Just another regular dialysis patient....so it was supposed to be.

[Hoofguy]

Okay, I will say it. Noobie, you and your partner have NO business in prehospital care, transporting live patients... heck; even dead one's. I would not even suggest being a driver of carcass removal transport system.

I will say thank-you though. Yeah, thanks for setting EMS back 40 years to the old "ambulance driver" stigma.

You both attempted to disguise yourself as a knowledgeable EMT's but in reality displayed the biggest case of dumbass! Seriously, you have just completed a first aid course and now you and your idiot partner attempts to interpret numbers that you have no clue what they represent!

As previously stated and discussed, there are multiple reasons for those numbers as well as numerous other potential risks and dangers. Again, material not taught in your first aid course.

If you do value your certification, then I would request to never work with that person again. I do hope the medics pursue and request formal action against your EMS and the other EMT. As well, as the patient and family take legal action and litigation against both of you.

I doubt that you will return and discuss this further, and I dare your partner to attempt to defend their action(s). I would welcome the opportunity!

I highly suggest to start hitting the books and gaining some real education and maturity. You will look back at this and hopefully chalk this up as experience on what not to do from now on.
R/r 911

Oh snap, he went there!

Excuse me while I clean up the mess I made with my drink while reading that.. Truth can be painful sometimes

 

[jgmedic]

There's a reason those fire medics tried to take your patient out of your ambulance and put them in another. In OC, there are few ambulance companies full of EMT's who think that they know what's best, most medics will not transport with these people and will request that the patient be transported by their usual transport agency. The OC system is f-d up as it is, but shutting the doors on a higher level of care because you "know what's better", come on now.

 

[shadowstewie]

The tachycardia may be normal for him. Immediately after a dialysis treatment the pt has a reduced blood volume because of the liters of fluid that have been removed. It can some times take the body a little while to reach homeostasis, especially in pts with artery/vein diseases (like someone with a hx of diabetes has a high likelihood of having).

There are also patients that have a reactive tachycardia to the reduced pre-load post treatment. Suddenly there is less fluid and their heart is like "wow, I can beat better!" and it speeds up.

If he's tearing up, he's probably not calm. The saline the RN gave him could have fixed tachycardia due to fluid loss, but by that time he was anxious which kept his pulse high.

I'm also very surprised that your EMT didn't get in trouble. If both ambulance companies are already on scene there is no delay in care for the ALS ambulance to take the pt. If a pt is an ALS pt, and the EMT refuses to turn pt care over they could end up with a major lawsuit on their hands if anything happened to the pt.

From what my Manager told me, the Paramedics were supposed to go in the ambulance with our crew since it is OUR patient, not the other company's. But the paramedics didn't, all they wanted to do was move the patient to the other ambulance since they were contracted with them. I'm not saying I know everything, but that I believe is not a smart move by the Paramedics.

 

[triemal04]

Ok, that is about enough of this crap. You need to seriously wake up, start thinking about what it is you do, what it is you know, what you DON'T know (a lot apparently) how EMS works, and how your system works.

You have a pt with a condition you know nothing about possibly having a problem you know nothing about and you want to drag him with lights and sirens screaming to the ER because you think you know best?

You want to sit and argue with someone about transport because the pt's BP is rising...after you spent how long grilling him and rechecking his pressure? Think it might have been because of you that his BP rose? That it might have been because of his dialysis?

You think that you actually know better than a doc and RN...you know, people who have way more knowledge than you, and in this case have specific education for this type of pt?

You actually think that it's acceptable to blow off people who know what they're talking about and do what you want because you think it's better for the pt?

You think it's acceptable to refuse to turn a pt over to a higher level of care (after ASKING for help no less) because you wouldn't get to drive and pay with the woo-woos and flashies?

You think it's acceptable to do that so that your company can bill the pt instead of someone else?

I'd go on but I'm allready foaming at the mouth.

Quit. Quit your job, turn in your cert leave everything to do with EMS for at least 5 years. Then maybe, just maybe start over from scratch. Which means learning about medicine, what we do, why we do it, how the system works, and what should have been done in all the situations above.

