EMS talking down to Nurse

[heynurse1996]

School Nurse Vent!!!

So, I see my nurse assist per IEP diabetic three times a day, he sticks himself but I carb count for him and help him draw up the insulin, supervise and make sure hes rotating sites,ect. Today he came in very panicked. Stating he was in DKA.

Now this kid is happy go lucky and never has a complaint...ever. So immediately I am worried. He has Large ketones in his urine, Blood glucose 390 (he usually runs low,never seen him above 180) And generally knows whats going on with his own body, He's vomiting, kussmaul respirations, fruity breathe, weakness, blurred vision, sleepiness the whole nine yards.

So I call 911, the EMS team thought I was an idiot, the paramedic informed me "390 is not even that high" I replied that he is a type one with dx hypoglycemia issues per MD and even printed out his CBG record and MD note stating this. Still the whole time they rolled my eyes made a big production and were dragging there feet on taking him. At one point when I handed them his dx list they stated that this was probably a "panic attack" because of his mental health dx. None being anxiety mind you.

I finally tell them they need to go with him to the hospital now. With some shuffling they go on. My RN supervisor (I'm an LPN) Seems to think its because I'm young and stated the same thing happened to her....I was wondering if anyone else has had the same experience.

It just frustrates me that people with mental health dx are being overlooked when its a WAY bigger issu because "Its just part of it" Anyways...very upset about the whole thing and kind of still seeing red...

Update: He's being transported to the "big city" Diabetic Peds unit...it was DKA

[ohiobobcat]

First of all, great job recognizing DKA and getting the student where he needed to be for treatment.

Secondly, thank you to the EMT personnel who responded to this. I don't feel that one profession blasted the other and that a civil discussion was had by all. It's also interesting to hear from your perspective.

I had one EMT crew that questioned my assessment on a student. I know what I saw, and I wouldn't make up the 5 seconds of seizure-like activity I witnessed as I caught a student in my arms as he passed out after getting hit in the head.

Bottom line is, though, that the students got the help they needed, despite the occasional bad attitude from EMS personnel. I'm lucky because most of the time I know at least one member of the crews that respond to emergencies at my school. We know and respect each other from my many years working in a local ED. I feel that relationship should not be necessary in order for them to respect my role as a school nurse and my assessment, though.

[MiladyMalarkey, ASN, BSN]

Way to advocate! I'm sure his parents are incredibly grateful for you.

[MrNurse(x2), ADN]

Working in a SNF has been a real eye opener. EMS is downright rude and condescending. Remember that EMS (mostly male, but I have seen it in the females) are normally the only medical personnel in their families, this makes them have an expert attitude to begin with. They have also seen things I would NEVER want to see, decapitations, disembowelment, etc. so this makes them a defacto expert. When they are given info they can't process, they have 2 choices, learn or belittle. The prior two things often get in the way so they belittle. I would follow up with management as most medical "volunteers" are actually paid in most areas to ensure coverage, and those positions are highly coveted. He will change if he chooses to value his job.

[darobow]

Maybe there was no ill will intended. There are several local EMS agencies in my area with the mindset that if its not life threatening but still serious then have a loved one take you to the hospital or ER and get treated and spare you the cost of an ambulance ride if it can be avoided.

[heynurse1996]

Maybe there was no ill will intended. There are several local EMS agencies in my area with the mindset that if its not life threatening but still serious then have a loved one take you to the hospital or ER and get treated and spare you the cost of an ambulance ride if it can be avoided.

The issue is as a school nurse I did not think he had enough time to wait for dad 30 minutes away and to than drive to the hospital another hour away....Also its hard because as a school nurse I'm armed with crackers and ice, didn't have anything to intervene had he taken a turn.

Not to mention student has several other dx that to me made him high risk to transport in the car.

Had we been closer I might have considered. But I would rather be safe than sorry with my peds patients.

