ER Etiquette

[LeftCoaster]

I earn my brownie points by volunteering in my local ER. And while as a volunteer I have to stand back and watch more than anything they cut me some slack because they know I am an EMT. Once they know you aren't a goof, they let you in. When you have a critical on the table and they are about to crack him/her open and you got a dozen folks jammed around the table eack one yelling instructions or relaying vitals, and more of the patients blood is on the floor then in them, how could you not help but surround themselves with people they know they can trust?

But once the 'battle' is over, most of the Drs, Nurses, Trauma Techs, etc. call each another by first name. No formalities. And if there is an interesting procedure the Dr will let you look over his shoulder while he performs a hemothorax, and explains it step by step.

But heaven help the crew that brings in a patient not packaged properly, or transports an ALS as a BLS (even IF the Dr said to transport them that way, still no excuse they should have known better to start with).

[JPINFV]

But heaven help the crew that brings in a patient not packaged properly, or transports an ALS as a BLS (even IF the Dr said to transport them that way, still no excuse they should have known better to start with).

Hmm, overly synical ER staff? Let's see, I can probably develop a short list of the possible hospitals that you volunteer at based on your description and the ER staff's attitude.

And, umm, FYI. I ain't called for medics when I'm next door to the hospital. The hospital IS my fastest ALS.

[AnthonyM83]

But heaven help the crew that brings in a patient not packaged properly, or transports an ALS as a BLS (even IF the Dr said to transport them that way, still no excuse they should have known better to start with).

What's the appropriate way for a crew to respond in this situation? I've been told not to argue with nurses...much less a physician. "The doctor said, ___, but based on my EMT training, I believe he is wrong." ?

[becksdad]

No, don't get into arguments on the radio. VERY bad etiquitte. For one thing, have all your control measures in place and on the way BEFORE you begin telemetry. You don't need a Doc to tell you your BLS assessments or skills. If, for some reason (and this would almost always be for ALS interventions), there is some miscommunication over the radio, it can present a sticky situation. A quick attempt at clarification may fix it. I can imagine some very rare situations where a provider just KNOWS he is right in wanting to do something or withold something. It would be even rarer to have that thing be so critical and time sensitive that a patients outcome depends on it. But if I knew it was that critical, I would do whats best for my patient and explain later - not argue over the radio.

EXTREME CAUTION: This is not a line to cross lightly! I honestly can't imagine this is a situation you would ever run into as an EMT. Thank God for that. Your advocacy for your patient will be manifesting itself in your own efforts to provide excellent care, and intervening if necessary with bystanders, first responders, etc. Now lets get on another topic - I'm sweating and hyperventilating just thinking about this!!

Just kidding - but focus on stuff you're going to be dealing with. You have a better chance of winning the lottery in China than finding yourself in a pissing match with a Doc as an EMT.

[Doczilla]

What's the appropriate way for a crew to respond in this situation? I've been told not to argue with nurses...much less a physician. "The doctor said, ___, but based on my EMT training, I believe he is wrong." ?

I'd agree about not getting in a pissing match with anyone. Smooth things over. "I'm sorry, perhaps there was a miscommunication" or "I had concerns about ______ which may not have come across in my radio report." If you err on the side of care and someone jumps your sh$t for overtreating, don't worry about it. Simply explain that at the time of presentation, things weren't as clear as they are now, or that you realize it was probably overkill, but that they can always just take them off the backboard or shut off the oxygen or whatever and do as they like. You are far less likely to get into hot water for overtreating than you are for undertreating. If you bring a patient into the ED who is blue or short of breath and doesn't have any oxygen on, or was found down in the street and you haven't backboarded him, then THAT's a real problem.

Forget the minor stuff. If they won't let it drop or it looks like you might get written up, go to your medical director FIRST. I'd rather hear it from you first than get blindsided by an angry phone call from one of my colleagues on a situation I know nothing about. Part of the job of the medical director is to serve as a liason between EMS and the ED. Punt the high level diplomacy to him.

'zilla

[Michael]

Nice, 'zilla! You and King Solomon, who wrote: "A gentle answer turns away wrath, but a harsh word stirs up anger."

Gold star.

[john_boston]

As an EMT newbie I just want to say thanks and that I appreciate all of the advice given in this thread. The few times I've been in an ER so far (on ride-alongs) have been exciting but made me incredible nervous.

[ERDoc]

As an EMT newbie I just want to say thanks and that I appreciate all of the advice given in this thread. The few times I've been in an ER so far (on ride-alongs) have been exciting but made me incredible nervous.

Especially for newbies, always remember to offer to wash the doc's car. :wink: