Rudeness from EMTs and Paramedics

txspadequeenRN, BSN, RN · Dec 21, 2007

uhhhh i was not responding to you post but to the op the commuter...i haven't even read your post....

please dont take my post that way. just explaining it from a paramedics point of view who has now seen it from the ltc side. im not trying to justify any emt treating a nurse poorly, i think the problem is two very different fields of expertise with very, very different protocols in a hectic situation. im not trying to sword fight with you :)

CapeCodMermaid, RN · Dec 22, 2007

If you read even a few of these posts, you'll see that there are bad nurses and good nurses in LTC--rude EMT's and wonderful EMT's. It seems to me we are losing sight of what is important---our patients. If I have to put up with 'attitude' to get my patient to the hospital I will. We have established protocols when we send someone out rescue. One nurse runs and gets chart information;someone runs to the copy machine to make copies of the med sheets, the other person stays with the patient. We call the front desk to let the receptionist know that rescue is coming and which floor they should go to. We have the elevator on hold. Someone always either escorts or meets the EMTs in the room and gives a verbal report. Has all this made it better? Of course. Does it work every time? Of course not. As with everything else we do we just do our best (which is pretty damn good) and take care of our patients.

That said, I am the first one to defend my nurses from stupid/rude/idiotic/did I say stupid? comments made by EMTs, or ER nurses or docs.

We sent a woman to the ER with a fractured hip. The ER nurse called and threatened one of my nurses with the DPH because we must have either dropped or hit the resident. I called her up and said WHAT? She proceeded to tell me that 'anyone knows little old lady's hips don't just break' Rather than holler at her, I asked her if she could see an orthopedic surgeon standing in the ER and if she could she should put me on hold and go ask him if 94 year old women with significant osteoporosis could suffer spontaneous hip fracture.....needless to say she was not a happy camper to have been proved wrong. But I made my point and my staff knew I wouldn't let anyone bad mouth them.

Sorry--looks like this turned into a rant....must be the 4 cups of early morning coffee.

Dunno? · Dec 23, 2007

Many nurses do not know that EMTs and paramedics are diffierent..A paramedic is highly trained and often are the ones who are medics during a war..An EMT is not that much trained and have less education..

AnnieOaklyRN, BSN, RN, EMT-P · Dec 23, 2007

hi,

I am not only a nurse, but also a paramedic and have been involved with EMS for 9 years. I have had plenty of nursing home nurses be just as rude and snotty towards me!! So it DOES go both ways, and when you read the following ACTUAL reasons given to me for the patient needing transport to the hospital you may actually understand why we can get rude.. No offence to nursing home nurses, but I have found that som!!e are not so good at patient assessment... Also it is hard to respect a profession when all I get just about every time I ask a question is "I am new to this floor" "I normally do not work on this floor" or "The patient is new here", now I am not asking for the world here, just some basic history on the patient, like their baseline mental status.... Anyway here is my list of true tails from my EMS related visits to nursing homes.

1) The pulse ox says his sat is 80 - Patient assessment= 70 something year old gentlemen speaking complete sentences , alert and orirented, pink, warm, and dry. clear LS- MY o2 sat with the same machine - 88%, hmmm lets try some new batteries.... OH MY the batteries fixed the patients oxygen saturation, he is now sating at 97% on room air- go figure, oh and the nurse still insisted that this patient go to the hospital, he was promptly returned within 15 minutes!! If I got a dollar for everytime some nursing home staff members assessed the pulse ox and not the patient I would be a millionaire, and this oppinion continues now that I work as an ER nurse!!!

2) Report from nursing home nurse: Patient's limbs are "cyanotic" and his pulse ox is low, but he says he is not having any trouble breathing, I put a nasal cannula on him, but he keeps insisting on taking it off saying he is not having trouble breath. I walked into this room (keep in mind it is summer) it had to be about 30 degrees in the room (AC is cranked), patient has advanced huntingtons and is only in a diaper. Limbs are cyanotic and cold BECAUSE THE PATIENT WAS HYPOTHERMIC, not hypoxic!!!!!

3) Patients labs are "off"... Patient taken to ER, labs are fine, Labs were so off that the patient should have been dead nad it was quite obvious that the blood was hemalyzed.

4) Report from nurse: Patient fell 24 HOURS ago and we just decided to xray her hip because she cant walk or get up... I walk in the room leg is shortned and rotated, um yes, we really needed and xray to know that the patient needs to go to a hospital since the hip is obvious fx and or dislocated. I would also be a milionaire if I got paid each time this happened, yet we get called when the resident has a scratch on their arm.

