I don't trust him

[emt seeking first job]

I'm not the one making the claim that there's zero difference between an EMT and a paramedic working as an EMT.

Once again, a paramedic working as an EMT has to follow EMT protocols.

There is a vollie in NYC, where an actual MD works. When he does so, he acts as an EMT, not an MD, he has not authority above anyone else or to do anything else.

 

[JPINFV]

Once again, a paramedic working as an EMT has to follow EMT protocols.

Using California as an example (because that's where I'm most familiar with), an EMTs scope of practice includes the ability to "evaluate the ill and injured." If I deem that a cranial nerve exam, for example, is indicated. Please tell me how I would be violating my protocol by conducting a cranial nerve exam? How about percussion? Rinse, wash, repeat with essentially all manual exam techniques. In fact, I could argue that I could use a lot of exam tools. If I'm, as an EMT, am empowered to "evaluate the ill and injured" and am properly trained in using an otoscope, is it really against my scope of practice to use one?

Even with strict protocols, there's still a fair amount of judgment that can be utilized. How is using a paramedic level of knowledge violating EMT protocols? Alternatively, is every action where you work dictated by protocol?

There is a vollie in NYC, where an actual MD works. When he does so, he acts as an EMT, not an MD, he has not authority above anyone else or to do anything else.

If he decides to go full physician, including taking on malpractice liability, there's absolutely nothing legally stopping him. If he wants to equip himself with a manual defibrillator, there's absolutely nothing stopping him. A license to practice medicine does not end at the hospital or ambulance's doors. I can, however, see liability and maintenance of drugs and equipment, and staffing concerns (if he is acting as a physician, then does he still count towards the minimum number of EMTs in states other than NJ?) as valid reasons to restrict the tools available.

Additionally, ask him if he limits his differentials only to those listed in an EMT text book, or if he uses his medical education to help make judgment calls. I'm also willing to bet that, when push comes to shove, he would take charge in a second if another provider started to engage in malpractice. However there's very little to legitimately foul up on a BLS unit. Seriously, in the grand scheme of things, there's very little to screw up on most patients.

Finally, ask him what he'll do when presented with a field birth of a baby with shoulder dystocia. I'm willing to bet that he wouldn't blink at placing the patient in McRoberts, or applying suprapubic pressure or performing an episiotomy if need be. By virtue of being a licensed physician, he has the legal authority to do those. The only question is, will he and at what cost?

 

[JPINFV]

It is the same as an out of work finance position with a Wharton MBA getting a job as a cashier at Applebees. The manager has an AA in liberal arts. Because the cashier has a higher level of buisness training does nothing to put them in automatic authority above anyone else in the organization.

I didn't realize that the cashier was at risk of practicing accounting without a license.

I didn't realize that cashiers had the potential to be in situations where they had to make life or death decisions.

As far as the medicine goes, dont quote me, but in my b class, I rmemver the instructor staing in NYS the protocol is glucose regardless if they are hyper or hypo since more sugar will not make a difference..not sure on the full explanation.

Anyone who administers glucose to a patient who is known to be hyperglycemia for the purposes of correcting ALOC due to diabetes is an idiot.

Anyone who wrote that protocol is an idiot.

Both are boarding on malpractice.

Now if you DO NOT know if a patient is hyper- or hypoglycemic, then I can agree with that argument.

 

[emt seeking first job]

As I said, I really forget the hyper/hypo issue in its entiretity. At my level, if faced with that sitaution, I would defer to the crew chief to make the call.

As far as the MD on a BLS ambulance. If he kept playing MD card and took over the scene, in theory, the BLS service could remove him. Then he would be free to drive around in his POV, roll up, and tell ambulance crews what to do.

Getting back to the original post. The original poster never answered my questions:

1) was there a crew chief on the rig

2) did nayone else complain, was it formally?

Ambulance services have mechanisms to review calls and my question to the OP was whether she used any of them.

 

[emt seeking first job]

why is that outside the US a 120 hour EMT would not be qualified to even set foot on an ambulance

Then Brown better get over to wikipedia and make some edits.

http://en.wikipedia.org/wiki/Emergency_medical_services_in_New_Zealand

"Training occurs across a broad range in New Zealand, and the range of training varies considerably between volunteer and paid staff. As a result, it is permissible to work on an ambulance with only a first aid certificate, or with a university degree in paramedicine. To some extent, availability of training may be affected by the location of volunteers, and also by their time availability, given full-time employment and other life commitments. There are, in fact, eight levels of training available.[13] It is quite common for New Zealand EMS staff to begin their careers as volunteers, and to progress into paid positions."

