Awesome Paramedic school I applied too

[ccmedoc]

I would go farther to say that rapport with a team makes for weak leaders.

I still disagree..this is old school thinking, and I have seen otherwise. If, when you come on scene, the people there know and respect you..you will most likely have an easy go of it. I have seen the opposite happen to colleagues that were difficult to deal with and simply demanded compliance with no respect from their subordinates.

I do not think the school should focus on making a team out of the students but rather have them focus on being a leader. Working in a team is not difficult when dealing with medicine.

I don't think the school should focus on teamwork either..I think they should educate paramedics that are practical, critical thinking, individuals able to take control and command respect..the teamwork and leadership is separate and should be accomplished in the work environment.

management 101 people

You cannot be good friends with the people you manage.

You cannot be good friends with the person who manages you.

Again, I believe this is old school thinking.

Husbands, wives, and other family in these positions is definitely asking for trouble. As for the friends, I think it depends on the quality of the individuals...You can never be friends with all of your subordinates..the people you lead..but I believe that forthright honesty, conviction, an obvious commitment to excellence, and straight honesty can level the playing field and garner respect in this arena. The ability to separate business and everything else is not a quality everyone enjoys..

As for the boss/leader thing, this is kinda how I see it..every leader is a boss. But every boss is not the leader. What defines the difference between a boss and a leader? The biggest difference between a boss and a leader is this; the boss is respected and obeyed because of their seniority. A leader is respected and looked up to as an example not only because of seniority but mainly because of the qualities of character and ability.

Those who aspire to become leaders must lead by example and the team must always have a firm belief that the leader will be there during every crisis. Not to fix the blame, but fix the problem. If the team members find that the leader does not follow what they preach, they will have no respect for him. They may obey them, but the respect will be missing. Leaders gain this respect by their actions. They look and act sincerely. There is no mismatch between their words and actions. They look integral in approach and character.

To be a leader, every boss must display characteristics such as knowledge, planning, anticipation, foresight, action, result oriented approach, perspective, respect every team member, earn their respect, act as a friend and act as a mentor. To be a good leader, in my opinion, need these qualities. Once a person earns the respect of their team members they ceases to be only a boss and transforms into a leader.

You have to be able to take the responsibility along with the increased accountability or you are not worth the paper your medic license is printed on.

Accountability is huge...I can't stress this enough. This goes with rapport, if your people know they can work without fear of unjust penalty or prejudice..they are more willing to work freely and confidently with and around you.

Teams have a tendency to break up and go silent running when someones butt is on the line.

This happens, without a doubt, and it seems you have been on the short end a few times (what I get from your writing)..hopefully the exception and not the rule. I have been in very bad situations with some of my people. Jobs and, potentially, licenses on the line. I have not had anyone roll on me or vice versa. Maybe I'm just lucky, but I prefer to think it is a respect thing.

Management and leadership are multifaceted, and many different approaches exist..these are just my opinions from my experience..

[Eydawn]

Mateo, I said *inevitably*... not *every time* which indicates a probability at some future point... maybe it was kind of unclear. Regardless, the attitude that you *always* know what is best is a great way to paint yourself into a corner. In any aspect of life.

As for the nurse doing what the doctor says or getting out, I'm not planning to risk *my* license after graduating nursing school if a doctor orders something that I know is *not* in the patient's best interests, and I will take it up the food chain if necessary, as well as refusing to carry out the order. Doctors make mistakes. There is a reason malpractice insurance is mandatory...

You missed my point. I am emphasizing that each provider at their level has just as much of an ethical and legal responsibility to provide excellent care as the doctor does. Therefore, we must act accordingly, so that our superior doesn't take a fall needlessly... instead of just relying on the fact that "they're in charge, so they must be right."

One would hope that the people you work with are able to work as an effective team, in an environment where a superior trusts your judgment enough to take into consideration points that you raise. If you're in a situation where your partners suck so bad that you absolutely have to take on the bad-ass commander role all the time, you need to find better partners or find a way to help your current ones improve.

Just a comment on leadership styles... I have infinitely more faith in the leader who comports themselves with a quiet demeanor. This kind of leader's authority is so implicit that it doesn't need to be illustrated in any fashion, save to the most imperceptive dolt. The leader who is brash, obviously in charge, loud, and re-iterates that at every turn hasn't mastered leadership yet. There are always situations where the sage has to raise voice to accomplish things... we can all think of several. But if that is the norm for leadership? The leader is still learning...

