Need help with article about EMS

  1. Hello to everyone!

    I am currently attempting to co-write an article for a national publication in regards to Problems in EMS. I am both a ER- RN for over 18 years and a field Paramedic. I believe there are some points that need to be addressed and changed.

    I would like to hear both the bad and the good points as well. Please, constructive criticism and downplay bashing if possible.

    My main focus will be on education, professionalism, and patient care, etc..

    If you feel you dont want to post them, you can PM me.

    Thank you for your time and responses,
    R/r 911
    Last edit by EricJRN on Oct 19, '06 : Reason: email removed per TOS
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  2. 29 Comments

  3. by   Larry77
    I've always wondered about the hours that medics work. If they are awake and working their whole 24 hr shift is it really safe care they are giving? I've received pt's from very good medics who have had a nasty shift and was very surprised at the lack of effort/energy.

    As an ED nurse I wish I was more involved with EMS in which I would have an increased knowledge of what their job entails. I did go on a short "ride-along" when I was a new hire but I think we should do more than that.

    Most of my experience with EMS has been very positive. I live in a small community (90k people) and we pretty much know all the medics that bring us patients so I think this helps our situation a lot (we are more comfortable to give instant feedback etc).
  4. by   hogan4736
    If I see one more toddler being transported on a parent's lap, or just sitting on the stretcher, with one seatbelt, I'll scream!!

    This is a HUGE problem in every Phoenix ER I have worked...

    All passengers need to be properly restrained...

    I NEVER transported a toddler without his carseat strapped to the gurney, and him securely strapped in it...
  5. by   Aliakey
    As an EMT-I, I would love to have more detailed education and skill training on special patients and their devices/treatments, like dialysis (example: AV grafts), ports, trachs, and all those other things you don't normally see in the general population. In my area, these are only briefly taught in the classroom, but we will come across them regularly out of an SNF, etc.

    I don't hesitate to ask nurses/RTs questions when caring for their patients at a facility, but if the situation is bad, well, I'd feel a whole lot better having the knowledge and skills beforehand when things are critical.

    In my offtime, I've found with the fear of liability that some dialysis nurses are hesitant to even instruct... they've been told by their "bosses" to not do so, due to the unfortunate result of a miscommunication in the past. We're expected to *know* how to care for these special patients, but the means of learning are difficult to come by.

    As for the toddler example, when taking a scheduled hospital to hospital transfer (non-emergent), it's easy for me to grab the child seat out of the station, stick it in the ambulance, and properly restrain the patient after we get to the hospital and assume care. But, for emergency and other unanticipated calls, there's a problem for us: no room! The normal child seats are so bulky, there is only one compartment on the ambulance big enough for it, but that is crammed with flexicots and multi-sized traction splints. This is on a Type III unit (van front/box back), so inside, the bench seat is already securing an LP12 and a portable vent. I've seen the newer ambulances with a convertable jump seat for securing the kiddos directly; don't have that yet here. But, even if secured there for transport, the kid would still have to be placed on the stretcher going through the ER doors, so it would appear that he/she travelled unrestrained. I haven't seen a good system for kids/toddlers yet that can securely restrain them on the cot during transport without inhibiting patient care and treatment.

    Just my two pennies worth, if it helps any.
  6. by   hogan4736
    There is a roll up, approved child restraint, that fits snugly on the back of a gurney...No excuse for ANY ambulance to not have proper child restraints...

    Takes up no more room than 2 boxes of gloves...Never has that or a carseat hindered ANY care I've needed to give...And I've transported kiddos on vents, IVs, monitors, etc...

    BTW, the carseat (which parents usually bring to the ED) secures safely onto the gurney, as well as the roll up child restraint...Not sure why you would secure a child on the bench seat???

    There is a general lack of knowledge when it comes to restaining childrean properly onto a gurney...

