

The chief is never likely to understand that he's NOT the highest level of provider there. They tend to get "training" and "rank" all twisted up in their heads somehow, and absolutely cannot comprehend that their rank in their little volley FD doesn't mean diddly to an unaffiliated service.

Best of luck to you in dealing with this.


Later!

--Coop

 

[Seaglass]

I hear ya too. I have an assistant chief whose cert almost certainly expired over a year ago, and who never was competent. I've also got a chief who never stops whining, and who has a real talent for self-righteously getting in the way. Can't go to the medical director because he's part of the problem. Same for local politicians. So I just silently hate them, come up with complicated schemes to get around them, and count down the days until I go to a different department.

 

[Hal9000]

I hear ya too. I have an assistant chief whose cert almost certainly expired over a year ago, and who never was competent. I've also got a chief who never stops whining, and who has a real talent for self-righteously getting in the way. Can't go to the medical director because he's part of the problem. Same for local politicians. So I just silently hate them, come up with complicated schemes to get around them, and count down the days until I go to a different department.

For expired cert./license, you shouldn't need to go to medical direction. It may seem a bit ruthless, but I've been in charge of making sure everyone's certs/etc. are up to date. I've written to my state and NREMT on two different occasions, due to EMTs knowingly "missing" dates by quite some time. I also had some new hires temporarily suspended as their licenses were technically fraudulent due to their own ignorance and the laziness of two instructors.

If you don's have the credentials, don't be on an ambulance until you do.

 

[Seaglass]

For expired cert./license, you shouldn't need to go to medical direction. It may seem a bit ruthless, but I've been in charge of making sure everyone's certs/etc. are up to date. I've written to my state and NREMT on two different occasions, due to EMTs knowingly "missing" dates by quite some time. I also had some new hires temporarily suspended as their licenses were technically fraudulent due to their own ignorance and the laziness of two instructors.

If you don's have the credentials, don't be on an ambulance until you do.

I actually never thought of doing that, since I've always had medical directors who were actually good at their jobs. I think I'm going to. I completely agree, and I've been extremely frustrated. The ego and incompetence is all well and good when we don't have serious calls, but when we do... yikes. I'm also way past compassion with this particular person, who can also kindly be described as a bully. Enjoys setting up some really nasty hazing pranks, and so on. And our certs officer sure isn't going to do anything.

 

[Hal9000]

I hope it goes well for you. Professional ethics should not be sacrificed simply because one person is a jerk. From my experience, the states and NREMT are more than adequately helpful in these matters.

 

[Seaglass]

I hope it goes well for you. Professional ethics should not be sacrificed simply because one person is a jerk. From my experience, the states and NREMT are more than adequately helpful in these matters.

Thank you. Do you know if I can do it anonymously? I'm leaving anyways in the near future, but I'd rather keep drama to a minimum.