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EMT's and how to deal with them

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I don't know if this is common (i've been a nurse about a year now) but i work 11-7 LTC and EVERY time I call 911 to send a res to the ER the EMT's act like JERKS... they question me about the why i'm sending them (in a very sarcastic manor) actually state that "there is nothing wrong with them but guess we'll take them anyways" and all around treat me like i'm stupid. Not that it matters, but every time i've sent someone out they've been admitted and although they may be a little better by the time the EMT's get there than when i first found them they still need to go! For instance one day i went into a res room cuz she was makin all kinds of moans and talkin to herself (not like her).. her 02 was in the 70's and wheezes all over.. starting to get cyanotic in her nail beds and not acting right at all.. i called the doc he said to put her on 02.. some of her symptoms subsided due to the O2, i explained all of this to the EMTs they accused me of calling them before i fully assessed the patient and of not checking on her before i called.. which i did.. i was in her room literally like 15 times in a 1/2 hour and had sent aides in there on top of that.. I don't know what the deal is with them.. but i am just wondering if this is common.. i mean correct me if i'm wrong but dont' we get a little more schooling than them? AND i think i know my res a wee little bit more than they do... :uhoh3:

I know exactly what your talking about! I know some are o.k. but the majority are just like you say. They also think they are more important than us (wee) nurses. I don't know where they get THAT from.I did have one come back once and tell me "That was a good call", as if it mattered.

Currently a Paramedic working on my RN, I wanted to post a reply to this thread. I'm not defending rude behavior by any EMS worker because it is inappropriate and unprofessional. What bothers us EMS workers at times is when we are called out to pick up patients that could be transported by private transfer ambulance services. When we are called out to 911 calls we expect to be responding to life or death emergencies. Some times doctors offices or nursing homes call 911 because they don't want to wait a longer time for a private ambulance service and they know when they call 911 that an ambulance will show up quicker. That is the only time I personally get upset. Not really angry, it just bothers me. Instead of being rude I just mention to the nursing staff to try to call a transfer ambulance next time.

In the case you mentioned, a hypoxic patient with altered mental status seemed like an emergency and I would not have even thought of complaining. I would have just been focused on pt care.

On what you state you have more education than paramedics, I'd have to say you actually do. Does that make you any better than us? Can you intubate? Read and interpret ECGs and 12 leads? Surgical airways? Chest decompressions?

I can also complain about rude ER nurses that act like we are bringing them pts because its fun for us. We know they are busy but we still get called and have to transport pts to the ER. They also get angry when we don't call ahead of time that we are bringing them pts. That is a courtesy. People don't call the ER before they decide to walk into one. We will quit bringing in pts when they turn off the big red 'Emergency Room' sign out front!

So instead of continuing or starting a fight between EMS and nurses, I think we should just work as a team to improve pt care.

When I was in nursing school, I had a guy in my class who had been a paramedic for years. I asked him this very same question and his response was that they thought we didn't do anything except pass pills and sit at a desk all day, and thought we sent people out who didn't need to be and it was a waste of their time. Yes there are times I've sent a res to the hospital and thought they didn't need to go, but family wanted them to or they wanted to go, and it made them feel better or the family. In a nursing home we don't have the hi tech equip that a hospital has, or a stat blood draw can take hours to receive. The guy in my class then went to work in a nursing home himself and guess what, he changed his ways of thinking and even griped about the paramedics coming in with their houlier than thou attitudes.

On the other hand you have good nurses and not so good nurses. I overheard a fellow nurse make a stupid comment to a paramedic one day during a code about she knew what he was doing because she had seen it done on ER. So I can understand their frustration if they get a lot of dumb comments and situations. The problem comes when anyone tries to group people in on lump sum... and make generalizations.

I usually just give my report and answer questions, if they don't like why I am sending someone out, to bad, that's their job.... and they don't sign my paycheck!!! I also try to have everything ready for them and have a hx.

One more thing and I will quit rambling. I don't think all paramedics/EMT's have this attitude, but the ones that do are the ones that leave the bad taste in your mouth and who you remember, which I'm sure is how they feel when they have a bad experience with a nurse.