He is also a mckinney-vinto kiddo (school nurses know this struggle) which made him another potential issue to transport w/guardian

[Eastern RN]

He has Large ketones in his urine, Blood glucose 390 (he usually runs low,never seen him above 180) And generally knows whats going on with his own body, He's vomiting, kussmaul respirations, fruity breathe, weakness, blurred vision, sleepiness the whole nine yards.

WONDERFUL assessment and you did exactly what you should have. You will run across a large amount of health care providers from different backgrounds, education, specialties etc in your career. Continue to do what you do, stand your ground and make sure your patient gets the proper and best care possible!

[Queen of Icepacks, RN]

At our school the standing protocol is that if the student is going to the ER, as opposed to an Urgent Care or MD office, they must be transported via ambulance. If the patient's condition were to change while in the car the parent who is usually by themself would not be in a position to handle it.

[BostonFNP, APRN]

Maybe there was no ill will intended. There are several local EMS agencies in my area with the mindset that if its not life threatening but still serious then have a loved one take you to the hospital or ER and get treated and spare you the cost of an ambulance ride if it can be avoided.

The point is, that mindset is wrong.

[heynurse1996]

I think the biggest issue is people get into EMS with this idea that there going to be the hero and be intubating and coding people all day snatching them back from the brink of death and the reality of healthcare is that most of what we do is manage chronic conditions/lots of psych and prevent the initial code!

In my mind (maybe because I don't work EMS) i just cant imagine not wanting to transport especially a peds patient....I think EMS is good at what they do managing care until it can be stabilized Old Dude was right they are the middle of the encounter.

Sometimes we get disillusioned with our particular careers based on what we see in media. Not to mention I don't think EMS is used to working with other healthcare workers they are used to running the show. I understand now the more I read why it happened, but it terrifies me that if someone takes this paramedic as knowing whats going on (most people do if they don't know any better) That it could become lethal.

Long rant short I think EMS needs some more education that even though this patient is alertish and speaking right now dose not mean it will not go wrong quickly!

[Rubor]

Great job!! I have come across nice ones and not so nice (as with any profession). At the end of the day you did not have the necessary equipment, tools or setting to "wait and see."

[NurseSpeedy, ADN, LPN, RN]

I worked in an assisted living facility very briefly (less than a year). EMS transport to the hospital for falls/emergent conditions was practically a daily occurrence (large facility). I could not believe the arrogance that I saw with EMS there versus when I dealt with them working at a hospital. They had a habit of talking to me (the nurse) like an idiot and would talk to the resident in a way that would get them to change their mind about going to the ER.

Well, one of my residents took forever to convince to go, then they talked her out of it. She made her own decisions. I then called the family and told them what was going on and they spent close to an hour convincing her to go to the ER. She finally did, with the same EMS team. Oh, and all that time wasted-she had a CVA. I was right about her symptoms. She never recovered enough to not need skilled nursing care and had to be moved to a nursing home.

[heynurse1996]

I worked in an assisted living facility very briefly (less than a year). EMS transport to the hospital for falls/emergent conditions was practically a daily occurrence (large facility). I could not believe the arrogance that I saw with EMS there versus when I dealt with them working at a hospital. They had a habit of talking to me (the nurse) like an idiot and would talk to the resident in a way that would get them to change their mind about going to the ER.

Well, one of my residents took forever to convince to go, then they talked her out of it. She made her own decisions. I then called the family and told them what was going on and they spent close to an hour convincing her to go to the ER. She finally did, with the same EMS team. Oh, and all that time wasted-she had a CVA. I was right about her symptoms. She never recovered enough to not need skilled nursing care and had to be moved to a nursing home.

Scenarios like this are what terrify me, I trust EMS to intervene in life saving events but I promise the nurses know what they are doing! This situation deeply saddened me because it really could have been prevented to a degree, time is brain tissue!

Just because it dose not seem emergent to them ie pt is breathing and not gushing blood dose not mean as nurses we don't realize that very quickly these scenarios turn bad I guess it is because EMS is looking at them with ABC goggles on and as nurses we look holistically / big picture