Awesome Paramedic school I applied too

[DwayneEMTP]

I entered this discussion based on your contention that behavioral science is nonsense in EMS, I've disputed it and taken the time to flesh out my opinion to make it easier to discuss. So for your points have made no sense, when you made points, instead of simply making comments.

This is one of those time that "cause I said so" just aint gonna get it done. Gonna fish, or cut bait?

[Don't put this all on me.

It was never my intention to do so. It was my intent to attempt to clairfy my position in an effort to promote the conversation. As I do, and always have had much respect for your intelligence and opinions, my attempt wasn't to 'put you on the spot' but to get you to clarify the error of my thinking. So far, you've simply made statements, not rationalizations, which hasn't helped me to clarify my thinking at all.

[Your constant assertion that those who don't care to play childish games in these pointless discussions are running from something significant is in itself psychobabble.

I don't have any idea what this means. You've often claimed to be strong in psychology, I'm simply beginning my argument from that point of view. If you're uncomfortable with the science behind behavioral psychology, I'll be happy to attempt to clarify my position and justify my claims, as it's been the center of my professional career for the past 20 years.

You simply lost me with "childish games", "pointless discusstions", and the the statement that I claim someone is running from something. Honest, I have no idea what these are about.

[it's the equivalent of, "I know you are, but what am I?" Come on, man. I know you're capable of better challenges than that.

Again, perhaps you've given me to much credit. I'm lost. You'll need to dumb it down for me. It thought that what I was asking was that you justify your position that behavioral science is "silliness" despite the fact that others use it to great advantage. Perhaps I didn't explain properly, or you misunderstood....I really have no idea.

You think my points make no sense. I think yours make no sense. So where exactly do we go from here?

Again, I'm completely confused by this statement. Isn't it obvious that we go to discussion and debate to help each other perhaps reach a level of understanding that we've not had before?

As when you mentioned it to Dawn...when did you decide that if two or more people disagree on something that is suddenly become pointless conversation? Who are you? And what have you done with Dustdevil!?!

And why is it more incumbent upon me to make sense to you than for you to make sense to me?

Is certainly is not. The difference here (Please reference by question above) is that I've attempted to explain my reasoning, The science is clear, yet you've only responded with 'statements' that demand that I change my view because "you said so", I'm going to go out on a limb and guess that perhaps you know that that is not my strong suite.

I think this is a vital question and concept for EMS and paramedicine in particular. Do I know better than you? Probably not, but I'll never know if you continue to come to the discussion with the preconceived notion that it's "pointless."

Because I respect you, and your opinions, and think of your as a friend, I'm not going to let this go.

You, for years have set the standard for logical debate and scientific justification of ideas at this site. Lately though, some of your arguments have struck me, as this one has, as being of the cloth of "I'm right, you're simply too dumb to explain it to."

In my case, I'm not going to pretend that that isn't true, but I believe it's beneath you to argue in that vein.

The weight isn't on you, and it's hard for me to imagine a time in the past where that would have been an issue, you would have simply shut me down with logical, and/or deductive reasoning. When did we cease to be worth the effort?

Dwayne

[DwayneEMTP]

Medicine is a team effort dependent upon the individual competencies of the practitioners. Yes, you must be the absolute best practitioner you can be and assume full responsibility for all of your decisions and treatments... but no, you are not the end all be all of medicine for this particular patient.

Man. I guess I'm destined tonight to argue with people smarter than me....hell.

I would disagree with you here Wendy. Since completing my medic, what I've come to understand is that paramedicine is an individual sport that forces you to pretend to be part of a team to enlist other's help with patient care. Because I'm the best? Maybe not, but I'm ultimately responsible and have to sleep at night with my moral/ethical conscience clear. Not that no one else's opinion matters, but it's still on the medic's shoulder's to decide who's right...and explaining that, "But Bob said we should wait!" doesn't get that done. And it makes no difference if Bob is a basic, another medic, a nurse or a doctor. It's all the same in the end.