    You wouldn't let your child just sit w/ a lap belt in the car, why do it in an ambo???
    Last edit by hogan4736 on Oct 19, '06
  7. by   Aliakey
    Quote from hogan4736
    There is a roll up, approved child restraint, that fits snugly on the back of a gurney...No excuse for ANY ambulance to not have proper child restraints...
    If you have a link or some other source of info on that, I would appreciate it. I never heard of this product.

    Quote from hogan4736
    BTW, the carseat (which parents usually bring to the ED) secures safely onto the gurney, as well as the roll up child restraint...Not sure why you would secure a child on the bench seat???
    I didn't make it clear... my appologies. Securing the car seat on the bench seat without a patient, to be removed only if/when you do have a pediatric patient. In other words, "storing" the seat on the bench, until you need it. Then remove it and secure on the stretcher when you do have a pedi.

    I work in a rural area of Texas. One of the BIGGEST preventable problems we have is unrestrained children ejected out of vehicles in wrecks. Without exaggeration, I find about half of the parents simply do *not* own a car or have access to a carseat, so I must rely on our own resources. Yes, they do transport their kids in their own vehicles all the time with no seatbelts and no carseats. And, my heart sinks when I see a dead kid in the ditch. These are usually migrant families who either tell me they cannot afford a carseat, or don't comprehend the dangers of transport without it (and don't want some gringo to educate them).

    Quote from hogan4736
    You wouldn't let your child just sit w/ a lap belt in the car, why do it in an ambo???
    If given a choice, I would *never* secure a child or anyone else for that matter improperly. Please don't think I'm trying to make excuses for our current practices. In fact, I *want* it to change. I would never let my own daughter ride without proper restraint, nor if given a practical method, allow another parent's child to be transported unrestrained. That is why I asked for a link to the roll up restraint; I am honestly interested in it and will forward the information to my Service Director, if offered.

    I am not a lazy, cold-hearted medic. I also know you have never met me, but you have met some medics that would make anyone cringe. I've met folks that fit that bill from all walks of life. But, please offer me the opportunity to prove otherwise. I want to see changes in EMS, because this is the field I love to work in and our sole purpose is to not cause further harm. But, help is needed, not criticism.

    If I took the tone of your reply the wrong way, again, I appologize. But Ridryder 911 asked for constructive advice and what we feel was lacking, and I posted what I saw in our neck of the woods. I also responded to your observation about the kids not as an excuse for what is done, but in hopes for a solution.
  8. by   Larry77
    Aliakey,
    Just wanted to say that was one of the most mature and constructive responses I have read on here. Most of the time people get defensive and start "shooting from the hip" at that point.

    Not enough nurses appreciate what you guys do and they tend to pick apart your work. "They didn't even ___", "They could have at least ____" Drives me crazy...
    Larry
    Last edit by Larry77 on Oct 21, '06
  9. by   rjflyn
    Quote from Aliakey
    If you have a link or some other source of info on that, I would appreciate it. I never heard of this product.



    Try this http://www.ferno.com/solution.aspx link for peds on the left.
    or here http://www.med-worldwide.com/pediatric-transport.html

    Rj
  10. by   hogan4736
    Aliakey,

    I certainly do not hold you responsible for the lack of knowledge regarding proper child restraints, in the prehospital fields...No personal attack here...I am frustrated at the apathy that I see. When I questioned a medic last week, his response was "we have a child restraint policy, but we don't have the equipment"

    That's a problem...His company likely won't back him up if that kiddo was hurt in an accident, as the 2 year old rode 20 miles to another hospital on mom's lap...He can blame the company, but it's his state medic cert that will be hung out to dry...He never even asked the parent if they had a carseat...

    I am an ER RN that worked for a year on an RN ambulance. I refused to transport 2 kiddos due to the lack of parents having a carseat (and for whatever reason, our rig was lacking the roll up restraint)...I have no "formal" prehospital training...I am just using common sense...

    I worked in Phoenix in many ERs, and this was (and is) a widespread problem...And all I get, when I question a medic, is APATHY...

