Taking Vitals

[snoopy911]

A driver's license. Not an emt license.

I do not have to sign any reports or run sheets, since technically I am functioning as just a driver. In the state where I am working out of right now, with a EMT-B in the back, the driver is only required to be a first responder. So am not even technically required to be an EMT to drive for BLS, but of course I am.

He is not my regular partner, I am not on the schedule yet, just asked to come in whenever there are open shifts. I really don't have a choice or an idea of who I am working with till I get there.

[Don1977]

I don't know about your location, but here each provider has a license and the same level of training, which means you are equally responsible for the info contained in that report. Thus, each of you is supposed to sign each report.

As providers, you are both responsible for patient care. Now in the case of long time partners, you KNOW the other person and trust their skills. As an officer, in my agency, I am responsible for writing the report. I sign my name but print my partner's. I was told by our system folks this is acceptable. If there is an unusual call or want to clarify important details, I have my partner look over the report to add anything he feels is appropriate before I finish it. My partner is an excellent medic, has excellent skills and I trust his judgment 100%. If he says something, I believe it. I've known him for years, and he's been in this business almost as long as I have.

When I work with someone new, one of the first things I ask is if they want to see the report before they sign it or are they OK with me printing their name. Some do, although I have a reputation of being a stickler for details and my patient reports are very thorough.

As far as court cases go, I've never been a defendant, but have testified and done depositions dozens of times as a witness. The lawyers always want to know who wrote the report, and usually are the ones who need to testify, although sometimes, one partner recalls or sees something different at the scene than the other, so both testimonies are needed. Obviously, if you are being accused of something and patient care and/or treatment is in question, both providers need to testify.

Huh? How can you work on an ambulance without a license/certification?

Some Ambulance services in PA you don't need a DL to work there....trust me

No he is definitely not pulling my leg. This is not the first incompetent behavior i have seen from him. He is literally dumber then a bag of hammers. The next patient, I made him take a BP, he whined and complained about it the whole ride home, said he didn't have a stethescope, didn't feel like getting all the stuff out for a 5 minute ride, every excuse in the book. He can't lift a stretcher properly either, and almost caused me to drop a patient, and i did throw my back out a bit.

I don't have to sign any paperwork. I have nothing to do with any patient paperwork as long as I am "just the driver".

Are you sure he knows how to take a BP????????

Edited May 29, 2010 by EMTDON970

[snoopy911]

No, I am not actually sure that he can really take one. Do you think you could pass EMT school by faking it? He wants to start paramedic school in the fall. Scary!

P.S. Don this is in MD not in PA, and alot of the EMT's at this company only provide and do not drive.

[Don1977]

No, I am not actually sure that he can really take one. Do you think you could pass EMT school by faking it? He wants to start paramedic school in the fall. Scary!

P.S. Don this is in MD not in PA, and alot of the EMT's at this company only provide and do not drive.

oh ok, my company is like that....

Edited May 29, 2010 by EMTDON970

[HERBIE1]

A driver's license. Not an emt license.

I do not have to sign any reports or run sheets, since technically I am functioning as just a driver. In the state where I am working out of right now, with a EMT-B in the back, the driver is only required to be a first responder. So am not even technically required to be an EMT to drive for BLS, but of course I am.

He is not my regular partner, I am not on the schedule yet, just asked to come in whenever there are open shifts. I really don't have a choice or an idea of who I am working with till I get there.

Ah-gotcha. Most places around here require a drivers license- nobody functions as just a driver- even on BLS rigs, and both people need to be EMT-B's.

[croaker260]

Tell him that unless you know he has taken vitals, you will not sign the run sheet.

Do them yourself. After you load the PT, grab the BP cuff and ears and obtain the V/S. The guy will either be guilted into it while working with you or you simply do them yourself. Do NOT trust someone who is this blatant about poor patient care.

