For the more seasoned EMTs, what does a new EMTB do that bothers you?

[DragonClaw]

What's even more stunning is how often paramedics will scold or talk down to providers (in front of patients no less!!) when BLS doesn't have vitals before they arrive. Or experience difficulty obtaining vitals.

Every new EMT wants to be proficient at their job, and when they are unable to get a basic skill (which results in the all knowing and all powerful medics looking down on them as a result), I can totally understand why they do it. I'm not saying it's right, but I can see why it happens.

It's even more embarrassing that the paramedic doesn't do what the EMT does, but rather they put the patient on the pulse ox or monitor (now they have the pulse rate), and the autocuff from the lifepak (BP), and they just make up the RR that is more often than not 16. But we don't need to talk about that stuff, do we?

Well I am interested in this. Assuming everything goes according to plan and I get a job, as a rookie, what should I be wary of when it comes to EMTs or paramedics?

 

[Tigger]

It's even more embarrassing that the paramedic doesn't do what the EMT does, but rather they put the patient on the pulse ox or monitor (now they have the pulse rate), and the autocuff from the lifepak (BP), and they just make up the RR that is more often than not 16. But we don't need to talk about that stuff, do we?

You mean what pretty much the entire medical community does?

 

[mgr22]

Well I am interested in this. Assuming everything goes according to plan and I get a job, as a rookie, what should I be wary of when it comes to EMTs or paramedics?

I understand your concern about coworkers, but in my opinion, the best you can do is focus on your own behavior and performance. That's much more within your control than what others do. Be competent, reliable, helpful, considerate, flexible -- whatever you'd appreciate from others. Let your actions speak for you.

 

[DrParasite]

Well I am interested in this. Assuming everything goes according to plan and I get a job, as a rookie, what should I be wary of when it comes to EMTs or paramedics?

Stay out of the drama, stay out of the gossip. don't date your coworkers. don't sleep with your coworkers. don't sleep with your married coworkers. show up on time; early is even better. do your job as your agency expects it done. Speak to your partner/FTO before your shift, and ask them what they expect of you. Do the same of your supervisors. Ask for feedback on how you would be better at your job.

Ask questions after the call, but if your paramedic FTO tells you to do something, even if you know a better way,, even if it is different than what you were taught in class, do exactly what they tell you to do. Some FTOs are better than others, and some will interpret you knowing a better way to do something as a challenge to their authority, so it's easier to just do what they say. They are the FTO, so they are ultimately responsible for what happens on the crew.

As a rookie EMT, you are at the bottom of the totem pole, so don't tell people what you know, show them. expect to work the crappy shifts, expect to be expected to do a lot of grunt work. But learn how the organization operates, and how they do things. each agency has it's own culture, so take the time to learn it.

 

[johnrsemt]

EMT-B's and new EMT-P's that won't talk to the patient, that will rush in, and do vital signs, and put them on O2 with out finding out what is wrong with them. and without getting baseline VS, esp. SPO2. Even in Resp. Distress. You can get SPO2 reading in the 15 seconds it takes to set up a NC or NRB, get it before you put them on O2. How do you know the Pt needs O2? you sure don't know they do because they are take 2 breaths per word. They don't talk to the patients 1st.
Get a 12 lead for cardiac patients before you start to treat them for the chest pain. You can do it while you are asking them questions. I have watched a new medic give a patient NTG, ASA, Fentanyl IN all before a 12 lead, just because the patient said that he was having chest pain, and before he asked any history, like maybe drug allergies, like his history of anaphalaxysis to ASA. Oops.
Learn to talk to patients, and more important, listen to them

 

[NomadicMedic]

What's even more stunning is how often paramedics will scold or talk down to providers (in front of patients no less!!) when BLS doesn't have vitals before they arrive. Or experience difficulty obtaining vitals.

Every new EMT wants to be proficient at their job, and when they are unable to get a basic skill (which results in the all knowing and all powerful medics looking down on them as a result), I can totally understand why they do it. I'm not saying it's right, but I can see why it happens.

It's even more embarrassing that the paramedic doesn't do what the EMT does, but rather they put the patient on the pulse ox or monitor (now they have the pulse rate), and the autocuff from the lifepak (BP), and they just make up the RR that is more often than not 16. But we don't need to talk about that stuff, do we?

I never make up the resp rate. I use an end tidal NC.

