What to do

[taxidriver]

To start, we were dispatched as a basic unit normal traffic for a sick person. The call ended up being way more serious. Pt presented with cyanosis, shortness of breath, and an o2 sat of 68-70% on room air. My immediate thought was we have to boogie. I don’t have the equipment to rule out many of the serious problems that could be happening with the pt so I contacted dispatch to ask where the nearest ALS unit was located. They were about equal distance from the nearest hospital so I decided to transport L&S. Seems pretty standard for how a basic unit should’ve handled the call. My issue is, I was taken back by the incompetence and terrible pt care performed by my partner. The whole call they had a nonchalant attitude and displayed an obvious lack of knowledge asking the pt questions such as if an 02 sat of 60% was normal for them. The police officers in the room were more worried about the pt’s condition than my partner. My partner didn’t recognize the cyanosis or that the pt overall looked like they were in terrible shape. The 02 reading did not concern them at all. Rapid transport wasn’t even something they were considering. As far as treatment they stated “I guess we can put them on 2 liters.” I promptly said that they needed high flow 02 and rapid transport. Driving to the hospital I had to continuously shout instructions to them. We were unable to obtain a proper history from the pt or family but the pt was maintaining an 02 sat in the mid 80’s on 10lpm via NRB. My partner made the decision to bump the pt down to a NC because the mask was uncomfortable for the pt and didn’t even attempt to explain the seriousness of the pt’s condition to them and explain why the mask was necessary. We came into the hospital with our pt’s 02 sat in the 70’s. It was embarrassing and unprofessional. I was planning on brushing it off but it is starting to bother me more and more that such bad pt care was performed in the back of the rig I was working. (Only reason I didn’t tech it is because I wanted to arrive at the hospital in one piece.) This is not a new EMT but I am genuinely worried about how they will handle future calls and how this call would’ve went had there been a less experienced basic running with my partner. So my question to those more experienced than myself, how do I handle this without it getting messy? I’m really not the type of person to rat a partner out but this shift was a nightmare. I don’t want to be on bad terms or gain a reputation as “that guy” but this was seriously bad.

 

[DesertMedic66]

Have you tried talking to your partner to see what was going on or why they thought this patient required different treatments.

So you were driving and shouting back directions to your partner in back while going lights and siren to the hospital? Please, if you are the one driving you should have one and only one responsibility and that is to drive safely and not to be directing patient care.

If you felt your partner was providing subpar patient care why did you not take over and tech the call? If you feel your partner is not safe while driving then that needs to be brought up to management.

If it is a lack of knowledge on your partners behalf then you should inform your QA/QI/CES/Training department about it and/or write up an incident report.

 

[taxidriver]

Have you tried talking to your partner to see what was going on or why they thought this patient required different treatments.

So you were driving and shouting back directions to your partner in back while going lights and siren to the hospital? Please, if you are the one driving you should have one and only one responsibility and that is to drive safely and not to be directing patient care.

If you felt your partner was providing subpar patient care why did you not take over and tech the call? If you feel your partner is not safe while driving then that needs to be brought up to management.

If it is a lack of knowledge on your partners behalf then you should inform your QA/QI/CES/Training department about it and/or write up an incident report.

I tried talking the call over. They just kind of laughed it off and displayed a “we’re just here to transport” type of attitude. In regards to me shouting directions, it was more of me checking in on how the pt was doing and if he was still keeping the pt on the mask. I wasn’t giving play by play instructions and was entirely focused on driving safely. I really had no idea that they how they were going to treat the pt in the back as I have never worked with this partner. Driving wise I was getting bounced around all day. They were hitting every curb possible and even scratched the truck while parking to get fuel. I plan on bringing this up to QI department but am just curious as to how messy these types of things can get.

 

[xxdanielt3]

Sounds like some issues need to be addressed with your partner. I would start there and see where it goes.

Why did you not take over patient care if you feel the patient was getting the best care able to be provided?

Talk to your partner and gauge the responses before going to management.

Is your partner a newer provider?

 

[mgr22]

Taxidriver, I'm not sure how I would have handled this at 19, particularly if my partner had been not only lazy or incompetent, but much older.

I get your concern about poor patient care versus complaining to management. If I were in that situation now, I'd start by discussing the matter with my partner, as you did. Maybe that partner will be more diligent about patient care when riding with you, just to avoid being called out by you. That's probably the best you can hope for. If the problem continues, you could invite your partner to accompany you for a sit-down with management. That would probably seem less sneaky to your partner. Just anticipate the possibility that management decides you're the one who's a problem -- not fair, perhaps, but a pretty common outcome.

Just one more thing: Maybe I shouldn't ask, but how did you pick your screen name? I mean, you're trying to make a case against someone who told you, "We're just here to transport," while your screen name makes me wonder about your attitude, too.

 

[EpiEMS]

My partner didn’t recognize the cyanosis or that the pt overall looked like they were in terrible shape. The 02 reading did not concern them at all. Rapid transport wasn’t even something they were considering. As far as treatment they stated “I guess we can put them on 2 liters.” I promptly said that they needed high flow 02 and rapid transport. Driving to the hospital I had to continuously shout instructions to them.

(Only reason I didn’t tech it is because I wanted to arrive at the hospital in one piece.) This is not a new EMT but I am genuinely worried about how they will handle future calls and how this call would’ve went had there been a less experienced basic running with my partner.

These are legitimate safety concerns - both for you and for your patient. You're right to bring this up to management.

 

[taxidriver]

Sounds like some issues need to be addressed with your partner. I would start there and see where it goes.

Why did you not take over patient care if you feel the patient was getting the best care able to be provided?