 

[NEMed2]

Oh snap, he went there!

Excuse me while I clean up the mess I made with my drink while reading that.. Truth can be painful sometimes

I almost dropped my beer... The brutal truth in some cases is the only way to set someone on the correct path.

 

[medichopeful]

The whole point of this story of a call is a couple things, for one, I don't care what anyone says to me, whether a Paramedic, RN, Doctor, whoever...if I feel something is better for the patient that's going to help them, I'm going to do it, plus that's what our company is strongly advising us to do, is to argue and do what's best interest for the patient.

You can't be serious. You are seriously going to go against the orders or opinion of somebody who has WAY more education than you to do what you think is the right thing? Get your ego in check. NOW.

I understand that your company is saying that they want you to do what is best for the patient. Stop being a cocky :censored::censored::censored::censored::censored::censored::censored: and do what is best for the patient: leave them with somebody who actually knows what their doing.

When questioning a doctor's or RN's orders, do it to learn. Don't do it to show how brilliant you think you are.

I, like others on this forum, question whether you have any right being in EMS.

 

[jgmedic]

From what my Manager told me, the Paramedics were supposed to go in the ambulance with our crew since it is OUR patient, not the other company's. But the paramedics didn't, all they wanted to do was move the patient to the other ambulance since they were contracted with them. I'm not saying I know everything, but that I believe is not a smart move by the Paramedics.

Hmm...maybe the paramedics knew they type of shenanigans your company has pulled(like BLS'ing obviously ALS patients, or arguing about transports on scene, in front of patients) and don't want to be involved in that type of business. Maybe not, but having worked in that system for several years before becoming a medic, it would not surprise me, things I have personally witnessed, like managers arguing with fire, because it is THEIR patient(not for pt care reasons, but for billing) and con homes telling me if I call for ALS(911) then they won't call our company anymore, because it'll ruin their stats.

 

[Akulahawk]

From what my Manager told me, the Paramedics were supposed to go in the ambulance with our crew since it is OUR patient, not the other company's. But the paramedics didn't, all they wanted to do was move the patient to the other ambulance since they were contracted with them. I'm not saying I know everything, but that I believe is not a smart move by the Paramedics.

If that crew called for ALS, waited on scene for ALS to arrive, then transport the patient to the hospital, that's generally considered delaying treatment for that patient. If that patient had an adverse event during transport, guess who butt is on the line? Not the Paramedic... Did that BLS transport unit have ALL the ALS equipment necessary for care on board? Doubt it. Probably not exactly legal. I doubt that the ALS crew had all their necessary equipment available in a bag to be able to deliver ALS care to the patient to the same level of care that they could in their ambulance.

I don't know what the transportation guidelines are for BLS -> ALS turn overs in your County, but I do know that Santa Clara County has a VERY specific policy in this case. It's simple for BLS: from the time you get on scene, you have 10 minutes to deliver the patient to an ER (only for patients requiring ALS care). Otherwise, you sit and wait for ALS. Period. Until about 2000-1 timeframe, the standard was get to the ER before you could get ALS to you = BLS transports. After that, an ALS unit was almost always within 10 minutes...

Now, back when I was an EMT, I did take an ALS Supervisor (non-transport unit) to the ER with a patient. That was a mutual decision by my crew and him. We were not with the same company. We turned our BLS unit into an ALS transport unit emergently. We loaded his equipment onto our ambulance. Nobody got grilled over it. Patient's best interest. The only issue was transport. The Supervisor had to fill out an "Unusual Occurrence" report... but that was the end of that story.

Learn the protocols and know exactly under what circumstances you can transport patients needing ALS care and when you should turn the patient over to ALS. Your boss might chew you out, but you'll still have your EMT Certificate... even if you become unemployed because of it.

Here's Santa Clara County's BLS Ambulance Utilization policy: BLS Ambulance Utilization Read it. It's very informative for these situations. Look for Orange County's version of this, if it exists, and follow it.

