I'm a fairly new Paramedic (8 mos into my job @ Private ambulance co.)
Unless we get a "call review" (which happens if we made bad jdgement calls, etc.) We really do not get much feedback other than "ok guys, thanks & have a good shift" or "good job" (Which is definitely a highlight of a shift when we get a response like that) I'd like to pride myself on my positive attitude towards helping my patients, keeping up my skills and not becoming known as just an "ambulance driver".
My question is, from others' observations, personal experiences with paramedics who bring in pt.'s to the E.R. (I know that some medics get branded as good, bad, etc.) What makes you label them as a "good" or "bad" medic? Id like to know so I can help make you guys' job a little easier and to help increase trust & repoire with the many nurses and Dr.'s I come into contact with.
I can't imagine being a paramedic. It's hard enough assessing a patient in the chaos of the ER. I sure wouldn't want to do it in the street.
I love the paramedics who act on their assessments. Oxygen and IVs for patients with chest pain; fingerstick, IVs and glucose for hypogycemic patients... I really don't like the ones who come in the the patient with no intervention because "we were just around the corner" (even with a patient who has a blood sugar of 14).
I love the paramedics who give the ER at least a 5 minute heads-up so I can get a room ready (usually having to relocate the patient who is already on the stretcher).
I really love the paramedics who start an IV and get blood on that 86 year old lady from the nursing home with no veins.
And I greatly appreciate the paramedics who hang around after bringing in a critical patient. I work in a small ER with very few staff members, and the paramedics have helped us out many, many times.
I think that 99% of the time our paramedics are awesome. And the 1% of the time that they aren't it's usually half my fault too. I'd kiss their feet if they didn't have all that crud on their boots.
If a paramedic can't tell the difference between A-Fib & V-Tach, then s/he should not be a paramedic!
The ER nurses at the hospitals I deal with are great. There are a few I don't particularly care to deal with on a professional level, but I think that is the case with anywhere you work. As long as the ultimate goal is achieved and that is passing along the best care to the patient.
Yes, there are paramedics who have bad attitudes and chips on their shoulders - just like other professions. You get the good & the bad....
I wasn't going to respond, but the last sentence in PHTLS's post made me. You said you hated ED/techs & paramedics who look down on nurses and then you did the exact same thing in your last sentence. It is a shame that you have dealt with those medics, but this is suppose to be a "helping" post.
There are several proposols about the big change that will hopefully happen in the near future for EMS: paramedicine will require a BS degree which, in turn, will increase respect from the medical community and increase the pay. I hope it comes through for EMS. They deserve it.
This one time, one of my DNR residents became unresponsive and had Kussmaul breathing, so I called his doctor anyway (hospital policy regardless of code status) and I was ordered to tx him to the nearest ER. Meanwhile, another licensed nurse was monitoring him closely (DNR) while I called the paramedics. 15 minutes later, he stopped breathing and when the paramedics arrived, one of them started acting like a jackass stating that I shouldn't have brought out the crash cart and so on because of his DNR status. I'm thinking, screw you! A responsible family member can change the code status of the pt anytime with the doctor and I wanted to make sure I had my equipment with me....well, because I'm hardcore! There was a dozen staff and visitors outside the resident's door at the time (curtains drawn) who witnessed us not initiating resuscitation actions with that resident. It's like screw these morons, I used to participate with code blues all the time when I worked acute care and being a part time EMT with the army reserves, I know my $hit! The problem with me is that I look really young and people/patients automatically assume I'm a naive newbie!
Anyhoo, this dork insisted on us putting up DNR signs and I'm like...helllo! does HIPAA ring a bell? What pisses me off was the next day, when my DON starts chewing my head about the crash cart BECAUSE she's afraid of lawsuits by the family or citations from whomever. Gee, thank you for the benefit of a doubt....witch! I already knew the resident was DNR, hell, we all knew his condition got worser and worser every week and his code status was always something we went over during report and from reading his orders.
