Partner not backing me up.....

[EchoMikeTango]

So i had a call dispatched as 56yo male feeling Dizzy and lethargic at work. We arrived to find the PT sitting in a chair, clammy skin, kinda tired. The LEO Gave him some soda thinking that it had to be a sugar issue. Baseline vitals revealed that his pupils were sluggish, and his BP was 192/110. Pulse 86, RR 16. No CP or any pain pf any kind. no HX of HTN or Diabetes. He sai that over all he was pretty healthy. No medications either.

Now I really wanted to take him into the ER because his pressure was so high, and told him that he should really get check out. i told him that his BP was high, and that something should be done. I explained the risks if he didn't go to the ER.

My Partner totally disregarded my assessment and told the guy that it wasn't "that" high, She apologized to him about me scaring him into going, and stated that his BP was a little above normal, and that if he wanted he could wait till Monday to go see his doctor.

Eventually his boss told him that he couldn't come back to work unless he went to the doctor, and he eventually came with us to the er after i was a little more persistent.

I don't know what to do about this? What do you guys think. Am i over reacting.

 

[Aidey]

12 lead?

 

[EchoMikeTango]

BLS, no 12 lead. no blood sugar ( not in jersey)

 

[Aidey]

Why on earth wasn't an ALS rig called?

Actually, never mind. Don't answer that, it will probably just give me a headache.

Ok, here is the deal with HTN and the ER. It has been found that it is better for high BP to be lowered slowly unless it is severely symptomatic. Going to the ER for high BP will get you a referral to see your GP and possibly 10 day RX of the anti-hypertensive of the month. They generally won't treat it unless you are having neurological symptoms. So, in that sense, your partner was somewhat right. If the guy had been my patient and had elected no transport he would have received a pretty detailed list of symptoms to be aware of, and to go to the ER immediately for.

That all being said, did the idea that he was possibly having an MI ever cross anyone's mind? This is kind of a classic a-typical presentation.

 

[EchoMikeTango]

Yea, that occurred to me, but again, I was not in charge, she was. I was junior on the bus, so i really didn't want to step out of line. Would have loved to call ALS.

 

[mgr22]

It sounds like the main issue is whether you'd want to say anything to a patient that might discourage him/her from seeking immediate, definitive care for a condition that you probably can't diagnose reliably. I'd be pretty reluctant to tell a dizzy, lethargic patient that they don't need a hospital.

 

[mycrofft]

Cut to the chase first, and don't use us to beat your co-worker silly.


If you feel cruddy, and espepcially if you have HTN and are not a spring chicken, go see the MD.
Putting a point on it: was the pulse regular, strong, bounding, irregularly strong/weak? These sorts of signs are apparnetly no longer taught becauise everyone has a little box with wires and a LCD flatscreen and utterly irrefutable interpretive software. (Ha. My MD's machine failed to interpet my atrial fib for five years over three ekg's). Also, lung sounds...full expansion, bilaterally symmetrical, rales or rhoncii?
HTN, rapid pulse, tiredness, clammy...could easily be low sugar and essential HTN, or it could be the most common arrythmia, atrial fibrillation, which tosses clots and causes...fill in the blank.
Every time I saw a pt we didn't tranport, and now when pelple brace me for advice, I ALWAYS end it with "You aren't going to like this, but you really need to go see your doc asap".

 

[Chimpie]

Yea, that occurred to me, but again, I was not in charge, she was. I was junior on the bus, so i really didn't want to step out of line. Would have loved to call ALS.

In my opinion, if you were not in charge you shouldn't have been making recommendations to the patient. The person in charge, the one making contact with the patient is the one who makes the recommendation.

Now, if you were in charge of the patient, meaning that you were the one in charge of patient care, then your partner should have backed you up. They are there to support you and your decisions, until you hand it off to someone else.

In this situation, if you did not transport I would have taken a few minutes (once back on the road) to review the call with your partner. Establish some roles and rules and go forward to save another life.

 

[Shishkabob]

Since you both are EMTs, and neither of you is a medic... whichever person is running the call, well, runs the call.

It truly doesn't matter who's "senior", it's who's name is going to be on the run form as "Attendant".





Now, my question to you is, why didn't you call for an ALS unit? This should have ultimately been THEIR decision.

 

[EchoMikeTango]

both names go on the form. I think it was a communication error, and i am going to work on it with her. We are a team after all, and we should work together on fixing it. BTW, she read this post and called me. were gonna grab coffee Monday and figure this problem out!

 

[Chimpie]

both names go on the form. I think it was a communication error, and i am going to work on it with her. We are a team after all, and we should work together on fixing it. BTW, she read this post and called me. were gonna grab coffee Monday and figure this problem out!

It's great that both of you are open to discussing it.

And since she is reading this, "Hi. Thanks for visiting our community."

 

[rescue99]

So i had a call dispatched as 56yo male feeling Dizzy and lethargic at work. We arrived to find the PT sitting in a chair, clammy skin, kinda tired. The LEO Gave him some soda thinking that it had to be a sugar issue. Baseline vitals revealed that his pupils were sluggish, and his BP was 192/110. Pulse 86, RR 16. No CP or any pain pf any kind. no HX of HTN or Diabetes. He sai that over all he was pretty healthy. No medications either.

Now I really wanted to take him into the ER because his pressure was so high, and told him that he should really get check out. i told him that his BP was high, and that something should be done. I explained the risks if he didn't go to the ER.

My Partner totally disregarded my assessment and told the guy that it wasn't "that" high, She apologized to him about me scaring him into going, and stated that his BP was a little above normal, and that if he wanted he could wait till Monday to go see his doctor.

