[rn29306]

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!

Does your listname stand for PreHospitalTraumaLifeSupport?

[Medic946RN]

Originally Posted by rn29306

Does your listname stand for PreHospitalTraumaLifeSupport?

That's what I thought too. You'd think that someone who had enough gumption to take PHTLS would understand EMS a little better.

PHTLS,
I understand your frustration and I feel your pain. I have worked both sides of the stretcher for years. I'm sorry you had to deal with the small minded but self important people you listed here. I can tell you that Paramedics like any other professions have their share of a-holes. But can I also tell you that for every a-hole medic you show me I can show you an a-hole nurse or PA, or NP, or MD, even cops and firefighters have theirs. I can also tell you that I worked ALS EMS in three different states for 25 years and I can count the number of times I have received a coherent complete report from the nursing home nurse on one hand. If you brought the crash cart to a pt who was circling the drain I'd be jumping for joy and high fiving you for thinking with a heads-on or as you called it hardcore attitude. But I can tell you of the time I was berated and scolded by the nursing home staff for assisting a pt who had marked respiratory distress. This pt clutched my hand and said "help me, help me' I asked her if she wanted me to help her breathe, she replied in the affirmative. I contacted medical control and the Doc agreed that we could disregard the DNR and help the woman. Then the entire staff including the DON came barging in the room and threatened my job if assisted this patient. They showed my the DNR which clearly stated that the pt only wanted CPR witheld. I put my pt in the ambulance, strung up an IV, wacked her with versed, lido, and etomidate and intubated the woman who was still asking for help until the drugs took effect. The nursing home staff
faxed the DNR to the recieving ED and raised holy hell with them. I was met in the parking lot by another group of irate( this time ED nurses so don't think I'm ragging only on LTC types) who screamed and rolled their eyes and told me I was violating the pt's rights to self determination, yadda freakin yadda. I delviered the pt to the room, gave a concise report to the ED Doc and then advised the ED RN's that DNR stands for Do Not Resucitate. In order for a DNR to be implemented the pt has to in need of resucitating. This lady just needed some help to breathe, and besides all that, she asked for my help which negates the DNR instantly. Now when I work the ED and I see a medic crew come through the door, their sweaty, their hair is all messed up there's blood everywhere. I help them into the room and dive in. I don't berate, chide or denigrate. If they couldn't get the IV, who cares, I'll the Doc to drop a CVL in the pt. If they couldn't get her intubated, I'll give it shot our we'll trache her. I know these guys and gals sometimes go through hell in a short period time. I don't need to give them anymore. BTW the pt above did fine. She had pneumonia and after three days and course of antibiotics she was returned to the Nursing Home.

[RNin92]

It just amazes me how nursing STILL "eats their own"...and I consider pre-hospital as "one of us".

Who cares of EMS didn't get then line???
Neither do I sometimes...and I am standing still not bouncing around in the back of an ambulance. Or having 25 family members screaming in my face to help their loved one.

Who cares if they "load and go"...that is what they are SUPPOSED to do.

As ER nurses we get all bent out of shape when the ICU wants the patient all "neat and tidy" and yet we have zero tolerance for the pre-hospital personnel.

Healthcare is a continuum.
What I start someone else will pick up and continue...

We need to support each other not destroy ourselves.

[nurse educate]

Originally Posted by Medic_78

I'm a fairly new Paramedic (8 mos into my job @ Private ambulance co.)
Unless we get a "call review" (which happens if we made bad jdgement calls, etc.) We really do not get much feedback other than "ok guys, thanks & have a good shift" or "good job" (Which is definitely a highlight of a shift when we get a response like that) I'd like to pride myself on my positive attitude towards helping my patients, keeping up my skills and not becoming known as just an "ambulance driver".
My question is, from others' observations, personal experiences with paramedics who bring in pt.'s to the E.R. (I know that some medics get branded as good, bad, etc.) What makes you label them as a "good" or "bad" medic? Id like to know so I can help make you guys' job a little easier and to help increase trust & repoire with the many nurses and Dr.'s I come into contact with.