Some of these paramedics can't even tell the difference between an Atrial Fib vs. V-Tach. Something I witnessed watching them transport a resident I had before who developed a stomach infection and was extremely hyperglycemic (no sliding scale). This one paramedic couldn't even interpret what she was seeing off her portable monitor. I just stood there stoic and I was thinking 15 liters of o2 for starters would be nice and rapid transport before the "golden hour" expires cretins!
Another time when I was a CNA in a convy, my RN at the time called for a transfer, and this freaking gorilla paramedic jut bit her head off about something. He was a total jerk with delusions of grandeur. It was like, sorry, did we disturb your coffee break or something.
Furthermore, I hate ED techs/ Paramedics who look down on nurses. They always brag about how they save people on the spot. Well, so what! they may know how to put on a PASG, but paramedics spend most of their time putting on o2 instead. Besides, who get's paid more and who has more training/education? Nurses!
Oh my...PHTLS my friend have you thought about valium...
Obviously you have had some bad experiences with paramedics...but attitude is screaming from your post.
Most of our medics are outstanding professionals. Most nurses I work with as well. But in any profession, there will be those who are more so than others.
Medics and EMTs have one of the most difficult jobs in healthcare. They are in the most unsafe environments, making the most critical of healthcare decisions and get the least respect.
If you are working in an environment that has medics who are "only putting on O2" as you state...perhaps your EMS system has read the research that states the best outcomes are when EMS transports WITHOUT taking time at the scene for IVs, etc...
I've worked both sides of the emergency room doors - as a RN in the ED / ICU and also as a CCEMT-P certified critical care transport nurse for a private ambulance company. The two jobs are radically different in approach and design. One thing I found to be difficult was readjusting to the restrictive hospital nature, even as a seasoned ICU nurse, after being on the specialty ambulance a couple of shifts. In the field in EMS, things are done that have to be done, often in a manner that dictates RIGHT NOW. On the critical care truck, the RN and critical care paramedic team had alot at their disposal - our own on-board DataScope balloon pump and a complete inventory of drugs, even RSI. Because of our training (emphasis on the both of us), we ran the calls ourselves. Never did we have to contact medical control at either hospital on guidance for medical direction (and yes we ran the sickest of calls). Most of our calls were unstable cardiac patients, most were vented, and ran some dying sepsis calls also. We also responded to 911 calls. I may be wrong and please someone correct me if this is the case, but medics who work as techs in the hospital often find their in-house job descriptions extremely restrictive when compared to the ambulances. Independent decision-making has been taken away and substituted for oftentimes menial jobs (don't blow up at me, I was a er tech while a senior in nursing school. On many days all I did was run to the lab and cast splints all day long). I would assume it is a hard adjustment for them, but in case you have not noticed, EMS does not pay well for what they have to put up with. Couple that to the fact that they have to work under some people who posted previously and that in itself is torture enough. While working as a ICU RN (i am a guy), all the rotating paramedic students were precepted under me. I found them to be extremely willing to learn, as most pre-hospital programs do not extensively teach ICU management.
All fields have bad examples. Fortunately the company I worked for in Atlanta had some of the most incredible pre-hospital professionals I have ever seen. I have seen Nursing as a field eat its own, and then one wonders what they do to other people. Both fields have bad examples, hopefully these are the minority. Basically what it boils down to is a bunch of educated, type A personalities are forced to somewhat get along at times and perform under constant stress and all that really matters is these persons come together for the patient being treated.
Thank you pre-hospital professionals for what you do day in and day out in a variety of weather, family conflicts, and the threat of crime. Thank you nurses for what you do in hospitals day in and day out. Hats off to both fields of healthcare. For either side that wants to understand the other better, I would encourage possibly a ride along for nurses (friday or saturday night) or perhaps a paramedic could follow a busy ED (also on a friday or saturday night). I believe a little bit of understanding would go a long way in this situation...........
