Conflict on Dual Medic Units

[FormerEMSLT297]

.... I have had a so called "conflict" only a few times in over 23 years as a medic...

The first one, was right after becoming certified, NYC had Morphine but it was only in protocol for cardiac chest pain and CHF/Pulmonary Edema, so, my partner and I respond to a scene where an 87 y/o f fell and Fx her femur. She was in excruciating pain and would not allow us to put on a traction splint.

I suggested calling medical control and getting a discretionary order for Morphine, my partner said "no, the doc would never go for that".. but i having just come out of training knew that they were moving toward a pain management protocol, and so, my partner didn't argue or try to stop me from calling, he just said i was wasting my time. Well, I called and got the order, and the pt. was a lot more comfortable and we got the traction splint on.

So, that wasn't really a problem.

The second scenario, was an unconscious diabetic. We get there she's cool, pale diaporetic, insulin dependent, so we give her a D-50 and she comes around. My partner then prepares to give her Narcan, I ask him why and (cook book medic) responds "it's in protocol".. to which i say, no it's not, she is now conscious, we don't suspect a narcotic od, WTF, to which he replies, i'm senior it's in protocol im giving it. After the call, I went to see a supervisor, but he was an EMT and not of much help, so, I contacted the Medical directors office, and they held a QA. Those are really the only incidents i remember.

[Dustdevil]

I also have to concur that my experience has been its usually the EMT-B/first responder whacker pack that will start an arguement on scene, and personally, I say its society's fault. We are a country built on democracy, where everyone gets a vote, but today's society has taken it one step further, where not only does your opinion count, YOU are the MOST IMPORTANT person, and what you say matters. If you're an EMT and you're used to watching any talk show, where anyone in the audience can stand up and challenge the expert and the arena of television gives them equal weight, why should you think any different when you get on a call? It doesn't matter if the person in the audience speaks in some regional subdialect of English and the expert has a PhD, the host will remind us that "everyone has a say," and this is what people learn. Sometimes you just have to say "Listen, this isn't American Idol, and your vote doesn't count as much as the judges."

God, I love your uncanny ability to take pieces of the puzzle and clealy and accurately place them into the big picture for all to see! I just wish more people were capable of making the connexion.

Occasionally, I get the partner who has no interest in anything but dumping the patient as quickly as possible. I've had that nearly turn into an argument on scene, as he was wanting to start toward the hospital before I had even assessed and done any stabilizing treatment on the patient. For that matter, even knew if any stabilizing treatment was necessary. I got quite a bit of attitude from him when I told him to slow down, give me a few minutes and let me know what exactly is happening with this patient. We discussed it after the call and he told me that he believes we should be moving toward the hospital anytime the patient is sitting in the ambulance, for liability reasons. I felt there was greater liability in not thoroughly assessing and treating the patient where they are. We reached a state of detente where basically, if it was his turn to write the report, he made the call and if it was my turn, I made the call of when we left scene.

Good point. This is indeed one problem that I have had with fellow medic partners. I consider it more of an operational issue than a medical issue, but it is a maddening one for sure. I've had a few medic partners who were senior to me who liked to cherry pick their runs. We'd get on a scene, they'd jump out and do a full assessment and institute treatment, then we'd load the patient into the ambulance. Next thing I know, the back doors slam and my "partner" jumps behind the wheel and starts driving away even though it is HIS patient. There are several reasons why this happens. Most of the time it's because all the cool stuff is done (or because there was no cool stuff to do on this patient in the first place), so now he's not interested in the patient anymore, nor the paperwork that comes with it. Sometimes it's because they are all eat up with code-3 driving and don't want to miss that opportunity. Sometimes it's because they're over their head with that patient and want to run away. But the result is that I get stuck with a patient that I did not assess, and I am rolling down the road before I have even finished transferring the O[sub:4043228dd8]2[/sub:4043228dd8] to the wall. But this is really not a medical issue, or a medic-medic issue. It's simply one of those arsehole, "I've worked for this company for 2 more months than you have, so I am your boss" issues that even Basics will throw at a medic.

While I respectfully disagree with Dust's belief that all ambulances should be ALS, I believe all ALS trucks should be dual-medic.

For clarification, I don't believe all ambulances should be ALS. I only believe that all 911 emergency ambulances should be ALS. Valid debate, though.

[BushyFromOz]

Before i get into it i would first point out that i am not a paramedic (though i am working on it i swear) and that i asked Dust via PM before posting in his thread.

