Being Questioned by Paramedics? Why?

  1. So the other night I was at work. The power went out earlier that day so we were running off of a half way working generator. Well I go to change my elderly pt's tube feed and noticed he was breathing pretty fast and retracting. Took some vitals BP 114/44, R 42 and labored, pulse 105, and O2sat 97%. He had a wet sounding cough but clear lung sounds. And overall, he just did not look right, he had a look of distress or "oh God" on his face, lol. When I asked him how he was feeling, he looked at me and continued breathing, usually he would respond without hesitation. So of course I call the on call and tell her my assesment, she immediately said send to ER for resp distress.

    So when the paramedics get there, they take vitals and assess, and look at me like I am stupid and say "his Sat is 98%.". So basically for ten minutes I get to just about argue them down as to why they should take him. They also sounded irritated that he was a full code. There arguements were 1) his vitals were good and lung sounds clear and 2) he has dementia, so how is he supposed to respond to you (***? HELLO! DEMENTIA DOES NOT EQUAL NOT ALERT!). They even asked me to call and ask the Dr's opinion. (HELLO! I CANT CALL YOU WITHOUT CALLING THE DR FIRST!) I had to tell them that I have seen a pt in resp ditress sat-ing great at 99%, and de-sat to 0% within seconds and code right before my eyes, and I did not want to wait and see if it happened with him. The Dr and I wanted him in the ER, at least they can do more than basic CPR (which is all i can do in my ltc facility). So they reluctantly took him.

    Has anyone had this happen to them? Why? A nurse cannot diagnose just as a paramedic can't, and neither one of us has MD behind our name! Do you think they didn't want to take him bc he was elderly in a nursing home? I mean, they really burned my butt with this!
    Last edit by UM Review RN on Jun 15, '09 : Reason: corrected title
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    About jayde_RN

    Joined: Oct '07; Posts: 17; Likes: 5
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    Specialty: New LTC nurse

    28 Comments

  3. by   CrufflerJJ
    Sorry to hear they jerked you around. They were called to do a transport, and obviously didn't want to xport the patient.

    RR of 42, tachy heart rate doesn't sound especially "stable" to me, no matter what the BP & Sat are.

    I'm not sure what sort of working relationship you have with the local squads, but as a former paramedic (for years & years & years), I'd be a bit peeved.

    Being the kind, gentle, non-abrasive sort that I am (snicker...snicker!), I'd be very blunt & just ask them "are you REFUSING to transport this patient?" Yes or no question. No need for a long discussion with them. If your patient is circling the drain, time to get very pushy if somebody is being an idiot.

    My "gut feel" is that the responding crew was being lazy & wanted to return to quarters for a nice little nappie or some ice cream.

    If you honestly feel that their dicking around put your patient in jeopardy (it sounds like it to me), I'd raise a major stink with their chief or medical director through your chain of command. Yes, they should respond to your site when called, & assess the patient. Their job is NOT to second guess the need for xport after being directed to xport the patient by a person with a higher level of certification (you or the MD).

    They need to be "spanked". Write 'em up.
  4. by   ktwlpn
    That happens alot-the ones I have met seem to feel that everyone in the LTC should be a DNR and they don't understand that it does not mean "do not treat" And some also have the attitude that we nurses in LTC are there because we are too stooopid to work any place else. It's best not to get into a debate with them-just be firm and say something like "The doc gave the order to send him for eval NOW and you are delaying treatment" Then ask for their full name.ANd follow up with your DON- ours will call in and make a complaint about this crap. ..You know your residents and can tell when they are in distress.
  5. by   JB2007
    Some paramedics, some hospital nurses, and some doctors think that because a nurse went to work in a nursing home he/she can no longer critical think. They act like either we could not cut it in the hospital or we are not smart enough to work in the hospital. The kind of attitude that you just described ticks me off also, but what can you do.
    FYI: No I am not putting all paramedics, hospital nurses, and doctors into the category of being jerks to LTC nurses, but the ones that do act that way makes our already very difficult job even more difficult.
  6. by   jayde_RN
    Wow! Thanks, I may be new but I know I am not stupid! It's amazing how as a nurse you get that gut feeling and just know, even if you can't quite put your finger on it. I should of asked tham if they could measure CO2, and if not then get that man to the ER! I know next time how to handle them! (hopefully there won't be a next time)

    He was tx at 2am and when I left at 10am, we still hadn't heard from the ER. When I called to tell them about something I forgot, they said he still wasnt back, at 5pm.I was also thinking how stupid they'd feel is he coded in route. But I have a feeling he wasn't okay, and will find out what happened to him when I get back to work monday night.

    And for all they know, I did not want to go into LTC. Due to nobody hiring, I opted to go to at least start working on my time managment skills. But as it turns out, I love my pt's! And I am still learning and using critical thinking, obviously! THanks you all!
  7. by   FLArn
    Faced this more times than I can tell you in my career in LTC. Sometimes they were right and the patient did not really need to go to the ER, as in the times when another MD was covering for the patient's regular MD-- i.e. I never saw this patient so I'm going to ignore what the nurse is asking for and "CMA" by sending him to the ER. But once the MD says 'send him -- he goes' I think that examples such as the above has more or less ruined our credibility with the EMT's / Paramedics. I'm glad I don't have this problem anymore - working with Hospice really limits the amount of 911 calls you make.
  8. by   Medic09
    I'm with CrufflerJJ on this one. Is this a 'transport only' service, rather than a '911 service'? A lot of the medics who end up doing 'transport only' are frustrated and not happy with their jobs. Sometimes, the 911 service would have them. Like JJ said, "are you refusing transport, or can we get a moveon?"