Just my 2 cents and sorry for the long post. Getting off my personal soapbox.
This one time, one of my DNR residents became unresponsive and had Kussmaul breathing, so I called his doctor anyway (hospital policy regardless of code status) and I was ordered to tx him to the nearest ER. Meanwhile, another licensed nurse was monitoring him closely (DNR) while I called the paramedics. 15 minutes later, he stopped breathing and when the paramedics arrived, one of them started acting like a jackass stating that I shouldn't have brought out the crash cart and so on because of his DNR status. I'm thinking, screw you! A responsible family member can change the code status of the pt anytime with the doctor and I wanted to make sure I had my equipment with me....well, because I'm hardcore! There was a dozen staff and visitors outside the resident's door at the time (curtains drawn) who witnessed us not initiating resuscitation actions with that resident. It's like screw these morons, I used to participate with code blues all the time when I worked acute care and being a part time EMT with the army reserves, I know my $hit! The problem with me is that I look really young and people/patients automatically assume I'm a naive newbie!
Anyhoo, this dork insisted on us putting up DNR signs and I'm like...helllo! does HIPAA ring a bell? What pisses me off was the next day, when my DON starts chewing my head about the crash cart BECAUSE she's afraid of lawsuits by the family or citations from whomever. Gee, thank you for the benefit of a doubt....witch! I already knew the resident was DNR, hell, we all knew his condition got worser and worser every week and his code status was always something we went over during report and from reading his orders.
Some of these paramedics can't even tell the difference between an Atrial Fib vs. V-Tach. Something I witnessed watching them transport a resident I had before who developed a stomach infection and was extremely hyperglycemic (no sliding scale). This one paramedic couldn't even interpret what she was seeing off her portable monitor. I just stood there stoic and I was thinking 15 liters of o2 for starters would be nice and rapid transport before the "golden hour" expires cretins!
Another time when I was a CNA in a convy, my RN at the time called for a transfer, and this freaking gorilla paramedic jut bit her head off about something. He was a total jerk with delusions of grandeur. It was like, sorry, did we disturb your coffee break or something.
Furthermore, I hate ED techs/ Paramedics who look down on nurses. They always brag about how they save people on the spot. Well, so what! they may know how to put on a PASG, but paramedics spend most of their time putting on o2 instead. Besides, who get's paid more and who has more training/education? Nurses!
Does your listname stand for PreHospitalTraumaLifeSupport?
Does your listname stand for PreHospitalTraumaLifeSupport?
That's what I thought too. You'd think that someone who had enough gumption to take PHTLS would understand EMS a little better.
PHTLS,
I understand your frustration and I feel your pain. I have worked both sides of the stretcher for years. I'm sorry you had to deal with the small minded but self important people you listed here. I can tell you that Paramedics like any other professions have their share of a-holes. But can I also tell you that for every a-hole medic you show me I can show you an a-hole nurse or PA, or NP, or MD, even cops and firefighters have theirs. I can also tell you that I worked ALS EMS in three different states for 25 years and I can count the number of times I have received a coherent complete report from the nursing home nurse on one hand. If you brought the crash cart to a pt who was circling the drain I'd be jumping for joy and high fiving you for thinking with a heads-on or as you called it hardcore attitude. But I can tell you of the time I was berated and scolded by the nursing home staff for assisting a pt who had marked respiratory distress. This pt clutched my hand and said "help me, help me' I asked her if she wanted me to help her breathe, she replied in the affirmative. I contacted medical control and the Doc agreed that we could disregard the DNR and help the woman. Then the entire staff including the DON came barging in the room and threatened my job if assisted this patient. They showed my the DNR which clearly stated that the pt only wanted CPR witheld. I put my pt in the ambulance, strung up an IV, wacked her with versed, lido, and etomidate and intubated the woman who was still asking for help until the drugs took effect. The nursing home staff
faxed the DNR to the recieving ED and raised holy hell with them. I was met in the parking lot by another group of irate( this time ED nurses so don't think I'm ragging only on LTC types) who screamed and rolled their eyes and told me I was violating the pt's rights to self determination, yadda freakin yadda. I delviered the pt to the room, gave a concise report to the ED Doc and then advised the ED RN's that DNR stands for Do Not Resucitate. In order for a DNR to be implemented the pt has to in need of resucitating. This lady just needed some help to breathe, and besides all that, she asked for my help which negates the DNR instantly. Now when I work the ED and I see a medic crew come through the door, their sweaty, their hair is all messed up there's blood everywhere. I help them into the room and dive in. I don't berate, chide or denigrate. If they couldn't get the IV, who cares, I'll the Doc to drop a CVL in the pt. If they couldn't get her intubated, I'll give it shot our we'll trache her. I know these guys and gals sometimes go through hell in a short period time. I don't need to give them anymore. BTW the pt above did fine. She had pneumonia and after three days and course of antibiotics she was returned to the Nursing Home.