Just my thoughts, sorry so long

I don't know if this is common (i've been a nurse about a year now) but i work 11-7 LTC and EVERY time I call 911 to send a res to the ER the EMT's act like JERKS... they question me about the why i'm sending them (in a very sarcastic manor) actually state that "there is nothing wrong with them but guess we'll take them anyways" and all around treat me like i'm stupid. Not that it matters, but every time i've sent someone out they've been admitted and although they may be a little better by the time the EMT's get there than when i first found them they still need to go! For instance one day i went into a res room cuz she was makin all kinds of moans and talkin to herself (not like her).. her 02 was in the 70's and wheezes all over.. starting to get cyanotic in her nail beds and not acting right at all.. i called the doc he said to put her on 02.. some of her symptoms subsided due to the O2, i explained all of this to the EMTs they accused me of calling them before i fully assessed the patient and of not checking on her before i called.. which i did.. i was in her room literally like 15 times in a 1/2 hour and had sent aides in there on top of that.. I don't know what the deal is with them.. but i am just wondering if this is common.. i mean correct me if i'm wrong but dont' we get a little more schooling than them? AND i think i know my res a wee little bit more than they do... :uhoh3:

Ok, I have to chime in on this one!!! I've been an EMT for 20 + years and a nurse for 18 years. I think one of the problems (at least in my state) is EMS is a magnet for adrenaline junkies. LTC transfers (commonly called granny tranies) irritate many EMT's because they like the high drama. I've even heard "what I wouldn't do for a good code, car wreck....." Not that I am defending the attitude. As an EMT instructor, it is difficult to teach compassion. There are many people drawn to EMS who are in it to play with the lights and sirens. If this is the case, they usually get bored and leave after a short while. EMS, Nursing.... IMHO is all about patient care and compassion for your fellow human being. It's too bad you have had these experiences with your prehospital people. Rest assured, we are not all rude. Some of us are quite informed and compassionate. I for one appreciate all the LTC, ICU, ER, Floor Nurses..... We need to remember we are all a team and we need one another. I've worked (and continue to do so) on both sides. As much as I love nursing, a part of my heart will always be in prehospital.

Sorry for my terrible spelling!!!!

Lori

After being on both sides, this can be a complex issue. I have done LTC transfers and 911 calls where the nursing had NO IDEA what was going on with the pt. I have gone to work at a LTC facility and found one of my patients with a six inch lac on her head. When I ask what happened the swing nurse told me "she fell I think" When, "few hours ago." Of course she got transfered to the ER. How does that look to the EMS crew?

On the other hand I have worked on both sides with great nurses in LTC.

Bottom line is both have a job to do and protocals to follow. Communication is the key, give a good report to the EMS crew just like you would do at shift change. Oh and smile, it goes along way.

Of course rude behavior is never expected and should be documented and reported.

Just my thoughts

Chet

We had this one guy (EMT), thought he was God's gift to humanity.After full assessment and contacting the doc, who by the way, gave the direct order to send to ER, this particular EMT, on two separate occasions, was very rude and condescending. The first time, I just let it slide off my back, the second time, I told him, "I call,you haul", if you have any further questions regarding care for my pt. please ask, otherwise, keep your opinions to yourself. Never had anymore problems with him. He still wasn't overly friendly but at least he didn't try to make me look like an idiot.

Have you talked with your DON or supervisor about this? Sometimes they can help you out with people like that. If not maybe talk with their supervisor. Who knows they may treat others that way not just nursing facility staff and residents in this manner. Good luck. I can sympathize with you there.

AKav8trix

Specializes in Trauma/Neurosurg ICU, MSICU, ED, Rural.

Currently a Paramedic working on my RN, I wanted to post a reply to this thread. I'm not defending rude behavior by any EMS worker because it is inappropriate and unprofessional. What bothers us EMS workers at times is when we are called out to pick up patients that could be transported by private transfer ambulance services. When we are called out to 911 calls we expect to be responding to life or death emergencies. Some times doctors offices or nursing homes call 911 because they don't want to wait a longer time for a private ambulance service and they know when they call 911 that an ambulance will show up quicker. That is the only time I personally get upset. Not really angry, it just bothers me. Instead of being rude I just mention to the nursing staff to try to call a transfer ambulance next time.

In the case you mentioned, a hypoxic patient with altered mental status seemed like an emergency and I would not have even thought of complaining. I would have just been focused on pt care.

