Difficulties with Paramedics as EMT's

[PRPGfirerescuetech]

I find it funny this comes from someone who described his occupation as "God".

But seriously, I agree with what you've posted here as well as with your follow up . Most of this bugs even other paramedics, too. So don't think it's just a EMT perception of medics.

-be safe.

LOL, yes, I also have a god complex. Does that make me a "EMTGod" or a Basigod"?

For another day I guess. Your right in your thought though....

[PRPGfirerescuetech]

You know, the other thing is that legally speaking, if an EMT screws up while working with a medic, the medic will hang for it. So, if I have to be a jerk and maybe hurt someone's feelings once in a while to prevent myself from ending up in front of a sleazy man in an overpriced Armani suit during a deposition, so be it. If the game is to rough for you, get off the field.

Your wrong on this actually. The EMT and Medic will hang for it. Similar to a nurse fouling up a med dose and killing someone. The nurse hangs for the mistake, the doc hangs as her overseer, and up the chain. For some reason, people see BLS as being liability free in the chain of events in patient care. There not...

Matter of fact, if YOU screw up, and the EMT has the knowledge to have stopped you, the EMT is just as liable.

In the litigious society were in, no one is free of legal implications in this business.

[Asysin2leads]

No, actually I'm not wrong on this actually. I didn't say the EMT would be held blameless, I mearly stated that if he or she did something asinine the medc would swing for it. Personally, if I'm having my whole life flushed down the toilet because of somebody else's behavior or action, then it is only small consolation that the other person is forced to find a new hobby.

Lets take an imaginary but I don't think too far fetched scenario.

Let's say me and my good buddy Randy the EMT are working a head injury patient. We'll have an unconscious but breathing patient with suspected head injury. All the spinal immobilization and BLS and scene safety happy stuff is taken care of peachy keen.

Me: Okay, Randy, start hyperventilating the patient while I prep to intubate.

Randy: Intubate? He's breathing pretty well. Why don't we just bag him until we get there with an oral airway?

Now, how exactly should I respond? Should I give Randy a crash course in the protocols of suspected head injury, or should I just ask him again real nice, or do I have to be a bit of a jerk to save time so we can get the nice patient to the hospital? What should I do if he continues to argue? What if Randy goes down to his watering hole later and talks about the idiot medic he worked with who was overzealous and didn't know what he was doing and people listen to him? How can I work through this situation without seeming like a 'paragod'? Please, let me know.

[Dustdevil]

Your wrong on this actually. The EMT and Medic will hang for it. Similar to a nurse fouling up a med dose and killing someone. The nurse hangs for the mistake, the doc hangs as her overseer, and up the chain. For some reason, people see BLS as being liability free in the chain of events in patient care. There not...

Litigation-wise, you are correct. But operationally, I believe you are off the mark.

Look at your own example in the broken monitor cables thread. You, like many, were looking for one person to punish and place all blame on. And, unfortunately, that is a pervasive mentality in EMS where "supervisors" are usually nothing more than the medic who has stayed around the longest, and have no formal education in supervisory or management practise. Management philosophy commonly focuses on making a public example out of some poor sap in order to intimidate the others, but specifically NOT placing blame on all who hold responsibility because replacing one suspended medic is easier than replacing five of them. Consequently, true remedial discipline is disregarded for managerial expediency. So yeah, Asys is spot on, as usual.

[ncmedic309]

No, actually I'm not wrong on this actually. I didn't say the EMT would be held blameless, I mearly stated that if he or she did something asinine the medc would swing for it. Personally, if I'm having my whole life flushed down the toilet because of somebody else's behavior or action, then it is only small consolation that the other person is forced to find a new hobby.

What I'm really getting at is attitude. Yes, even the non-psychological complex medics can be pushy jerks at times, but its not a power trip, its a matter of survivial. You want to be a hero and do things your way and all that happy cowboy horsecrap? Fine, here's a Gall's catalogue, have a blast.