It just amazes me how nursing STILL "eats their own"...and I consider pre-hospital as "one of us".
Who cares of EMS didn't get then line???
Neither do I sometimes...and I am standing still not bouncing around in the back of an ambulance. Or having 25 family members screaming in my face to help their loved one.
Who cares if they "load and go"...that is what they are SUPPOSED to do.
As ER nurses we get all bent out of shape when the ICU wants the patient all "neat and tidy" and yet we have zero tolerance for the pre-hospital personnel.
Healthcare is a continuum.
What I start someone else will pick up and continue...
We need to support each other not destroy ourselves.
I'm a fairly new Paramedic (8 mos into my job @ Private ambulance co.)
Unless we get a "call review" (which happens if we made bad jdgement calls, etc.) We really do not get much feedback other than "ok guys, thanks & have a good shift" or "good job" (Which is definitely a highlight of a shift when we get a response like that) I'd like to pride myself on my positive attitude towards helping my patients, keeping up my skills and not becoming known as just an "ambulance driver".
My question is, from others' observations, personal experiences with paramedics who bring in pt.'s to the E.R. (I know that some medics get branded as good, bad, etc.) What makes you label them as a "good" or "bad" medic? Id like to know so I can help make you guys' job a little easier and to help increase trust & repoire with the many nurses and Dr.'s I come into contact with.
Some Medics are good and some are bad. The good ones are the product of the the abilty to think quickly and arrive at the correct conclusions the majority of the time, this combined with the abilty to perform the nessesary skills make what I would call a solid paramedic. Truly good Medics are few and far between. My best advice is this, do your job and your relationships with hospital staff will be fine. Get the lines in, get the meds onboard, get a good history, get the Pt's that need tobe intubated, intubated. Don't put yourself in a situation where you feel the need to make an excuse. Example - "The line blew" (it didn't blow you never got it) "The tube must have moved" (no it didn't it was never in the right place).
PS - This post was written by the husband of BonemarrowRN
RainbowSkye
127 Posts
I can't imagine being a paramedic. It's hard enough assessing a patient in the chaos of the ER. I sure wouldn't want to do it in the street.
I love the paramedics who act on their assessments. Oxygen and IVs for patients with chest pain; fingerstick, IVs and glucose for hypogycemic patients... I really don't like the ones who come in the the patient with no intervention because "we were just around the corner" (even with a patient who has a blood sugar of 14).
I love the paramedics who give the ER at least a 5 minute heads-up so I can get a room ready (usually having to relocate the patient who is already on the stretcher).
I really love the paramedics who start an IV and get blood on that 86 year old lady from the nursing home with no veins.
And I greatly appreciate the paramedics who hang around after bringing in a critical patient. I work in a small ER with very few staff members, and the paramedics have helped us out many, many times.
We're all in this together.