Wendy

CO EMT-B

[ccmedoc]

Just some backgrouond...

Exactly. When it comes down to it the nurse may disagree with the doctor but she WILL follow his orders or get out. This is where it is not a team sport. In a team you must conform what you do to what other players are doing. As a doctor or paramedic in charge they are not a part of the team, they are the leader. That is the difference.

This is a ludicrous statement. In hospital is far from a authoritarian atmosphere..These are bygone days of "nurse do this or else..". There is a legal and ethical duty to evaluate every situation and treat the patient accordingly, in their best interest..not yours. You, or a nurse, is not compelled to perform any procedure on a patient simply because you were told to..this is negligence to some..malpractice to others..

I am the one who is taking in all the information, I see the big picture, I see what is going on with the whole scene. As a team member they are assigned a specific task, they should be busy doing something else, they will miss points that I see ultimately.

This is an arrogant and self important statement. By discounting the rest of the players on a scene, YOU will be the one who ultimately misses something..Only my opinion, but I believe you have some growing to do..I have yet to see a paramedic that was a one-man-show..at least a good one :shock:

[Asysin2leads]

I'm going to weigh in here. I agree medicine is a team sport. However, I also believe that the discipline of a hierarchy is imperative to good quality prehospital care. I don't need someone to help me make the diagnosis. I don't need them to give me tips when intubating. What I need is someone to be able to have the BVM, suction, and oxygen ready so I can focus on correct tube placement.

Personally I can't stand this touchy feely Dr. Phil BS that takes the place of professionalism in the work place. I don't come to work to be anyone's friend. I don't come so that everyone has a good time or goes home feeling good. I come to work to do my job, assess, treat, and transport, go home safely and collect a paycheck.

Of course I believe that if someone of higher authority is doing something that will grossly endanger a patient they should be called on it. But the cases of that happening versus the far more common phenomenon of some poor overworked paramedic nicely explaining his decisions just so he doesn't have to grow another set of hands out of his ass so the EMT's will do their job are very small.

In the cases of a dual medic truck, if the two paramedics disagree, usually either a paramedic supervisor or, even better, the telemetry physician is called in to mediate.

When people really need care, it is time for the people in charge to do their job, and the people under them to do theirs.

And the bottom line is despite what all of the textbooks, and psychologists, and social workers may say, I do NOT have to respect any body's opinion about my patient care decisions who does not have equal or greater knowledge and experience in regards to the same situation as I do. Just because the patient's family member thinks I should shock the patient doesn't mean I'm going to, and just because the EMT thinks its a stroke and not hypoglycemia will not make a difference in my patient care decision either. If we're talking about what to barbecue, your opinion is just as valid as mine, if we're talking about how to treat the patient, it isn't. If you can't handle that I suggest another line of work where not acting correctly, swiftly, and decisively will not end in death or litigation.

I shouldn't have to worry if my persona or my demeanor or my "rep" is enough to "command respect". I should be in a system that teaches enough respect in its subordinates that unless I am doing something grossly inappropriate, people should understand that their JOB is to follow orders, just like mine is.

Personally I think we've gone overboard with the teamwork and brotherhood and camaraderie and patting each other on the back crap to the point we've lost sight that we are supposed to be PROFESSIONALS doing a JOB. Professionals don't take canoe trips.

[DwayneEMTP]

I thought I was pretty specific....

I've approached this subject from the behavioral science aspect, as it is proven science, and is used successfully in many disciplines.

Dwayne

You know, I have read this post, and I have found no valid evidence that points to the canoe trip as anything other than a vacation. It appears to be a "break the ice" modality, and allows for the students to get to know each other. This is not the same as what you have been alluding to in your behavioral science references..

You are absolutely right. Having spent the better part of my adult life making a living as a behaviorist I often assume that when behavioral situations are interjected into normally strict intellectual environments that there is a scientific basis for it's application. What I'm hearing is that is not always, if ever the case.

My theory stands though, and I would love to see it applied, but I can see now that I have most likely been arguing that apples are oranges...when in fact they are simply the apples they appear to be...

I see a canoe trip and instantly think, "Score! I control the environment, the amount of work, the interaction of the participants, breaks, food, sleep, etc. Everything I need to create positive behavioral changes." But in reality.......it's probably just a canoe trip. (But I'm still going to keep my fingers crossed)

[Without the information on teamwork, you simply have a group playing together. This is where, in my experience, just throwing students into group work or teamwork exercises undoubtedly ends with one primary worker, and a couple of tag alongs.