Eventually his boss told him that he couldn't come back to work unless he went to the doctor, and he eventually came with us to the er after i was a little more persistent.

I don't know what to do about this? What do you guys think. Am i over reacting.

Now whether or not your idiot partner was right, which she most certainly is not, the symptomology alone says he's not okay. His symptoms did not resolve when he rested for one and a BP of 192/110 has lead to many a bleed. Send her back to Basic EMT. Better yet, MFR. Even better, have a sit down with her and if she won't take friendly advise, see the person next up on the ladder. Her skills need some tweeking.

 

[46Young]

In my opinion, if you were not in charge you shouldn't have been making recommendations to the patient. The person in charge, the one making contact with the patient is the one who makes the recommendation.

Now, if you were in charge of the patient, meaning that you were the one in charge of patient care, then your partner should have backed you up. They are there to support you and your decisions, until you hand it off to someone else.

In this situation, if you did not transport I would have taken a few minutes (once back on the road) to review the call with your partner. Establish some roles and rules and go forward to save another life.

What you're saying would be true if the partner had a higher cert level. They're both basics. Should something go down, the employer and the courts alike will find both crew members at fault, since this process was onscene, and it wasn't like one was driving and the other screwed up.

In most cases, yes, the crew leader should be directing pt care to an extent. It makes for an orderly, efficient scene, and eliminates a piecemeal approach to pt care that makes the crew appear disorganized and unprofessional. However, when that crew leader demonstrates negilgence and laziness, the other member needs to oppose this. In the event of an untoward pt outcome, you'll both be found liable. I worked for five years at a militant, liability phobic hospital in NYC. I speak from experience.

That's the intent of having double medic rigs. It's not just about being able to do the same skills. The other medic is there to discuss a plan of action for pt care, to offer suggestions and to bounce ideas back and forth. The partner is also there to make sure that the other one isn't doing anything that could potentially harm the pt, such as not recommending txp for a medical condition, as is the case here.

I've had partners that don't want to board and collar; they want to walk everyone to the bus; they want to do a refusal on anyone they can, to get out of the transport. To secure a proper refusal, the pt needs to be fully advised of the benefits of tx/txp, as well as all of the potential consequences of refusal of tx/txp. That didn't happen here. Good for rj in being the pt advocate and not allowing the partner to skell out.

Edit: I spoke of double medic rigs. I used that example as a double BLS rig follows the same line of thinking.

 

[mycrofft]

Good on you for being able to talk to her about it.

Get her to post about HER side!B)

 

[jjesusfreak01]

As a BLS rig, shouldn't you need to be pretty dang sure there isn't anything else going on before recommending that they don't go to the hospital?

 

[46Young]

BTW, I feel that having the senior crew member (of the same cert level) making all the pt care decisions does the junior member a disservice. Whether it be EMT-EMT or medic-medic, how is the junior member supposed to learn? If your role is fetching vitals and performing skills, how are you supposed to develop critical thinking skills? The preferred method should be to have the junior member riding lead, and to have the senior partner intervene when necessary, and also for consult. That's the best way for the junior member/probie to learn. Besides, if the pt is severely injured or otherwise CTD medically, then both crew will be in the back with pt for the ride to the hospital anyway. This is more of an ALS thing, but it still certainly applies to BLS as well. At the very least, the crew should be swapping calls, or changing the lead position each day.

 

[Chimpie]

What you're saying would be true if the partner had a higher cert level. They're both basics. Should something go down, the employer and the courts alike will find both crew members at fault, since this process was onscene, and it wasn't like one was driving and the other screwed up.

Nothing in the original post mentioned what level the partner was.

However, I agree with you, and it was really the underlying point of my post. Whoever is in charge of pt care is the one who should give recommendations. The other basic/paramedic should not be going behind their partner and making contradictions in front of the patient.

 

[46Young]

Get her to post about HER side!B)

True, fair is fair. She ought to have the opportunity to explain her thought process. She can validate her position, or use this as a learning experience.

 

[MrBrown]

Anybody who wants to leave this guy at home needs thier authority to practice taken away.

If an elevated BP on its own was his only symptom and he was dancing a gig around the room then perhaps in the absense of neurological or cardiac suspectors I might recommend he see his GP within 24 hours.

 

[46Young]

Nothing in the original post mentioned what level the partner was.

However, I agree with you, and it was really the underlying point of my post. Whoever is in charge of pt care is the one who should give recommendations. The other basic/paramedic should not be going behind their partner and making contradictions in front of the patient.

True. Having disagreements IFO the pt does appear unprofessional. I can overlook the smaller things. But, if there is a potential for gross negligence or real pt harm, Ill step in and start doing what needs to be done.

As an example, last night we had a third party caller for the fall x 24 hours, and currently intox, at 0100 hours. We're double medic, and my Lt was riding lead. He wanted to do a refusal before we even made contact. She fell yesterday evening, around 30 hours prior. It was a fall from standing. No LOC. Left eye shiner, some facial abrasion, bilat knee abrasions. Female, 50's, CHF hx. She was A&O but quite intox. No c/o pain. ECG NSR, BGL WNL, neuros intact, BP 84/50. He still wanted to do a refusal. I advised the boyfriend and then the pt's mother via L/L, who finally convinced her to go. My LT was irritated, but I told him this: Intox pts cannot refuse, since the ETOH may mask certain S/Sx. They are also presumed to lack decisional capacity if it was more than a drink or two. Furthermore, should the pt turn up dead the next moening or so, a lawsuit against us, loss od our jobs, and a news story in regards would be likely outcomes.