On what you state you have more education than paramedics, I'd have to say you actually do. Does that make you any better than us? Can you intubate? Read and interpret ECGs and 12 leads? Surgical airways? Chest decompressions?

I can also complain about rude ER nurses that act like we are bringing them pts because its fun for us. We know they are busy but we still get called and have to transport pts to the ER. They also get angry when we don't call ahead of time that we are bringing them pts. That is a courtesy. People don't call the ER before they decide to walk into one. We will quit bringing in pts when they turn off the big red 'Emergency Room' sign out front!

So instead of continuing or starting a fight between EMS and nurses, I think we should just work as a team to improve pt care.

As someone who has been in EMS for a while (and also almost done with nursing school), I wholeheartedly agree with what you wrote. I too, want to say that the patient described in the OP certainly sounded like someone who truly needed EMS. I'm sorry the EMT's were rude--nobody has the right to treat someone else that way for any reason, imo. I would have been grateful to get such a thorough patient report. It would have enabled me to be able to continue to provide the best care possible for their patient by having the knowledge of what the patient's presentation had been prior to my arrival.

That being said though; unfortunately, I have been on several calls where the patient simply needed to be brought to the ER for a few stitches, or to have a foley replaced, and other things that are not emergencies, nor required the staff or equipment on an ALS ambulence. When my service runs a call like that, it means our rural district is without a 911 ambulence for > 1.5 hours only because someone wouldn't wait for a non-emergent transfer ambulance or car to come, or didn't consider other non-911 options, first.

The problem isn't even that we get called for something non-emergent (we can always evaluate the person and give a second opinion on whether they should be seen in the ED right away or not). It never hurts, when in doubt, to call 911. The problem is when we've evaluated the patient and determined they really don't need a 911 ambulence ride and recommend an alternate, but the caregiver still insists we take them in regardless. We do not have the option to refuse. It can be frustrating, but does not make it okay for anyone to be rude.

I have been on a few pretty serious calls at LTC's, and assisted living places, where it was because of the close, careful, attention of the nurse or CNA who noticed a serious problem developing with a client, that the client was quickly transported and treated at the nearest hospital before the problem became fatal. My hat is off to all of you who work so hard to care for your many clients/patients to ensure they have the best life possible.

I have seen less than desirable patient care performed because of the egos of both medics and nurses. Sometimes, I've wondered if it wouldn't be a bad idea to have each side spend a few days in the other's shoes, if that were possible. I think it might foster a little more understanding regarding why the other person is reacting the way they are to a situation.

I also agree about calling 911 for non emergency care, we have a transporter ambulance as well, but when they are on call and out of town sometimes it will take 2-3 hours for them to get back in town. It isn't always the nurses who are unwilling to wait if it isn't an emergency, it is the family. There has also been times that I have called the transporter ambulance and they have said that they don't feel comfortable transferring that person d/t what is going on with them. Then we don't have any other choice.

Also while we are on this subject. I was always taught if someone falls and we suspect a hip fx to leave them and not move them, yet when the ambulance gets there they usually make some comment about it. All the nurses in my facilty were taught this as well, is this standard practice????

Thanks

I also agree about calling 911 for non emergency care, we have a transporter ambulance as well, but when they are on call and out of town sometimes it will take 2-3 hours for them to get back in town. It isn't always the nurses who are unwilling to wait if it isn't an emergency, it is the family. There has also been times that I have called the transporter ambulance and they have said that they don't feel comfortable transferring that person d/t what is going on with them. Then we don't have any other choice.

Also while we are on this subject. I was always taught if someone falls and we suspect a hip fx to leave them and not move them, yet when the ambulance gets there they usually make some comment about it. All the nurses in my facilty were taught this as well, is this standard practice????

Thanks

You are right Nurse Rachett. If a pt falls and there is any question of a break the pt should not be moved. Call 911 and cover the pt and make them as comfortable as possible. Obtain vitals and brief assessment for report. Another poster wrote about a pt who dropped their sat. It is always considered an emergency whenever respiration and mentation changes occur.

Lori wrote about the young gun EMTs who want car wrecks and trauma. After a few years of cutting children out of cars or trying to save gunshot victims with half their faces gone or have to go into a burning building but are too late to rescue anyone a LTC call will be a welcome relief.

