Rubberneckers, Lookie Loos, and other Civilian Interference Stories

[Bloom-IUEMT]

Let's see what can a doctor do:
Take BP and vitals
hold c-spine
help backboard
help to lift the backboard
determine LOC
determine medical hx
Trauma assessment (yes believe it or not even an OB/Gyn can see bruising and deformities)
Cranial nerve assessment (are paramedics even trained to do this?)
treat for shock
splint (really its not brain surgery)
start on IV/venupuncture
setup an IV
obtain lung sounds
put on a NRB or NC
BVM if needed
intubate if needed
ACLS is required for most if not all OB/GYN's
Interpret arrhythmias
CPR
manually stabilizing a fx
prescribe medication if patient refused transport (that's a big one! )
I'm sure there is more I'm neglecting but the idea that a physician can't help in an emergency situation is ridiculous. Emergency medicine is required by all physicians (even psychiatrists).

I am disappointed because this statement bespeaks the attitude some paramedics have that they are Jesus incarnate and that no medical authority can match wits and knowledge.
And if a dentist comes to a scene and says that s/he is "doctor" that is bordering on criminal misrepresentation of licensure. That person was announcing his or herself as a "physician."

 

[usafmedic45]

And if a dentist comes to a scene and says that s/he is "doctor" that is bordering on criminal misrepresentation of licensure. That person was announcing his or herself as a "physician."

I've had several dentists offer assistance in restaurants, on golf courses and in other public settings over the years . Normally it's "I'm Dr. Soandso, a dentist.....can I help in some way?" That's not criminal misrepresentation. It's just the fact that on these forums people seem to leave out the key bit of how most introduce themselves that leads to assumptions like you have made.

prescribe medication if patient refused transport (that's a big one! )

Which I have never seen nor heard of happening. Many docs are so risk averse that they would not do it unless the patient was one of theirs before the call. I don't know many docs who carry a prescription pad around with them while off duty and don't think many are prone to just randomly calling in scripts for people they meet and don't know.

I'm sure there is more I'm neglecting but the idea that a physician can't help in an emergency situation is ridiculous.

But it is often the case. On several occasions, I've seen docs pressured into assisting by their wifes, friends or other bystanders who know their occupation. It's not uncommon to hear comments like "I'm out of my element and don't have any experience at this....what do you want me to do?". In fact, that's probably the most common first question I've heard out of doctors on scenes in my decade or so of experience. The ones who tend to overestimate their abilities in my experience are nurses and off-duty EMS personnel.

Emergency medicine is required by all physicians (even psychiatrists).

No, actually it's an elective at most medical schools and even during residencies that require ED rotations (which not all do) there is a big difference between rotating through an ED and actually becoming competent. Even then, would you want someone who hasn't seen an emergency patient in years telling you what to do? Most docs know when they are in over their heads and are the first to say so (often quietly so as to save face). Why should we assume they are medical supermen who trump our skills when many don't simply because they have more generalized education?

Cranial nerve assessment (are paramedics even trained to do this?)

Better question: does it really have the much utility in the field?

BTW, yes, most of the paramedics I know can tell you how to do a basic cranial nerve exam as would be needed for the prehospital assessment of a patient with possible deficits.

start on IV/venupuncture

Ever heard the phrase "perishable skill"? Even a lot of EM docs I work with are rusty on their IV skills. Outside of anesthesiologists, I don't know many docs who start their own IVs very often.

BVM if needed

See above. It's a hard skill to master, one that fades rapidly when not used and one I would hesitate to put in the hands of someone I did not know was recently practiced at it.

intubate if needed

Definitely see above under "BVM if needed". You're talking one of the most danger laden skills in EM/CCM. Not something you want to let a family practice doctor try since he probably hasn't tubed anyone since his internship. Actually a lot of new residents I have met say they've never tubed anyone because the anesthesiologists they rotate under are not willing to let them do it and force them to simply observe or use things like LMAs because of the better safety profile.

ACLS is required for most if not all OB/GYN's

That does not mean that anyone who passes it is the best qualified person to run the show. Ever seen the studies showing how fast ACLS and similar knowledge fades without review or application?

Interpret arrhythmias

Once again, something that your skills at fade very quickly without practice.

Just because someone is a doctor (without regard to specialty) does not mean they know more than an EMS provider anymore having an EMT-P implies they know more about managing asthma than say a respiratory therapist as an example.

 

[EMS49393]

I work in an urban arena. Most of my interference is from family members screaming "Oh Lord, Oh Lord, Oh Jesus, Oh Lord Jesus, help them Lord" over and over again. They also tend to place their big rear ends right in my way when I'm dealing with the patient. Mind you, these are normally patients that have little more wrong with them then a bruise from falling off the couch in a drunken oblivion.

