Horizontal Violence - EMT's and Paramedics VS LPN's and RN's

TheCommuter, BSN, RN · Oct 5, 2012

I created a discussion about this very same phenomenon nearly five years ago. The thread attracted more than 100 replies, so these incidents are not isolated. Rather, rudeness from EMS personnel is common and widespread.

Click on the link below if you'd like to read the enlightening discussion. Nurses, EMTs, and paramedics contributed in a collegial manner and gave their insights.

https://allnurses.com/geriatric-nurses-ltc/rudeness-emts-paramedics-268561.html

jadelpn, LPN, EMT-B · Oct 5, 2012

I am a nurse who happens to be an EMT as well. It is pre-hospital vs hospital care, different scopes, different duties. All mandated by a specific scope of practice.

There are many people in the medical world not just exclusive to EMT's who like to put their 2 cents worth of "deciding" if a patient is truly where they need to be, if they are experiencing a true emergency, if they need to be transported, if they needed to come into the ER, if they needed to be admitted---and on and on it goes.

Bottom line is this--if a patient feels like they are experiencing an emergency, then they can and do call rescue. If a nursing home's protocol is such that an ambulance needs to be called for an alternate level of care for an acute condition, the nurse calls rescue. And when the patient hits the ER, depending on what is going on, the patient is admitted or the patient goes home. There are always those personell that will make "why are we transporting, why did you call us, why is this person in our ER again and why is this person being admitted" comments. It is not always going to be tragic accidents, codes, or some elaborare exotic disease processes. (Thankfully, but you know where I am going with this).

EMT's scope is entirely different than that of a nurse. In fact, EMT's are taught NOT to overthink, but to stabilize as able and transport. Period. Paramedics certainly can do more interventions, however, the goal is a higher level of care. When you start getting first responders and firefighters and CNA's and family, and the volunteer who does bingo in the mix, it can be overwhelming, ridiculous and would make the patient feel like they are asking for something that they should not be. That is NEVER where we want to go. And I don't have an answer to that other than "my protocol is such that this patient needs to be checked out by the ER". And perhaps there's a specific private ambulance company that your nursing home can meet with to discuss transports who will do so with some dignity left over for the patient.

morte, LPN, LVN · Oct 5, 2012

And perhaps there's a specific private ambulance company that your nursing home can meet with to discuss transports who will do so with some dignity left over for the patient.

the above quote may well be part of the answer. sometimes, the nursing home transfers DONT need 911, but if that is your only option, then ya gotta do, what ya gotta do. I have a VERY good record, that if i send'em out, they stay! I am older than most EMts, (wayyy older than some) and i think my "don't mess with me" comes through......Did have a paramedic call the staties on me though, best experience I ever had with a cop!

realmaninuniform · Oct 9, 2012

Well the attitude I have experienced primarily comes from municipal EMS, ie the REAL EMS responders, not the transport companies, though I have had bad experiences with them as well.

We called the ambulance service for a a pt with +3 pitting edema in the lle, transport arrives, medic says he can feel a post tib/fib so there's no reason for a stat venous dopplar. Well apparently this guy flunked a&p big time. First of all, what he could supposedly feel is arterial, what we were concerned with was venous. I mean this is just basic common sense. Clots most commonly occur in veins, just because you can feel an arterial pulse does not mean a thing...

At any rate it just seems as though these people are ****** when they're called upon to do their job regardless whether its public or private EMS. The public EMS personnel act like we are wasting their time because it's not a GSW or MVA. The private EMS act like they don't need to take anyone because they already know the dx and tx and we're stupid for keeping them in business...

realmaninuniform · Oct 9, 2012

I read some posts in your thread. The common thing I can find is it seems that the EMT's think that they are much more educated and capable than they really are. I could become an EMT is two weeks, regardless of my experience as a nurse. In my state, they have several programs where you go 8 hours a day 3 times a week for two weeks. Usually it is 3 months, but you're going one or two days a week 4 to 5 hours at a time.

None the less, it really irks me that these people think they have more knowledge than a nurse who went to school anywhere from 2-4 years full-time.

Let's not forget EMT-B can't even administer medications. They're trained in first aid. That's about the extent of their knowledge. EMT-I's and EMT-P's have a little more practice allowance, but it's still very limited. I've found however they think they are capable directing an entire course of tx when in fact they are not.