    They are providing a false sense of security to these unknowing parents...I had this very discussion with Phoenix Fire's medical director, and his response was "we're working on it"

    "working on it?????"
    that's crap...I asked him if he would let his 2 year old ride in his lap on a gurney, and the conversation went silent...

    My apologies for being passionate and outspoken about this...

    but your a** will be on the line if you transport a kiddo unsafely!!
  11. by   hogan4736
    thanks for the links RJ...we used something like the "Pedi-Mate"

    Rolls up neatly...

    I'm curious for your take on this...Even when I question ER nurses, most have never given it ANY thought...

    some links:

    http://www.healthandwelfare.idaho.go...restraint'

    http://www.nccep.org/content/ems/sta...restraint'


    http://www.freshpatents.com/Pediatri...0050193491.php
  12. by   tridil2000
    Quote from Larry77
    Aliakey,
    Just waned to say that was one of the most mature and constructive responses I have read on here. Most of the time people get defensive and start "shooting from the hip" at that point.

    Not enough nurses appreciate what you guys do and they tend to pick apart your work. "They didn't even ___", "They could have at least ____" Drives me crazy...
    Larry
    i agree!!!
    nicely worded aliakey!

    the only thing i'd like to say is that after you place the pt on our bed pls move out of the way. i need to get the pt on o2, monitor etc and get the line if you didn't. some medics just stand there and it really is annoying.... as if they don't want to "let go."

    thanks.
  13. by   Aliakey
    Just wanted to thank you folks for the kind words, and for the link to the Pedi-Mate. We use Stryker stretchers, and although it appears to be designed for Fernos, I am going to see how we can make it work. Looks very practical, and just what we need. Thank you again.

    Hogan4736, I can understand the fustration. There are more than a handful of medics I would never let touch my own family. And there are medics who I would want as my family because I can trust them so well. Sounds like you were dealing with a service that was similar to one I got out of years ago because of the lack of concern for the patient. It's unfortunate it would have to take the threat of law, the threat of a lawsuit after the patient dies, or the threat of Medicare payments to change their ways of thinking. That's not how our profession should operate. I love the rural volunteer EMS I'm with now... a 180 degree change from what I finally left.

    Tridil2000... I used to be one of those EMTs when I first started out, hehe! If it's the medic who's assumed care of the patient, I know those rooms can get kinda tight but he/she needs some way to give report to the RN. But, if more than likely, it's the partner (driver) who doesn't get the hint to move his or her backside, well... as a nurse with a sense of humor told my Paramedic (when I was a gawkin' driver), "Doesn't she have an ambulance to clean up?". She said it in a way that was kind of funny... not aggressive or condensending. I realized real quick that I was hoggin' up space, appologized, and got back to what I was supposed to be doing. Never made that mistake twice, lol!

    Just a thought to maybe help the situation. Medics should have tough hides and a sick sense of humor; use that to your advantage, lol!

  14. by   Medic2RN
    We have pediatric restraints built into our captains chair in the back of every MICU. We fortunately <knock on wood> have very few pediatric transports. Hogan, I appreciate your passion and concern regarding the subject and agree with you wholeheartedly.
    Ridryder 911, I do have a criticism of EMS as a whole with respect to the educational aspect. I would like to see more pathophysiology in the EMT-B's course. I would also like a more comprehensive curriculum similar to nursing school for paramedics. Becoming a nurse has helped me tremendously in the EMS world and I would like to see more medics with a solid background in broader areas of medicine. I can't tell you how many times I have heard, "Why do we need to know that, we can't do anything for that condition." Well, medics may not be able to do anything, but the knowledge of the disease and related symptoms may explain complaints they are being called for or potential symptoms that may arise. If not anything else, they will be able to understand and relate to the doctors and nurses to whom they are transferring patient care.
    This is my opinion based upon my experience. I love EMS and only want to make it better. Thanks!

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