I have noticed a few references to new medic's causing conflict on dual medic units through ignorance, arrogance and not knowing their place once the magical "P" word hits their shirts. Its probably the same issue preceptors have when they have university students doing ride time during their bachelor degrees placed under them. As someone who will (hopefully) be a new medic in the early part of next year, and as a ride along at the end of november it also something i will have to deal with soon, that is walking the fine line between being a diligent enthusiastic student or just being an ass.

There is a fault in the education system here. Everything is presented as "You". We are told what "You" are responsible for, when "You" are in charge and what skills "You" can do. The worst part is having sunshine blown towards you about how fantastic the world will be when tertiary education is a pre-requisite, how it will be the driving force for professional registration and how we will be the next breed of all singing all dancing paramedic. Some of us manage to filter the BS from reality and understand the limitation of classroom education and translating into the field, how it is a continuous process and, most importantly understand that our part in whatever service takes us is to contribute through learning as a student, learning as a team player and then learning as a teacher. Most people miss this and instead believe that once they are in a nice new uniform the learning stops because they have left the classroom and because they have left the classroom they now know everything they need to know - hence the conflict with new medics.

What i am getting at is that the new medic/student issue is more of a result of a failure in a system, as opposed to the failure of a person to interact with their co-workers. I think a good service will be able to weed out the true tossers through selection and be able to initiate the misguided ones through proper induction into the system and appropriate mentoring throughout it.

That all seems less relevent than i first thought, but i'm not going to waste it

[Dustdevil]

That all seems less relevent than i first thought, but i'm not going to waste it

I think it is relevant to point out that there is indeed a special dynamic at work in the relationship betwen a medic and a new grad, and that it doesn't necessarily equate with that of two experienced medics working together.

That's a good point to note in the context of this discussion. Because obviously, new medics should not be working with a basic. Yet, the relationship between a new medic and his senior partner is not typical of the dual medic relationship in general.

[Fuzil]

Unfortunately, I sometimes have conflict when working with another medic. I work for a rural company that does 911 as well as transfers to larger hospitals. We often are partnered with basics and occasionally with other paramedics. I am the youngest medic by more then 25 years, and I am also one of three women. All of the other paramedics have been certified for no less the 10 years and were taught the “old school” ways and are completely comfortable just doing O2, IV, and EKG then hauling ass to the ER. We have a somewhat aggressive protocol; however it is rarely followed completely. Drugs are rarely given if we are within 15-20 minutes of the hospital or if we are running a code. I was taught to be very aggressive with interventions. Therefore, when we are on scene and I suggest or begin to do something, I’m stopped, questioned, and sometimes told that I need to keep suggestions and comments to myself. I’m constantly told that “I’ve been a medic for x number of years and this is the way we’ve always done it.” The other two female medics have tried to help and are willing to teach or explain why they do something differently then they way I was taught. I actually enjoy working with the basics and intermediates. All of them are going through intermediate or paramedic school, so they ask me questions and also bring up new treatments and ways of treating that are being taught to them. Even though all of the basics and intermediates are older then I am, they tend to show somewhat more respect to me because I am their paramedic partner.

[Ridryder 911]

Unfortunately, I sometimes have conflict when working with another medic. I work for a rural company that does 911 as well as transfers to larger hospitals. We often are partnered with basics and occasionally with other paramedics. I am the youngest medic by more then 25 years, and I am also one of three women. All of the other paramedics have been certified for no less the 10 years and were taught the “old school” ways and are completely comfortable just doing O2, IV, and EKG then hauling ass to the ER. We have a somewhat aggressive protocol; however it is rarely followed completely. Drugs are rarely given if we are within 15-20 minutes of the hospital or if we are running a code. I was taught to be very aggressive with interventions. Therefore, when we are on scene and I suggest or begin to do something, I’m stopped, questioned, and sometimes told that I need to keep suggestions and comments to myself. I’m constantly told that “I’ve been a medic for x number of years and this is the way we’ve always done it.” The other two female medics have tried to help and are willing to teach or explain why they do something differently then they way I was taught. I actually enjoy working with the basics and intermediates. All of them are going through intermediate or paramedic school, so they ask me questions and also bring up new treatments and ways of treating that are being taught to them. Even though all of the basics and intermediates are older then I am, they tend to show somewhat more respect to me because I am their paramedic partner.

Does your service perform QI or discuss this with administration and possibly your Medical Director? Just, because they have received a pay check for years does not mean they have been providing good care.... one can be stupid for a long time !

Sorry, I have been around for a long time. Nothing irritates me more than an old timer not wanting to do their job... they know better.