My favorite though... a minor MVC, not even any damage to the cars, and perfect do-gooder strangers tell everyone inside the vehicles "you need to go to the ER and get checked out since they're (us) here anyway." No, you really don't have to, hell you don't even need anything more than some strong turtle wax to buff the scratch out of your bumper.

 

[kecpercussion]

Haha sounds typical of most people

 

[Mountain Res-Q]

Let's see what can a doctor do:
Take BP and vitals
hold c-spine
help backboard
help to lift the backboard
determine LOC
determine medical hx
Trauma assessment (yes believe it or not even an OB/Gyn can see bruising and deformities)
Cranial nerve assessment (are paramedics even trained to do this?)
treat for shock
splint (really its not brain surgery)
start on IV/venupuncture
setup an IV
obtain lung sounds
put on a NRB or NC
BVM if needed
intubate if needed
ACLS is required for most if not all OB/GYN's
Interpret arrhythmias
CPR
manually stabilizing a fx
prescribe medication if patient refused transport (that's a big one! )
I'm sure there is more I'm neglecting but the idea that a physician can't help in an emergency situation is ridiculous. Emergency medicine is required by all physicians (even psychiatrists).

I am disappointed because this statement bespeaks the attitude some paramedics have that they are Jesus incarnate and that no medical authority can match wits and knowledge.
And if a dentist comes to a scene and says that s/he is "doctor" that is bordering on criminal misrepresentation of licensure. That person was announcing his or herself as a "physician."

No one is disputing these facts. However, dispite the fact that a Doctor can do everything an EMT and Medic can do, several points stand out:

1. If the Doctor can do perform procedures, the equipment must be on scene. If it is on scene, it is being carried by the EMTs or Medics. If they are carrying it, they must be able to use it... so why do you need the Doctor to do it? In the case mentioned we are talking about ski patrollers trained to a OEC-BLS level... what are they carrying that only a Doctor could use?

2. We are talking about Prehospital Emergency Medicine, something few Doctors are truely familiar with. Largely Doctors work in Hospitals and Offices, most do no realize what needs to be done in the prehospital world to get them to the Hospital. In this case we are talking about a Frozen Mountain at 7,000 feet. The Ski Patrollers have the training, experience, and familiarity with the protocols to get eh job done every other day of the week... what realisticly does the OB have to offer that the Patrollers do without every other day of the week?

3. No one is saying they are better than the Doctors who offer help, but we know our job better than they know our job. I have no issue accepting help when needed or accepoting it when forced upon me by law, but do I or the pt. really need it? If the Doctor feels that the pt. does, then it is within their ability to insist and take the scene. However, having an MD after your name doesn't make you an expert on everything. On SAR we get Paramedics, EMTs, and Doctors joining up. I'd rather have OEC or other wilderness certified people on medical calls with me... why? They understand the environment. and the application of even their lower version of medicine in those unique circumstances.

If a Doctor wants to take the scene from me... hey whatever... it is their right, but from that moment onward than responsibilty lies on them (ALL OF IT). But in my experience, how ofter is that needed... and how often do the Docs really want to go that route? Just like a good EMT or Medic will acknowledge that the Docotr has supperior medical knowledge, a good Doctor will recognize the fact that the field personel are not just trained monkeys and allow them to do the job they are trained and experienced to handle. IMHO.

 

[amberdt03]

Nothing too terrible... I've had a family member (This is one of the "OH THANK GOD YOU ARE HERE!!!!" patients) insist the patient could walk to the stretcher (She didn't want us to "drop him" so wanted him to walk, probably because we were both small looking females.) That's all well and good, BUT the patient had multiple fx and according to their charts and orders was non weight bearing AND if they walked they were going to foot the bill because medicare would reject the claim. We tried to reassure her and such but eventually just found two strong looking males, one tech one nurse, to sheet lift him over.

i once had a family member ask if we could just take the hospital bed to transport her mother........female crew and we were taking her back to a nursing home with a hip fracture......we were like no maam it won't fit in our ambulance, and i don't think the hospital would be to happy with us taking one of their er beds with us.

 

[silver]

FYI before you blow off OB/GYN docs, in most residency programs they do internal medicine, and intensive care rotations and a lot elect for emergency medicine rotations. So someone fresh out of their residency should know there stuff. Of course they don't work in the field, but don't blow them off like they only know OB/GYN. Use them as a resource when needed (which isn't often that we need help, but it does occur).

 

[Bloom-IUEMT]

To be clear I never the doc should take control of the scene---I said they can assist. An ob taking over an emergency scene is an ego move, just like saying an ob doc can only be involved in babies and vaginas.

