What should the Basic-Medic Partnership look like?

[medic001918]

I do have a problem with medics who cannot seem to understand that if something goes wrong in the box with the patient, it has just as much potential to damage the career of the basic as it does the medic. Medics are not the only ones licensed and therefore are not the only one whose licenses can be pulled.

Just for some clarification, not all states have "licensed" EMT's. In Connecticut, paramedics are the only one's that are licensed. An EMT holds nothing more than a certification. The standards to which they are held is vastly different, along with the responsibilities. Should something go wrong on a call, yes it should be a shared responsibility. Unfortunately, the first person they are going to contact and ask questions to is the paramedic (I know this from experience). I have done calls that have required further questioning, and my EMT partner was never even made aware that there was an inquiry into the call. How's that for a shared experience? But either way, you're right, it should be shared. Unfortunately, this is not a perfect world and that's not how it always works.

As far as my feelings on the medic/basic relationship, it's one that is sometimes handled delicately and other times not so delicately depending on the situation. I am okay with my partner doing things such as an assessment or skills within their scope of practice. However, one thing that I ask for is the courtesy that you talk to me about wanting to do some of these things (like assessment) before we get to a call. I have no problem letting someone do something if I know you're going to do it. That way I can allow you the courtesy and respect of performing the task. What I don't like is when someone interrupts my assessment trying to ask questions of their own or even worse, something that I've already asked. Chances are that if I'm in the middle of my assessment, I'm going somewhere with it. I won't interrupt your assessment if you don't interupt mine. I had to have words with someone after a call one night after being told that I was "stepping on their toes" because I stepped up and directed things to get done on a BLS call. As a paramedic working with basics, I have an obligation to make sure that things flow smoothly and the job gets done. If noone else is going to get things done, and noone has voiced a desire to take initiative; then guess who's going to do it? That's right, me as a paramedic.

I think the biggest breakdown in the paramedic and basic relationship starts with communication. People don't communicate their intentions and desires well enough until their in the middle of a situation, and then only after someone already has taken issue with something. If more people would talk about how calls should be run when working together before getting to a call and seeing how things go, there would be less discontent.

As a paramedic, I find myself educating my partners frequently. It's part of my job as a paramedic. It's not just to provide patient care, but to help others further their careers and knowledge levels as well. My full time position is as a paramedic that works with a volunteer service. This requires me to be more "political" (for lack of a better word) in how I handle issues that arise on my shifts so that people still want to ride with the service. It becomes more of a constant state of education rather than discipline or discouragement. On that note, I also take the initative when riding with someone new of talking to them at the start of the shift about what I expect out of them, and what they can expect out of me. It's in these intital conversations that things get outlined. These things can range from when it's okay to question something about a call to my willingness to cover any kind of material that they request (I'm currently reviewing A&P with one of the members currently in paramedic school at his request and it seems like it could turn into a regular review with more of the membership). By opening the communications early, they are not afraid to talk to me about calls, ask questions or perform their required skills.

The biggest breakdown is communications. Once we all work on that issue (from the medic and basic side), many services would find a better working relationship between levels. My partner is there to perform a job, and to assist me in my job expectations; just as I am there to assist them. Let's all work with each other so that we can all benefit.

Shane

NREMT-P

[BushyFromOz]

Allright then........

Ok, i will throw this out there take it or leave it i really dont care BUT if you take it on board things may actually work better for everyone

Somedic is a scottsmen, and like a true scottsmen he does not mince words, beat around the bush, stroke egos or any of that crap. He states what he thinks with the minimum of words, he doesn't BS, he doesn't mess around. The end result is what often come across as brutal and confronting posts, but hey..if you look past it somedic is quite a good person to talk to (for a scott :wink: )

so take it or leave it i dont care, but one thing i deffinately know is scotts have no time for whingers or people who even think of whinging, and i have learned that the hard way as my fire brigade captain is a scott :shock:

take it or leave it......

[EMS49393]

Actually, Somedic, that was me that told NREMT-Basic to "pay his dues."

[MadMod]

In the state and service I work for:

The Paramedic is in charge. Deal with it.

Why? Because the State's Department of Health Divsion of EMS said so. End of story.

If the state discovered a EMT Basic was not operating under the direction of a Paramedic (taking directions or orders) on a licensed ALS rig the service would be fined $7000.00 per incident and we could lose our service license.

The medical director would be fined $7000.00 per incident and lose his Dr. license.

The Paramedic could be decertified.

The state considers the Paramedic as the highest trained person in charge of patient care and the one legally in charge.

There has to be a chain of command.

