For 'newer' medics and students... abdominal pain management

[DrParasite]

I've had two separate EMTs report me to higher-ups for improper patient care due to administering painkillers for abdominal pain. The supervisors they report me to also disagree with pain management for abdominal pain.

What does your medical director think? After all, you are working under his license,so it's only his opinion and direction that really matters.

On an unrelated topic, I have 0 respect for any EMT who whines to the higher ups about a paramedic treating a patient who was in pain.

 

[RoadRat]

What does your medical director think? After all, you are working under his license,so it's only his opinion and direction that really matters.

The protocol states the typical "consider pain management" line even for abdominal pain. We never actually have face-to-face or even electronic/radio contact with our medical director, so we can only assume he approves of abdominal pain management.

The private company's CEO (a critical care medic of 20+ years) counseled me due to the complaints by partners and after 10 minutes of discussion he agreed with my methods. A supervisor was also present to witness the discussion, so it's known that I'm correct in my habits. But that doesn't change that I make my coworkers uncomfortable with my pt care choices.

They're reacting naturally, but not logically.

... I'll also add I'm a bit abrasive to EMTs who question my choices. My pride is overdeveloped, and so when they ask why I administered pain meds I don't explain my thoughts in a calm manner. I can't really blame them for complaining to an ear who will listen.


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[DrParasite]

The protocol states the typical "consider pain management" line even for abdominal pain. We never actually have face-to-face or even electronic/radio contact with our medical director, so we can only assume he approves of abdominal pain management.

I thought that was a requirement to operate under their license? Maybe a phone call or email would be in order, provided it was passed up through the chain of command?

The private company's CEO (a critical care medic of 20+ years) counseled me due to the complaints by partners and after 10 minutes of discussion he agreed with my methods. A supervisor was also present to witness the discussion, so it's known that I'm correct in my habits. But that doesn't change that I make my coworkers uncomfortable with my pt care choices.

They're reacting naturally, but not logically.

... I'll also add I'm a bit abrasive to EMTs who question my choices. My pride is overdeveloped, and so when they ask why I administered pain meds I don't explain my thoughts in a calm manner. I can't really blame them for complaining to an ear who will listen.

So was the complaint that you didn't explain properly, or because you administered pain meds to the patient? and were you counseled on your administration of pain meds, or your interactions with your partners?

As an EMT, it is not my place to decide whether my partner paramedic gives pain meds to someone, and I stand by my statement that I have zero respect for EMTs who whine about it to supervisors. If you want to treat a BLS patient with ALS equipment and meds, it's one less chart me to to write.

Now if you are treating your EMT partners like crap and getting all defensive because they are asking you a question about why you did something, that's a different story. A chat with the boss was probably warranted, even if simply "hey, don't be a jerk off when they ask you a question. Explain why you do something, and then if they still have an issue with it, then both of you should come to my office and we can discuss it together. But tone it down with the abrasiveness, it's completely uncalled for."

Contrary to the belief of many paramedics, paramedics do make mistakes, do miss things, and it's much easier to work with an EMT partner vs having them work for you. But if they have an issue with giving any clinically indicated medication, and it goes up to the CEO's office, than that sounds more like a system issue. But I have a hunch it wasn't what you said or why you did something, but rather how you said it.

 

[VentMonkey]

Contrary to the belief of many paramedics, paramedics do make mistakes, do miss things, and it's much easier to work with an EMT partner vs having them work for you.

Quoted for its emphatic truth.

 

[StCEMT]

Contrary to the belief of many paramedics, paramedics do make mistakes, do miss things, and it's much easier to work with an EMT partner vs having them work for you..

Quoted for its emphatic truth.

That's a big reason why I am I am chasing down a friend to start working as my partner. He knows the area, he's a good EMT, and since he is a good ways through medic school he will be someone I can bounce ideas off of.

I can understand the annoyance with people handing stuff like that when your treatment was right though[/QUOTE]

 

[RoadRat]

I thought that was a requirement to operate under their license? Maybe a phone call or email would be in order, provided it was passed up through the chain of command?

Now if you are treating your EMT partners like crap and getting all defensive because they are asking you a question about why you did something, that's a different story. A chat with the boss was probably warranted, even if simply "hey, don't be a jerk off when they ask you a question. Explain why you do something, and then if they still have an issue with it, then both of you should come to my office and we can discuss it together. But tone it down with the abrasiveness, it's completely uncalled for."

Contrary to the belief of many paramedics, paramedics do make mistakes, do miss things, and it's much easier to work with an EMT partner vs having them work for you. But if they have an issue with giving any clinically indicated medication, and it goes up to the CEO's office, than that sounds more like a system issue. But I have a hunch it wasn't what you said or why you did something, but rather how you said it.

I recognize medics make mistakes. And I welcome an experienced EMT partner's input.

I also try to monitor my interactions with my EMTs. I realize my ego is not their problem, and they are not responsible for tip-toeing around it. I don't expect them to.

Whenever I feel an exaggerated emotional response to a partner's pointed question, I take a moment to calm down before explaining myself through calm but gritted teeth. So, perhaps from the perspective of the EMTs, "gritted teeth" warranted being reported.

Again, I know my ego is my problem and no one else's.

But, I will say in my defense that I don't become aggravated without first being jabbed in the side. An EMT who - in front of a patient - dramatically rolls his eyes, huffs, waves his hands in a dismissive fashion, and outright argues with me about ALS care is promised to get an angry reaction.