From the basic point of view it would appear to be a team sport. But I was criticized, and rightfully so, at times for allowing another medic, that actually had legal care of the patient, to do things that I felt were not in the patients best interest.

I came to understand that though I enjoy the team concept, that I must hold myself at least a little in reserve, as I may have to step on some, or all toes, to make sure that my patient gets the best care that "I" believe they can get. Because it comes down to "I".

The captain of the football team is certainly the star of the team, but still part of the team. A medic must always be apart from the team thus allowing him/her the freedom to say, "Stop it! Change the treatment and do it now! This is what will be done." The captain always has to think of winning as a team, the medic always HAS to win as an individual when the situation calls for it. And can't do so unless keeping his/her self apart as an individual. Does that make any sense?

Just my thoughts....

Dwayne

[ccmedoc]

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..

A group, even a group that gets along and plays well together, does not equal a team. Three days on the river, bon fires, and a workout with a hockey player sounds like a lot of foo foo, feel good stuff.

For the behavioral science portion you are looking for to be effective, the team building getaways that corporate America is so fond of, incorporate a lot of trust building exercises, leadership seminar, exercises to bring out qualities of leadership in individuals (if there are any), promote self efficacy, and offer education about what a team is and how to function as such. The canoe trip, hiking, biking, extracurricular stuff is for diversion. to lighten the load, so to speak.

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.

This is where this comes in.....

Every class, course, or school that I have ever taken, where they used the team approach, I ended up doing all the friggin' work myself while everybody else either did nothing or just complained. Then they all took credit for my work, and I took credit for their FAILURE. Screw that. This is one of those psychobabble theories that sounds wonderful to all the feel-good social worker and elementary education types, but ultimately FAILS in the real adult world.

......my experience as well, as both a student and an educator.

I would expect to get better results from paramedics educated on how to be an effective leader as well as how to function in a team. An effective leader leads by example as opposed to simply telling people what to do (read..BOSS). A paramedic needs to be this effective leader since most onscene personel look to them for reassurance and guidance. Teamwork follows with the leadership...simply being a boss breeds discontent, and even the strongest "team" will fall apart.

EMS is a team sport, but the paramedics need to be the leader of the team in the field, and an effective communicator to the in hospital team...

From the basic point of view it would appear to be a team sport. But I was criticized, and rightfully so, at times for allowing another medic, that actually had legal care of the patient, to do things that I felt were not in the patients best interest.

To voice the opinion in a professional manner to the other medic is the epitome of teamwork. It is not only encouraged to speak up, it is your responsibility. A good leader, notice leader not boss, would take the criticism in stride and use it or put it aside. You need to know your place.

Two effective leaders can work together, in my opinion...two bosses usually clash from the power trip.

The captain of the football team is certainly the star of the team, but still part of the team. A medic must always be apart from the team thus allowing him/her the freedom to say, "Stop it! Change the treatment and do it now! This is what will be done." The captain always has to think of winning as a team, the medic always HAS to win as an individual when the situation calls for it. And can't do so unless keeping his/her self apart as an individual. Does that make any sense?

I couldn't disagree more....(sound familiar?)Health Care Team

A true leader has the rapport with his team to make these comments or decisions in the best interest of his team. This is, in my opinion, the difference between a team and a group, a leader and a boss..

Paramedics are inherently the medical person the group looks to for guidance in the field, whether they want to be or not. I believe that effective leadership training is what would allow the paramedic to turn this group into a team..NOT a canoe trip with hockey players..

As for the program..may be a good educational experience.

As for the canoe trip building teamwork and leadership qualities...I don't like it either...

(edits...I kept finding stuff) :shock:

[JakeEMTP]

You think my points make no sense. I think yours make no sense. So where exactly do we go from here? And why is it more incumbent upon me to make sense to you than for you to make sense to me?

Why do I feel like this is a Monty Python moment? http://www.youtube.com/watch?v=teMlv3ripSM

[Dustdevil]

Why do I feel like this is a Monty Python moment? http://www.youtube.com/watch?v=teMlv3ripSM

ROFL!!