I run a shift in an Advanced Life Support Service. We run a service in which each rig is staffed by a Paramedic and an EMT-Basic. We encourage our EMT-Basic's to operate to the fullest extent of what our protocols say they can. However, they still have to let the Paramedic know what they're doing. Why? Good teamwork and more importantly, good patient care. Nurses still have to tell the doctor what they have done even if the doctor trusts them completely. We require it because ALL actions have to be time stamped by the Paramedic in the documentation. Our quality control does random sampling of patient care reports (PCR's) and the initial impression reports of the ER nurses. We check to see if what our Paramedics report matches what the nurses report we bring in. Good quality control. Therefore, the EMT-Basic MUST tell the Paramedic if for nothing else proper documentation.

If the Paramedic doesn't want the EMT-Basic to do something, since he/she is legally in charge, he/she can tell the EMT-Basic not to do it. The state will hammer the Paramedic if the EMT-Basic messes up. Mostly from what I see it's a matter of a crew being a team and being able to trust one another. This takes time and work from both parties. Even when we staff two Paramedics on a rig, one is the senior Paramedic in charge.

As for stories of Paramedics being abusive to the EMT-Basic, that appears to be an example of a hostile workplace. Also, poor management of the field crews. That behavior cannot be tolerated. This appears to be a situation in which one holds authority over another and abuses it. you will find this in all job field and the military. We do not tolerate it. But it goes both ways. I cannot be abusive to my shift. I cannot brow beat my crews simply because I want too.

We have let our share of EMT-Basics, Paramedics and 1 supervisor go because they were not willing to conform to our rules, procedures, and policies. I have often wondered if the pill would have been easier to swallow if the terms were EMT-Basic, Intermediate, and Advanced. That clearly sets apart the resposiblities of each.

I had an EMT-Basic on shift that felt he could do whatever he wanted as long as it was within his scope. He constantly complained about the Paramedics he worked with. He constantly refused to work with people; or to have his partner changed in the middle of the shift. He would "write up" paramedics about their treatment of patients (ronically, this was his biggest mistake. Because the Medical Director (a doctor) had to review the calls in question and concluded that the EMT-Basic was wrong. His choice of treatment would have caused potential harm to the patient. Always take time to consider how deep the water is before you plung in)

We eventuately terminated his employment for insubordination due to the fact he would not follow our policies and procedures.

[NREMT-Basic]

You know, in as much as I could, I have tried to remain constructive even when I was getting personally bashed rather than bashed as an EMT. I am just as guilty of making some personal comments to others. But if you repsond to a thread which has a particular topic and you cant manage to confine your tirade to the topic at hand, but only post for the purpose of personal attack, then (Somedic) you are indeed a small and petty person.

I agree that the basic (i dislike the use of the abbreviation emt when referring to a Basic, since Medics are infact also EMTs, as much as they fight it they are still a technicians) takes his orders in the immediate from the Medic. However, my authority to practice as a Basic, doesnt derive from the medics license at all, since if it did we couldnt have basic/basic rigs. My authority to make any decisions or provide any interventions is derived solely from the Medical Director under whose license and whose license alone I operate. Im not sure if thats a concept not understood by many, or if there are states in which that is not the case. Here, ultimately, the final word on anything I do is the medical director.

I experienced on Thursday what may prove to be one of the single most gut wrenching experiences of my EMS career whether I decide to stay a Basic for 20 years or move on to become a medic. At a roll over accident scene, I held a mothers lifeless infant in my arms after the child had been ejected from the vehicle because she had not been restrained, but rather was being held on the mothers lap with the drivers window part way down to clear the fog on the windshield. Though the child was dead when I arrived on scene in my POV at the same time fire-rescue arrived on scene (responding as ems with local volunteer dept) there will never be a time in my life that I wont wonder if I had gotten to that part of the scene a few minutes earlier, if that child could have been saved. Likely she was gone the moment she hit the pavement on the freeway and in a way I hope that is the case because she must have suffered horribly if briefly if it wasnt. So yes, my view of things has been pretty angry for the last few days and for that I apologize as I do for taking my anger out in so many of my posts. Im not asking for anyones sympathy or even asking for a free pass for being a jacka** because I have had an experience that just about everyone in our field of endeavor has had or will have at some point. Im just tellin ya where im at.

They say you learn more from those with whom you disagree than from those with whom you agree so I will try to bear that in mind. That being said, I am not fond of personal abuse or attacks and i have always thought it to be one of the great shortcomings of the internet that so many people are moved to say things both about and to other people that they have never met that their conscience and humanity would never allow them to say to another person face to face. But thats the world we live in. Letters have given way to emails and hurtful words are flung like edged weapons at people we will likely never see. We cant know each others realities as the vast majority of us will very likely never know each other as anything more than clever little names and avatars next to posts. Thats a shame I think, especially when the people flinging the barbs at each other do the same jobs and fight the same battles. And so it is with new found respect for the agreeable and the disagreeable alike that I bow out of the City for awhile to gain some perspective which can only be had in the real world and simply cannot be gained from a pseudo reality which consists of flickering pixels and thoughts sent around the world almost as fast as we can think them. And so, in the words of one of my great heros, Edward R. Murrow....Good Night...and Good Luck.