Years ago when I was on the privates, we were supposed to take a patient out of an ICU to go to another hospital. No special meds or drips, but it was someone with a very sick heart. We asked the nurse what the vitals were and she said- stable, normotensive. We looked at the guy and he LOOKED like he was ready to code. I told my partner to manually check his BP and it was 60 systolic. I told the nurse this guy was NOT stable and asked if they were going to do anything about the BP. She checked with the resident and he blew it off- "Just transport him". I said I was not comfortable with that BP and called our medical control. We were instructed NOT to take the patient. Of course the doc and nurse had a hissy fit, we put them on the phone with our doc, and the resident looked really sheepish. He hung up the phone and directed a tirade at us. We ignored the guy and walked away, expecting to catch hell from our bosses because we pissed off one of our big accounts. I told the boss the story and surprisingly, he backed us up.

It's your license to lose. Protect it and your livelyhood.

Or , if you had taken the transport of the unstable patient, then you could have ended u like the medics in the 10 million dollar lawsuit recently.

[WolfmanHarris]

Huh? How can you work on an ambulance without a license/certification?

Heck, due to a quirk in the language of the Ambulance Act, even all the Air Ambulance medics in Ontario still have to maintain a valid "F" Class license to work legally.

This is why I'm glad the ambu-taxi business is separate from EMS around these parts. With the thousands of routine transfers every day, placing a medical professional in the role of taxi driver, day in and day out is a recipe for complacency. Sure we do the odd stable, non-emerg IFT here, but they are rare and usually the patient has a complicated medical history to warrant a Paramedic crew attending. (In my district most are repatriations of recent MI's from the PCI lab to their community hospital.)

Now the transfer industry here is in desperate need of regulation and standards, but at least it's not part of EMS. None of those yahoos will find themselves running a 911 call the next day.

As for your partner, I'd suggest just doing it yourself until he gets the picture. When you put the patient on the stretcher just hold up for a minute in place and say "Hang on one sec, I'll just grab some baselines for you while you get history from the patient/staff."

Edited May 30, 2010 by docharris

[DwayneEMTP]

I Don't know what's best for you to do, but I can tell you with confidence the way the conversation would go with my partner and I....

"Did you get a manual pressure on this pt, or did you just trust the monitor cuff the whole way?"

"No man, I got some manuals, but the monitor cuff is good enough."

"I was watching and didn't see you get out or the intubation seat the entire transfer, when did you do your manuals?

"How about if you don't worry about it??"

"You should plan a meeting with the District Manager in the morning. I'm going to take it to him and allow him to sort it out."

At which point he would go to bed and in the morning he would burn my ass down for being a dipshit, pretend medical provider. And I couldn't respect that more.

The reason I'm saying that I can't tell you what to do is that, though I love his attitude, and his willingness to question me on anything and everything, not all services value that. If yours does, you should throw this lazy prick to the dogs. If they don't, then you need to balance your need to feed your family against a complaint that is likely to do nothing more than make you feel better, yet not change anything.

Decide now what type of provider you're going to be. I've known since treating my first patient that sooner or later I am going to be fired for defending my morals or ethics. I'm fortunate that my wife has made it clear that should I ever decide to injure my spirit to maintain my paycheck that it's best that I keep that to myself as I will not be considered a hero at home, but not all families are like that.

You must decide now, and every day, what you're willing to forfeit morally and ethically to maintain your job. If the answer is very little, to nothing, then create some paper on this shithead and help management begin the task of putting him in the unemployment line.

Not sure if this helps, but I find that the moral/ethical challenges of EMS make the medicine pale in comparison.

Dwayne

[HERBIE1]

Heck, due to a quirk in the language of the Ambulance Act, even all the Air Ambulance medics in Ontario still have to maintain a valid "F" Class license to work legally.

This is why I'm glad the ambu-taxi business is separate from EMS around these parts. With the thousands of routine transfers every day, placing a medical professional in the role of taxi driver, day in and day out is a recipe for complacency. Sure we do the odd stable, non-emerg IFT here, but they are rare and usually the patient has a complicated medical history to warrant a Paramedic crew attending. (In my district most are repatriations of recent MI's from the PCI lab to their community hospital.)

Now the transfer industry here is in desperate need of regulation and standards, but at least it's not part of EMS. None of those yahoos will find themselves running a 911 call the next day.

As for your partner, I'd suggest just doing it yourself until he gets the picture. When you put the patient on the stretcher just hold up for a minute in place and say "Hang on one sec, I'll just grab some baselines for you while you get history from the patient/staff."