"Basic and IntermediateBasic life support providers use the same skill set used by BLS providers around the world. With additional training, some BLS providers may operate at an Intermediate Life Support level, including IV starts, and some drugs.[17]"

 

[emt seeking first job]

I didn't realize that the cashier was at risk of practicing accounting without a license.

I didn't realize that cashiers had the potential to be in situations where they had to make life or death decisions.



.

The issue was boiled down to authority on an BLS ambulance.

I was trying to keep morality, saving lives, etc, out of it.

 

[FrostbiteMedic]

I really, really, REALLY wish andecotes such as this would disappear...:glare:

Told ya'll I was gonna get yelled at for the post. Oh well....

Just a thought....

 

[emt seeking first job]

here is my issue...

My volly unit only runs as BLS. We have a transplant from another state who likes to take over calls refusing to allow EMT-B's to tech.

He feels ultimately responsible as the highest trained provider.

I know my training is lower than his, but I think my college level biology class educated me more in anatomy than his paramedic course did.

If I'm stuck up front driving because he's pulled the "higher trained" card and jumps in back, I am afraid of not being able to advocate for a patient if he pulls one of these stunts on call.

I've not run a single call with him yet, but it's only a matter of time and I need to figure out what to do with my personal feelings about this guy before it happens.

GETTING BACK TO THE OP'S ISSUE:

If this were my service, each crew of up to four people has a role and a place:

1) crew chief
2) driver
3) emt

If someone is on the schedule to be the driver, they drive that shift. They assist but the EMT for that shift is the person making patient care decesions, based on the protocols. The driver has no authority to tell the tech to drive and take over patient care. Regardless of his or her training or authority in some other agency (and that happens in NYC).

If two or more emts have a disagreement the crew chief decides. If someone wants to go over the crew chiefs head, they call the medical director on the phone or an FDNY conditions boss to the scene. If it was criminal, the NYPD.

If anyone does not like what went down on a run, they make an incident report and the board conducts a hearing.

The OP has never ridden with this person, but has all these issues? Did the other people on the crew take any action through proper channels?

An ambulance crew paid or volunteer is not just a bunchg of people showing up and then arguing about who has more authority based on external factors.

 

[emt seeking first job]

Regarding the treatment protocols:

I may stand corrected, but in NYS:

http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols

M2- Page 2

A patient with AMS, history of diabetes controlled by medication, able to drink, administer oral glucose, transport, keep warm. Request ALS but do not delay transport.

In NYS BLS, we do not test blood sugar.

Again, I am new to EMS, so I may stand corrected on the protocols, however, I am not knew to the world, and I had a valid reply to the OP re: adressing her concerns through proper channels.

 

[usalsfyre]

Told ya'll I was gonna get yelled at for the post. Oh well....

Just a thought....

Not yelling at you at all, just expressing my displeasure at that kind of quote. It shows a gross misunderstanding of the difference in thought processes.

It's like me saying a physician has "MD syndrome"' when I don't have an effing clue about his thought process on a patient.

Suffice to say if I'm skipping over EMT-B practice levels it's because the patient is better served by something more advanced NOT because it's beneath me. Some people can never be convinced of this (not saying your one of them).

 

[JPINFV]

I'm also willing to bet that NYS EMTs don't administer 50% dextrose IV solutions either and the OP specifically mentioned "hypERglycemia."

As I said, administering glucose or dextrose to a patient known to be hyperglycemic due to ALOC due to diabetes is stupid and tantimount to malpractice.

Administering glucose to a patinet who is altered, has a history of diabetes, and absent the ability for point of care blood glucose testing isn't ideal, but understandable. I would go further to say that an EMT at a health care facility for a patient who has had an immediately recent (pro-tip: Ask for an updated BGL at a nursing home and more often than not they'll get one in front of you. Document "BGL ____ at ____ Per RN") blood glucose measurment and that measurment is not low has strong standing to not administer a glucose product, regardless of the protocol.

 

[JPINFV]

If someone is on the schedule to be the driver, they drive that shift. They assist but the EMT for that shift is the person making patient care decesions, based on the protocols. The driver has no authority to tell the tech to drive and take over patient care. Regardless of his or her training or authority in some other agency (and that happens in NYC).

Assuming both providers are eligible to drive, does your system allow for a mutually agreed upon switch in positions? After all, if your personal interest is respiratory calls and mine is psych, it makes sense that I take psych patients and you take respiratory patients.