Talk to your partner and gauge the responses before going to management.

Is your partner a newer provider?

Based on the pt’s presentation I made the decision to load and go. The only issue we could correct with our scope of practice and protocols was the hypoxia at hand. I assumed a licensed emt who’s been doing the job longer than I have would at the very least be familiar with this. I think that’s a fair assumption to make. I decided to do the driving as I honestly didn’t trust them to drive L&S based on the driving they did earlier. This is not a new provider.

 

[taxidriver]

Taxidriver, I'm not sure how I would have handled this at 19, particularly if my partner had been not only lazy or incompetent, but much older.

I get your concern about poor patient care versus complaining to management. If I were in that situation now, I'd start by discussing the matter with my partner, as you did. Maybe that partner will be more diligent about patient care when riding with you, just to avoid being called out by you. That's probably the best you can hope for. If the problem continues, you could invite your partner to accompany you for a sit-down with management. That would probably seem less sneaky to your partner. Just anticipate the possibility that management decides you're the one who's a problem -- not fair, perhaps, but a pretty common outcome.

Just one more thing: Maybe I shouldn't ask, but how did you pick your screen name? I mean, you're trying to make a case against someone who told you, "We're just here to transport," while your screen name makes me wonder about your attitude, too.

The problem is I have no way of knowing that I will ever work with this individual again based on how both of our schedules operate. In regards to my name, it’s just sarcasm. There are definitely people out there that believe we just drive and I’m playing off of that.

 

[mgr22]

The problem is I have no way of knowing that I will ever work with this individual again based on how both of our schedules operate. In regards to my name, it’s just sarcasm. There are definitely people out there that believe we just drive and I’m playing off of that.

So if you don't ever work with that partner again, you're good to go, right?

 

[taxidriver]

So if you don't ever work with that partner again, you're good to go, right?

I’m ultimately concerned about how they will handle calls in the future and what kind of care they will provide.

 

[DrParasite]

You have spoken to your partner, and he blew you off. Have you addressed your concerns with a supervisor? what about QA and management? If he caused damage to the ambulance (you said he scratched it earlier), what was management's response?

Sounds you work for an IFT company, where the only requirement is a pulse and a patch. See what management says, but if it isn't a constructive answer (and knowing how too many IFT companies work, I wouldn't hold my breath), I'd start looking for a better job.

 

[mgr22]

I’m ultimately concerned about how they will handle calls in the future and what kind of care they will provide.

Ok, nothing wrong with that, but it's unlikely you have enough juice to solve that problem for all time. How about a compromise: Focus on being the best EMS provider you can be. If/when someone gets in the way of that, try to fix it at the lowest possible level. At your age and level of experience, that's probably the best you can do.

 

[taxidriver]

It’s not strictly an IFT company. Yes, as basics we do IFT’s. But we also respond to calls that in theory should be basic calls. I appreciate everyone’s input and will use it to make what I feel is the right decision.

 

[DrParasite]

I'm curious, what state is this in? I have heard and experienced similar stories about this happening in my home state, and I'm curious is it happens elsewhere too.

 

[EMTlash]

To start, we were dispatched as a basic unit normal traffic for a sick person. The call ended up being way more serious. Pt presented with cyanosis, shortness of breath, and an o2 sat of 68-70% on room air. My immediate thought was we have to boogie. I don’t have the equipment to rule out many of the serious problems that could be happening with the pt so I contacted dispatch to ask where the nearest ALS unit was located. They were about equal distance from the nearest hospital so I decided to transport L&S. Seems pretty standard for how a basic unit should’ve handled the call. My issue is, I was taken back by the incompetence and terrible pt care performed by my partner. The whole call they had a nonchalant attitude and displayed an obvious lack of knowledge asking the pt questions such as if an 02 sat of 60% was normal for them. The police officers in the room were more worried about the pt’s condition than my partner. My partner didn’t recognize the cyanosis or that the pt overall looked like they were in terrible shape. The 02 reading did not concern them at all. Rapid transport wasn’t even something they were considering. As far as treatment they stated “I guess we can put them on 2 liters.” I promptly said that they needed high flow 02 and rapid transport. Driving to the hospital I had to continuously shout instructions to them. We were unable to obtain a proper history from the pt or family but the pt was maintaining an 02 sat in the mid 80’s on 10lpm via NRB. My partner made the decision to bump the pt down to a NC because the mask was uncomfortable for the pt and didn’t even attempt to explain the seriousness of the pt’s condition to them and explain why the mask was necessary. We came into the hospital with our pt’s 02 sat in the 70’s. It was embarrassing and unprofessional. I was planning on brushing it off but it is starting to bother me more and more that such bad pt care was performed in the back of the rig I was working. (Only reason I didn’t tech it is because I wanted to arrive at the hospital in one piece.) This is not a new EMT but I am genuinely worried about how they will handle future calls and how this call would’ve went had there been a less experienced basic running with my partner. So my question to those more experienced than myself, how do I handle this without it getting messy? I’m really not the type of person to rat a partner out but this shift was a nightmare. I don’t want to be on bad terms or gain a reputation as “that guy” but this was seriously bad.

I totally understand you and have had the honor of working with a bunch of ignorant EMTs that do not even touch the pt. My best advice could be to first try to avoid working with them because something will eventually go wrong if you start your shift with a negative attitude and a distrust in your partner's skills and abilities. Second if you had to work with them make sure to prevent any serious malpractices when they are with the pt. Like on thing I was wondering about the call that you talked about was whether or not either of you asked if the pt is allergic to anything or noticed any swelling in the face.

Stay safe

 

[Emily Starton]

Try talking to your partner