 

[Akulahawk]

Hmm...maybe the paramedics knew they type of shenanigans your company has pulled(like BLS'ing obviously ALS patients, or arguing about transports on scene, in front of patients) and don't want to be involved in that type of business. Maybe not, but having worked in that system for several years before becoming a medic, it would not surprise me, things I have personally witnessed, like managers arguing with fire, because it is THEIR patient(not for pt care reasons, but for billing) and con homes telling me if I call for ALS(911) then they won't call our company anymore, because it'll ruin their stats.

That brings back memories too... Mostly from other employees of other companies. We followed the BLS transport policies to the letter... back when I worked BLS. Doing that kept out collective butts out of the wrath of the County EMS Agency. I suspect that one company didn't do that... and no longer is an approved provider for anything over there...

 

[jgmedic]

Unfortunately, in OC the only ALS 911 ambos are FD. All others are BLS, most cities use a private BLS ambo with Engine based medics who ride in on ALS calls. The problem is that some con homes and other facilities know what companies will call for ALS and which ones will just haul the pt off with few to no questions asked. They are the same places that train their EMT's to act like this guy and flaunt their "knowledge" in everyone's face.

 

[Akulahawk]

Unfortunately, in OC the only ALS 911 ambos are FD. All others are BLS, most cities use a private BLS ambo with Engine based medics who ride in on ALS calls. The problem is that some con homes and other facilities know what companies will call for ALS and which ones will just haul the pt off with few to no questions asked. They are the same places that train their EMT's to act like this guy and flaunt their "knowledge" in everyone's face.

And doing that does him (and everyone else) a huge dis-service.

 

[Ridryder911]

Anyone want to bet that the blood pressure might have been taken in the arm with the shunt? ......

R/r 911

 

[Akulahawk]

Anyone want to bet that the blood pressure might have been taken in the arm with the shunt? ......

R/r 911

And this would not surprise me... a 1 month EMT with little education in dealing with Dialysis patients...

 

[lsingleterry]

dialysis patient run

I am really disgusted by the actions of this BLS unit. These guys should not be ems providers. They will not be beneficial to the community that they serve. They will become an eyesore to other EMS providers, and if they are not careful they will lose certs. and cost the company some money if not the right to practice in the community they should love.

 

[Tiberius]

Holy crap....I must have received the wrong training.

I mean, after only a month on the truck and this cat knows everything. I've been out here for about 10 years and feel as though I know nothing...wow.

From what my Manager told me, the Paramedics were supposed to go in the ambulance with our crew since it is OUR patient, not the other company's. But the paramedics didn't, all they wanted to do was move the patient to the other ambulance since they were contracted with them. I'm not saying I know everything, but that I believe is not a smart move by the Paramedics.

The last sentence in your post contradicts itself and proves everyone's point. HOW do you know it wasn't a smart move by the medics??? The ink on your card is still wet. Trust me, you are no authority on what is and isn't a smart move by the medics. I sure wasn't after a month out of school.

Furthermore, we are out here to to what's right for the PATIENT, NOT FOR THE AMBULANCE COMPANY'S BOTTOM LINE!!! Once ALS is called and arrives on scene, the PARAMEDIC calls the shots. NOT YOU! Your patient now becomes the medic's responsibility. The medic should have went after your and your partner's license.

Oh, and BTW, your manager is a :censored: incompetent moron.

 

[Sasha]

From what my Manager told me, the Paramedics were supposed to go in the ambulance with our crew since it is OUR patient, not the other company's. But the paramedics didn't, all they wanted to do was move the patient to the other ambulance since they were contracted with them. I'm not saying I know everything, but that I believe is not a smart move by the Paramedics.

I'm wondering how you think that a paramedic can treat a patient in a BLS truck. Surely they cannot move all the equipment over to the BLS truck. IV and a bag of saline, maybe the drug box, maybe, but they can require more than that and you wouldnt even know it.

 

[daedalus]

Duuude. You have NOO idea what you don't know. and if you plan on over riding doctors and nurses you are in for a short career. My CCT RN had a few EMTs fired the other month because they choose to fight with a cardiologist about the transfer of a patient who the EMTs said was "unstable". The guy needed a very quick and stress free ride to the cath lab. EMTs cannot possibly think that they can interpret vital signs or other diagnostic information.

