[PHTLS]

This one time, one of my DNR residents became unresponsive and had Kussmaul breathing, so I called his doctor anyway (hospital policy regardless of code status) and I was ordered to tx him to the nearest ER. Meanwhile, another licensed nurse was monitoring him closely (DNR) while I called the paramedics. 15 minutes later, he stopped breathing and when the paramedics arrived, one of them started acting like a jackass stating that I shouldn't have brought out the crash cart and so on because of his DNR status. I'm thinking, screw you! A responsible family member can change the code status of the pt anytime with the doctor and I wanted to make sure I had my equipment with me....well, because I'm hardcore! There was a dozen staff and visitors outside the resident's door at the time (curtains drawn) who witnessed us not initiating resuscitation actions with that resident. It's like screw these morons, I used to participate with code blues all the time when I worked acute care and being a part time EMT with the army reserves, I know my $hit! The problem with me is that I look really young and people/patients automatically assume I'm a naive newbie!

Anyhoo, this dork insisted on us putting up DNR signs and I'm like...helllo! does HIPAA ring a bell? What ****** me off was the next day, when my DON starts chewing my head about the crash cart BECAUSE she's afraid of lawsuits by the family or citations from whomever. Gee, thank you for the benefit of a doubt....witch! I already knew the resident was DNR, hell, we all knew his condition got worser and worser every week and his code status was always something we went over during report and from reading his orders.


Some of these paramedics can't even tell the difference between an Atrial Fib vs. V-Tach. Something I witnessed watching them transport a resident I had before who developed a stomach infection and was extremely hyperglycemic (no sliding scale). This one paramedic couldn't even interpret what she was seeing off her portable monitor. I just stood there stoic and I was thinking 15 liters of o2 for starters would be nice and rapid transport before the "golden hour" expires cretins!

Another time when I was a CNA in a convy, my RN at the time called for a transfer, and this freaking gorilla paramedic jut bit her head off about something. He was a total jerk with delusions of grandeur. It was like, sorry, did we disturb your coffee break or something.

Furthermore, I hate ED techs/ Paramedics who look down on nurses. They always brag about how they save people on the spot. Well, so what! they may know how to put on a PASG, but paramedics spend most of their time putting on o2 instead. Besides, who get's paid more and who has more training/education? Nurses!

[mattsmom81]

I have a lot of respect for paramedics because I can only imagine the difficulties of emergency care in the field...I would not want their job. It is hard enough in facilities!

Yes, I run into a few paramedics who look down on nurses, but since I work ICU and used to work ER, they seem to be a tad more respectful...I guess they can relate more to the emergency settings.

Tunnel vision abounds and its easy for people to miss the big picture in favor of their own narrow view.

[RainbowSkye]

I can't imagine being a paramedic. It's hard enough assessing a patient in the chaos of the ER. I sure wouldn't want to do it in the street.

I love the paramedics who act on their assessments. Oxygen and IVs for patients with chest pain; fingerstick, IVs and glucose for hypogycemic patients... I really don't like the ones who come in the the patient with no intervention because "we were just around the corner" (even with a patient who has a blood sugar of 14).

I love the paramedics who give the ER at least a 5 minute heads-up so I can get a room ready (usually having to relocate the patient who is already on the stretcher).

I really love the paramedics who start an IV and get blood on that 86 year old lady from the nursing home with no veins.

And I greatly appreciate the paramedics who hang around after bringing in a critical patient. I work in a small ER with very few staff members, and the paramedics have helped us out many, many times.

We're all in this together.

[canoehead]

I think that 99% of the time our paramedics are awesome. And the 1% of the time that they aren't it's usually half my fault too. I'd kiss their feet if they didn't have all that crud on their boots.

[Medic2RN]

If a paramedic can't tell the difference between A-Fib & V-Tach, then s/he should not be a paramedic!
The ER nurses at the hospitals I deal with are great. There are a few I don't particularly care to deal with on a professional level, but I think that is the case with anywhere you work. As long as the ultimate goal is achieved and that is passing along the best care to the patient.
Yes, there are paramedics who have bad attitudes and chips on their shoulders - just like other professions. You get the good & the bad....
I wasn't going to respond, but the last sentence in PHTLS's post made me. You said you hated ED/techs & paramedics who look down on nurses and then you did the exact same thing in your last sentence. It is a shame that you have dealt with those medics, but this is suppose to be a "helping" post.
There are several proposols about the big change that will hopefully happen in the near future for EMS: paramedicine will require a BS degree which, in turn, will increase respect from the medical community and increase the pay. I hope it comes through for EMS. They deserve it.

[RNin92]

Originally Posted by PHTLS

This one time, one of my DNR residents became unresponsive and had Kussmaul breathing, so I called his doctor anyway (hospital policy regardless of code status) and I was ordered to tx him to the nearest ER. Meanwhile, another licensed nurse was monitoring him closely (DNR) while I called the paramedics. 15 minutes later, he stopped breathing and when the paramedics arrived, one of them started acting like a jackass stating that I shouldn't have brought out the crash cart and so on because of his DNR status. I'm thinking, screw you! A responsible family member can change the code status of the pt anytime with the doctor and I wanted to make sure I had my equipment with me....well, because I'm hardcore! There was a dozen staff and visitors outside the resident's door at the time (curtains drawn) who witnessed us not initiating resuscitation actions with that resident. It's like screw these morons, I used to participate with code blues all the time when I worked acute care and being a part time EMT with the army reserves, I know my $hit! The problem with me is that I look really young and people/patients automatically assume I'm a naive newbie!

