EMT's and how to deal with them

Schmoo1022 · Jun 5, 2005

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.

hollyster · Jun 6, 2005

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 · Jun 6, 2005

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 · Jun 6, 2005

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 · Jun 6, 2005

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 · Jun 6, 2005

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.

aprilleverett · Jun 6, 2005

Just want to say that I don't think just cuz i've had more "book learnin" than an EMT that I am better than them.. i just think that when (especially in this area) they come to pick up a res that they should think about that fact that I know that res better than they do.. if there is something wrong and I and the DR feel they need to go I don't see why they have to have attitude.. a lot of times the ones here walk through the door acting mad or annoyed... in this area all we have is the 911 ambulance.. no private transport and so that's how they have to go.. I don't think i'm above anybody.. and i appreciate what EMT's do.. we do have like 2 that come in and are nice and friendly.. lol all i know is when i was fresh out of school working night shift i was almost afraid to call the EMT's when i needed to ship someone out cuz they were so mean lol also.. about the laceration that had been there 2 hrs... it's taken me longer than that to get ahold of the dr before.. especially on noc shift.. if neuro checks were fine maybe that's why they didnt call sooner? just a thought

Aneroo, LPN · Jun 6, 2005

Just want to say that I don't think just cuz i've had more "book learnin" than an EMT that I am better than them.. i just think that when (especially in this area) they come to pick up a res that they should think about that fact that I know that res better than they do.. if there is something wrong and I and the DR feel they need to go I don't see why they have to have attitude.. a lot of times the ones here walk through the door acting mad or annoyed... in this area all we have is the 911 ambulance.. no private transport and so that's how they have to go.. I don't think i'm above anybody.. and i appreciate what EMT's do.. we do have like 2 that come in and are nice and friendly.. lol all i know is when i was fresh out of school working night shift i was almost afraid to call the EMT's when i needed to ship someone out cuz they were so mean lol also.. about the laceration that had been there 2 hrs... it's taken me longer than that to get ahold of the dr before.. especially on noc shift.. if neuro checks were fine maybe that's why they didnt call sooner? just a thought

I certainly do not doubt your education. We're all smart, just in different areas. Sadly, a lot of us have experience with RN's and LPN's who don't know their residents like they should, don't care to know them, and could care less. I recommend speaking to the DON. Whether there is a private squad or not, you're both there for the patient. Maybe your DON can speak to the dept head with EMS and set them straight. Also, keep in mind, those EMT's might have been out working all night long, had just fallen back to sleep after codes and car accidents. -Andrea

aprilleverett · Jun 6, 2005

Indeed.. i have worked with MANY LPN's and RN's who know less about their res. than a stranger walking in off the street.. and i'm sure that would be frustrating as an EMT, especially if u got a lot of calls from the same place with nurses like that... i wish all nurses were as good as I, then we wouldnt have this problem.. j/k lol

LEGOS4HM · Jun 7, 2005

I've been an EMT in Los Angeles County for 7 years now and have had my fair share of incompetent RN's who call for transport. I agree with the others, EMT's should never be rude or self rightous to the nurse. However, I've experienced nurses who are unable to explain the reason why they have called, or fail to have the proper information available such as history, allergies, and medication. Some nurses are unable to explain the patient's normal LOC even though they are calling to report an altered patient. I also find that many call 911 when a basic transport can be arranged with an ambulance company. The call takers have protocols they will go over with the caller to ensure that a life-threatening emergency does not exsist, if one does, 911 will be dispatched. By the same token, I have experienced nurses who call for private transport and fail to disclose the patients actual reason for transport and when the BLS EMT's get there, the call is obviously an ALS call and the staff gets upset when the EMT's have to call 911. I've begun RN school and I feel the most important way to deal with rude EMT's and RN's is through mutal respect, don't play the blame game and just DO YOUR JOB! Maybe you don't agree with each other, but don't forget that the patient is your number one priority!

RoxanRN · Jun 7, 2005

if i may..... other frustrations i've experienced at ltcs is the lack to enough history to do my job. many rns i've encountered have appeared a little more than put out that i've asked about the residents overall history, not just 'why am i here today.' i need to know everything they know about the resident (in a nutshell) in order to treat them appropriately. this includes looking at all the transfer papers. and i won't talk about the 'ambulance driver' comments we get. :angryfire :angryfire :angryfire however, these observations are not limited to ltcs. i've had the same attitudes and comments when transferring patients/residents from the hospital back to the ltc. i still have to know the history of the people in my charge in order to make sure i care for them properly - even if it's a non-eventful trip spent talking about their grandchildren or if they crash and burn.

it can be very frustrating to have a foot in two very different yet very similar (sometime competing) worlds. but i digress.... now back to our originally scheduled program.

Antikigirl, ASN, RN · Jun 7, 2005

Okay, seems like we have the commonalitys down..now how to change it!

I have dealt with rude EMS since before I was a nurse, and I am married to one! It is the same everywhere...you have your good apples and bad ones. The trick is to remember, despite the pain of it all at times, the person to be concerned about first and foremost is the PATIENT!

Now, I know most if not all my areas EMS (fire/police and medical) and I have a few bad apples that think they are like the bionic brained man/woman...questioning why I am sending them in when they have DNR's (like they shouldn't know that that doesn't mean do not treat! I keep reminding them every time!).

The thing is is that I treat them with respect and a friendly "hello, so glad to see you guys again, hope your shift is well....well now, we have a 86 year old..........". Or I may say "wow, haven't seen your for a while, great to see you!". I am friendly and very calm and that seems to be the trick.

And when I get sarcasm I simply say "according to my own clinical opinion, this patient is beyond my facilities ability to assist in comfort measures or treatments. They need to be assessed at the ER because there has been a change in condition that warrants such".(and if an MD agreed then I state as much as well).

SO far so good, even the chip on the shoulder ones (usually fire medical!). I mean, many of the EMS I talk to have a sterotype of the nurses in our types of facilites..that we are either stuck up snobs with God complexes looking down at them, or we are stupid as rocks! I try to dispell that immediately by showing first...I am not a "God complex" nurse and am friendly, and two..showing respect for them using my clinical opinion and treating them like a equal! YES AN EQUAL! (remember..they specialize in this and know their stuff in acute situations where many nurses may freak out or have probelms remembering the right thing to do, therefore I consider them specilists!).

Just be respectful and kind..word will get out (they are as grapevine as a hospital! LOL!) that you are a good egg...just takes time :).