Should I have done this another way?

[Icecuban]

Currently I'm a student for EMT-B and we are in the stage of internship (riding with a EMT team) The squad I was with had a medic and a Intermediate on board. We go a call to a patient that was unresponsive. The patient had and upper airway occlusion. The medic started ventilation with a BVM using the one person technique (don't know why he didn't have me on the bag) Anyways a family member of the patient was there asking questions about what was going on and the medic would answer. While this was going on the EMT-I was going to get the cot, he was going to have me help him but before I left I noticed that the medic was distracted and stopped pumping the bag and it was like 10 seconds since the last pump. I tried to tell the medic to keep pumping but he was focused on the family member. I said "Sir your not pumping the bag anymore" in a louder voice. He must of not heard me because he just snapped at me telling me that I'm only a student and I am just there to watch. By this time he hasn't pumped for 30 seconds and I can see the patients tidal volume not so good. So I just reach for the bag so the pumping can start again and the medic see me and yells at me again to tell me to back off. But he starts pumping again few seconds after that the EMT-I comes back with the cot and he's upset at me because I didn't help him out. Once the call is over the medic just goes off on me and doesn't give me a chance to speak.

I just want to know should I handled that some other way? I didn't want to yell or manually take over to make the paramedic look like he didn't have it under control since the family member seemed to have little faith in EMS already. So I tried to deal with it in a way to help him out with out letting people really know even though it didn't work. But in all honesty if I did the wrong thing and should of done something else? Please be honest I just want to know so I know what to do if this ever should happen again.. I still have a few more internships but not with that team the medic doesn't want me with him.

Sorry if I put this in the wrong forum I wasn't sure where to put it. And since I'm a student I just put it here

[akflightmedic]

Can you explain what an upper airway occlusion is and why the treatment was to keep ventilating? Sorry, I am just confused.

Anyways, as far as your question, you did act appropriately and the medic was out of line. Could be a lot of reasons why he reacted the way he did, but it is not right regardless.

[Icecuban]

Since the paramedic didn't let me help or told me what was going on I only could watch.. All I know is that he was unresponsive, a blocked airway so he did the head-tilt-chin-lift and used a BVM to get air in and out. I didn't learn anything because the medic was acting the way he did and the EMT-I took his side so I was left out of the loop..

[FormerEMSLT297]

The term you were looking for is obstruction, not occlusion.

As for what you have done, I'm not 100% clear on all the facts, but its really not a good idea for a student to correct 2 senior people especially in front of family members.

What was the outcome of the patient ??????????????

[Icecuban]

I tried not to correct them but he was not paying attention to the pumping of the bag. As for the patient I don't know what was wrong with them. But I know the are currently in CMC hospital

[ERDoc]

One thing that is not taught in any school is tact. There is a tactful way to approach a situation like this that will ususally not offend anyone. The best way to do it is to make it look like you are trying to do some of the work for the medic so that he can do more important things. Try something like, "Do you want me to bag him so that you can take care of the family/start an IV/etc." You are not questioning their ability and pointing out their deficiencies, but kindly taking over a menial task so that they can move on to bigger and better things.

[Dustdevil]

I'm confused by this scenario from the get-go.

Currently I'm a student for EMT-B and we are in the stage of internship (riding with a EMT team) The squad I was with had a medic and a Intermediate on board.

How is it an "EMT team" if it is staffed by a Medic and an Intermediate? Was there also an EMT involved in this team? And by "squad," what exactly do you mean?

We go a call to a patient that was unresponsive. The patient had and upper airway occlusion.

Your answer to the previous question did nothing to clear this up. Was the obstruction/occlusion cleared up by the head tilt-chin lift manoeuvre? You mention a low tidal volume. Does this mean that the patient was breathing spontaneously? If so, did he really even need a BVM? Most unconscious people breathe shallowly. It's not a problem. If it was really uber shallow and uber slow respirations, then he might benefit from assisted ventilations, but not everybody needs a blow every five seconds like in CPR. As for the 30 second thing, time has a tendency to slow down and drag when you are a n00b in emergency situations. What seems like ten minutes may be only one minute. And somehow I seriously doubt you were sitting there watching your second hand tick away for thirty seconds. At least, I hope not.

