Pesky bystanders and stupid people who want to take CPR...

[Just Plain Ruff]

So do paramedics - they need doctors to work under also. Let's not forget that. Where do you think you get your orders from? Where do you think you get your protocols from. You also have to have a medical Doctor to be your service's medical director.

Standing orders are approved by physicians from where I come from so yes you do work under a doctor.

Yes the nurse was out of line but I believe that cotjockey was out of line too and her snappish comments only accelerated the issue.

[Asysin2leads]

While the attitude may need a little tweaking, I think that he has a right to be annoyed. I'm amazed at the number of doctors and nurses who are completely ignorant of prehospital emergency care. I don't go up to a construction worked and tell them how to rivet, so why is it okay for people to tell us how to do our jobs.

As for the CPR thing, well, there are dumb people in the world, but we still need them for bystander CPR. Do your best.

[AZCEP]

My customer service skills are unmatched... but they are for the customer, my patient, not for bystanders and not for off duty medical personell that don't have there own medical license with which to work under ( nurses still need doctors to work under ).

Anyone and everyone that you come into contact with is a customer. I know, I had a hard time listening through that seminar as well.

Telling anyone something that feels good at the time is usually a bad idea. Without being on scene, I won't second guess what was done, but my own history leans toward making the public less than happy with what I have said. Act like a professional, look like a professional, if you want to be treated like one.

[Asysin2leads]

That's not true. Too many services believe they need to run their service like a customer service based for profit business. That's not what EMS is about. Do providers need to maintain a professional and caring attitude towards their patients? Yes. Do providers have to bend to every whim of the patient to ensure 'good customer service'? No. My job is not to make people happy, or put on a show, or sell goods, my job is to provide the appropriate medical care. Unfortunately, many administrators of ambulance services are so far removed from the operations level, they try and run it like Wal-Mart or Starbucks.

[cotjockey]

I knew the patient was diabetic because we pick her up every other week or so. I did ask the RN what she found and she said, "This lady is sick." I then asked if she could move out of the way so I could start getting vitals and things when we started the "But I'm an RN" conversation. I'll admit I should have handled it better, but sometimes the only thing that works is saying "You need to move so I can close the door" instead of "Excuse me." "Excuse me" doesn't always work. I really think she was out of line to be questioning what we were doing...again, I don't walk into L&D and ask her if she checked with the doctor before she increased the pit...I know that L&D is her world and I trust her to do her thing. If we were doing something obviously negligent, sure she would have the right to intervene, but we were doing exactly what needed to be done.

I don't have an issue with nurses in general...just a few that I never really got along with in the first place. When I worked at the hospital, I got along with everyone pretty well...sure I did the head butting thing on occasion, but everyone else did too. This particular RN is generally awesome...more than anything, I think she wasn't thinking Saturday afternoon. I also think that a lot of them forget that when I step outside the hospital doors, I have a totally different scope of practice...I can do all sorts of things that I can't do as an LPN. It's pretty rare that I will pull the cocky paramedic bit with people, but occasionally, it needs to be done...just like they sometimes need to do the "because I'm an RN" bit with me.

This was more a vent than anything...sometimes I think we all need to spout off a bit about the things and people we encounter. I'm sure she would complain about me equally if I wouldn't get out of her way while trying to provide care for one of her patients.

[cotjockey]

I have to wonder what the reaction would be if the story were told from the RN's point of view.

I was walking out of Burger King, when I heard someone screaming for someone to call an ambulance. I went over to investigate and found a lady slumped over the steering wheel of her car...she was barely responsive. As I tried to talk to her, someone came up to me and said, "Hi Kelly, what do we have?" I told her that the lady was very sick. She asked me to move and I told her, "I am a RN." She countered with, "But I am a paramedic." I again informed her that I am an RN and she told me, "OK...but I have D50." What was she going to do with D50? They got the woman into the ambulance and I went over to see what they were going to do. They pulled her coat over her head even though it was freezing outside and they began their search for a vein. When they finally found one, they inserted the line and started pushing D50 without even calling the doctor to ask permission. I asked them if they had called to get orders and one of them said, "No, we don't have to." Another one said, "You'll need to move so I can shut the door." I stood there for another minute or so when she said, "I'm shutting the door...move." How rude! I am an RN...I used to supervise the one who told me to move when she worked at the hospital...and now she is telling me to move? And these EMTs are telling me they don't have to ask permission to give meds? What is that about?