Good luck!

R/r 911

[Dustdevil]

All of the other paramedics <snip> were taught the “old school” ways and are completely comfortable just doing O2, IV, and EKG then hauling ass to the ER.

Welcome to the Dallas Fire Department!

Minus the IV and EKG, of course. :roll:

One extremely important thing for you to recognise here. This has nothing to do with "old school ways." I was in EMS ten years before the guys you are talking about, and I can assure you that "O2, IV and EKG" were not the state of the art 25 years ago. In 1982, we were still sitting on trauma scenes and shooting the wad with mast pants and bilateral 14 gauges and working chemical codes on traumatic full arrests. They only thing you're doing now that we weren't doing in 1982 is pacing and RSI. Other than that, don't think that EMS has done any major progression in the last 25 years, because you would be very wrong.

These guys aren't old skool. They're just lazy, burned out arseholes who should have been moved out to pasture years ago. I've seen it happen to people in two years, so 25 doesn't surprise me at all.

[Fuzil]

Unfortunately, the majority of them have not been around for 25 years, but the newest medic prior to my hiring has been a medic for 11 years. Don't get me wrong, when they have to be, they are great medics. It's the "when they have to be" part that irritates and angers me. I realize that there hasn't been that many improvements in pt care in the last few years, but EMS has found better ways to use what equipment and knowledge they have. The guys I work with grip when they have to renew ACLS and PALS, and trying to get another class, such as PHTLS, is next to impossible. They don't want to learn anything new if it requires effort. We do QI, however the administration consist of the manager and the owner, who were included in that group of individuals. They all know they are burned out, but if they quit, there will be no one. None of the recent grads from the local community college program are wanting to stay in the area, but who can blame them when places such as Austin and Lubbock are offering large sign on bonuses and good benefits.

[spenac]

Unfortunately, the majority of them have not been around for 25 years, but the newest medic prior to my hiring has been a medic for 11 years. Don't get me wrong, when they have to be, they are great medics. It's the "when they have to be" part that irritates and angers me. I realize that there hasn't been that many improvements in pt care in the last few years, but EMS has found better ways to use what equipment and knowledge they have. The guys I work with grip when they have to renew ACLS and PALS, and trying to get another class, such as PHTLS, is next to impossible. They don't want to learn anything new if it requires effort. We do QI, however the administration consist of the manager and the owner, who were included in that group of individuals. They all know they are burned out, but if they quit, there will be no one. None of the recent grads from the local community college program are wanting to stay in the area, but who can blame them when places such as Austin and Lubbock are offering large sign on bonuses and good benefits.

First Dust I apologize for crashing Paramedic only conversation. But maybe since I have made it clear that I to feel only Paramedics should be on 911 ambulances, you will allow this.

Fuzil, as a fellow Texan, I gotta say sounds like you need to find another system to work in. Sounds like they are not planning to improve, if as you say owners and management are happy with the status quo. It may mean a move or a long drive, but find a better place to work. West Texas is seeing better pay and for the most part seem to be progressive services. I know of several communities now paying Paramedics $18 an hour to start with overtime after 40 hours a week. It is no fun to get stuck with a bad partner, but it sounds like you got a whole bunch of bad partners. Don't let them ruin you and your reputation.

Just the thoughts of a lowly TEXAS EMT-I and future Paramedic.

[firemedic05]

I have encountered the "You think you're better than me because you are a medic" from the EMT B's and quite frankly it gets tiresome. I like, ak, was the "greatest EMT B the world has ever known", till I went through medic school and realized the huge leap from basic to paramedic. I like ak, also, have karma haunting me. I feel quite shameful of my cockiness and ignorance, now looking back. I have tried to reason with the EMT B, that I am currently working with but he takes every comment as a personal attack. Now, I am to the point of just telling him Get over it! I am tired of stroking your ego. I have told him, as smart as you are, why don't you sign up for Paramedic classes. Suprise, he doesn't want to take that responsibility on.

I have worked with some lazy medics but also have never had a major conflict with one. I did have a new medic that used cold fluids and I told him to put them on the heater, of which he declined. The patient began to seize in the ER - coincidence ??? I do believe, though, he has learned a valuable lesson. I am also one who likes to D-stick, IV, and ECG on every patient. My core reason began out of being a scared sh*tless medic to having found on more than one occasion, more than one medical problem occuring at one time.

Dust, I do think it is a shame, when you are being kept busy roping in a EMT B, when you should be totally focused on your patient care. Unforunately, we can't keep medics so EMT Bs is what you get.