I apologize because I assumed ER is a requirement for all schools. Though it is a requirement for MANY schools and chances are (especially an ob) has been trained to do it.
And let me be clear----did you in fact say using a BVM is a difficult skill to master? Putting a mask on someone's face and squeezing a bag every 5 seconds......In my state, well I guess your state too, BVM is a BLS skill We even let lay responders do it if we need an extra set of hands.

 

[Rob123]

HEY... Wait-a-minute, I was one of those Civilian Rubbernecking Lookie Loos.

Background:
I am a Volunteer EMT and was having lunch from my paying job.
We were at an extremely large dairy supermarket with picnic tables and a petting zoo that was closed for the season.

I overheard the two-way radio of security guard indicating a "Confirmed unconscious female behind the petting zoo."

I walked towards the scene and a guard stopped me.

I explained that I was an off-duty EMT from New York City and wondered if there was anything I could do. He smirked and said everything was under control. He then stepped aside allowing me to see that somebody was placing an AED on... Rescue Anne!!!!

I was so embarrassed.
Apparently they were performing a mock-rescue, drill or something similar.

 

[ffemt8978]

BVM is an easy skill to learn, but is not so easy to master. I think that's the point he was trying to make.

 

[silver]

We were at an extremely large dairy supermarket with picnic tables and a petting zoo that was closed for the season.

Stew Leonards?

stew's is awesome...

 

[Dominion]

I don't know if I would feel comfortable letting a doctor take over the scene at all. There is only two docs I would feel comfortable turning the scene over to around here and one is a medical director for many EMS agencies who really knows his crap, the other is a friend of mines dad who happens to be an ER doc with alot of experience and also really knows his crap, pre hospital and otherwise. Unless I knew the doc to be an active ER doc I probably would not turn over the scene but would ask them to step back.

At the most I was told in my last job that if an active ER doc showed up on scene requesting control, I was to contact the hospital he claimed to be afiliated with, ask for ID, and then confirm with that hospitals on call MC if it was ok to defer the scene to that doc. Then my *** was covered and I would assist him into the hospital (which had to be his hospital or hospital group)

 

[Rob123]

Stew Leonards?

stew's is awesome...

Yes, Stew's in Yonkers, NY.
And they are awesome in many respects.
(I have actually seen several documentaries about the company)

 

[usafmedic45]

An ob taking over an emergency scene is an ego move,

...except that an OB is about the 4th most experienced field in terms of resuscitation you're going to find in a hospital (behind EM, anesthesia, and surgery).

Though it is a requirement for MANY schools

Actually according to the numbers given at the AAEM meeting last year on the state of EM education, it's a requirement at <20% of schools.

did you in fact say using a BVM is a difficult skill to master?

Yes, I did.

BVM is an easy skill to learn, but is not so easy to master. I think that's the point he was trying to make.

What he said.

Almost anyone who has a decent amount of experience and doesn't have a narcissistic streak a mile wide will tend to say pretty much the same thing. It's arguably the skill people have more trouble with in EMS than probably any other....you just don't hear it discussed as such since it is considered a "low level" or BLS skill and there is a pervasive attitude of "Well, if I can't ventilate, I'll just tube 'em" which is a mistaken and very misguided belief that gets a lot of people into a lot of trouble.

Putting a mask on someone's face and squeezing a bag every 5 seconds......In my state, well I guess your state too, BVM is a BLS skill

BLS =/= simple. The fact that you made such a statement with the implications you've given it means you're either really ignorant, really inexperienced or both.

We even let lay responders do it if we need an extra set of hands.

I think your medical director and likely the state EMS commission would have a serious problem with that.

Seriously....stop and think for a second about what you just said. Any competent attorney- hell an incompetent one on a bad day after a few drinks- would hand you your *** on a platter if such a case wound up going to court (don't laugh, more EMS cases go to court than people seem to think) and that little bit of trivia came to light. Just because it's a "BLS skill" does not imply you can put a BVM into the hands of an untrained civilian because you need a spare set of hands. We don't "battlefield commission" people to practice our skills because we need extra help.

If you don't have enough people to do what you need to do beyond the airway, nothing gets done beyond the airway. I mean what else are you doing as an EMT-B that is so important that you're going to hand the airway (the thing that if you screw it up will kill the patient faster than pretty much anything else) off to someone with zero training?

 

[GR1N53N]

On the (already beaten to death) subject of efficacy of doctors in the pre-hospital care scenario:
I was with an ER nurse in a BTLS class (along with a bunch of fresh-from-school paramedics), and we were supposed to be quickly demonstrating that we could size and collar a patient, so that the instructor could sign us of on that banal (or so he thought) skill. He turned to the nurse, and she immediately said, "I've never put one on before, all I do is take them off!" Which got a good chuckle, and made us all realize that while this RN probably knew more than all of us about emergency medicine, that did not necessarily translate into knowledge of pre-hospital care skills or protocols.
Just something to note in regards to having allied health professionals on scene.