That one never gets old!

[Mateo_1387]

I couldn't disagree more....(sound familiar?)Health Care Team

A true leader has the rapport with his team to make these comments or decisions in the best interest of his team. This is, in my opinion, the difference between a team and a group, a leader and a boss..

In regards to your last two sentences, I would have to disagree with you (assuming that I am getting the meaning out of it you were intending). I agree with Dwayne that a leader must hold himself as an individual and not part of the team. There is nothing in stake of the team if things do not go right. The only people at stake is the leader and the patient. A paramedic leader must be able to come into a situation with people he has no interaction with and be able to guide them to provide the best patient care. The leader does not need a rapport to make the best decisions. As an educated professional you will know what you patient needs, you will not be worried about how well your rapport is with your team. This is especially true in big urban areas. You work with different people all the time. It is necessary that you as a medic can lead these people to accomplish goals, even though you have no rapport with them.

I would go farther to say that rapport with a team makes for weak leaders. Just something about knowing someone too well makes them look at you more as an equal than as a leader that they must follow. If you do not have a rapport with them then they have nothing to hold against you. When you come to a situation with them they do not have any stake in it with you, they should follow your commands, and go on with life after the situation is over.

I do not see what the difference between a boss and a leader is. To me a boss must be a good leader.

In my experience the leader is the boss, what he says goes. When I am in charge of a patient and I have a team working for me, I expect what I say to be done, even if you disagree. As a leader I should also be receptive to input from my team, but in the end I am "numero uno" when it comes to the care the patient receives..

As Dust said

I only care about how good I am, and how well the team listens to me and follows my directions.

I believe that effective leadership training is what would allow the paramedic to turn this group into a team..NOT a canoe trip with hockey players..

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. As a team member you are expected to follow what the leader says. When he says do a skill, you do it. Plain and simple. The harder part is going to be the leadership position. This person has to weigh in everything that goes on and make the best decisions. That is where I think the focus should be.

As for the program..may be a good educational experience.

As for the canoe trip building teamwork and leadership qualities...I don't like it either...

On a side note, if they traded hockey players with Hooters girls, then we'd be rockin' !! That is my idea of a good experience

[Just Plain Ruff]

management 101 people

You cannot be good friends with the people you manage.

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

There is a reason why many good agencies do not allow husband and wives to work in the same department and NEVER in a supervisory capacity.

The same goes for boyfriend and girlfriend. Never get involved with your supervisor and as a supervisor NEVER NEVER Get involved with someone you manage. It will be nasty all around if a breakup occurs.

Teamwork is good but remember, the medic is the leader and all the teamwork in the world means crap if the team doesn't back or support the leader.

This sounds like a novel concept, team building in paramedic school but in the end, whose butt is on the line? Yours, as the medic, who has the highest level of training and something goes wrong, you are called on the carpet to justify or explain why it went to hell in a hand basket.

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

[Eydawn]

What I'm trying to say is that many sets of eyes means different input and perhaps a way to catch things that might kill your patient. You might be the best friggin' whatever in the world, be it nurse, medic, basic, doctor... and if you're wrapped up in "It has to be this way because this is what *I* see and to hell with everyone else's input" then you *will* inevitably miss something vital and kill a patient.

If paramedicine is an individual sport, and each and every decision should be carried out by a paramedic because of what they're seeing and their analysis of the situation, WTF are you proposing we run dual medic rigs for? If it's just playing along to get things done, with you as the final "buck stops here," what are you going to do if your partner is ALSO a paramedic with the same constraints and responsibilities as yourself? If he/she sees something different and is *sure* that the treatment needs to happen their way, what do you do? Throw your equally certified/licensed partner out of the truck so you win?

If that's the way paramedics have to operate, it completely kills the idea of dual medic rigs. Might as well just have EMT's as partners.