[PRPGfirerescuetech]

That's not true. Too many services believe they need to run their service like a customer service based for profit business. That's not what EMS is about. Do providers need to maintain a professional and caring attitude towards their patients? Yes. Do providers have to bend to every whim of the patient to ensure 'good customer service'? No. My job is not to make people happy, or put on a show, or sell goods, my job is to provide the appropriate medical care. Unfortunately, many administrators of ambulance services are so far removed from the operations level, they try and run it like Wal-Mart or Starbucks.

I disagree with you on this.

Your job is not medical care, nor customer service. Its both. To do just one or the other, does not accomplish the job.

EMS as a whole is simple.

Patient requests service.

We provide service.

Patient gets bill.

Patient pays for service.

Simple as that. No if's, ands or buts.

Simply broken down, this EMS equation is the same as requesting a handyman to fix your dishwasher.

Request service, provide service, bill, and payment.

EMS is a customer service based business. Ambulances aren't the only mode and method of moving a person who is ill and injured to a hospital for treatment. Wonder why we get no respect? One reason is why we dont give it.

As an administrator of several current businesses, and a prior EMS administrator, I have always looked at the bigger picture. Everytime you aren't courteous to a patient, that patient thinks twice about utilizing your services in the future. This creates PR issues. This creates a decrease in volume. Its a snowball effect. This cant be allowed to happen. Especially because the crew decides the aren't going to take the extra step to provide quality care, and customer service.

Always remember, NOTHING SAYS A PATIENT HAS TO CALL 911.

[Asysin2leads]

Nope, sorry, I'm going to have to disagree with you on this. For a transport service, yes, its a customer based service, supply and demand, keeping the customer happy, et cetera. But on the 911 end of it, it is an emergency service, just as important as a police or fire response.

However, because of the consumer culture of the United States, patients expect that they can place the same demands on an service provider that they can on as you say, a mechanic or a repairman.

This is not the case. Medicine is about doing what is appropriate for the patient, not what makes the patient happy. Sure, usually they're the same thing but not always. I'm not going to risk an injury to myself or my partner just because the person who called the ambulance wants to be carried today, if they are fully able to walk. I'm not going to push diazepam because the patient is feeling a little anxious and wants to take the edge off. I will do these things when I deem it medically appropriate, not when the patient does.

Don't believe me that consumer culture has no place in emergency services? Listen to the 911 tape of the woman who called Burger King to have the cops come down to have her burger made the way she wanted. By your rationale, to keep the consumer happy, we should rush down there to try and fix the problem.

I guess where we differ is that I believe that people shouldn't call the ambulance unless they really, really, need to, but you believe that since we can generate a bill, the more time someone calls 911, the better. Maybe it'll make you money, but that ain't right.

When it comes to emergency medicine, the customer is not always right.

[PRPGfirerescuetech]

Nope, sorry, I'm going to have to disagree with you on this. For a transport service, yes, its a customer based service, supply and demand, keeping the customer happy, et cetera. But on the 911 end of it, it is an emergency service, just as important as a police or fire response.

However, because of the consumer culture of the United States, patients expect that they can place the same demands on an service provider that they can on as you say, a mechanic or a repairman.

This is not the case. Medicine is about doing what is appropriate for the patient, not what makes the patient happy. Sure, usually they're the same thing but not always. I'm not going to risk an injury to myself or my partner just because the person who called the ambulance wants to be carried today, if they are fully able to walk. I'm not going to push diazepam because the patient is feeling a little anxious and wants to take the edge off. I will do these things when I deem it medically appropriate, not when the patient does.

Don't believe me that consumer culture has no place in emergency services? Listen to the 911 tape of the woman who called Burger King to have the cops come down to have her burger made the way she wanted. By your rationale, to keep the consumer happy, we should rush down there to try and fix the problem.

I guess where we differ is that I believe that people shouldn't call the ambulance unless they really, really, need to, but you believe that since we can generate a bill, the more time someone calls 911, the better. Maybe it'll make you money, but that ain't right.

When it comes to emergency medicine, the customer is not always right.

We disagree for once. 1st time for everything. Meh. As a proverbial white flag of truce, heres a photo of two dancing cats for your amusement

[Asysin2leads]

I like kitties!