knightfire8
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WARNING: Incoming LONG post (thank you in advance for your time & patience in reading as much as you can...)
Hi guys! First post here so if this is in the wrong section feel free to move it. Wasn't 100% sure where exactly this post would fit.
Anyways! I just hit my 3 year mark as an EMT in Seattle working for AMR. I told myself that I would apply to King County Medic One once I hit the minimum requirements (3 years) and then if I got denied I would just look elsewhere for Paramedic Training (TCC, Central, or maybe even outside the state).
This is where my current dilemma comes in. The last 3 or so months my partner and I have been interacting with Medics that have given us a lot of grief for requesting a Medic eval. We don't call for medics unless we're actually worried about our pts. I'm talking BPs 70/50, HR > 140, pale, diaphoretic, etc. We are very familiar with the system we work in and how more pts are likely to go BLS versus ALS based on the way the system is set up. We realize that sometimes it's better to just run the pt into the hospital if we're 5 minutes away with a good report rather than waiting 10-15 mins for medics to show up and /possibly/ take the pt. We also know when the boundary of negligence and recklessness is being pushed a bit too far.
The last few times we've called for medics the ones that have showed up have been rude to us, treated us as lesser coworkers, and generally been irritated that they were called to begin with. Most recently we were told we needed to "review our ALS indicators" when we called for medics for a female in her 50-60s that was pale, altered, in and out of consciousness, BP of 70/50, and with a weak radial pulse.
Now I realize no 2 medics are identical...we're human after all. But this past run I had with medics actually made me fully reconsider if I even want to apply to KCM1 to begin with. We were dispatched to an elderly female (70s-80s) for a possible allergic reaction. It's built as a medic response. We have an extended response time and when we get there we don't see a medic unit, just the fire engine. So either the medics got code greened and cancelled or they evaled the pt and cleared her BLS. In the elevator the FF is telling us that she had an upper endoscopy this morning and afterwards just started feeling like crap; nausea, vomiting, & dizziness. Says she felt completely fine beforehand. He also mentions that she's been having issues positioning herself anything above supine as it increases her dizziness...queue the possibly hypovolemic/postural hypotensive vibes. We get her on the bed and out of her apartment and while we're loading her into the truck she starts vomiting pure blood that looks dark. Pt acuity just went up. Now this isn't my first time a pt has done that in the back of the truck with me but usually it happens when it makes more sense for us to either upgrade our transport priority or to just continue on to the hospital. This is the first time it's happened while still on scene with Fire (to my knowledge). So I flag down the engine before they leave and have them call medics. We finish loading her into the back, get her on some supplemental oxygen, keep her flat, and monitor her vital signs. I get a bp of 74 systolic heard all the way down, hr of 72 strong and regular. pt still fully a&o but now she's pale as a sheet of paper. She's vomited 350-400ccs of blood by now. So now it seems like an active upper gi bleed. I ask about thinners and she says she's taking xarelto AND plavix for predisposition to clots. Higher and higher acuity...
The medics get there and the first thing they clear up with the engine on scene is /who/ called for the medic eval...the engine tells them it was us (AMR) that wanted it. Now their attitude towards being called out there seems to have...changed. One of the medics hops in the back with me and I ask him if he got a story/short. He says 'yes' and begins interviewing the pt while putting her on a 4 lead. He says her heart looks good...which is obviously phenomenal if that was the issue. He then takes a supine bp on the pt. He says he got "90 all the way down". I had taken 3-4 bps at this point and none of them were above 80. I also noticed that when he was taking a bp the needle 'bounced back' at around 68. He wants to do posturals. So I helped him sit her up semi-fowlers and before he takes the next bp he prefaces it by saying, "I don't know if I'm going to hear anything different...". I see the needle bounce back at 64 this time. He takes his ears off and says he got "90 all the way down" again. He asks if I'm "comfortable with that". I tell him "No, she's got multiple comorbidities-" and that's where he cuts me off. He scoffs and says "OH comorBIDITIES" as if it was such a big boy word I used and promptly exits the ambulance saying "I hate this new AMR policy" on his way out. I'm professional on scene with other responders and especially in front of the pt until we transfer the pt over to the medic stretcher, load up our truck, and start driving with the door closed. That's when I start openly venting to my partner.
This was the call that finally broke me. Now I'm questioning if I even want to apply to KCM1 anymore. Do I want to end up like that guy? Would I want to be under his tutelage on a car with him for 24 hour shifts during training? Partnered with him after training? Are these the kinds of medics this program breeds? Where is the extensive training they have? Because I'm not seeing it.
The medics that got me interested in the program, the ones that I model myself after, the ones I look up to for guidance, the ones I respect...I feel I'm running into those medics less and less often. If I had to put a number to it I'd say I run into those medics 10% or less of the time. It actually catches me off guard these days when I have a professional interaction with medics.
I'm confident enough in my ability as a provider that any paramedic program would be fine for me. I'm hard enough on myself and my biggest critic that I always want to do my very best for my pts. I take it personally if I screw something up or could have done something just a bit better.
I'm considering still applying for the program perhaps just the 1 time because of what the program offers. The physician taught courses and lectures. The extensive time in the hospital and field to really hone my craft. The see it, learn it, do it. Learning from people that are more than just a paramedic; that are good people and know how to talk to pts and their families. The fully balanced paramedic in multiple facets of their profession.
