Hospital settles for childs death, faults EMTParamedic

[VentMedic]

I am not against education, rather I am against being kept down by RNs.

Being kept down? No, that we did all by ourselves. If anything the RNs have supported EMS by helping to establish many Paramedic programs and foster continuing education. For their thanks, EMS providers have continuously bashed and insulted RNs for years. The RNs didn't tell us not to go to college or get our education in the backroom of a FD or ambulance station.

However, just like they fight to maintain the highest level of care possible inside the hospital, they expect others to step up to the plate. This included gnawing away at some of their own including LVNs. Every healthcare profession within the walls of the hospital has had to challenge nursing in some way. Guess what? That was done through education. Now almost every licensed professional inside the hospital has at least a two year degree. Even the phlebotomists are getting nationally certified for recognition in some states. We didn't join them in their profession but joined forces with them as educated and respected professionals. For those of us OJT tank jockeys in RT, that was quite a feat.

Why should be poor paramedic be treated any differently?

Every other profession knows there is a different between votech education and college degreed. To be an accountant one must have at least a Bachelors degree. And with that, this person may only get the entry level status of book keeper or file clerk at minimum wage until more eduation is obtained.

The skill set the Paramedic possesses is not unique (except for the places you work) as many other professionals can do the same things plus more both inside and outside of the hospital environment. The difference is the other professionals have an educational background from which to build upon. The education first, then the skills. My next comment is not meant to be insulting but some of the "skills" , including ETI, a Paramedic has is now EMT-B level. I cringe but again EMS has done its patch work of handing our certs instead of fixing the problems with any definitive solutions.

RNs and MDs love to teach but as I said in one of my posts, I, too, will not formally teach Paramedic students in a classroom unless college level A&P (both semesters) is a prerequisite. It is great to show interesting stuff here and there but there needs to be a structured foundation so what is being shown will have some true meaning. Too often people try to pigeon hole some disease process into some they thought they saw before and it could've been that.

Treating from the 12-lead along with other symptoms, which is what you are really treating, has been around for awhile. However, not that many services utilize the 12 lead and some are trusting the machine interpretion. ETCO2, another great device, is not well understood even on CCTs. There's so much work to be done within the EMS educational system. It is time to get qualified instructors and not just someone who can tell good field stories. Then, if the instructors had higher education, they could mentor others for higher education. No instructor who "got to where he/she is today and with no education" is providing the mentorship or foundation to make the EMS leaders of tomorrow.

RN and RT educators have at least a Masters degree with some teaching methods within that degree.

The statistics in this country for EMS providers that have little or no college education are overwhelming. The backroom medic mills at the FDs and ambulance companies have churned out some impressed numbers over the past couple of decades. Couple that with the private for profit medic mills and you have some very poor numbers to build a solid foundation from.

Start with raising the standards on the educators. Get all the programs accredited (in the works) to weed out the weak.

[ECC]

Wow Vent, you must have it rough. I have (along with many of my Fire Service Paramedic Comrades) very little contact with RNs (except the Triage nurse at the ED.

My Paramedic Program had no input from RNs. RN input in programs I am aware of is minimal at best. With the excemption of my ACLS refresher 6 years ago, and some CME regarding Helicopter Ops, I rarely even see RNs in educational roles. My monthly call review is given by my medical director, an MD. When I was in NY, my CMEs were given by other, capable, Paramedics...or MDs. So much for universal RN support or involvement in EMS

Being kept down by RNs...when I was in NY, we could thank the New York Association of Nurses for keeping licensure off the floor in the Legislature.

As for my skill set or what I do and know...dont assume...you are doing enough of that already. You are not getting another resume from me...that was several posts back. I can read and interpret ECGs just fine, ETCO2 and I was treating patients before O2 Sats became fashionable. :roll:

Lastly I will agree with you about our own role in keeping us down. You could not keep a bunch of EMTs and Paramedics together as a Union in NY until recently. We allow these Paramedic Mills to operate...and we fix their problem children into functioning paramedics and EMTs.

And thanks for targeting an off hand remark with a 10 paragraph diatribe without addressing anything else I said. :roll:

[VentMedic]

Being kept down by RNs...when I was in NY, we could thank the New York Association of Nurses for keeping licensure off the floor in the Legislature.

RNs again for fighting for raising the standards in health care even if it meant saccrificing their own (LVNs).

They're not against the EMT or Paramedic personally, they just prefer not to have "techs" doing advanced pt care procedures. If you (as a whole group) all had a two year degree, they probably would not have said a word. But, with the attitude and a medic mill cert, I can see their point of view.

I work with RNs on Flight, on Specialty transport teams and in the units. When you respect each others profession and learn how they compliment each other, it makes for better care for the patient.

Everyday I am in awe of some of the professionals that make up the heathcare teams. I always tell EMTs not to waste those precious BLS transports by copping an attitude. They should go into the hospital with their eyes wide open for all of the neatest medical innovations and care they might see. Networking with others is a great way to get respect by showing an interest in what they do and letting them know who and what you are.

I worship some of our Physical Therapists, Occupational Therapists and Speech Therapists. The rehab center puts the best gyms to shame. Their work at getting some of our near dead patients back to fully functioning people again is amazing. The research our Exercise Science and Cardiopulmonary Center is doing is astounding. Saving the patient's life is just one chapter. The end outcome is what matters and there are so many other professionals (nurses and RTs included) that work to make your effort in the field a true SAVE.

