The issue, to say it again, was not when to escalate a pt from BLS to ALS, but when to tell the boss that the Paragod was too big for his britches when it comes to snubbing EMT-Ds. We are their support, not just there to drive the ambulance and take their abuse.
See, I have a few problems.
What's wrong with driving? It seems to be an integral part of EMS. It's like CNAs complaining about wiping butt. You know what, if I have a family member in the hospital or (starting in June) when my patients are in the hospital, someone wiping their butt tends to be extremely important. In fact, life saving important. It might not be savory, but, be it butt wiping or ambulance driving, it's exceedingly important. A better tactic would be owning it. "Yea, one of the things I do is drive, but it's better than crashing into your family on a transport." The only reason why it has power in the first place is because you give it power as a negative.
However, the paragod tends to be constantly pared up with EMT-Hero, and both are exceedingly stupid. You're an EMT. Outside of patient packaging and driving, there really isn't much you can do in a patient that doesn't "need" a paramedic. CPR? Needs a paramedic on the off chance of ROSC. Outside of that, it just needs someone who can push fast on the chest and run an idiot box (on a side note, I'd love it if someone made an AED for EMS that didn't include voice instructions). Neither of those are restricted acts, as can be seen by public access defibrillators. The vast majority of what EMTs do are rather simplistic, over used, or not really effective. Normally a combination of at least 2 of those. Saying "Yea, we're better than driving" is like a McDonalds employee complaining that Gordon Ramsay isn't giving him respect because their both "chefs."
The unfortunate fact is that, given the limited scope of practice,the most important job an EMT does is drive, regardless of EMT/EMT or EMT/Paramedic crewing as that's the one thing that EMTs do that can kill the patient if done incorrectly. The problem with paragods is that they tend to shove the EMT's face in it, which is completely unnecessary the vast vast majority of the time.
I gotta agree with the unpopular opinion that was mentioned earlier though. This IS my call. Yes we work together on it, but it is MINE and what I say is whats going to happen. Arrogance? No. Scene management and control. I will be more than happy to explain my reasoning at a later point, but while we are there I will be making the determination of whether this is an ALS or BLS patient, what the differential diagnosis is, and what the treatment modalities will be. Now, that being said, I involve my partner to the limit of their skills base and do my best to educate them above and beyond wherever they're at. Me likey teachey.