Anyways, I just get ****** off when I encounter such arrogance, negligence, and flat out ****** patient care in the field. I worked hard to become a nurse, and just as hard to stay one. I go out of my way to be nice and professional to other members of the team, whether they be EMS personnel, therapists, CNA's, MD's, etc. It makes me lose a lot of respect for a person as a whole, and their profession when they are rude, nasty, and negligent for no apparent reason at all.

rntj · Oct 9, 2012

So glad this thread was started. I have been an RN for 10 years. When i worked home health, I found one of my patients unarousable, snoring, with a pulse ox of 76%. I called EMS. They treated me like dirt, acted like "why did I call them?" Even though I told them multiple times I am this patient's nurse, when they were talking to each other they'd say things right in front of me like, "I don't know why they called, this PERSON--or THIS LADY-here called us" and I insisted they take him to the hospital right away. The patient ended up in the ICU, and I got props from my home health agency and tons of gratitude from the patient's wife. I have always wondered why I was treated this way by EMS. Is it that they are jealous I have more education than they do? Or are they just unbelievably cynical and negative people? It really rubbed me the wrong way, I'll tell you that much.

realmaninuniform · Oct 9, 2012

Nearest I can tell, unless the pt is in cardiac arrest, a GSW, MVA, or some sort of serious trauma, the EMS personnel feel the case "below" them. I think they need to re-work their curriculum. Very early on in nursing school they said 90% of your working life will be dealing with the aged.

Apparently EMS personnel believe that 90% of their working life will NOT be dealing with the aged. They're still stuck in the 9/11 hero mindset, and forgot what health care is really about.

I definitely get the feeling they are jealous and trying to get one up on nurses. I mean why else would you be so rude, arrogant, and flat out ignorant in your interactions with other health care personnel for no apparent reason at all?

I think EMS personnel just aren't educated well enough on the health care continuum. Some are stuck in the whole transport only mindset, while others, (probably worse yet) are stuck in the whole beginning and the end of care mindset, in which case they are the supreme authority.

jadelpn, LPN, EMT-B · Oct 9, 2012

In some states, EMT-B's can administer limited medications after certifcations. EMT-I's can start IV's and put in advanced airways, and EMT-P's can do all that plus cardiac meds. It does vary by state. Not in a private ambulance company, but one's local Town ambulance, there is always a "lead EMT" (or should be). The second that someone would give me lip about transport, would be when I would say that I wanted to communicate with the captain of the team only. This is not a debatable thing--the patient WILL get transported. They do need to do an assessment for continuity of care, however, if they would like to call the MD themselves to discuss transport, have at it then.

We are but the "messengers". The doctor wants the patient transported for a hangnail, then we need to carry out those orders. Period. It is not time for lively debate. I would not bet my license on someone losing a leg on the scenario described by a pp on the debating of the need to vascular doppling of an extremity. An EMT wants to play "Dr. House" they can do it on their own time.

It seems as if in the entire continuity of care, there are those who question and debate everything from "why is this person in the ER" to "why is this person being admitted". So it is not exclusive of the EMT's and ambulance companies.

With all that being said, how awful for the patient to have to hear all of this carrying on by EMT's who then they have to be alone with for any extended period of time. And that is the bottom line, and I would call them on it. When they hit the door. Mr so and so needs to be admitted to the floor (assessed in the ED) per the MD. Then I would give them a quick head to toe report. I would then really say that the MD ordered this transport, that it is not debatable, and please refrain from any and all comments to the contrary.

If it keeps up, I would go to administration regarding the transport of patients and the scope of EMT's in that role, and perhaps a meeting with adminstration of the ambulance companies you use--

realmaninuniform · Oct 14, 2012

I always give a report to the dispatcher when I call for EMS. After they leave with the pt. I also call the hospital to give report. I'm not the nurse who freaks out and calls the doctor over something trivial either, and I always relay that the attending has ordered transport in report. Still the attitudes persist.

I feel I have gone out of my way on every occasion to accommodate, and still they show up with an attitude, and it's not exclusive to any certain company or municipal service. I am always there when they arrive, give them report again in person, and assist them with transferring. All of the paperwork is always neat and organized and ready.

I haven't been so bold as of yet to really chew one of them out on it, but it's getting close.

TheCommuter, BSN, RN · Oct 14, 2012

I always give a report to the dispatcher when I call for EMS. After they leave with the pt. I also call the hospital to give report. I'm not the nurse who freaks out and calls the doctor over something trivial either, and I always relay that the attending has ordered transport in report. Still the attitudes persist.
I feel I have gone out of my way on every occasion to accommodate, and still they show up with an attitude, and it's not exclusive to any certain company or municipal service. I am always there when they arrive, give them report again in person, and assist them with transferring. All of the paperwork is always neat and organized and ready.
I haven't been so bold as of yet to really chew one of them out on it, but it's getting close.

After a few LTC nurses regularly placed phone calls to the regional manager of the local EMS service to report the horrible attitudes of their EMTs and paramedics, I'll admit that their attitudes have somewhat improved in the city where I live.

My former LTC coworkers would report each rude EMT or paramedic immediately after each instance of bad behavior, and they would be sure to gather pertinent details such as their last names and titles.

They're less likely to be disrespectful if they know they will be held accountable for their treatment of LTC staff.

realmaninuniform · Oct 15, 2012

I'm not into the whole contacting the supervisor thing. I just feel like it would be a waste of their time to have to deal with something so stupid. Then again, if they hired correctly, it probably wouldn't have happened in the first place.

I just feel like it's a matter of professional courtesy and EMS seems to have missed that section during their schooling...