I have a life though. I have rent and bills to pay, and a whole bunch of things that depend on me having a job to support myself. So if I have to be a little pushy about it, so be it. If make someone feel inferior because they were about to do something that to get me fired, I'll drive them to group therapy and we can all talk about our emotions. I have orders to take and procedures to follow that are really not open to interpretation from the peanut gallery. If an EMT has a problem with that, I really don't care and I really don't think I need to express that in a positive constructive manner. I mean, sure, I'll try, but if push comes to shove, I'm going to get my way one way or the other.

I agree with you, when it comes to protecting your career, you have to do what's necessary to take care of business. I think it's wrong that any person should reap the consequences of somebody elses mistake. If your trained and certified, you should know your scope of practice and your limitations, and you should be held to them at all times. If you deviate from them then you should be punished accordingly. You can't prevent the actions of some idiots, but you have to look at it from the stand point of "we have a fucked up government and nothings going to play in your favor when it comes that time..."

[Nate]

OMG, now I know why I don't post a lot over here anymore.

[DCMed124]

I'd like to throw 2 cents on this one... with the understanding that I'm still the new guy in EMS and whatever I say is solely applicable to myself.

Dust.. I respect the hell out of you. you've proven yourself to be amzingly smart, talented, and experienced.

that having been said, you posted the following in the medic thread... (in the interest of brevity, I'll only paste a few)

/quote

EMT argues with paramedic who chooses a scoop stretcher to move a patient instead of a long board.

EMT argues with medic who places high flow oxygen on a distressed COPD patient.

EMT argues with medic who gives only D50 to the unconscious diabetic instead of the whole "coma cocktail."

EMT argues with medic who intubates a patient who is not in full arrest.

EMT argues with medic who runs a non-rebreather at 12 lpm instead of 15 lpm.

EMT argues with medic who doesn't let him drive hot to the hospital with non-critical patients.

/endquote

ok... I can certainly see how those would grate on you. I'd ask you though (while hiding behind the garbage can lid) did you intubate the patient not in full arrest while the EMT stood around doing nothing? or was there some verbal discourse along the lines of "hey EMT, I'm going to do <insert procedure here> 'cause <insert intructive reasoning here>.

I guess what I'm asking (and I have to ask since I've never ridden with you and have no other way of knowing) do you teach your EMT as you're doing a procedure? I'm seriously thankful for the medics I run with. They always will give me a running dialogue of what they're doing and why. I catch and comprehend about 75% I'd say, and we debrief afterwards for the rest.

I can't agree enough that education is paramount (not just in EMS by the way). I'd also submit that education occurs more outside the classroom then in (also not just in EMS by the way). I can't tell you how many times during EMT class I thought to myself "self... remember when Medic001 did THIS? HERE'S why..." or some such thing.

I'll admit to probably having more to learn about EMS then anyone else on this board. However, I DO know how to learn. I'm pretty good at it. Not for nothing, the trick is in finding the good teachers.

/flame on... got my garbage can lid deflector firmly in place.

[Nate]

Most of the things that were quoted should be known by the average EMT-Basic. My EMT's don't argue with me, and from what I've seen with their interaction with other paramedics, they don't argue with them etiher. Point being, you don't argue with the person who is of a higher patch unless you see them about to do something very wrong (such as intubate a person who is talking to you and has nothing really wrong with them other then they are really freaking annoying). They will ask questions such as what does that do, or would this be the next step on patients who are out of it. If the patient is A&O x 4, then they will usually hold those questions until after the call because they don't want the patient to think that only one person on the truck knows what they are doing.

With that being said, damn well near all of my EMT's that I run with know what every single drug in that bag does, what it is used for, and what is going to be needed in association with the drug. Most of my EMT's know what I'm about to do, so when I'm going to give Lasix all they ask is "what size syringe would you like?" The got that because when they showed up on day one they went through the ambulance, they did that on day two, three, four, etc. until they knew every single object on that ambulance and it's use. When a rookie comes in, I show them my squad, my bags, and explain anything they aren't clear about. I don't expect them to know it the first time out, but by the sixth time they should have a pretty good understanding.

