Need ALS feedback

[Janmarie3]

Sounds like to me that the Paramedic probably seen that the patient was on some Beta Blockers and probably had a history of atrial fib, not atrial flutter. As well, since he was not hurting he is asymptomatic, and really there is nothing to physically to do. However; he was definitely wrong on his examination, assessment and even treatment skills.

For the patient was a diabetic, and had history of of some symptoms, then your obligated to assess the patient. Yes, he is definitely wrong if he did not cardiac monitor, and at least perform a FSBS and yes he should had transported!. For as oxygen therapy, that is good, but really unless it is ectopic beats, caused by hypoxemia, it is not going to change anything.

Thank you that answered my question

As for the rest of your comment.......I didn't call for the medic...he was dispatched along with us from central who determined the call to be ALS. My job is to get onscene, assess the patient and determine if I need ALS or not. If I had thought that there was nothing more the medic could do that I could do...I would have canceled him. I don't carry a heart monitor and considering the patients age, hx of heart and an irregular heart beat of which being told that it was NOT normal for this patient. My concerns for him increased and I did not cancel the Medic.

I didn't tell him how to do his job, granted I was not tought pharmacy but I asked him why he didn't do the things that I thought he should have from my own experience with running with other medics who would have taken the time to evaluate and check my patient out. I think it was in my own best interest if I was to run into this again if I should chance it and cancel the medic and end up with a full blown heart attack on my hands....or keep him coming. My chewing a medics butt isn't as bad as it sounds...but I did question him and I thought I had a right to know where his head was.

As for Diplomacy? I know you don't know me....but here it is.

I do and I have assisted many medics and have learned a lot from them...I enjoy them and they enjoy me. In fact they are more then happy to come this way when I'm on shift, because they usually know that if I keep them coming...its something serious. And they know that I have their backs at any given time. This medic I usually don't run with and when I have in the past he has been excellent. I didn't throw any stones at anyone. It was a good conversation...he let me say and ask and vent my frustration about the call... and he listened to me...even though I did not agree with his answers and we left on good terms. I think he realized he should have done things differently. I hope.

[Janmarie3]

I would hate to see the remainder of you after you attempted to chew my butt out.. and you were the one who called, and lacked the knowledge, experience, and skill to do anything but slap oxygen on him.... be forwarned, your name will be remembered!R/r 911

I hope my name is remembered...because I was the one who actually gave a damn and I won't tolerate a medic belittling an EMT because of lack of skill or knowledge that they do not teach us in the first place...from my understanding we are all in this together and I believe that is correct. I appriciate your comments and I respect what you had to say. But you had to be there Rid to fully understand before you accuse me of being a bitch to the medic.

[kevkei]

I hope my name is remembered...because I was the one who actually gave a damn and I won't tolerate a medic belittling an EMT because of lack of skill or knowledge that they do not teach us in the first place...from my understanding we are all in this together and I believe that is correct. I appriciate your comments and I respect what you had to say. But you had to be there Rid to fully understand before you accuse me of being a bitch to the medic.

I believe Ridryder was making reference to the Medic on the call and using it as an example of how to tread carefully in your workplace.

Remember, we are hearing your side of the story and are absent of the Medics side to see what he saw and thought. Don't assume that you know everything and start blaming them for being wrong. Maybe in this case you were right, but what about the future? You had better be damned sure to be 100% correct to challenge them to their face. For example, you felt they were in atrial flutter but what if the Medic said 'no, it's a-fib' and he has a history of this based on his medications (first clue is he is on blood thinners).

As for going around behind their back, it sounds to me like the guy admitted he made a mistake and attributed it to work load. Can you tell me you have never taken a short cut or not done something for a patient for personal or selfish reasons? We are only human.

To be specific, there is nothing with the first patient that screams out at me that this needs ALS intervention. Weak and dizzy is a very common complaint amongst the elderly and the majority of times it is very benign. Could also explain him being pale, 'shaky' and the elevated BP, due to the catecholamine response.

The second patient sounds very vague. In the end, what is it you expect? So if they were wrong not putting O2 on, why didn't you?

Something else to consider is, what are the ALS resources like in your area? For example, what is his train of thought to tax resources that don't absolutely require ALS in the event a cardiac arrest comes in or an MI? It's also about triaging and prioritizing.

[Ridryder 911]

Like I said, I believe he was wrong in his assessment and follow up, by not assuming care and monitoring FSBS level. (Yes, I quite aware that basic not able to FSBS, a shame but that is a different post)

As kevkei was describing, he admitted to it, as well as you had previously stated you chewed his butt, now admit more of a discussion. The main point is .. Yes be a patient advocate, ( I am and have no rear left) but since you are new and want to progress in the food chain of EMS, pick your battles very wisely.... wrong or right this business, can be ruthless...

