Emt problems

Wuzzie · Nov 18, 2016

We hear about nursing home nurses all the time in the ER from EMTs and Paramedics as being real ********* or their favorite term for all nurses is "buttwipers". But, if the patient isn't in pieces on the street bleeding out, it is just a ******** call. We often have to get the patient away from them as fast as possible because some don't care if they are making the patient feel worthless by calling their complaint ******** while complaining them as they are pushing the ambulance stretcher. I hate seeing an elderly patient made a fool of in the middle of an ER because they are septic, have PNA, an UTI or some other ******** complaint. I guess in the hospital and nursing homes we just take these things, including lab values or CXRs, too seriously according to some EMTs and Paramedics.

I'm not disputing your experience but wow I have never worked with paramedics that were THAT overtly hostile to/about nursing home caregivers. They must be real dreams to be around.

Still, I can understand frustration (not outright rage) being verbalized when 911 is called because a resident pulled out their g-tube or a urine culture came back positive. I don't think it's unreasonable for a true EMS crew to refuse transport in these situations and ours can but that's because, living in a large city, we have multiple options for appropriate transport. That's why I asked the OP if they were calling 911 for everything. We don't really have a complete picture of what's going on.

Buyer beware, BSN · Nov 24, 2016

I've never heard of an EMT refusal to transport.

When I worked in Atlanta the EMTs would get hoodwinked into taking patients for a ride downtown to Grady Memorial.

Once the patient arrived there it was "thanks suckers" from the bogus infirmed and off they went.

Of course good community relations allowed these stellar citizens immunity from prosecution. Heart attacks be damned.

My point is that if the EMTs could do this, it seems logical that they would honor a duly qualified physician's order to transport.

Maybe this is why some are so picky.

Sucker overload.

akulahawkRN, ADN, RN, EMT-P · Nov 24, 2016

Just a quick question for you guys: do any of you have issues with paramedics coming in and trying to tell you that they will not transport a PT to the hospital after the physician has ordered them to go? We seem to have emts come in, talk to us like we are stupid, and refuse to transport. It is so frustrating.

I have been on the "other side" of this situation more than a few times. Please understand this one thing: when I'm working 911 or in any other EMS role, your physician is NOT in my normal chain of command and I do NOT have to follow yours. My P&P manual is going to be VERY different from yours and my skill set is going to be different from yours. If I'm in a 911 role and you call 911 for a transfer that a non-emergency ambulance can do, you'd better believe I'm going to get very grumpy about it. In those situations, you'd best have all the paperwork ready because in 10 minutes, I'm out the door, and I'll generally be following my local policies permitting me to do so.

Also, generally speaking, when you call 911 you will get at least a Paramedic. This person is a specialist in the care and management of prehospital patients. This person is usually generally an expert in this field. You, quite likely, are not. There is a vast difference in knowledge and abilities between an EMT (very basic knowledge and skills) and a Paramedic (fairly advanced knowledge and skills). If you call for transport and you get an EMT-level crew and they refuse the patient, it may be that the patient requires care that is above their level of care. The crew probably expects you to understand that the patient may actually not legally be able to be transported by them.

In my time as an active Paramedic, I have met more than my fair share of nurses that just make me hang my head in shame. I have also met many more that just amaze me with their knowledge and ability. I have heard all the excuses and lines that a SNF nurse can give regarding why a patient isn't ready, didn't go by 911, or should go by 911 or why the nurse doesn't know anything substantial about the patient or (sometimes) even why the patient has to be transported in the first place other than a physician has ordered the transport.

I have emergently transported patients whose vital signs were deteriorating (ended up coding the patient in my ambulance) who wasn't in good shape 2-3 HOURS ago when the initial calls were made to get the patient transported and the nurses didn't have a clue as to why suddenly I'm going from "garden variety weak/lethargic complaint" to a scoop-and-run because the patient was actively decompensating right then.

I have many more first-hand accounts like this that (unfortunately) make me often think that certain nurses really have become stupid.

Now then, I have more than a few stories as an RN (and as a paramedic) where the paramedic is barely more than a knuckle-dragger and make me wonder how this medic managed to pass EMT school, let alone paramedic school, their internship, and accreditation rides...

Fixing this by addressing the problem with the specific EMT or Paramedic crew that responds to your place isn't going to work. Calling your physician just to complain isn't going to work well unless you can find a way to get your physician to call the EMS Medical Director and complain. Your best bet is to factually document any incidents and submit your complaints to the EMS Agency that licenses/certifies the crew OR authorizes the crew's agency/company to provide services in that area.

brillohead, ADN, RN · Nov 24, 2016

I would ascertain whether you're calling the ambulance company for a routine transport (meaning looking up their phone number and dialing the number directly), or whether you're actually calling 911 (dialing 9-1-1) for every type of transport need.

In our area, the same ambulance company provides both services, but emergency calls are dispatched through 911 and non-emergency calls are dispatched through the ambulance company.

I work for a hospital, and we call and fax the ambulance company directly when we need to transfer someone to another facility for a higher level of care (we don't have a cath lab in our facility, for example) -- we don't call 911. The ambulance company then dispatches a unit to our facility based on the needs of the patient (generally need cardiac monitoring and multiple drips, etc.).

We do the same when we're discharging someone back to a nursing home -- call/fax the ambulance company, and they assign the calls to the appropriate unit. Sometimes the person just needs wheelchair transport, sometimes they need a stretcher -- we let the ambulance company know that and they send the appropriate unit when available.

If you're calling 911 to transport someone to the Emergency Room for a bladder infection or a case of pneumonia that doesn't even require supplemental oxygen, I don't blame the EMTs/paramedics for being ticked off -- that's a non-emergent transport that should be routed through dispatch, not emergency.

But if you're calling the ambulance company directly and requesting a non-emergent transport and they're still refusing, that's when you go up the chain of command, as others have discussed. Get your facility's management involved with the ambulance service's medical director.

emtpbill, ASN, RN, EMT-P · Nov 25, 2016

I too agree, I think this needs more information. My service does 911 (Medic Units) and also interfacility transports (BLS transport units). Many times I have been called to a nursing home and greeted with " Oh we were given a two hour pickup time and even though this patient is beyond stable and has had xyz problem for two weeks, they didn't want to wait". Well then yes, you will get an attitude from the Medic crew. There is probably a reason you're gonna get a two hour pickup time, its because we are busy.

Also,getting called to a nursing home and if the patient says "No, i don't want to go" , well thats the magic words. We don't care if the surgeon general of the United States is the patients doctor and want's them to go to the hospital. Also, even though their son or daughter has power of attorney doesn't take the rights of an individual away in determination of their own care. I've had nurses throw fits and threaten me and even though the patient probably should go to the hospital, as long as they are conscious alert and oriented x4, people have the right to make bad decisions.

I do say this from experience. I am on my 20th year as a paramedic and just finished Nursing School.