    I have another question though. What did you mean by "a look of distress or "oh God" on his face, lol." LOL, or Laughing Out Loud, doesn't seem an appropriate response in such a situation. When my patients have that 'look of distress' I worry for them. Maybe you didn't mean to say here 'lol' ?
  9. by   jayde_RN
    I'm with CrufflerJJ on this one. Is this a 'transport only' service, rather than a '911 service'? A lot of the medics who end up doing 'transport only' are frustrated and not happy with their jobs. Sometimes, the 911 service would have them. Like JJ said, "are you refusing transport, or can we get a moveon?"

    I have another question though. What did you mean by "a look of distress or "oh God" on his face, lol." LOL, or Laughing Out Loud, doesn't seem an appropriate response in such a situation. When my patients have that 'look of distress' I worry for them. Maybe you didn't mean to say here 'lol' ?

    Actually it was 911, that's what shocked me. It wasn't my pt's condition I was laughing at. The "lol" came from the feeling I had about the post and also the fact that "Oh God" was the best way I could describe the look. I would never laugh about something like that. The reason I went against every other nurse's opinion on even calling the md, and went against what the paramedics thought was because I knew he was a full code, and I didn't want the man to die. Face it, basic CPR only works a fraction of the time, and that is all I can do at me LTC facility (crash cart only has an ambu bag), and I didn't want to the man to die. If it came off as inappropriate, it definitely was not meant to.
  10. by   CNA_Timmy
    You may want to call a transport company next time. I am a EMT-B/CNA/Nursing Student, and I occasionally pick up shifts for a local ambulance transport company. We pretty much specialize in transporting LTC to hospitals/doctors appts/other places. The 911 guys are more of a call in an emergency situation, and they get a little huffy about doing anything that lacks getting to intubate someone (sorry 911 guys, but you know you do it for the adrenaline, not the transports, at least all the 911 guys I know). Anyway maybe that will eliminate some of your future problems.
  11. by   kkluczynski
    oh i definately have had my share of issues with the paramedics giving us a hard time or giving us the look like we're idiots, i feel your pain....
  12. by   TheCommuter
    I started a thread on this very same issue. It has been common practice for some EMS personnel (EMTs and paramedics) to treat LTC nurses in a less-than-respectful manner, which is very unfortunate. Click on the link below to read the responses.

    https://allnurses.com/geriatric-nurs...cs-268561.html
  13. by   UM Review RN
    I'd be ticked, too.

    I've seen patients with that look and the exact s/s you describe (could it be the "feeling of doom" look that you saw?) for up to an hour prior to full-blown CHF.

    First time it happened, I was a CNA in a LTC. Patient was a/o x3, and insisted she couldn't breathe. No retractions, clear lungs, not even a cough. I took vitals manually. Everything was fine, except her resps were elevated. LPN said the patient was fine and told me to ignore it. But I knew the patient and I knew something was terribly wrong, so I stayed with her. Suddenly -- and I do mean suddenly -- she was gasping for air and sounding like she'd inhaled a gallon of water.

    EMS got there in the nick of time.

    Also, if they don't know that an O2 sat is not a true indicator of oxygenation status, you might want to ask their boss to educate them on that topic.

    Moral of the story--you were right to do what you did.
  14. by   BabyLady
    Quote from jayde_RN
    So the other night I was at work. The power went out earlier that day so we were running off of a half way working generator. Well I go to change my elderly pt's tube feed and noticed he was breathing pretty fast and retracting. Took some vitals BP 114/44, R 42 and labored, pulse 105, and O2sat 97%. He had a wet sounding cough but clear lung sounds. And overall, he just did not look right, he had a look of distress or "oh God" on his face, lol. When I asked him how he was feeling, he looked at me and continued breathing, usually he would respond without hesitation. So of course I call the on call and tell her my assesment, she immediately said send to ER for resp distress.

    So when the paramedics get there, they take vitals and assess, and look at me like I am stupid and say "his Sat is 98%.". So basically for ten minutes I get to just about argue them down as to why they should take him. They also sounded irritated that he was a full code. There arguements were 1) his vitals were good and lung sounds clear and 2) he has dementia, so how is he supposed to respond to you (***? HELLO! DEMENTIA DOES NOT EQUAL NOT ALERT!). They even asked me to call and ask the Dr's opinion. (HELLO! I CANT CALL YOU WITHOUT CALLING THE DR FIRST!) I had to tell them that I have seen a pt in resp ditress sat-ing great at 99%, and de-sat to 0% within seconds and code right before my eyes, and I did not want to wait and see if it happened with him. The Dr and I wanted him in the ER, at least they can do more than basic CPR (which is all i can do in my ltc facility). So they reluctantly took him.

    Has anyone had this happen to them? Why? A nurse cannot diagnose just as a paramedic can't, and neither one of us has MD behind our name! Do you think they didn't want to take him bc he was elderly in a nursing home? I mean, they really burned my butt with this!
    A perfect example of a paramedic that has just enough knowledge to be dangerous.

    I would have said ONCE that the physician is requesting transport.

    When they started giving you the run-around, I would have said, "That is the decision of the physician...would you me to get the physician on the phone so you can explain why you are REFUSING transport?"

    I have a feeling that their questions of nonsense will stop.

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