Good luck,

R/r 911

[Nate]

That medic would have been fired on the spot had he been employed by either service I work at. If he can't handle working the hours he works, then he needs to do something about it...after the call. I think you were doing yoru job 100%, but your patient suffered because of his lack of drive to be a decent ALS provider.

[Janmarie3]

I believe Ridryder was making reference to the Medic on the call and using it as an example of how to tread carefully in your workplace.

Remember, we are hearing your side of the story and are absent of the Medics side to see what he saw and thought. Don't assume that you know everything and start blaming them for being wrong. Maybe in this case you were right, but what about the future? You had better be damned sure to be 100% correct to challenge them to their face. For example, you felt they were in atrial flutter but what if the Medic said 'no, it's a-fib' and he has a history of this based on his medications (first clue is he is on blood thinners).

As for going around behind their back, it sounds to me like the guy admitted he made a mistake and attributed it to work load. Can you tell me you have never taken a short cut or not done something for a patient for personal or selfish reasons? We are only human.

Granted I run on tiredness and burn out often and I have to get myself in a mindset of "Bring it on!!!" before I even start my shift. But from where I come from there is this thing called a "courtesy call" and every medic knows it. If there was no reason for him to be there..he should of at least fully assessed, took a BGL and reassured the patient. He didn't even do that. And like I said before...he let me vent my frustrations on him about that call..(chewing his butt off)...and then he explained that he was tired and it was almost shift change. I'm sorry but that doesn't seem like a good enough reason to me. But we did leave on ok terms. And I had a right to know where his head was on that call....so if I ran into it again...I could make better choices.

My question was answered and thanks you guys for giving your input

[Connie31079]

A the very least, a blood glucose should have been done, with the diabetic history of this patient.

Second, the patient should have been placed on the heart monitor, and seen exactly what rhythm he was in. What if he was in 3rd degree block? Or maybe had the beginnings of sick sinus syndrome? Slap on the pacing pads, baby, and be prepared to pace this fella!!

I think since the medic was out there, he should have rode in with the patient. Doesn't matter how tired he is, or if he was at the end of a 14 hour shift or not.....patient care always comes first.

If you don't wanna take care of your patients, then go home, or call in sick if you're too tired to come to work.

[DrAsystole]

Sounds like to me that the Paramedic probably seen that the patient was on some Beta Blockers and probably had a history of atrial fib, not atrial flutter. As well, since he was not hurting he is asymptomatic, and really there is nothing to physically to do. However; he was definitely wrong on his examination, assessment and even treatment skills.

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When you refer to the patient "NOT hurting", did you mean chest pain??? Are you saying that the ABSENCE of chest pain means all is well?? I dont think that is the message you wanted to send.

In older male diabetics, the absence of chest pain during an M.I. is certainly possible. This is another reason why this emt was right to worry about her patient and question the absence of ALS care.

[Spock]

I worked part-time on an ALS intercept unit for almost 15 years and one of my many rules was to never but never turn a call over to a BLS crew unless the EMT taking the patient was comfortable with my decision. I think the medic was wrong in his treatment or lack thereof.

Live long and prosper.

Spock

[snapdragon]

No JanMarie I do not believe you were out of line in talking to the medic. Just make sure when you do address an issue do not come off accusatory, it then puts someone in a defensive mode and nothing is accomplished.

As far as the pt it could have been several things.

1. Most obvious, he took too much insulin and his BS was low. Easily ruled out by a Glucometer or even a chemstrip.

2. When you said his pulse was irregular was it fast or slow. Many diabetic pts are put on Beta blockers, and you mentioned a BP medication in your scenario. Beta blockers can lead to decreased heart rates which then can lead to arrhythmia's since the heart itself is getting ischemic from lack of blood.

3. You can also get a mixture of points 1 & 2. Normally when a diabetics blood sugar decreases the heart increases to make up for poor energy use. Beta blockers will stop this increase making the pt even worse off then in a normal hypoglycemic episode. Beta blockers are your "olols" propanolol (Inderal), atenolol (Tenormin), and metoprolol (Lopressor, Toprol) in case you did not know.

So in my humble opinion he should have ran an EKG and gotten a blood sugar double quick on arrival. If he failed to do this he was out of line.

Peace,

Marty

:joker:

Marty,

You hit every thing that I would have checked as an ALS provider. Shame on the Medic that turned that patient back over to the BLS provider. A newly diagnosed diabetic with a HX of heart problems can be a ticking time bomb.

Snap