5) Called to nursing home for a code. on arrival asked how long CPR had been going on, I got an answer of 45 minutes, after pinching myself to make sure this wasn't just a weird dream and realizing that it wasnt I asked the nurese why they had been doing CPR for fourtey five minutes without calling 911 so maybe the patient would have an increase chance of survival since they woul receive ACLS (meds, intubation etc), the nurse replied: Oh, I wanted to get an order from the doctor to send the patient to the hospital.

These are only 5 examples of the many I have expereinced over the last few years, and yes they are all true stories!

I am not trying to bad mouth nurses here (especially since I am one), but since you are bad mouthing and generalizing EMTs and paramedics, I feel the need to do the same to LTC nurse, and maybe after reading my post you will understand how many NEEDLESS transports we get out of nursing homes, while other patients who do need to go to a hospital (ie. the hip fx's) are made to lay in bed and suffer for hours because someone doesn't know how to assess for hip fractures (they are really easy to spot).

So next time remember there are two sides to every story, and those EMTs and paramedics may be on there 5th nursing home run, and maybe there 5th uneccasary (SP) transport.

Sweetooth

AnnieOaklyRN, BSN, RN, EMT-P · Dec 23, 2007

one of the cardinal laws of EMS is you cannot take a patient anywhere, really cant even touch them, without their consent unless they are demented, unconcious or dead.... kinda like the rule of with the heimlich manuever... falls into that whole mess of assault and battery. ive noticed thats were alot of head butting gets done. i definately know nurses have alot of CYA-ing to do, but EMTs do also.
there are alot of ambulance watchers out there. just like nurses, EMTs are monitored closely and put in legal jeopardy if the protocols are not followed. if i responded to a patient who called 911 and said they were dying of a heart attack, and i arrived at their house and they say dont touch me, and i took them anyways, i am very, very liable to be sued.

I beleive to poster was speaking about confused patients, and if the patietn is confused ( meaning the are not oriented x3, we CAN take them against their will, even if they say no, it is implied consent since they do not have the cognitive ability to understand the dangers of refusing medical treatment.

Sweetooth

AnnieOaklyRN, BSN, RN, EMT-P · Dec 23, 2007

Boy! O Boy! I dont think there is a nurse out there that hasn't experienced the "Mr. Doctor Paramedic" one night we had to send a resident out who was a brittle diabetic who I had found soaking wet with sweat and registering a 20 blood sugar. Well the RN supervisor who had 40 years under her belt took care of calling the paramedics and doctor and we had worked on this guy till they got there and we had his sugar up to 70 or so and the smart alec paramedic says "Don't you people here know what normal sugar is? What are you calling us for we arent taking this guy to the hospital and with that the nurse said yes you are and I will get the doctor on the phone and the paramedic waited up at the station for the doctor to call back and when he did he proceeded to argue with the doctor!!!!! well after all this fortunately our resident came through okay they took him and while they were leaving to transport this man to the hospital they were making remarks under their breath to the tune of "This place hires idiots!" Boy did I feel like punching that guy right in the mouth ! hahahah! I dont know what gives some of those guys the attitude that they are above everyone else.

I am sorry that the EMS staff were rude to you; however if the patient was awake and sugar was 70, why not do what the ER will do... FEED HIM food... I am sorry but I am not saying that the EMT/Paramedic had any exuce for being rude, but this is just another example of a patient that did not realy need to go to the ER, unless I am missing something here. I am also an ER nurse, all we would have done was given him/her a tray and send them back...

Sweetooth

robfall · Dec 23, 2007

Perhaps the issue is a basic misunderstanding of how EMS/ambulance service works. There are essentially two levels of service:

1. Non-emergency transports; i.e patients being transported for evaluations, appointments, etc.

2. 911 calls for lifethreating emergencies.

One of the consistent frustrations with LTC's, when I was a paramedic, was being called code 3 (lights and sirens) only to find a conscious, alert, NAD patient being "sent out" for a long term issue. While I understand that being asked questions by EMS (i.e. being grilled) is frustrating for LTC nurses; you have to realize that the paramedic/EMT does not know the patient, and is responsible for assessing/caring for him/her during transport. The issue of lack of respect is two sided; for every EMT/paramedic who thinks that LTC nurses are unskilled/uncaring; the is an LTC nurse who thinks EMS personnel are 'just ambulance drivers', who shouldn't ask questions.

jnette, ASN, EMT-I · Dec 23, 2007

Perhaps the issue is a basic misunderstanding of how EMS/ambulance service works. There are essentially two levels of service:
1. Non-emergency transports; i.e patients being transported for evaluations, appointments, etc.
2. 911 calls for lifethreating emergencies.
One of the consistent frustrations with LTC's, when I was a paramedic, was being called code 3 (lights and sirens) only to find a conscious, alert, NAD patient being "sent out" for a long term issue. While I understand that being asked questions by EMS (i.e. being grilled) is frustrating for LTC nurses; you have to realize that the paramedic/EMT does not know the patient, and is responsible for assessing/caring for him/her during transport. The issue of lack of respect is two sided; for every EMT/paramedic who thinks that LTC nurses are unskilled/uncaring; the is an LTC nurse who thinks EMS personnel are 'just ambulance drivers', who shouldn't ask questions.