This topic is just another small example of how different our systems are across the globe, and while many problems we face are similar, there is no panacea to cure all the ills because of these differences.

If it is a nonemergent transfer and the patient can sit in a wheel chair, we have "medicars" where the attendant only needs a D/L. If they go in an ambulance, both providers need to be at least EMT-B.

I Don't know what's best for you to do, but I can tell you with confidence the way the conversation would go with my partner and I....

"Did you get a manual pressure on this pt, or did you just trust the monitor cuff the whole way?"

"No man, I got some manuals, but the monitor cuff is good enough."

"I was watching and didn't see you get out or the intubation seat the entire transfer, when did you do your manuals?

"How about if you don't worry about it??"

"You should plan a meeting with the District Manager in the morning. I'm going to take it to him and allow him to sort it out."

At which point he would go to bed and in the morning he would burn my ass down for being a dipshit, pretend medical provider. And I couldn't respect that more.

The reason I'm saying that I can't tell you what to do is that, though I love his attitude, and his willingness to question me on anything and everything, not all services value that. If yours does, you should throw this lazy prick to the dogs. If they don't, then you need to balance your need to feed your family against a complaint that is likely to do nothing more than make you feel better, yet not change anything.

Decide now what type of provider you're going to be. I've known since treating my first patient that sooner or later I am going to be fired for defending my morals or ethics. I'm fortunate that my wife has made it clear that should I ever decide to injure my spirit to maintain my paycheck that it's best that I keep that to myself as I will not be considered a hero at home, but not all families are like that.

You must decide now, and every day, what you're willing to forfeit morally and ethically to maintain your job. If the answer is very little, to nothing, then create some paper on this shithead and help management begin the task of putting him in the unemployment line.

Not sure if this helps, but I find that the moral/ethical challenges of EMS make the medicine pale in comparison.

Dwayne

Well said, Dwayne.

You said a mouthful here. It's up to us to have our own moral compass, which I feel is far more valuable than medical knowledge and can be applied in our personal lives as well. Almost any idiot can commit EMS protocols to memory, but the true top notch provider lets his own personal ethics and standards dictate how they live their life AND do their job. I think too little emphasis is placed on this in schools.

When I teach my EMS administration class, I devote a great deal of time to ethics and morals, and how it relates to our profession. I propose difficult scenarios, we talk them out, and often times there is no "right" answer, just the best possible solution to a complicated problem. It's fascinating to watch the students express their opinions, and defend them. Many of these guys are firefighters, and they are used to black and white situations- if A, then do B. Rarely are you faced with a moral dilemma when fighting a fire, so many of them are uncomfortable with the topic at first. The variables of medicine ensure that as soon as we may become comfortable in our roles, a patient and/or a situation throws us a curve ball. I loved the fact that these guys were expanding their horizons and their thinking, and several have noted on my evaluations that they enjoyed being challenged like that.

I have used a similar scenario as this in the past, and it always generates a good debate.

[AT-Medic]

Tell him that unless you know he has taken vitals, you will not sign the run sheet.

Do them yourself. After you load the PT, grab the BP cuff and ears and obtain the V/S. The guy will either be guilted into it while working with you or you simply do them yourself. Do NOT trust someone who is this blatant about poor patient care.

Years ago when I was on the privates, we were supposed to take a patient out of an ICU to go to another hospital. No special meds or drips, but it was someone with a very sick heart. We asked the nurse what the vitals were and she said- stable, normotensive. We looked at the guy and he LOOKED like he was ready to code. I told my partner to manually check his BP and it was 60 systolic. I told the nurse this guy was NOT stable and asked if they were going to do anything about the BP. She checked with the resident and he blew it off- "Just transport him". I said I was not comfortable with that BP and called our medical control. We were instructed NOT to take the patient. Of course the doc and nurse had a hissy fit, we put them on the phone with our doc, and the resident looked really sheepish. He hung up the phone and directed a tirade at us. We ignored the guy and walked away, expecting to catch hell from our bosses because we pissed off one of our big accounts. I told the boss the story and surprisingly, he backed us up.

It's your license to lose. Protect it and your livelyhood.

Very good advice, and an excellent post. Way to stand your ground and do the right thing for the ICU pt, inspite of being pushed by the resident MD and the nurse!