Some Medics are good and some are bad. The good ones are the product of the the abilty to think quickly and arrive at the correct conclusions the majority of the time, this combined with the abilty to perform the nessesary skills make what I would call a solid paramedic. Truly good Medics are few and far between. My best advice is this, do your job and your relationships with hospital staff will be fine. Get the lines in, get the meds onboard, get a good history, get the Pt's that need tobe intubated, intubated. Don't put yourself in a situation where you feel the need to make an excuse. Example - "The line blew" (it didn't blow you never got it) "The tube must have moved" (no it didn't it was never in the right place).

PS - This post was written by the husband of BonemarrowRN

[ladytraviler]

As a paramedic who did not renew their certs, I understand both sides of the story. I used to get jumped on by nurses for not telling them patient had something like scabies or lice before telling them that the patient was allergic to what ever and treatment given. I was taught ABCD. Thats how I always gave report. Then some nurses would appriciate that. It was the nature of the nurse.

I now work OB and some ER. I look at the medics as one of the best friends I could have. If they have a line that is in place great if not thats something I know needs to be done. Starting it is no peice of cake going down the highway. I know when I came off the streets that I could not start an IV unless I bounced the hand up and down. I still do it from time to time without realizing it.

I have worked with some snotty paramedics and some that were awesome. I have worked with the same in nurses. I value a medic that keeps his/her head when everything else is going down the tubes. I value that medic that helps at the same time. I wish medics who didn't know would ask and those that do know, and want to brag that they know, would shut up. I don't need a medic telling me that the patient is fubared, I need to know what you have done and how they responded, what you saw, and mech of injuries.

I take my hat off to you. I no longer do the job due to injuries. Take care of yourself and your partner. Remember you first, partner second, and patient third. You seem to have a good head on your shoulders. Give respect when due and demand the same. Each side of the coin has a roll and from time to time, they overlap.

[emsboss]

Originally Posted by Medic946RN

As a nurse that was (is) a practicing paramedic for the last 25 years. (I know, I'm old) I can tell you one of the best things to do is seek out the nursing staff or even the MD when you have one of those borderline calls that your not so sure about. Ask them, hey I felt this guy was a (add your feild diagnosis here) was I right, was my treatment appropriate. This goes miles. As long you're not doing it on every call. In the nursing profession it's collaborating. The RN's and Doc's will take you for Paramedic that concerned about his patients and improving his practice. You automatically set yourself up as part of health care team, which you are. (It's much nicer nowadays, I remember back in the Dark Ages of Paramedicine when nurses and medics were mortal enemies and the patient usally got the short end) Don't be afraid to ask questions and don't be afraid to check on your previous patients when you bring a new one in. Good luck and stay safe!

Medic_78...This is probably one of the most appropriate replies that I have seen in this thread. The "'medic bashing"...well...get used to it. Here in WVa a 'medic is now an A.A.S. degree, just like an R.N. Yes, there are some A$$hole 'medics, just like there are some A$$hole nurse, LPN's and CNA's. Get used to it and just be sure that you are not one of THEM. GOOD LUCK!!!!

[rn29306]

Originally Posted by travilinglady

As a paramedic who did not renew their certs, I understand both sides of the story. I used to get jumped on by nurses for not telling them patient had something like scabies or lice before telling them that the patient was allergic to what ever and treatment given. I was taught ABCD. Thats how I always gave report. Then some nurses would appriciate that. It was the nature of the nurse.

I now work OB and some ER. I look at the medics as one of the best friends I could have. If they have a line that is in place great if not thats something I know needs to be done. Starting it is no peice of cake going down the highway. I know when I came off the streets that I could not start an IV unless I bounced the hand up and down. I still do it from time to time without realizing it.

I have worked with some snotty paramedics and some that were awesome. I have worked with the same in nurses. I value a medic that keeps his/her head when everything else is going down the tubes. I value that medic that helps at the same time. I wish medics who didn't know would ask and those that do know, and want to brag that they know, would shut up. I don't need a medic telling me that the patient is fubared, I need to know what you have done and how they responded, what you saw, and mech of injuries.