I was not counseled on my interaction with the partners who reported me. If how they received my demeanor was the motivating factor behind reporting me, it was never indicated to me by my supervisors or the CEO. The CEO specified that several EMTs were concerned I was inhibiting care of abdominal pain pts by giving analgesics.




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[EpiEMS]

As an EMT, it is not my place to decide whether my partner paramedic gives pain meds to someone, and I stand by my statement that I have zero respect for EMTs who whine about it to supervisors. If you want to treat a BLS patient with ALS equipment and meds, it's one less chart me to to write.

If my medic partner decides to not give a patient in pain treatment for pain, it's totally reasonable for me to ask after the fact why they didn't, no?

An EMT who - in front of a patient - dramatically rolls his eyes, huffs, waves his hands in a dismissive fashion, and outright argues with me about ALS care is promised to get an angry reaction.

Absolutely. (Nothing wrong with asking afterwards, though, I'm sure you'll agree!)

 

[DrParasite]

ok, let me see if I have this right.....

1) you treated a patient in pain, in accordance with you agency's protocols
2) your EMT partner (actually several of them), filed complaints about your patient care with the supervisor, despite you following your medical director's clinical protocols (which everyone is aware of, since everyone has a copy of the protocols)
3) The supervisor evaluated the complaints, felt they were valid and with merit, and gave them to the CEO to initiate a disciplinary session
4) The CEO counseled you on your actions, despite agreeing that pain should be treated, despite you following the protocol from your medical director, and despite the fact the modern studies say prehospital treatment of pain does not prevent objective assessment of abdominal issues

Assuming i got that right, I have questions: assuming everything you said is 100% true, why didn't the supervisor quash these complaints immediately? why is your CEO counseling you on anything, shouldn't the supervisor be doing it? why didn't the supervisor (who I am assuming is a paramedic) ask you to explain your actions prior to going to the CEO? What gives an EMT the right to argue over you wanting to provide ALS care? I can see arguing over NOT providing needed ALS care, but if you want to treat the patient, they are throwing a hissy fit?

 

[NysEms2117]

I'll also add I'm a bit abrasive to EMTs who question my choices. My pride is overdeveloped, and so when they ask why I administered pain meds I don't explain my thoughts in a calm manner. I can't really blame them for complaining to an ear who will listen.

1. glad we aren't partners lol, That wouldn't fly with me
2. they aren't complaining, they are asking you(whom the state of whomever deems you have more education in healthcare then they do) which you interpret as complaining.
3.It may benefit you to explain your thoughts in a calm manner, becuase if your like a certain person i know who works as an EMT-B, but is a physician he will then proceed to i believe the saying is "rip you a new one?"
4. What happened to the whole you never learn unless you ask questions thing? Maybe it has something to do with abd pain in LRQ instead of LLQ, but if i dont ask, how am i supposed to know?
Edit: at DR.P from my interpretation i think the EMT's asked a question, not arguing. I think they were just trying to learn why tbh. but this is my youthful ignorance as one of those pesky question asking emt's

 

[RoadRat]

ok, let me see if I have this right.....

1) you treated a patient in pain, in accordance with you agency's protocols
2) your EMT partner (actually several of them), filed complaints about your patient care with the supervisor, despite you following your medical director's clinical protocols (which everyone is aware of, since everyone has a copy of the protocols)
3) The supervisor evaluated the complaints, felt they were valid and with merit, and gave them to the CEO to initiate a disciplinary session
4) The CEO counseled you on your actions, despite agreeing that pain should be treated, despite you following the protocol from your medical director, and despite the fact the modern studies say prehospital treatment of pain does not prevent objective assessment of abdominal issues

Assuming i got that right, I have questions: assuming everything you said is 100% true, why didn't the supervisor quash these complaints immediately? why is your CEO counseling you on anything, shouldn't the supervisor be doing it? why didn't the supervisor (who I am assuming is a paramedic) ask you to explain your actions prior to going to the CEO? What gives an EMT the right to argue over you wanting to provide ALS care? I can see arguing over NOT providing needed ALS care, but if you want to treat the patient, they are throwing a hissy fit?

You are correct in all aspects of what you have written, except for one large and overhanging concept: you assume my company's management system and structure is effective with dealing with employee complaints. I am unable to explain the faults in the management system, and am only able to relay what I have witnessed and perceived.

It also seems that we have deviated from the topic of this forum. It's also obvious no matter how clearly and accurately I explain the situation, someone will compare it to a perfectly functioning EMS system and find suspicion. I didn't comment on this topic with the hopes of being subject to this tiring back-and-forth.

Believe what you will.


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[NomadicMedic]

Eh, this doesn't exactly sound like the whole story. I think we all know newer medics who believe in "treating all the pain". As in, "I've got a drug box and I'm gonna use it".

Yep, I was there too.

And those salty, jaded EMTs can be a thorn in the side of a newer medic, especially when the supervisor says something to the effect of, "Bill's been an EMT for a long time. He knows more than most medics. He'll keep you out of trouble."

Sounds like a combo of a new medic overtreating, salty EMTs taking their role as new medic babysitter a bit to seriously and the CEO trying to smooth things over, but just making it worse (in the eyes of the OP).

There's always three sides to every story.

 

[RocketMedic]

I've been that guy, and mostly still am. The best answer is really just to ask yourself "is it worth it?" Sounds terrible, but now I find myself asking if my anticipated treatments are actually likely to make a difference or if they're just to make me feel better. That and I have become far less outwardly passionate about good care- you'll never change anyone who self-identifies as "salty", especially a career EMT. Not worth your time.