What should I do?

[Ray1129]

I'm pretty sure what I'm going to do, but I want some input from other EMS providers before I make a final decision.

I'm a volunteer EMTB in Harford County, Maryland. We have two paid departments, however they are military governmental type agencies. We also have *some* paid EMS in various departments. That's neither here nor there, though.

My question is more complicated. When I started riding the ambulance, there was one paramedic that typically rode all the time. She's pretty old, was pretty much forced to retire from her job because of her age (she worked as a paramedic).

In the beginning when I was an in-experienced wide-eyed probie, I used to think that everything this paramedic did was right. Well, now that I've been through the training and have a bit of street experience, I have seen several instancees where she has done some pretty terrible things in my opinion.

Not even going into ALS skills I've witnessed her do wrong (since I'm not an ALS provider myself, I feel I don't have room to criticize), I've seen her do some basic skills (or in this case not do) that were completely wrong.

For instance, on a cardiac arrest, she never intubated the patient. 10 minutes on scene time (which was a bit much in my opinion in the first place), and 10 minute en route to the ER time. Never even got the equipment out. And I do believe that intubation falls under the letter A in the ABC acronym.....the first thing that should be maintained in all instances. It was even mentioned to her that air was not quite entereing the lungs, or the stomach for that matter, yet still no intubation. <_<

That's just one example of many things that I've witnessed that has quite disturbed me. What should I do? I know that in my volunteer service, we need as many ALS providers as possible, however, what she is doing is wrong and may even be detrimental the patients health (it's just not one of those obvious detrimental things).

I'm planning on writing to my EMS captain and Chief, however, I don't know if anything will be done about it since it is a volunteer service. You know, the whole "we're friends, right?" situation. A simple talking to and minor slap on the wrist and off you go type of deal. I don't think that's what needs to happen here....though I don't know exactly what *should* happen.

I'd appreciate any advice anyone can give me.

:unsure: Ray

 

[ffemt8978]

First of all, you need to understand that it can be difficult for you no matter what you decide. If you bring this up, things can get interesting around the station (to say the least). If you don't bring it up, it sounds like you may have a hard time dealing with it.

Trust your instincts on this one, although it sounds like you already made up your mind. That being said, I'll give you what I would PROBABLY do in your situation.

1. I would go and talk to your EMS Captain first, face to face. Putting your complaints in writing pretty much formalizes the whole deal, and you could be subject to some "backlash" from it. Also, you want to start out at the lowest point in your chain of command and work your way up. Going to the Chief right off the bat may cause you additional problems down the road.

2. Don't bring up calls that happened in the past. If you're going to do this, make sure it is a recent call (preferably one you just came off of, if at all practical). Bringing up calls that happened weeks or months ago makes it look like you have a vendetta against this paramedic, and may shut you down for future complaints.

3. Don't come out and say that the paramedic made a mistake. I've often found it easier to say something like, "I have a question about this procedure/protocol, since I've seen it done differently." Who knows, there may have been a valid reason for the change in procedure/protocol.

4. Be realistic. This paramedic probably will get a "slap on the wrist" for the first complaint. But as each successive complaint is validated, or you work your way further up the chain of command, the action taken by the department will get more severe. And remember, if every thing else fails, you can always talk to your medical director. It is his license that you are operating under, and I can almost promise you that he will not let it slide. (I recommend this only as a last resort, for obvious reasons.)

That being said, I'm glad I'm not in your shoes. In closing, I would like you to remember two points.

1. BLS skills are what save paramedics.
2. Your patient should always be treated you would want one of your family members treated.

 

[SafetyPro2]

I agree 100% with what Scott said, particularly about putting it in writing. Handing in a written complaint as the first step definitely escalates the situation and may actually end up making you look bad. It's definitely a better idea to bring it up informally first, and I like the idea of phrasing it as a question. I've used that "trick" a few times myself, even when I knew (or thought I knew) the answer. Sometimes, you find out that the situation actually was correct and keeps you from looking like a troublemaker.

That being said, I'd go ahead and keep a detailed log for yourself of situations as they occur. That way, if action isn't taken, you can escalate it as necessary and not be talking just from memory.

Good luck. It's never a fun situation, but as Scott said, after our own safety, good patient care is our first priority.

 

[MA-EMT76]

did't you mention that she was forced to retire? or does she still work on the volley squad with you?

 

[rescuecpt]

Originally posted by Ray1129@Jul 22 2004, 11:53 PM
For instance, on a cardiac arrest, she never intubated the patient.  10 minutes on scene time (which was a bit much in my opinion in the first place), and 10 minute en route to the ER time.  Never even got the equipment out.  And I do believe that intubation falls under the letter A in the ABC acronym.....the first thing that should be maintained in all instances.  It was even mentioned to her that air was not quite entereing the lungs, or the stomach for that matter, yet still no intubation.  <_<

Is intubation an ALS or BLS skill in your County? In mine it is an ALS skill. Forget about ABCs for now - get a copy of the protocols that apply to her (most likely ALS). What type of cardiac arrest was it? Asystole? V-Fib? V-Tach? PEA? etc. Figure out which protocol applies. In an Asystole/PEA case (non-shockable rhythms) the provider usually "stays and plays" because they need to get an IV and start pushing drugs before they go. V-Fib and V-Tach are usually shock-shock-shock, drugs, shock, GO situations. Intubation may not necessarily be at the top of the standing orders, which may explain why she didnt do it.

I had a similar situation before I became ALS, with a medic who didn't try to pace an asystole patient. The pt was 35 with a history of drug abuse and we didn't push narcan either (naloxone). There was also questionable tube placement. When we walked into the room that patient was dead - sometimes you can just feel it - but still, it would have been nice to follow protocol. I was actually approached by the County training supervisor because the PCR was flagged for the potential missed tube - and when I went over the protocol for Asystole with him we figured out several problems that occurred, AND that the medic wrote up the PCR perfectly, but it was not an accurate reflection of what happened. The medic ended up in an intubation class and he also had a counseling session with the training supervisor. It made a sticky situation in the FD though, because word got out that I was involved (even though I didnt seek out the supervisor). It's over now, thankfully...

 

[ffemt8978]

Originally posted by rescuelt@Jul 23 2004, 06:49 AM
What type of cardiac arrest was it? Asystole? V-Fib? V-Tach? PEA? etc. Figure out which protocol applies. In an Asystole/PEA case (non-shockable rhythms) the provider usually "stays and plays" because they need to get an IV and start pushing drugs before they go. V-Fib and V-Tach are usually shock-shock-shock, drugs, shock, GO situations. Intubation may not necessarily be at the top of the standing orders, which may explain why she didnt do it.

Good point, since there is very little the ER will do differently in the first 10 minutes of a cardiac arrest call. The procedures and drugs are the same, so most ALS agencies have a "stay and play" policy in this situation, whereas BLS agencies are of the "PUHA" philosophy.

 

[Ray1129]

Thanks guys. I appreciate your help. There are some things I opted to leave out, but I got the general idea of what to do. I wasn't too keen on writing a letter in the first place, but I didn't know what else to do. Though, my ambulance captain will probably do nothing. I know her and how she works.

I'll make a list, though....that'll help. I know some people up where it matters and if something really wrong occurs, I'll make sure someone who will do something about it knows about it....

Ray