Nurses and Fire/Rescue have different skills but they are both trying to provide the best care then can. I love being a unit RN and I teach at Fire/Rescue on the weekends and unfortunately the Us vs Them attitude still exsist.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

At my facility, if someone falls, we call Code Star. The DNS, ADNS, and supervisor all respond to the scene. The thought is...better to have many people decide if the person is stable to move...we must hang together or surely we shall hang seperately. (Thank you Ben Franklin) If there is the least question of a fracture, we leave the person on the floor and call 911. We have developed a good raport with the local rescue guys....they know we only call in a "true" emergency. I wish I could say the same for the local chair car service...yikes... I think they all wanted to work in the ER and ended up driving a wheel chair van to take Aunt Minnie to the eye doc!! No wonder they have major attitudes.

I just have to respond to this thread! I have only called 911 ONE time in the two years I have worked long term care, usually I call the local transport. This one time, I had an admission at 8:30 at night, sweet little man. Very confused, but sweet. At 10 pm, patient becomes blue, not responsive with very weak vitals. Toss the gent back in bed, put him on O2 and he starts to come around...WTH?? Don't really know this patient, called 911. They were totally rude. "Oh his pulse ox is 96% percent...what an emergency!!"

The patient died the next day.

I just have to respond to this thread! I have only called 911 ONE time in the two years I have worked long term care, usually I call the local transport. This one time, I had an admission at 8:30 at night, sweet little man. Very confused, but sweet. At 10 pm, patient becomes blue, not responsive with very weak vitals. Toss the gent back in bed, put him on O2 and he starts to come around...WTH?? Don't really know this patient, called 911. They were totally rude. "Oh his pulse ox is 96% percent...what an emergency!!"

The patient died the next day.

Like I said in the previous post. If they drop their sats and/or have changes in mentation they belong in a hsp. It is a medical emergency and the EMS know that and should have transported the pt STAT.

RoxanRN

Specializes in CCRN, CNRN, Flight Nurse. Has 10 years experience.

also while we are on this subject. i was always taught if someone falls and we suspect a hip fx to leave them and not move them, yet when the ambulance gets there they usually make some comment about it. all the nurses in my facilty were taught this as well, is this standard practice????
i believe this is meant to be standard practice, but in reality...... as a paramedic, i can't count how many times i've been called to transport "miss jenny" to the hospital because she fell. when i get there, miss jenny is in bed. please note that the following is more common then some might admit.

'when did she fall?'

'she was found on the floor this morning by an aide' (it's now 6-8+ hours later).

'did she have any noted injuries at that time?'

'oh, she complained of some hip pain when we helped her stand and get back into bed.'

'what is the complaint you are calling me for now?'

'her family wants her seen because she was found on the floor.'

'did you find any injuries when you checked her over before moving her back to bed?'

'she was only a bit confused (she normally knows everything that's going on around here) and her lungs were clear after she was back in bed.'

as part of preparing to package miss jenny for transport to the hospital i bring in a long spineboard and c-collar.

'oh, you won't need those; she doesn't have any injuries or broken bones.'

'according to our protocol and her mechanism of injury, i have to put these on. if someone were to invent a pair of x-ray glasses, they would make a mint. i'd even by a pair; but until then, unfortunately, i still have to assume something is broken.'

upon my complete assessment in the back of my ambulance, i find miss jenny is lethargic and confused to location and date (per staff, normally extremely alert and very oriented). she has a large knot forming on the right side of her head. her pupils are sluggish. there is also shortening and external rotation noted to her right leg.

after examination by the trauma team, numerous w-rays of her hips and a ct of her head, c-cpine and back, she is diagnosed with a severely communited right femoral head fracture and subdural and epidural bleeding in her head.

unfortunately, in my pre-hospital career (18+ years) the above scenerio has played out more often than it has not.

no offense is meant to anyone. this is just my experiences as i've encountered them. there are some wonderful nursing homes out there who take the greatest care of their residents; and then there are those who are the complete opposite. these are the ones people tend to remember.

roxan

emict, rn

Aneroo, LPN

Specializes in Cath Lab, OR, CPHN/SN, ER.

I am an EMT, and before nursing school, I worked for a private EMS service. I treated some RN's and LPN's in LTC like pure crap, but given the crap I had seen in those facilities and from that staff, I don't blame myself. Ever get snappy with the drug seeking patient b/c you're tired of it? Same thing with some EMS crews.