Anyhoo, this dork insisted on us putting up DNR signs and I'm like...helllo! does HIPAA ring a bell? What ****** me off was the next day, when my DON starts chewing my head about the crash cart BECAUSE she's afraid of lawsuits by the family or citations from whomever. Gee, thank you for the benefit of a doubt....witch! I already knew the resident was DNR, hell, we all knew his condition got worser and worser every week and his code status was always something we went over during report and from reading his orders.


Some of these paramedics can't even tell the difference between an Atrial Fib vs. V-Tach. Something I witnessed watching them transport a resident I had before who developed a stomach infection and was extremely hyperglycemic (no sliding scale). This one paramedic couldn't even interpret what she was seeing off her portable monitor. I just stood there stoic and I was thinking 15 liters of o2 for starters would be nice and rapid transport before the "golden hour" expires cretins!

Another time when I was a CNA in a convy, my RN at the time called for a transfer, and this freaking gorilla paramedic jut bit her head off about something. He was a total jerk with delusions of grandeur. It was like, sorry, did we disturb your coffee break or something.

Furthermore, I hate ED techs/ Paramedics who look down on nurses. They always brag about how they save people on the spot. Well, so what! they may know how to put on a PASG, but paramedics spend most of their time putting on o2 instead. Besides, who get's paid more and who has more training/education? Nurses!

Oh my...PHTLS my friend have you thought about valium...

Obviously you have had some bad experiences with paramedics...but attitude is screaming from your post.

Most of our medics are outstanding professionals. Most nurses I work with as well. But in any profession, there will be those who are more so than others.

Medics and EMTs have one of the most difficult jobs in healthcare. They are in the most unsafe environments, making the most critical of healthcare decisions and get the least respect.

If you are working in an environment that has medics who are "only putting on O2" as you state...perhaps your EMS system has read the research that states the best outcomes are when EMS transports WITHOUT taking time at the scene for IVs, etc...

[erdiane]

why oh why don't they start iv's on seizure patients?

[Medic2RN]

Why don't they?

[newfloridaRN]

Dont call it a Red or Yellow over the radio just so you think you're going to get a room.

[rn29306]

I've worked both sides of the emergency room doors - as a RN in the ED / ICU and also as a CCEMT-P certified critical care transport nurse for a private ambulance company. The two jobs are radically different in approach and design. One thing I found to be difficult was readjusting to the restrictive hospital nature, even as a seasoned ICU nurse, after being on the specialty ambulance a couple of shifts. In the field in EMS, things are done that have to be done, often in a manner that dictates RIGHT NOW. On the critical care truck, the RN and critical care paramedic team had alot at their disposal - our own on-board DataScope balloon pump and a complete inventory of drugs, even RSI. Because of our training (emphasis on the both of us), we ran the calls ourselves. Never did we have to contact medical control at either hospital on guidance for medical direction (and yes we ran the sickest of calls). Most of our calls were unstable cardiac patients, most were vented, and ran some dying sepsis calls also. We also responded to 911 calls. I may be wrong and please someone correct me if this is the case, but medics who work as techs in the hospital often find their in-house job descriptions extremely restrictive when compared to the ambulances. Independent decision-making has been taken away and substituted for oftentimes menial jobs (don't blow up at me, I was a er tech while a senior in nursing school. On many days all I did was run to the lab and cast splints all day long). I would assume it is a hard adjustment for them, but in case you have not noticed, EMS does not pay well for what they have to put up with. Couple that to the fact that they have to work under some people who posted previously and that in itself is torture enough. While working as a ICU RN (i am a guy), all the rotating paramedic students were precepted under me. I found them to be extremely willing to learn, as most pre-hospital programs do not extensively teach ICU management.
All fields have bad examples. Fortunately the company I worked for in Atlanta had some of the most incredible pre-hospital professionals I have ever seen. I have seen Nursing as a field eat its own, and then one wonders what they do to other people. Both fields have bad examples, hopefully these are the minority. Basically what it boils down to is a bunch of educated, type A personalities are forced to somewhat get along at times and perform under constant stress and all that really matters is these persons come together for the patient being treated.
Thank you pre-hospital professionals for what you do day in and day out in a variety of weather, family conflicts, and the threat of crime. Thank you nurses for what you do in hospitals day in and day out. Hats off to both fields of healthcare. For either side that wants to understand the other better, I would encourage possibly a ride along for nurses (friday or saturday night) or perhaps a paramedic could follow a busy ED (also on a friday or saturday night). I believe a little bit of understanding would go a long way in this situation...........
Just my 2 cents and sorry for the long post. Getting off my personal soapbox.