Very well said, well presented, and sensible post. Thank you. :)

Let's try to always see both sides of the coin and not succumb to fingerpointing. There's enough frustration to go around for all.

TheCommuter, BSN, RN · Dec 25, 2007

Many nurses do not know that EMTs and paramedics are diffierent..A paramedic is highly trained and often are the ones who are medics during a war..An EMT is not that much trained and have less education..

Let's please refrain from belittling or demeaning anyone's educational attainment.

EMTs and paramedics are both important players in emergency care, since they are often at the front lines. Very little is contributed to this discussion when we make statements such as, "An EMT is not that much trained and have less education.."

calliesue · Dec 25, 2007

My favorite comment ... How long has the pt been like this? As if we just sit around with thumb up butt waiting for the pt to go south and then call 911.

Paramedics who trash talk nurses in the portico in front of family for following facility procedure. Actually said this is a bunch of bull (expletive), In front of family member and visitor. Wow the professionalism just floored me.

Having one throw his hand up in my face while telling my pt "the nurse here is going to tell you you have to go to the hospital, but you look ok to me." :angryfire

Thanks a lot. The pt stayed and coded later that night.

That said, seems like here lately say the last six months or so they have been getting a lot nicer. Can't account for it. Maybe they are having customer service training too.

morte, LPN, LVN · Dec 25, 2007

hi,
1) The pulse ox says his sat is 80 - Patient assessment= 70 something year old gentlemen speaking complete sentences , alert and orirented, pink, warm, and dry. clear LS- MY o2 sat with the same machine - 88%, hmmm lets try some new batteries.... OH MY the batteries fixed the patients oxygen saturation, he is now sating at 97% on room air- go figure, oh and the nurse still insisted that this patient go to the hospital, he was promptly returned within 15 minutes!! If I got a dollar for everytime some nursing home staff members assessed the pulse ox and not the patient I would be a millionaire, and this oppinion continues now that I work as an ER nurse!!!
4) Report from nurse: Patient fell 24 HOURS ago and we just decided to xray her hip because she cant walk or get up... I walk in the room leg is shortned and rotated, um yes, we really needed and xray to know that the patient needs to go to a hospital since the hip is obvious fx and or dislocated. I would also be a milionaire if I got paid each time this happened, yet we get called when the resident has a scratch on their arm.
I am not trying to bad mouth nurses here (especially since I am one), but since you are bad mouthing and generalizing EMTs and paramedics, I feel the need to do the same to LTC nurse, and maybe after reading my post you will understand how many NEEDLESS transports we get out of nursing homes, while other patients who do need to go to a hospital (ie. the hip fx's) are made to lay in bed and suffer for hours because someone doesn't know how to assess for hip fractures (they are really easy to spot).
So next time remember there are two sides to every story, and those EMTs and paramedics may be on there 5th nursing home run, and maybe there 5th uneccasary (SP) transport.
Sweetooth

1) i too, am irrate at the number of persons whom only look at the number, but that works both ways....the EMT/PM who insist on putting o2 on someone who doesnt need or want it because of a low number, or the nurse/emt/pm who doesnt know that at 96% a person can still be in air hunger depending on H&H....

2) hip fx ARE NOT ALWAYS SO OBVIOUS, had one recently, there was no shortening, minimal if any external rotation and no pain nor crepitus on lateral thigh....the only complaint was groin pain...i think, thought of course i cant prove, that this was a spontaneous fx...and it was right below the head of the femur...had to have a replacement ...nothing to pin.....i think the groin pain was the hint here...

years ago....had a man knocked over by a fellow resident...again no shortening, no external rotation, no crepitus....shipped out about 6 hours later, when swellling was becoming obvious....

EricJRN, MSN, RN · Dec 25, 2007

My favorite comment ... How long has the pt been like this?

It's a question that has to be asked, but tone and body language are critical. It's very easy to come across as critical and unprofessional in an emergency.