I take my hat off to you. I no longer do the job due to injuries. Take care of yourself and your partner. Remember you first, partner second, and patient third. You seem to have a good head on your shoulders. Give respect when due and demand the same. Each side of the coin has a roll and from time to time, they overlap.

As someone who has worked both sides of the sliding ED doors, what a beautiful post. Thank you.

[rn29306]

Originally Posted by bonemarrowrn

Some Medics are good and some are bad. The good ones are the product of the the abilty to think quickly and arrive at the correct conclusions the majority of the time, this combined with the abilty to perform the nessesary skills make what I would call a solid paramedic. Truly good Medics are few and far between. My best advice is this, do your job and your relationships with hospital staff will be fine. Get the lines in, get the meds onboard, get a good history, get the Pt's that need tobe intubated, intubated. Don't put yourself in a situation where you feel the need to make an excuse. Example - "The line blew" (it didn't blow you never got it) "The tube must have moved" (no it didn't it was never in the right place).

PS - This post was written by the husband of BonemarrowRN

As a RN in many previous hosptial subspecialties, critical care transport RN, and current now SRNA, the tube movement comment strikes home. Perhaps it happens on occasion in your ED (and for that I am sorry), but tube movement, either into the bronchial mainstem or actual dislodglement is no joke. Yes, it should be the first thing noticed, as A is the first in the ABCs, but it is hard to comtemplate first arriving at your patient in a drainage ditch in the rain at midnight, intubating, then running a code by yourself (paramedic + a fireman if you are lucky), then bouncing up and down in the back of an ambulance. Ever notice how running a code is a hospital is such organized chaos? Try for an instance running it by your lonesome in a moving environment. Tube displacement occurs in the relatively stable environment of the OR on numberous occasions and I am sure the ambulances are more prone to it than lying or turning in the OR.
Tube displacment is no joke, it happens to MDAs and CRNAs in the OR.

[sixes]

I work in LTC as the charge Nurse it is frustrating when I need to call for an ambulance.
You must remember that most of our residence have some form of dementia and can't always tell us what is wrong .
We know our residence and we must us our nursing skills and usual habits of our residence.
Nothing burns me more then when a paramedic walks in and says. Well what did you call us for.Resident is DNR. Well just because they are old and demented doesn't mean they have to suffer.
One of our residents goes into CHF often we have orders. Asprin 81mg chewable. Nitro patch o.6mg; Im lasix 40mg; repeat Lasix if not resolved. Call ambulance if not resolved in 20min.
Paramedics arrive on scene and say why did you call us?
Just because our resident has dementia doesn't mean they have no quality of life
When she is well she attends the hairdresser, church crafts etc.
Just because they don't know where they are or what year it is doesn't mean they deserve to suffer
Sorry for the rant
My point is that my job is to make sure they have optimal care. In a long term facility we are limited in what we can do and the eqiupment we have.
Please don't look at me like I'm a complete idiot. I get that enough from the ER docs.
I even had one DOC who sent a Psycotic resident back to me with an order to only give him plastice utensils. Couldn't understand the problem of sending him back to a secured alzhemiers floor. He said "it's a secured unti isnt it"
A secrue unit in LTC isn't a secured unit at a psych.
Didn't seem to understand that i had 37 other dememted people walking around and that he posed a risk. P>S> the paramedics called for police escort so why would we be able to handle him???
Please advocate on behalf of these people. Believe you me I wouldn't call for you if Our facility was equipped to deal with the problem at hand

Most of you are great to work with and I appreciate the hard work you do

[RN92]

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

Their main objective is to get the pt to the er asap. Many do try. Try starting an IV on a pt who may be seizing while going down a bumpy road or a busy city street. As a nurse, I have all the respect in the world for paramedics/emts. I dont wear their shoes and they dont wear mine. Just try and get an IV the second they come through the door.
HATS off to any medical professional that can respond to an uncontrolled scene and stabilize a pt while at the same time trying to get them to the ER.
Some are bette than others - but thats true in any profession.
**********paramedics/emts - LOVE you guys****************