New Partner.

[eCamp91]

4lpm nasal.

Aspirin if none taken within 24-hours

Ask if Viagra had been taken; male and female.

Nitro if no Viagra.

Paramedics need to obtain 12-lead (if possible.)

No, keep this alive if need be. You're educating me, as well. I'm not getting offended. I'm open for talk.

If you want to keep talking directly shoot me a PM. We can go more in depth with it.

[Bieber]

I suppose another question to ask might be? How open is your service to protocol deviation? Do they expect their paramedics to think critically or to simply follow protocol to the letter?

[island emt]

That is a simple recitation of a cookbook medicine protocol.

Do you know when to and when not do do the above & why?

Why are you giving the aspirin? according to current AHA practice recommendations are to give 325mg even if they have taken a daily dose :: UNLESS ???

what effect does it have on the cardiac system?

Why are you giving the O2 by nasal@ 4lpm?

What are the effects and contra indications for giving nitro?

It's a little more than asking if they're taking viagra or ciallis or levitra.

I'm not busting your chops here really. These are just things you have to know before blindly going down the cookbook medicine protocol.

Education is a wonderful motivater knowledge is king!

I would expect that before giving nitro that a 12 lead would be done to rule out a few things and IV established. Do you know why?

Peace

edit to add: The answers to the above are things that any provider should have in their knowledge base, Even at the Basic level.

The first rule is : Do no further harm!

Edited October 12, 2012 by island emt

[RuralKSEMS]

That is a simple recitation of a cookbook medicine protocol.

Do you know when to and when not do do the above & why?

Why are you giving the aspirin? according to current AHA practice recommendations are to give 325mg even if they have taken a daily dose :: UNLESS ???

what effect does it have on the cardiac system?

Why are you giving the O2 by nasal@ 4lpm?

What are the effects and contra indications for giving nitro?

It's a little more than asking if they're taking viagra or ciallis or levitra.

I'm not busting your chops here really. These are just things you have to know before blindly going down the cookbook medicine protocol.

Education is a wonderful motivater knowledge is king!

I would expect that before giving nitro that a 12 lead would be done to rule out a few things and IV established. Do you know why?

Peace

edit to add: The answers to the above are things that any provider should have in their knowledge base, Even at the Basic level.

The first rule is : Do no further harm!

12 lead and 15 leads are used to rule out certain kinds of MI's. There are studies that say one incidence of hypotension can dramatically lower survival rates in certain types of heart attacks. Nobody below a paramedic is allowed to give nitro in our service anymore for this reason You need to know what kind of heart attack is going on if you can. STEMI protocols can also be enacted per your system if you have certain types of heat attacks. In my protocols, there are set parameters for when the medics can give nitro (certain types of MI's, bp above 100 systolic, etc). It's not just blindly given anymore. Also, I'd do 15lpm by NRB because the pain is caused by heart muscle dying due to lack of oxygen.

Aspirin is an anti clotting drug. It will help stop any NEW clots from forming and doing more damage.

And some kind of pain medication would probably also be lovely from the pt's point of view. I'm not totally for sure if this is all correct, but then again, I'm not a paramedic either

[Bieber]

12 lead and 15 leads are used to rule out certain kinds of MI's. There are studies that say one incidence of hypotension can dramatically lower survival rates in certain types of heart attacks. Nobody below a paramedic is allowed to give nitro in our service anymore for this reason You need to know what kind of heart attack is going on if you can.

That's interesting. So EMT's aren't allowed to give a treatment which patients can give themselves?

EDIT: Another question regarding this point... what does your medical director say in response to the fact that, elsewhere in the country where EMT's can still give nitro, there does not seem to be a mass of deaths from EMT's giving nitro? And exactly what is the environmental factor there in Rural Kansas that makes EMT's giving nitro much more dangerous than EMT's elsewhere in the country?

Also, I'd do 15lpm by NRB because the pain is caused by heart muscle dying due to lack of oxygen.

Couple of questions...

If it's a thrombus that's obstructing blood flow to the region of the heart experiencing the MI, how is oxygen going to get around that? It's not a thrombolytic, you know. Also, if they're already sating >/=94%, why do they need additional oxygen?

Aspirin is an anti clotting drug. It will help stop any NEW clots from forming and doing more damage.