Give me some advice ya'll...because I'm really struggling here.
Hi guys! First post here so if this is in the wrong section feel free to move it. Wasn't 100% sure where exactly this post would fit.
Anyways! I just hit my 3 year mark as an EMT in Seattle working for AMR. I told myself that I would apply to King County Medic One once I hit the minimum requirements (3 years) and then if I got denied I would just look elsewhere for Paramedic Training (TCC, Central, or maybe even outside the state).
This is where my current dilemma comes in. The last 3 or so months my partner and I have been interacting with Medics that have given us a lot of grief for requesting a Medic eval. We don't call for medics unless we're actually worried about our pts. I'm talking BPs 70/50, HR > 140, pale, diaphoretic, etc. We are very familiar with the system we work in and how more pts are likely to go BLS versus ALS based on the way the system is set up. We realize that sometimes it's better to just run the pt into the hospital if we're 5 minutes away with a good report rather than waiting 10-15 mins for medics to show up and /possibly/ take the pt. We also know when the boundary of negligence and recklessness is being pushed a bit too far.
The last few times we've called for medics the ones that have showed up have been rude to us, treated us as lesser coworkers, and generally been irritated that they were called to begin with. Most recently we were told we needed to "review our ALS indicators" when we called for medics for a female in her 50-60s that was pale, altered, in and out of consciousness, BP of 70/50, and with a weak radial pulse.
Now I realize no 2 medics are identical...we're human after all. But this past run I had with medics actually made me fully reconsider if I even want to apply to KCM1 to begin with. We were dispatched to an elderly female (70s-80s) for a possible allergic reaction. It's built as a medic response. We have an extended response time and when we get there we don't see a medic unit, just the fire engine. So either the medics got code greened and cancelled or they evaled the pt and cleared her BLS. In the elevator the FF is telling us that she had an upper endoscopy this morning and afterwards just started feeling like crap; nausea, vomiting, & dizziness. Says she felt completely fine beforehand. He also mentions that she's been having issues positioning herself anything above supine as it increases her dizziness...queue the possibly hypovolemic/postural hypotensive vibes. We get her on the bed and out of her apartment and while we're loading her into the truck she starts vomiting pure blood that looks dark. Pt acuity just went up. Now this isn't my first time a pt has done that in the back of the truck with me but usually it happens when it makes more sense for us to either upgrade our transport priority or to just continue on to the hospital. This is the first time it's happened while still on scene with Fire (to my knowledge). So I flag down the engine before they leave and have them call medics. We finish loading her into the back, get her on some supplemental oxygen, keep her flat, and monitor her vital signs. I get a bp of 74 systolic heard all the way down, hr of 72 strong and regular. pt still fully a&o but now she's pale as a sheet of paper. She's vomited 350-400ccs of blood by now. So now it seems like an active upper gi bleed. I ask about thinners and she says she's taking xarelto AND plavix for predisposition to clots. Higher and higher acuity...
The medics get there and the first thing they clear up with the engine on scene is /who/ called for the medic eval...the engine tells them it was us (AMR) that wanted it. Now their attitude towards being called out there seems to have...changed. One of the medics hops in the back with me and I ask him if he got a story/short. He says 'yes' and begins interviewing the pt while putting her on a 4 lead. He says her heart looks good...which is obviously phenomenal if that was the issue. He then takes a supine bp on the pt. He says he got "90 all the way down". I had taken 3-4 bps at this point and none of them were above 80. I also noticed that when he was taking a bp the needle 'bounced back' at around 68. He wants to do posturals. So I helped him sit her up semi-fowlers and before he takes the next bp he prefaces it by saying, "I don't know if I'm going to hear anything different...". I see the needle bounce back at 64 this time. He takes his ears off and says he got "90 all the way down" again. He asks if I'm "comfortable with that". I tell him "No, she's got multiple comorbidities-" and that's where he cuts me off. He scoffs and says "OH comorBIDITIES" as if it was such a big boy word I used and promptly exits the ambulance saying "I hate this new AMR policy" on his way out. I'm professional on scene with other responders and especially in front of the pt until we transfer the pt over to the medic stretcher, load up our truck, and start driving with the door closed. That's when I start openly venting to my partner.
This was the call that finally broke me. Now I'm questioning if I even want to apply to KCM1 anymore. Do I want to end up like that guy? Would I want to be under his tutelage on a car with him for 24 hour shifts during training? Partnered with him after training? Are these the kinds of medics this program breeds? Where is the extensive training they have? Because I'm not seeing it.
The medics that got me interested in the program, the ones that I model myself after, the ones I look up to for guidance, the ones I respect...I feel I'm running into those medics less and less often. If I had to put a number to it I'd say I run into those medics 10% or less of the time. It actually catches me off guard these days when I have a professional interaction with medics.
I'm confident enough in my ability as a provider that any paramedic program would be fine for me. I'm hard enough on myself and my biggest critic that I always want to do my very best for my pts. I take it personally if I screw something up or could have done something just a bit better.
I'm considering still applying for the program perhaps just the 1 time because of what the program offers. The physician taught courses and lectures. The extensive time in the hospital and field to really hone my craft. The see it, learn it, do it. Learning from people that are more than just a paramedic; that are good people and know how to talk to pts and their families. The fully balanced paramedic in multiple facets of their profession.
Give me some advice ya'll...because I'm really struggling here.