Agreed. Again I think I was arguing from my pipe dream. Team work is definitely a science and should be taught as a matrix with a positive behavioral slant.

Thanks for your thoughts.

Dwayne

Edited for unimportant spelling/grammar stuff. No contextual changes.

[Lone Star]

At the 'hospital level', medicine MAY be a 'team sport' with the different disciplines coming together like a good jigsaw puzzle, (ie radiology, cardiac, respiratory, etc), in the field the whole 'team thing' falls apart and does so quickly.

On a sports team, you have no real 'hierarchy'...you have different 'specialties' working together for a specific goal..(to score points). The quarterback is no good if there aren't competent receivers to catch what he throws. The receivers aren't going anywhere if they don't have blockers doing their job. Hell, the quarterback isn't going to do anything but look at the sky if the linesmen aren't doing their job!

In EMS, you have different levels of the same information (the body in general works under only certain conditions, and all bodies pretty much work the same way, with different tolerances).

To illustrate Ruff's 'scatter when the shit hits the fan' statement: when I was testing at state level, I got paired with (I hate to say 'partnered with' because partners will eventually work together for the same goal), a complete MORON!

Because I got paired with this knucklehead, I almost failed the state practicals.....every time I stepped back from the scenario involved, the person I was paired with claimed that he did nothing wrong. (One example was this person refused to pad the buckles of a KED on a male 'patient' because as my 'other person' simply stated "He don't need padding, he don't have tits." Before that, I had to direct him to hold c-spine, and measure for the correct C-collar, had to direct him when to apply the collar, and basically had to keep hauling him back to the 'mundane tasks at hand' because he kept straying off to just stand and watch me work.

I don't see how the canoe trip, meeting with a former NHL player has any bearing on the actual day to day duties of pr-hospital care in the field.

I for one REFUSE to carry an incompetent 'team member' along for the ride,...because when it all hits the fan, MY license is on the line.

To illustrate this point, I'll tell you about someone I got paired with running actual calls. How this guy EVER passed the course finals and the state testing is a mystery to me!

First call was for 'difficulty breathing' in an ECF (Extended Care Facility) setting. (For brevity purposes I'm not going to narrate the whole call.)

On arrival, I started to assess and deal with the difficulty breathing, and suggested that he start by assessing B/P. He placed the cuff, and starts inflating it without watching the gauge. He's got no stethoscope (B/P by palpation, you say?). He starts palpating wrist on the anterior aspect (in the anatomical position) for the pulse. How can you detect the pulse on the WRONG side of the wrist? When I suggested that I'll deal with the B/P, his remark was "Why, because you have a stethoscope?" (I so wanted to tell him that I would do it, because I was at least competent enough to do it CORRECTLY! [NOT something you want your patient to hear!])

Second call, (another ECF call) for a possible elbow fx. This person I was working with decides that the ONLY thing needed is a long padded splint and a single ACE wrap. Patient turns out to be CAO X4, nonverbal responsive and when questioned, is complaining of abd pain, not elbow pain.

Had I subscribed to that 'happy happy feel good' team approach, I wouldn't have had a license when they came to take his.

[mobey]

You may very well be correct Dwayne. The instructor just finished up his Phd in adult education.

[JPINFV]

On a sports team, you have no real 'hierarchy'...you have different 'specialties' working together for a specific goal..(to score points). The quarterback is no good if there aren't competent receivers to catch what he throws. The receivers aren't going anywhere if they don't have blockers doing their job. Hell, the quarterback isn't going to do anything but look at the sky if the linesmen aren't doing their job!

example:

[Lone Star]

example:

POINT, JPINFV!

[Dustdevil]

You may very well be correct Dwayne. The instructor just finished up his Phd in adult education.

Ya know, I may have to reconsider my belief that educators educated as professional educators would be a big positive step forward for EMS education. This is the third PhD in adult education that I have seen running a medic programme, and all three of them are doing this sort of nonsense.

Experimenting with teaching styles in order to find the optimum programme for your students is a good thing. But I have yet to see any of them ever go back and rethink these theories after they are implemented. Just like the rest of EMS, they just continue to do what they've always done because it's easier than changing, and certainly easier than admitting your plan didn't work.