And some kind of pain medication would probably also be lovely from the pt's point of view. I'm not totally for sure if this is all correct, but then again, I'm not a paramedic either

I think you were correct except for the suggestion of oxygen for an MI. =)

Edited October 12, 2012 by Bieber

[MikeEMT]

I give everyone a chance. I don't care what other people say, I will form my own opinion of you.

Whether I like you or not is a moot point though. It makes for a loooong shift if we don't get along but my ultimate goal is patient care, not being popular or finding drinking buddies. As long as you do no harm to the patient and have their best interest in mind then we will be fine.

I don't like reporting people for what I don't know. I don't know ALS protocol and I am not a medic. Do something neglectful, or to harm the patient and I will be all over you. My name is on that PCR too, and I won't have anyone dragging me down because of their own ineptitude. I earned my basic and I will be damned if I will lose it over someone elses stupidity.

If I were you - first day you have a heart to heart with him. You outline your expectations to him. Be proactive as well and find out what he expects of you. Maybe he is perceived as a jerk because he has had crappy EMT's. If I were on an ALS unit, I would want to learn ALS protocols and techniques. My job as a basic is to assist the medic and If I can educate myself in what their role is I can help speed things along.

Just because your BLS doesn't mean you can't educate yourself in what his role is. You may not be allowed to give IV's, but nothing says you cant prepare the set up. You may not understand the different arrythmias, but what is keeping you from applying the 12 lead for him?

Im not a medic and I don't use 12 leads, but if I was a couple of minutes away from a hospital I might not apply a 12 lead either. What is going to be more effective for patient care: applying a 12 lead with all the wires dangling and the heavy monitor, or load and go the 2 - 3 minutes to the ER? Hard to answer that one.

Bottom line...ignore the "gossip" and form your own opinion. If you go out of your way to be the best EMT and he is still a jerk then the problem is his. It will catch up to him at some point. However, if you listen to the gossip and go in thinking he is a jerk, then you are as guilty as him and you deserve the blame for a bad partnership as well.

Pick your battles carefully.

[scratrat]

I have to agree with Mike. He may well just be an asshole, or he's just had horrible EMT's.

Like he said, ask about YOUR expectations. Ask what you can/cannot do, or want he doesn't want you to do.

Personally, my peeve was the drug box. We have narcotics that I'm responsible for. Unless I ask, don't touch my drugs. Other than that, I'm happy to educate and show you how to do a 12 lead, what I'm looking for, why I am or are not administering a medication.

But like many people have said, form your own opinion. Learn first though. I couldn't help but notice you mentioned his lack of following protocols was that he wouldn't use a monitor when he's 3 minutes from the hospital. I probably wouldn't either. Why sit on the side of the road when the hospital is 3 minutes away?? Things like that aren't a big deal, so I wouldn't form your opinion around that.

[mikeymedic1984]

Back to your original question:

1. As suggested work with him and observe his behaviors and treatment before you judge.

2. Suck up to him, tell him you want to learn from him, realizing the book knowledge you have gained is about 1% of what you need to know. Sounds like a burn-out, who needs a different career.

3. When you see something questionable, wait until after the call and ask him about it face to face in a calm and private manner (You know, they told me in school that anyone with a glucose of less than"x" should get D50, but you gave oral orange juice, Why ?)

4. If he is a burnout worthless slug, explain to him that you will not tolerate any behavior that puts your job/license at risk; start making a private list of your concerns that you can take to a supervisor shift 1, didnt take B/P on refusal pt, shift 2, didnt immobilize someone I thought should have been, shift 3, told radio there was no patient at the scene and went 10-8, when there was a drunk homeless pt there). If he is worthless and cutting corners, he needs to be counseled and set back on the right path. It makes the supervisor's job easier when he has a documented list that is somewhat verifiable by witnesses, than just listening to you say he is "lazy" and you want a shift change.

[eCamp91]

Sorry guys for the late response. Been putting in a lot of hours, you know to get rich, eventually. Ha.

I totally agree with everyone's response. I really do. I truly appreciate you guys replying and giving me some insight on this and I can say it helps.

But I shall be back Saturday with an update. My first unofficial shift with my new partner. ^.^

You guys/gals be safe out there.

[Mateo_1387]

Good luck with your situation. It should teach you something, weather it be medical or social skills.

Only thing I really have to add is that I'm a firm believer in we teach others how to treat us. Keep that in mind. From your responses, you probably already have a sense of that though.

My $0.02...

Matty