EMTs are not taught anything about how to manage this patient. The amount of pathology going on in that patient (the renal failure, the obesity, the probable DM and other co-morbidites) requires an internal medicine doctor to sort out. The kind of person who spends four years after medical school learning how disease states of the adult body alter function. All of these diseases also will affect vital signs. An EMT with a few hours of training on how to take vital signs is no better than a man who stayed in a Holiday Inn Express last night when it comes to helping a patient like this.

EDIT: Holly Hells Bells, I just read some of the original poster's follow up comments. If I knew who you were, OP, I would work hard to make sure you never treated a patient again. To think you knew what was best over the nephrologist and dialysis RN, and than the responding paramedic, is ludicrous. You disobeyed a paramedic on scene, who according to the state and county, is the in charge medical authority at the scene of a prehospital incident. That alone can land your company in hot water and yourself flipping burgers. I hope that you take Rid/Ryder's and others comments on here very seriously and leave our profession expeditiously.

 

[shadowstewie]

That's another thing, did you manually take a pulse or BP? Or just look at the machine and want to go A-Team to the hospital? Treat the patient NOT the machine..

Okay, a couple of things. For one, the patient's pulse kept elevating higher and higher. Two, the RN was the one who was getting worried and didn't know why the patient's pulse was that high. According to her, his pulse is always in the mid 80's right after he is done with dialysis. I wasn't near the patient when I was talking to my partner on what we should do. Plus I wasn't freaking out over anything. I was calm and so was my partner. The one who didn't seem to know what was going on was the RN, and it took her about 25 minutes to finally get an answer from the doctor on what she should do.

And last. We took his blood pressure with our cuff multiple times switching arms. Even my partner used a thigh cuff once on him, and his BP and pulse was still matching the machine.

 

[shadowstewie]

I'm wondering how you think that a paramedic can treat a patient in a BLS truck. Surely they cannot move all the equipment over to the BLS truck. IV and a bag of saline, maybe the drug box, maybe, but they can require more than that and you wouldnt even know it.

No, I understand that. Just that every BLS call we've had to turn into it being an ALS call...the paramedics would always just hop in the back of our BLS ambulance with their bag.

 

[shadowstewie]

Duuude. You have NOO idea what you don't know. and if you plan on over riding doctors and nurses you are in for a short career. My CCT RN had a few EMTs fired the other month because they choose to fight with a cardiologist about the transfer of a patient who the EMTs said was "unstable". The guy needed a very quick and stress free ride to the cath lab. EMTs cannot possibly think that they can interpret vital signs or other diagnostic information.

EMTs are not taught anything about how to manage this patient. The amount of pathology going on in that patient (the renal failure, the obesity, the probable DM and other co-morbidites) requires an internal medicine doctor to sort out. The kind of person who spends four years after medical school learning how disease states of the adult body alter function. All of these diseases also will affect vital signs. An EMT with a few hours of training on how to take vital signs is no better than a man who stayed in a Holiday Inn Express last night when it comes to helping a patient like this.

EDIT: Holly Hells Bells, I just read some of the original poster's follow up comments. If I knew who you were, OP, I would work hard to make sure you never treated a patient again. To think you knew what was best over the nephrologist and dialysis RN, and than the responding paramedic, is ludicrous. You disobeyed a paramedic on scene, who according to the state and county, is the in charge medical authority at the scene of a prehospital incident. That alone can land your company in hot water and yourself flipping burgers. I hope that you take Rid/Ryder's and others comments on here very seriously and leave our profession expeditiously.

Wooow dude relax. All I'm saying is that I don't feel like leaving a patient with an RN who seems to be having trouble not knowing why the patient's pulse is extremely higher than normal and how she's running around the dialysis center looking for things to help him when nothing is working. The oxygen didn't work. The Saline didn't work. Nothing was working and his pulse kept elevating higher and higher. I mean if everyone here is going to tell me to not care what's going on and to let the higher authority deal with the patient...when there could be an option that is in better interest for the patient, then so be it I guess. I'm just trying to see if anyone knows where I'm coming from with the RN running around not knowing a clue what she's doing.