[medic001918]

I agree that the basic (i dislike the use of the abbreviation emt when referring to a Basic, since Medics are infact also EMTs, as much as they fight it they are still a technicians) takes his orders in the immediate from the Medic. However, my authority to practice as a Basic, doesnt derive from the medics license at all, since if it did we couldnt have basic/basic rigs. My authority to make any decisions or provide any interventions is derived solely from the Medical Director under whose license and whose license alone I operate. Im not sure if thats a concept not understood by many, or if there are states in which that is not the case. Here, ultimately, the final word on anything I do is the medical director.

I experienced on Thursday what may prove to be one of the single most gut wrenching experiences of my EMS career whether I decide to stay a Basic for 20 years or move on to become a medic. At a roll over accident scene, I held a mothers lifeless infant in my arms after the child had been ejected from the vehicle because she had not been restrained, but rather was being held on the mothers lap with the drivers window part way down to clear the fog on the windshield. Though the child was dead when I arrived on scene in my POV at the same time fire-rescue arrived on scene (responding as ems with local volunteer dept) there will never be a time in my life that I wont wonder if I had gotten to that part of the scene a few minutes earlier, if that child could have been saved. Likely she was gone the moment she hit the pavement on the freeway and in a way I hope that is the case because she must have suffered horribly if briefly if it wasnt. So yes, my view of things has been pretty angry for the last few days and for that I apologize as I do for taking my anger out in so many of my posts. Im not asking for anyones sympathy or even asking for a free pass for being a jacka** because I have had an experience that just about everyone in our field of endeavor has had or will have at some point. Im just tellin ya where im at.

First of all, I'm sorry to hear about your call. That's a really bad call and unfortunately, one that many of us can relate to at least in some form. It's amazing how as hardened as we become to many calls, that there are still those calls which impact us so greatly. Hopefully in time you'll come to terms with that whole call and everything that happened.

As for your comment about your authority to practice coming from a medical director, you are 100% right about that. However, if a paramedic is on scene they become responsible for managing patient care. This includes directing the other providers on the scene to accomplish tasks. Your medical director sets forth the protocols for what you are allowed to do, the paramedic on scene (if you're working with one) is responsible for making sure it gets done and when it gets done. There is a difference between the two. When you're working with a basic, you're following their protocols and procedures. When you're working with a paramedic, they follow their protocols and procedures; up to and including managing patient care. All of that being said, if you want to do something within your protocols that goes against what the medic on scene wants; who do you think is going to have the final decision? The final word of what you're allowed to do is decided by your medical director, but when working with a paramedic the final word on what and when things happen is decided by the paramedic on scene. Working paramedic/basic truck is vastly different from working a basic/basic truck.

Good luck,

Shane

NREMT-P

[Asysin2leads]

NREMT, to answer your question about the child, unfortunately, if you had gotten there a few minutes earlier, the only thing you could have done was perhaps watch the child draw his last breaths. If the child had landed on the operating table of a Level I trauma center with a trauma team ready to work, the outcome probably would not have been different, and if the child had survived, he would probably be on a ventilator the rest of his life.

[Chrisclark]

I know I am new here so I will try to keep it short and to the point.

I am not even certified yet and have not finished school. I just graduated high school in 2006 and have worked as a lifeguard. EMS just felt like a natural thing to do for me because it interested me and I have many family members in medicine. Just form work as a lifeguard I have worked with some truly amazing Basics and I have worked more distantly with some awsome medics. I have also know some incompetent Basics, and some medics that were sad excuses for individuals. The bad, however, always seem to stand out in your mind. The worthless basic is remembered and the cocky medic is also remembered. The medic that taught you how to get an I.V. started perfectly every time is not quite as memorable. It even applys to the first responders. Some of the guards I worked with were worthless I remember these more than the ones I would trust my own family to. My skills as a basic student are (hate to toot my own horn) are top notch because I obsessively study and practice. I also read all kinds of books just so I can be ahead of the curve. I realize that even as a basic, if I kill somebody, that will haunt me for the rest of my life, especially if the medic takes the heat.

The person with the most training is responsible for whatever rig you are running. In ALS rigs, that medic is the go man. He is the captian of that ship. That really sucks for the basic, but tough. If you want to be in charge go to medic school.

The other side of the coin is that the medic cannot be overbearing. If the medic is a pain in the ass the pt suffers.

[BushyFromOz]

My skills as a basic student are (hate to toot my own horn) are top notch

Big call.....

[somedic]

NREMT-basic: I dont buy your BS. So what you had a "single most gut wrenching experience"! Guess what? Thats what real EMS is all about on a daily basis. Dead kids are a fact of life in our world you want to be a command emt basic in.

I say again that you need to be script writing for daytime television instead of blowing your horn in any type of EMS serivce.

Somedic