I'm damn proud of them, and I'll stand behind every last one of my crews. I believe in them, and would put any of them against any other EMT on this site. Call it cocky, I call it a good crew. They like to be the best, they know they are the best, and most of them are headed for bigger better things (nursing, paramedic, other four year degree fields). They didn't get this way simply because I told them this or that, they are this way because we communicate, we talk things over, and most importantly, THEY WANT TO BE THE BEST.

My belief is this; we are the same people outside of EMS, we are the same people in the station, the only difference between you and I is the fact that I'm the highest ranked person on the ambulance. Outside of that call, we are the same. So I treat them with respect, they treat me with respect, and we provide great patient care. The end result of the crews I work with is:

[*]Fewer work related accidents

[*]Fewer mistakes made in regards to patient care

[*]Incrased understanding of the EMT-B level

[*]Good base for advancement to other levels

[*]Awesome work environment

[*]Less stress, everyone has a good time

[*]The formation of a working relationship that allows crews to come together as a district/station/service and handle just about anything

What those of you who have issues need to do is get off your fat, lazy butt and start freaking talking to your paramedics/EMTs and opening up those channels for communications. I'll be the first one to say my service has it's downfalls too, but after hitting rock bottom a few of us paramedics and EMTs said screw this, we can do better then this. So in the end we have what we have, but that isn't possible if we don't trust each other, talk to each other, and respect each other.

Grow the hell up or go find another career path to follow, this field is to damn important to have a bunch of babies who can't get along.

[cosgrojo]

What those of you who have issues need to do is get off your fat, lazy butt and start freaking talking to your paramedics/EMTs and opening up those channels for communications. I'll be the first one to say my service has it's downfalls too, but after hitting rock bottom a few of us paramedics and EMTs said screw this, we can do better then this. So in the end we have what we have, but that isn't possible if we don't trust each other, talk to each other, and respect each other.

Grow the hell up or go find another career path to follow, this field is to damn important to have a bunch of babies who can't get along.

Nate- Thank you... Thank you for bringing in a little sanity to the subject. The whole premise of this thread is infantile. "BOO-HOO why can't we get along? What do you hate about your paramedic? Now let's discuss the possible solutions...."

Here's a solution.... Why don't we grow up and start treating eachother like adults? We are an industry full of people with tremendous skill. Unfortunately we haven't developed the ability to manage our skills in regards to playing with others. We are a bunch of catty adolescents that need to be the one who is right. You are wrong, I'm right... na-nee na-nee noo-noo!

We all have our roles, we all have our strengths. Why we have to complain about each-other's roles is beyond me.

I've been staying away from this thread, but I had to back Nate up on this.

[Dustdevil]

ok... I can certainly see how those would grate on you. I'd ask you though (while hiding behind the garbage can lid) did you intubate the patient not in full arrest while the EMT stood around doing nothing? or was there some verbal discourse along the lines of "hey EMT, I'm going to do <insert procedure here> 'cause <insert intructive reasoning here>.

That's actually a very good point, DC. Communications is a two way street, and it only works if both parties are capable of listening and comprehending at least as well as they speak. It is crucial to the success of a partnership. And that is exactly why the better paramedic programs require a course in college Speech and Communications.

I am very patient and communicative with my partner. In fact, as you might imagine, most of them want me to STFU. But the situations I was speaking about were not simple questions or discussions about treatment options. They were flat out insubordination. They were undereducated EMT's who got mouthy and either interrupted my plan for a loud debate, refused to follow orders, or even physically interfered with my treatment because they thought their month of night school taught them everything they needed to know about emergency medicine. Explaining things to them doesn't work, no matter how hard you try. Their school and their instructor and their education is the "best in the state," so if I'm doing something that they didn't learn in school, then I must be the one who is incompetent. :roll:

I am a medic with a lot of patience and understanding for my partners and students. It is my goal to ensure their success, not to weed them out. I bend over backwards to help them in any way possible. But quite frankly, some people are beyond help. If you just aren't getting a grasp on medical concepts, I'll do all I can to help you. But if you have a bad attitude, I don't give a rats arse how well you did on NR or how much experience you got as a junior member of the volly squad in Hooterville when you were in high school, you're useless to me and to my patients, and I will not waste my time or sanity trying to help you change that.