-Called to a LTCF, mid-afternoon. I am first semester nursing student at this point, assessment skills are sharpening! I ask what pt is going to ER for (she had MD orders). Response? With the flip of a hand, I hear "Oh, everything". I look this woman straight in the eye, tell her, "They're going to laugh at us if we tell them she's here for everything". She then tells me the lady hasn't eaten in 2 weeks, and just isn't acting herself. We get her loaded, trying tog et a set of vitals before we go. Luckily, ER is across the street. I ended up calling city Paramedics, b/c I couldn't palpate a pulse or get a BP (although she was alive, looking at us, breathing, just so darn dehydrated we couldn't get crap). EMS told us they wouldn't be able to get a line on her, but a paramedic rode with us to the ER. How do you let a client go two weeks without eating? How do you get to the point where your pt looks like they're going into shock before you call EMS? That was where my frustration came into play. Admin didn't care enough to write out a nice list of "Call EMS for this, call private company for this".

However, there were the nurses we loved. They cared about their patients, and knew what to do, when to call. We just got so darn frustrated with the ones who didn't have a clue! -Andrea

cardiacRN2006, ADN, RN

Specializes in Cardiac.

I have also been an EMT for many years, (10 or so) and I have seen that attitude lots of times. I worked for a private ambulance company and the fact of the matter is that their job is to transport sick and injured pts to the ER. Not just the critically injured or the acutely sick. Sometimes pts call 911 when they haven't felt well for weeks-so what! You still treat people with respect, which includes nsg staff and the pts. I had one firefighter/paramedic tell me that unless the pt was on fire, he didn't want to touch them. Nice.

flashpoint

Has 23 years experience.

As a paramedic who works both in the field and ICU/ER, I'll admit that I sometimes get attitude with LTC staff...also with ER staff and patients in the public. One of the LTCs we go to often has no one available to direct us to the patient...we'll ask where the patient is and get and anwer like "uh, in her room." or "in the blue room." Well, that doesn't tell us anything. We also get yelled at for parking the ambulance in the worng spot (I guess that big AMBULANCE PARKING ONLY sign doesn't apply to us) or we'll have trouble getting into their locked unit because we don't know the code and none of the staff will come over and either let us in or verbally tell us the code. I don't read lips very well, so when the staff mouths the code to me so they aren't heard saying it out loud, it doesn't benefit me. I also grow a little weary of having tranfer papers ripped out of my hand because "that's confidential...that is for the HOSPITAL, not an ambulance driver." Hmmm...if they are getting into my ambulance, I have a right to know the whole story. We also show up to find all doors locked in the middle of the night and have to call dispatch to call the facility to let us in. We get called at 2:00 AM for patients who fell at 8:00 AM the day before or who have problems that really should have been dealt with during normal waking hours...patient hasn't voided for 15 hours, patient has a laceration that happened at 6:00 PM that the nurse finally decided isn't going to close without sutures, etc. We've also had to deal with a lot of "We need to have the patient before you take them" of "Wait just a minute and we'll get their clothes for tomorrow (dentures, shoes, hair dryer, etc)...never mind that the patient is blue.

This doesn't happen all the time, but it happens enough that a lot of us dread going to the LTCs. So often, from the minute we walk in, we are treated poorly by staff or will have staff argue with us about what we are doing and how we are doing it...everything from putting O2 on a COPD patient to putting a patient on a backboard or vacuum matterss. The way I see it, we are called because there is a situation that cannot be handled within the facility. Once we show up, we are responsible for what goes on with the patient...we have protocols to follow and we generally have a very good reason for what we do. No, EMTs don't have the training that an RN does, but we do have the training to do what we do...we should be allowed to do it without a lot of hassle from staff...and when staff argues with what we are doing or tries to correct us or disagrees with out protocols in front of the patient, it makes us look bad and it takes away a certain amount of trust that the patient has in us. Sure if we are doing something that is very obviously wrong, something should be said to protect the patient, but staff should keep quiet about things that they do not understand...if they have questions they can call the station and ask later, but it is not fair to us to try and stop us from doing our jobs just because they do not know the purpose of a vacuum mattress or SAM splint.

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