 

[Melclin]

+1 on the already +453266236 subject.

Aside from the issue of forgetting stuff they learn't years ago,

1. They're not up to date. Esp not with pre-hospital stuff. How many OBGYNs/shrinks/GPs/nephrologists...etc would know not to give fluids to penetrating thoracic trauma, or be familiar with the latest guidelines for o2 admin in stroke pts? Bugger all.

2. Most doctors, even the ones familiar with emerg medicine will have trouble in the pre-hospital setting. It's so much different when you are not in the controlled, familiar environment of the hospital...All the nurses doing my degree say that.

3. With less gear, less help, less technology, the approach is different. I just started volunteering for a bit of experience and fun with St. John's ambulance (volly organisation, provides first aid/AED at events, first aid training to public etc). So I'm doing their scenarios and training stuff, and I find that without what I thought were basic tools: stethoscope, BP cuffs, cardiac monitors, pulse ox, thermometer, BGL and our normal array of VSS assessments, I feel quite hamstrung. Another eg: doing CPR with an AED... I didn't know that I had to keep doing compressions until it decides it wants to analyze again...here I am pressing buttons after my 5 cycles trying to get it to analyse the rhythm. How do u go about relieving pain when you can't use drugs? Its not rocket science, but I have to take a step back and think, where as a first aider who has trained specifically in that lower level, doesn't.

Stepping down from paramedic to first aid, caused me quite a few troubles. I would imagine that a doctor stepping down to first aid would have even more.

 

[FFMckenzie]

I have one from a few years ago. The dispatch was tour bus vs vehicle no further information. The engine I was on was first at scene.

I was assigned to the vehicle a honda accord the bus had minimal damage so the captain went to asses the bus and occupants. There were no injuries.

The left side (drivers) of the vehicle had over 24 inches of intrusion the right side of the vehicle was un damaged. I went through the right rear door to find one patient in the passengers seat.

Did my initial and by that time the medic showed up to pick up because I was stuck holding manual c-spine. Also I forgot to mention this was during the end of a marathon run so there were 30-40 bystanders.

It hits me then, why do we have one patient and she is in the passenger seat. Im asking her if she was driving she says she does not know. She was AOx3 did not know what happened.

Captain comes over asks "where is the driver?" I answer, "I have no idea she has no idea" he walks to the drivers side of the vehicle to find the seatbelt cut clean.

We get her on the board the medic is exposing and Im still holding manual. I hear the captain yelling at the crowd "did anyone see where the driver of this vehicle went".

We get her in the ambulance they take off.

I go back to the captain to see what he wants to do about finding the driver he is standing with a civ off to the side and he says "forget it she was the driver go ahead and start cleaning up".

Now I can hear some yelling I cant make certain what exactly is being said but its between the captain and they guy that I did happen too see standing in the back of the crowd of onlookers as we extricated her from the vehicle.

I find out the guy was a doctor and for what ever reason (none of us could ever come up with one) he cut her seatbelt and moved her to the passengers side of the vehicle and slipped back into the crowd, when the captain was yelling for some information on the driver another onlooker pointed to the doctor. Needless to say the captain was very angry with this "doctor".

I know it was not a very exciting story but it proved to be a somewhat confusing call. Ironic but the doctor turned out to be a chiropractor.

 

[WolfmanHarris]

I have allowed one bystander to BVM a patient for me. They were an RRT attending for homecare when the pt. arrested. I was still a student and decided she'd be more competent to bag at this point then me. My preceptor gave me the nod and I continued to run the arrest while he confirmed the circumstances with the family and got the pronouncement. (N-stage lung CA, no DNR but had only be diagnosed the day before. Give no more then a month and had come home to die. RRT was there as part of palliative care plan.)

 

[usafmedic45]

They were an RRT attending for homecare when the pt. arrested.

Exactly. If they have their license and can prove their credentials, I have no problem with them offering assistance. As for handing the BVM to a drunk frat boy like the IU campus EMT suggested and going "Here...have fun"....totally different ball game.

 

[Bloom-IUEMT]

YES YES YES I am inexperienced. No need for name calling though, you may leave your ego intact.
Why is BVM difficult skill to master?? What about it makes it difficult, I'm curious because I've only done a couple of times. There is not many components to it. Do people find it difficult to obtain a tight seal on the face because Ive had difficulty with that.
But seriously, check the ego. I've never would have believed I would be scolded so much as I am by paramedics---many "old dogs" (and I am referring mostly to the service I work for) seem to forget they were new once and don't realize all the knowledge they have I won't obtain in a week of working EMS. "OH my god!! you don't how to do that!! What the hell!! You are stupid/ignorant/incompetent and you will never be as brilliant as me!" It makes me wonder why anyone would want to continue being an EMT. But I suppose that's another thread--