[scratrat]

Here's my two cents :

I've worked with paramedics that I would trust my 3 year old with. I've also worked with medics whom I would not let near my dog.

I've worked with nurses..........same as above.

Stop bashing each others profession. Each has different requirements, educations, and personalities. Neither is any better than the other, education or not. Like I said, I've worked with nurses who have a masters, and I was better off talking to a box of hair. And likewise, I've worked with medics with umteen hours of education and experience, and the same thing applies.

[scratrat]

Two more cents. I just thought of this, and it made me chuckle a little.

Medics tend to have a holier than thou attitude.

Nurses tend to have a snottier than thou attitude.

See? No difference...

[ambodriver]

Two more cents. I just thought of this, and it made me chuckle a little.

Medics tend to have a holier than thou attitude.

Nurses tend to have a snottier than thou attitude.

See? No difference...

agreed haha

[bigj1130]

I just want to add a few things on this topic and they are just observations not designed to offend, upset, or anger, and are merely points of discussion.

The forum has pretty much resigned itself to the fact that mistakes were made, be it by the EMT-P, The Hospital Administration, or the Primary care Physician.

I think the argument about Start Triage, JCAHO, MSE's and who can do them, and what went wrong for this kid are interesting.

That being said, I have very little experience with Bacterial Meningitis. I know the signs and symptoms that were taught out of my Bledsoe book. I also know the definitive diagnostic tool for Bacterial Meningitis is a spinal tap. Besides this basic info we are taught what should I know about Bacterial Meningitis? What kind of beneficial Field Tx. have you seen or done that works well for you, Aggressive fluid therapy etc? I am one of those medics who took a year long course and is now struggling to finish My AAS then Complete my BS.

OK I got that out of the way, now this might seem like stirring the pot but... I know some facilities have what they call a "quick look" where basically you register and they get your chief complaint then triage you based off that. It has been several years since I transported a patient to Ingalls in Harvey. Is it possible that what this article is referring to as triage was only something like that and therefore JCAHO compliant? Perhaps some of our members in the south burbs of Chicago can help me understand what it is that Ingalls does. These points are not intended to try the clear the paramedic of any wrongdoing or create any infighting either. If I knew this medic's I would make pretty sure he didn't "triage" my daughter if he can't spot a sick kiddo that needs to be seen. A sick kiddo is a sick kiddo in or out of the hospital. Just my 2 cents

[dougd]

So what do you think would happen to EMS if he went the route that Vent just showed us. What would the ramifications be to our profession if we were as structured as RT seems to be with all the requirements?

The ramifications: There would be a lot of people so worked up siting around IAFF and IAFC conference tables that blood would literally shoot out their noses.

[AndrewSchulcz]

I work as a EMT -Triage officer working alongside RNs for a mid-size Detroit hospital ER. I completely agree with Ridryder911's two points about Triage being a common spot to put burned out nurses (my interpretation, not his actual words)... and that in order to be done effectively, you must put a LOT of work into effective screening of patients... especially given the very brief window we are given to push patients down the cattle chute into the main ER.

Those two facts work against each other when it comes to performing triage, as I have many experienced and educated nurses that are so "not interested" in the patient. For example, the one who sits in front of them with a swollen tongue. Patient is given a low acuity level, sent to sit on a bed in the dark back hallway because no one noted the swelling for what it was. The patient then spent a week in the ICU after intubation as the tongue became swollen and obstructed the airway HOURS later.

Many (most?) times triage seems reduced to determining who has cardiac-related chest pain, all else can sit and wait. We are unofficially told to watch for whatever symptoms JCAHO is concerned with this year, and focus directly on them (like r/o STEMI), to the exclusion of others...

One thing I would love to see, although I know medical privacy laws would never allow it, is the list of WHO (what) ELSE WAS being triaged while this sick kid was "ignored". I have had many patients who complain that I was ignoring their vag bleed or their gangrenous leg over a chest pain, or a cyanotic lung CA patient. Since HIPAA is here, will we ever really know what ELSE this paramedic was actually facing in the lobby that night? Just like on the ambulance, the ED has a finite amount of resources! That agent, whether Paramedic/RN/PA/MD etc. has to make the best decisions- and the choices are frequently blurred. Tying green/yellow/red/black tags around toes in the waiting are does NOT go over well.

From my own experience being the first face patients see when they enter the ER, this limited resource point is very real to me! On an emotional level, I want to reach out and comfort the 26 year old female, 6 weeks pregnant who has just started bleeding and is likely losing her 3rd pregnancy in a row. At the same time, I am required to more promptly attend to the 65 year old COPD'er who set herself afire (again) while smoking using her nasal cannula and now smells like an overcooked meatloaf, while fashionably modeling a georgeous new blue skin tone. You take the obvious choice, only to be assaulted by the first patient's family member who swears that when they lose this baby, it is my fault, and I'll be sued.

So, I guess what I am saying, Triage can really SUCK! You can do the right thing, and people are still going to end up dying, even when every I is dotted, t is crossed and each tired cliche is used. If this girl was as sick as this article has indicated, yeah, he/she should've noticed. But again, what else was he/she also working on getting into the ER?

(Just my thoughts... let the yelling continue...)

[Ridryder 911]

I find it ironic that nobody recognized that the ENA triage program is 18 sections long. That in reality, maybe as long/ with associated clinical experience as a EMT program.. just the triage portion alone.

R/r 911