 

[CbrMonster]

driving way to fast, for code 2 or 3, not knowing their place, seems especially new emt's think they're gods greatest gift to mankind and they're some hot shot doctor and insanely intelligent.

 

[KingCountyMedic]

If you have a good selection process, good SEI's in charge of the class, good instructors, and a great FTO program you won't have any problems with your new EMT. We were all new once. All of the issues folks have listed here would be covered and handled in the first part of training if you have a good program in play.

 

[Bullets]

I never make up the resp rate. I use an end tidal NC.

You do this for every patient? We have these and ive tried to get in the habit of using it more as well as getting 12 leads on more patients but i find myself not thinking about EtCo in non-respiratory complaints

 

[DragonClaw]

You do this for every patient? We have these and ive tried to get in the habit of using it more as well as getting 12 leads on more patients but i find myself not thinking about EtCo in non-respiratory complaints

Can you put that into layman's terms? Not sure if it's wrong to ask that or not, being the site that this is. But I've not gotten to that part yet in my training.

 

[joshrunkle35]

I never fault an EMT for ignorance if it is related to inexperience. We were all there once. I just try to help them through the process. The one thing I can’t stand, though, are the brand new EMT’s that think that they know more than the Medical Director.

All in all, more than the new EMT’s, what irritates me much more are EMT’s with 20 years of experience who will never advance their training in any way, but will tell the medics how to do their job, and will not back down when confronted with reasonable scientific/medical evidence. Example is: I had an EMT complain about a medic for not giving high-flow O2 to an emphysema patient with an SP02 of 90%. The medic even explained why to the EMT. The EMT was pissed because they didn’t grasp the concept. They won’t advance their training but they’ll make their ignorant opinions well known.

 

[DragonClaw]

I never fault an EMT for ignorance if it is related to inexperience. We were all there once. I just try to help them through the process. The one thing I can’t stand, though, are the brand new EMT’s that think that they know more than the Medical Director.

All in all, more than the new EMT’s, what irritates me much more are EMT’s with 20 years of experience who will never advance their training in any way, but will tell the medics how to do their job, and will not back down when confronted with reasonable scientific/medical evidence. Example is: I had an EMT complain about a medic for not giving high-flow O2 to an emphysema patient with an SP02 of 90%. The medic even explained why to the EMT. The EMT was pissed because they didn’t grasp the concept. They won’t advance their training but they’ll make their ignorant opinions well known.

What's the actual reason you don't need to give O2?

 

[VentMonkey]

When they obsess over what others think about them. Then again, to be fair, I find this rather off putting in general.

But, this is the best advice thus far (IMO) in this thread:

Be competent, reliable, helpful, considerate, flexible -- whatever you'd appreciate from others. Let your actions speak for you.

I could not have said it better myself. It’s often missed on the majority of people in this field in general. All levels of provider and experience.

 

[CbrMonster]

What's the actual reason you don't need to give O2?

In short copd patients have a normal spo2 of 89-92% r/a. I would recommend looking up the whole path phys behind it

 

[joshrunkle35]

What's the actual reason you don't need to give O2?

Short version:

First off, I said they wanted to give high-flow O2.

Second, 90-ish% is pretty normal and usually pretty stable for an emphysema patient.

Third, patients WITHOUT emphysema breathe based on their high CO2 levels. We breathe to get rid of CO2, not just to take in Oxygen. Patients WITH emphysema live with chronically high CO2, so, over time their bodies can adjust to breathe off of not having enough oxygen. If you give them high flow O2, their body feels satisfied and does not sense the need to breathe and you can kill them. So, you can give them low-flow O2, if you feel it is necessary, and then very slowly increase the rate.

 

[CbrMonster]

Short version:

First off, I said they wanted to give high-flow O2.

Second, 90-ish% is pretty normal and usually pretty stable for an emphysema patient.

Third, patients WITHOUT emphysema breathe based on their high CO2 levels. We breathe to get rid of CO2, not just to take in Oxygen. Patients WITH emphysema live with chronically high CO2, so, over time their bodies can adjust to breathe off of not having enough oxygen. If you give them high flow O2, their body feels satisfied and does not sense the need to breathe and you can kill them. So, you can give them low-flow O2, if you feel it is necessary, and then very slowly increase the rate.