An ambulance crew paid or volunteer is not just a bunchg of people showing up and then arguing about who has more authority based on external factors.

There's never a place for arguing. However there is a place for collaboration, which is definitely enhanced by external factors.

 

[emt seeking first job]

Suffice to say if I'm skipping over EMT-B practice levels it's because the patient is better served by something more advanced NOT because it's beneath me. Some people can never be convinced of this (not saying your one of them).

But if you are on a BLS unti and "skip over" BLS practice levels and things go wrong, you could get in a jam.

CYA stick to the protocol.

 

[reaper]

But if you are on a BLS unti and "skip over" BLS practice levels and things go wrong, you could get in a jam.

CYA stick to the protocol.

There is no such thing as BLS or ALS!!!

There is medical education and treatments. Most basics have minimal education and treatments. Most medics have a better education and treatments. You use the appropriate treatment for the assessed pt. That is all that should be done on any pt you see.

Do not live or die off protocols. They are Guidelines to let you know what should normally be done for a pt in that situation. Does not mean that they are the rules for every pt. That is the difference between cookbook medicine and critical thinking!

 

[emt seeking first job]

Well, for example, a surgeon riding on a BLS ambulance, if he or she did an emergency trachetomy (sp?) in the field, he or she does so on their own, not as a member of that ambulance service......

 

[emt seeking first job]

GETTING BACK TO THE OP'S ISSUE:

If this were my service, each crew of up to four people has a role and a place:

1) crew chief
2) driver
3) emt

If someone is on the schedule to be the driver, they drive that shift. They assist but the EMT for that shift is the person making patient care decesions, based on the protocols. The driver has no authority to tell the tech to drive and take over patient care. Regardless of his or her training or authority in some other agency (and that happens in NYC).

If two or more emts have a disagreement the crew chief decides. If someone wants to go over the crew chiefs head, they call the medical director on the phone or an FDNY conditions boss to the scene. If it was criminal, the NYPD.

If anyone does not like what went down on a run, they make an incident report and the board conducts a hearing.

The OP has never ridden with this person, but has all these issues? Did the other people on the crew take any action through proper channels?

An ambulance crew paid or volunteer is not just a bunchg of people showing up and then arguing about who has more authority based on external factors.

I stand by this post as my reply.

I can empathize with the OP has I have known volunteer services to often have more drama than paid jobs.

I would strongly urge her to reach out to other members in her service to build consensus and failing that, consider switching to another service....

 

[usalsfyre]

I stand by this post as my reply.

I can empathize with the OP has I have known volunteer services to often have more drama than paid jobs.

I would strongly urge her to reach out to other members in her service to build consensus and failing that, consider switching to another service....

What If the "crew chief" is about to administer a treatment that will be a detriment to the patient or (GASP!) violate protocol? Does the rest the crew have no authority/is under no obligation to do everything in their power to prevent suboptimal care?

 

[emt seeking first job]

What If the "crew chief" is about to administer a treatment that will be a detriment to the patient or (GASP!) violate protocol? Does the rest the crew have no authority/is under no obligation to do everything in their power to prevent suboptimal care?

Then the crew should muntiny and hog tie the crew chief to the brush bar and ride lights and siren through the perimeter of their chartered service area.

Are you happy?

There is always a medical director on call to contact for treatment issues. There is always an operations officer on call for administraive issues. In NYC the FDNY has conditions bosses.

What happens in an OR room if a surgeon does something wrong? What do the nurses and techs do ?

The point I was making was to bring other people in the issue at the scene..

You dont debate it with the person one on one and then go to an online forum to gain consenses by whose paramedic certificate is more valid than another persons. Or who has education extra and above the EMT certificate....

I thought I asked a logical follow up question(s) to the OP.....

 

[Jon]

PA State EMS requires each agency adopt a policy that provides for the highest certified provider on scene to be responsible for the ultimate care of the patient.

When I run BLS (Ambualnce or First Responder) I'm still under this, as I'm an active medic in PA (and even in my County/Region).

Here's a PA-specific thought (Not sure if it applies) Does this person have active medical command status as a paramedic within the Commonwealth? Within the Region? If not currently an active medic in the Commonwealth, then he isn't SUPPOSED to wear anything that says Paramedic, and he's limited to being an EMT-B.

 

[emt seeking first job]

does your system allow for a mutually agreed upon switch in positions? .

Yes, however, the switch is not agreed on by the OP

I am still unsure if she ever rode with him or she was projecting.