Finally, they don't like "notification only" type radio reports. Even though by EMSA policy base contact is only required in very limited circumstances, in practice we have to do it on every call. Because the hospitals get all in a tissy if you just notify. They say it "builds relationships" and I suppose it might, but it gets old real fast.
So, does anybody have anything similar going on in their system?
Is that like a, "We'll be there in 5 with a bla bla bla, cya" instead of consulting with the doc about what you should be doing with that pt? If so, I'm sure thats quite frustrating.
More often that not, we have problems with hospitals wanting to do the wrong (archaic, misguided) thing with pts who up until arrival have been being treated according to current standards of care. We have a lot of small rural band aid stations around where I work. Most of the doctors have questionable crit care skills and a few of the nurses, while they seem to try a little harder than the docs are not much better most of the time. To be fair, they're often not specialist emergency providers but it does cause some issues sometimes. Certain doctors have reputations. One for example has a habit of using certain inappropriate antiarrhythmics in inappropriate doses and then gets all in a huff when pts become hypotensive.
Many nurses don't like that chest pains aren't on tons of oxygen. I've had nurses wave their finger at me and put an NRB @ 15 on chest pain pts only to find they aren't on O2 10 mins later after medical review. Similarly, picking pts up for transfer, it can take a bit of explaining as to why you're taking them off O2.
They get a bit of a shock at how much pain relief we give people too. We'll bring in an abdo pain with 25mgs of morphine on board and they just about fall over backwards.
Despite, or perhaps because of, the above, mostly the local doctors know when they're out of their depth and are happy to defer to us to an extent with the sicker pts. Locally, intensive care paramedics are dispatched to manage critical pts in the EDs until retrieval teams can fly out. As far as I know, this is reasonably common throughout the state, especially with pts requiring intubation. I've never had any serious trouble myself, but I've heard of there being some heated discussions. I did once have a disagreement with a GP about pain relief in an acute abdomen. He said it would infringe on the surgeon's assessment, but it didn't take long to talk our way through it. I pride myself on being able to talk through most issues, but its a two way street. I've personally found that most of the GPs in the surrounding areas running the clinics and band aid stations are very polite and more than happy to consider our opinions and accommodate our wishes, clinical and logistical.
I don't know of any specific problems that our hospitals have with our guidelines although I'm sure its possible that some may exist outside of my knowledge :lol: I know locally, our main hospital seems to wish we could do more. Mostly, it seems, so that they could do less. They hate inappropriately immobilised pts, pts still in pain, pts not adequately fluid resuscitated and most of all they seem to hate receiving pts without adequate IV access. They hate it when we bring in pts that don't really need to be there but that we transported because 1) We avoided taking the responsibility of making the decision, or 2) We really couldn't reasonably leave the person at home, but the hospital doesn't really need to do anything. Minor ODs constitute most of the second category. They hate us bringing in the repeat offender ODs who took 6 xanax and 3 tylenol without a specifically suicidal intent. We can't not transport them, because they're inherently unreliable when 1) They tell us they
only took X and 2) They didn't
want to kill themselves, but we don't usually get a warm reception at hospital. Last time I brought a pt in like this, I had a full blown argument with the triage nurse about whether or not I should have transported.