From what I was taught that whole hypoxic drive thing really doesn’t do that for the short term that we take care of them. In long term like hours you could kill the respiratory drive

 

[joshrunkle35]

From what I was taught that whole hypoxic drive thing really doesn’t do that for the short term that we take care of them. In long term like hours you could kill the respiratory drive

That’s what I was taught in basic, but not what I was taught in medic. I can find peer-reviewed studies that show high-flow O2 = potentially bad for emphysema. I cannot show any studies showing that it is ok within “X” amount of time.

ETA: regardless: my point is not about the info. My point was about how annoying it is when I have an EMT complaining to me that a Paramedic they were with chose a different treatment option which was within the protocol, was based on solid reasoning, and based on their report seemed to be the best treatment for the situation, but the EMT is complaining because they are too ignorant to see different sides to the same coin.

 

[DrParasite]

That’s what I was taught in basic, but not what I was taught in medic. I can find peer-reviewed studies that show high-flow O2 = potentially bad for emphysema. I cannot show any studies showing that it is ok within “X” amount of time.

Which is part of the problem. When EMTs are taught one thing, and medics are taught something else, conflicts occur, because both are right according to their training. When I took my first EMT course in NJ, as well as my second EMT course in NY, I was taught that every patient should get high flow oxygen; not administering it was a critical fail on my exam.

And of course, in 90% of the patients that I put on a high flow NRB, the moment a paramedic showed up, they took it off them, because they were taught that it wasn't needed. And 98% of the time, when we brought someone into the hospital on a NRB, the first thing they did was take it off them.

Medicine should be taught consistently, from basic first aid, to EMT, to paramedic, to nurse, to doctor. The same concepts should be the same throughout the progression.

All in all, more than the new EMT’s, what irritates me much more are EMT’s with 20 years of experience who will never advance their training in any way, but will tell the medics how to do their job, and will not back down when confronted with reasonable scientific/medical evidence.

don't you guys have the same medical director? follow the same protocols, and have the same standards? I mean, once the paramedic shows up, the EMT should be handing the patient off to them (figuratively), and then doing what the paramedic is asking for, as they are the highest level of clinical care present. The EMT can make suggestions, and if you have a 20 year EMT, I imaging they have seen a thing or two, so their suggestions shouldn't be ignored, but at the end of the day, it is the paramedic's call. And many paramedics have been "saved" (and I'm using that term in the loosest possible way) from missing something or making the wrong call by listening to their EMT counterparts.

Example is: I had an EMT complain about a medic for not giving high-flow O2 to an emphysema patient with an SP02 of 90%. The medic even explained why to the EMT. The EMT was pissed because they didn’t grasp the concept. They won’t advance their training but they’ll make their ignorant opinions well known....My point was about how annoying it is when I have an EMT complaining to me that a Paramedic they were with chose a different treatment option which was within the protocol, was based on solid reasoning, and based on their report seemed to be the best treatment for the situation, but the EMT is complaining because they are too ignorant to see different sides to the same coin.

Was the patient having difficulty breathing? were they cyanotic? were accessory muscles being used? were they feeling dizzy?

If the answer to these questions is yes, than your paramedic was likely wrong, and the patient should have received high flow oxygen, because, yes, long term high flow oxygen is bad for the patient, but in the acute setting, if they need oxygen, give oxygen. You shouldn't be knocking out their respiratory drive with 10 minutes of O2 via NRB, but it can help with other things.

Now if your patient was in no distress, and the only reason the EMT said the patient needed high flow O2 was because the pulse ox said 90, that's a different story....

 

[Qulevrius]

What are some bad habits or assumptions that EMTBs have that are more than just personal choice that you think should be avoided? What makes someone bad to work with/be your partner? What mistakes to new EMTS make that are life-threatening (I hope these aren't common)?

Not using their heads, and getting all worked up when others call them out. For example, I don’t care how long you’ve been on the job or what letter there is in your abbreviated title - if you try to stick a thermometer probe in a mouth of an altered or nauseated pt, I’ll bite your head off.

 

[dutemplar]

Breathe.

OK OK,... just kidding. It was a bit of a shock going from the US to Qatar. Back home, if a BLS called it was for a purpose and they had an idea of what ALS brought to the call for interventions. Here, it's call for a magical assessment, x-ray vision, and a magic 8 ball prognosticator to show what is secretly wrong (but quietly shift the blame, just in case the patient has a stage 9 undiagnosed malignant explosive tumor of some sort.) If we run 20 minutes hot to get somewhere, yeah, maybe not just to assess someone they think is fine and they're delaying transporting to the hospital on...

Oh, and given the climate change, DEODORANT.