Now, if medicine *is* a team sport, which I firmly believe it is, then the situation changes. The doctor, in hospital, is ultimately responsible for a patient's care. But each nurse assigned to that patient and each tech assigned to that patient is also personally and professionally responsible for the patient's care. It is the responsibility of a nurse to challenge a decision they think is detrimental to a patient, rather than just saying "I was following orders" and doing something they are unsure of. If you administer the wrong medication just because you assumed the captain (the doc) has it all under control and you kill the patient, you're still liable for your actions.

The paramedic, in the back of the ambulance, is akin to the doctor. Ultimately responsible for patient care decisions. But if a partner challenges the decision, and the paramedic immediately dismisses the input because they are numero uno and what they say flies, and the partner happens to be right and the patient is adversely affected, the paramedic's arse is fried.

Now, this isn't to say that you absolutely have to listen to everything your partners are saying and consider each possibility that they present and change your treatment based upon it. You do have to be aware that they might be seeing something you're not.

I guess my take home message is that I think it is extremely foolish to assume you know everything when you're treating a patient and to proceed without paying attention to those who are also working with you to provide patient care. Yes, you are ultimately responsible. So do the responsible thing and keep your mind open. Don't get tunnel vision just because you're on a new level.

Wendy

CO EMT-B

[Just Plain Ruff]

Wendy you are so correct and your voice of reason again astounds me

I hope that wasn't all directed at me and I'm sure it wasn't but I've been in the field long enough to have seen both the "I'm the medic and I'm the one in charge" groupthink all the way down to "we ahve to work as a team and if you don't you are out"

I do know that it is human nature to scatter when the shit hits the fan. It's second nature to many of us.

I just was saying that as the medic, as the highest level trained person on scene that it is your responsibility and your butt on the line. If you don't listen to your partner and it goes bad then it's your butt. If you listen to your partner and it goes bad then it is your fault.

it's the nature of the beast that we take on this role of authority and in the end it is my license on the line and if I don't agree wiht something or a suggestion from my partner then I didn't do it. We of course talked about after the call but unfortunately my patient my responsibility my care. They are not mutually exclusive.

I have been in several situations where everyone but your's truly was running frantically trying to cover their own asses after a call went bad. In the end, I was the one suspended for 2 days or fired, in the end I had to face the patients attorney and mine. In the end, I know that I did right with the patient and there was no lawsuit moved forward but as for my so-called team-mates who so quickly abandoned ship when the weather got bad, what goes around comes around.

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.

just my 2 cents, adjusted for inflation - .004 cents

[Mateo_1387]

"It has to be this way because this is what *I* see and to hell with everyone else's input" then you *will* inevitably miss something vital and kill a patient.

Poor argument. This is not a cause and effect. Sure, it is possible to miss things, but it will not happen every time as you say. With a competent provider this should not be a common problem. If it becomes a problem then I did say

As a leader I should also be receptive to input from my team, but in the end I am "numero uno" when it comes to the care the patient receives..

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. That is why it is acceptable to have a suggestion, but when I call the shots I see the big picture and take everything into consideration. That is what you do as a leader.

If paramedicine is an individual sport, and each and every decision should be carried out by a paramedic because of what they're seeing and their analysis of the situation, WTF are you proposing we run dual medic rigs for? If it's just playing along to get things done, with you as the final "buck stops here," what are you going to do if your partner is ALSO a paramedic with the same constraints and responsibilities as yourself? If he/she sees something different and is *sure* that the treatment needs to happen their way, what do you do? Throw your equally certified/licensed partner out of the truck so you win?

I have always thought that a rig should have a single medic because it makes for strong providers. In the case of riding with a lower level partner they should have enough sense to know that they lack the education of a degreed paramedic.

As for a partner that disagrees with your patient care and is hell bent that they are right, then somebody is missing something major with the patient. How do you expect and answer for this? We will never know who is right in this context. Obviously one person knows what is probably going on, I guess all we can do is hope they are large and in charge.

Now, if medicine *is* a team sport, which I firmly believe it is, then the situation changes. The doctor, in hospital, is ultimately responsible for a patient's care.

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.

You do have to be aware that they might be seeing something you're not.(in reference to partners)

I agree, but this also works both ways.