The medic started ventilation with a BVM using the one person technique (don't know why he didn't have me on the bag)

And I don't know why you didn't take the initiative to do it yourself without having to be asked. Was there any question in your mind that the patient needed BVM ventilations? Would have you made that same call, or was this idea straight out of the head of your Medic without crossing your mind? If it crossed your mind, you probably should have been busting a move before he did. I'm getting the impression that this patient didn't really need it at all, and the medic knew it, therefore not really putting a big effort into it.

I said "Sir your not pumping the bag anymore" in a louder voice. He must of not heard me because he just snapped at me telling me that I'm only a student and I am just there to watch. By this time he hasn't pumped for 30 seconds and I can see the patients tidal volume not so good. So I just reach for the bag so the pumping can start again and the medic see me and yells at me again to tell me to back off.

I'm betting you were one of those unfortunate victims of a lame EMT instructor who filled your head with idiotic BS stories about how "EMTs save paramedics," and how you are an invaluable member of the EMS team because you are such an expert at all the BLS skills that your paramedic will forget all about. That's what it sounds like. If so, forget those stories. Whoever told them was full of it. There is a good chance that this medic knew exactly what he was doing, and how frequently he was ventilating. And no, an EMT student is not expected to know the difference. That’s why you do NOT start trying to correct a paramedic on a scene when you are there as a student. In fact, 99.9 percent of the time, you shouldn’t be doing it as a working EMT either. If you think something is wrong, fix it yourself, don’t verbally correct somebody on a scene.

...the EMT-I comes back with the cot and he's upset at me because I didn't help him out.

The EMT-I can suck a big one. You're not there to be his bitch. You're there to get practise at the medical skills you are learning. And if he wanted your help, he should have asked for it. He'd piss and moan if his medic jumped him for not doing something he never asked him to do.

But in all honesty if I did the wrong thing and should of done something else? Please be honest I just want to know so I know what to do if this ever should happen again..

[Icecuban]

thanks for the input I'll keep this all in mind. Hopefully I never have to be in a position like that again but if I am then I'll know what to do.

[AnthonyM83]

I definitely agree that tact is a necessary tool. I've had a few EMT student ride-alongs this summer and I've never been annoyed by their comments, yet. I guess they've just been able to phrase things well and without even having to do it indirectly or with a preface. Tone of voice and intonation of the sentence (if there's a difference) as well as rapport with your preceptor makes a difference.

Our last ride along reminded us of something (I forget what it was), but she said, "don't you want to ___". Even though it didn't have to be done that way, it actually impressed me, because it showed me she had been listening and remembering in class and was able to apply it to the situation. Most of the ones who say things more bluntly tend to be premed students and as long as it's said in appropriate tone, I really don't mind.

But if it was said in the way it was said in your post, I think I would have been pretty annoyed, though I wouldn't have chewed you out, but definitely discussed the whole situation with you afterwards.

But anyway, good advice was given in this thread. I hope you do additional ride-alongs for your class (if they don't put a limit on them).

[BEorP]

I don't mean to beat a dead horse since my reply will echo the rest of the replies, but I just wanted to point out how a little bit of knowledge can be a bad thing. When going from being a First Responder to completing the Primary Care Paramedic program, I have seen that things that first responders consider extremely important (let's say for example that in an unconscious patient you must check the carotid pulse on the side closest to you or you will stop them from breathing) that are not true.

If someone is doing something that might be detrimental to the patient and you are knowledgeable enough to tactfully question it then I fully support you. We have established that you could have done so more tactfully. The other issue though is you can't even tell us what was going on with the patient other than that they were unconscious and had a "upper airway occlusion." If you are going to question something, make sure you know what is going on with the call.