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.
As a paramedic who did not renew their certs, I understand both sides of the story. I used to get jumped on by nurses for not telling them patient had something like scabies or lice before telling them that the patient was allergic to what ever and treatment given. I was taught ABCD. Thats how I always gave report. Then some nurses would appriciate that. It was the nature of the nurse.
I now work OB and some ER. I look at the medics as one of the best friends I could have. If they have a line that is in place great if not thats something I know needs to be done. Starting it is no peice of cake going down the highway. I know when I came off the streets that I could not start an IV unless I bounced the hand up and down. I still do it from time to time without realizing it.
I have worked with some snotty paramedics and some that were awesome. I have worked with the same in nurses. I value a medic that keeps his/her head when everything else is going down the tubes. I value that medic that helps at the same time. I wish medics who didn't know would ask and those that do know, and want to brag that they know, would shut up. I don't need a medic telling me that the patient is fubared, I need to know what you have done and how they responded, what you saw, and mech of injuries.
I take my hat off to you. I no longer do the job due to injuries. Take care of yourself and your partner. Remember you first, partner second, and patient third. You seem to have a good head on your shoulders. Give respect when due and demand the same. Each side of the coin has a roll and from time to time, they overlap.
As a nurse that was (is) a practicing paramedic for the last 25 years. (I know, I'm old) I can tell you one of the best things to do is seek out the nursing staff or even the MD when you have one of those borderline calls that your not so sure about. Ask them, hey I felt this guy was a (add your feild diagnosis here) was I right, was my treatment appropriate. This goes miles. As long you're not doing it on every call. In the nursing profession it's collaborating. The RN's and Doc's will take you for Paramedic that concerned about his patients and improving his practice. You automatically set yourself up as part of health care team, which you are. (It's much nicer nowadays, I remember back in the Dark Ages of Paramedicine when nurses and medics were mortal enemies and the patient usally got the short end) Don't be afraid to ask questions and don't be afraid to check on your previous patients when you bring a new one in. Good luck and stay safe!
Medic_78...This is probably one of the most appropriate replies that I have seen in this thread. The "'medic bashing"...well...get used to it. Here in WVa a 'medic is now an A.A.S. degree, just like an R.N. Yes, there are some A$$hole 'medics, just like there are some A$$hole nurse, LPN's and CNA's. Get used to it and just be sure that you are not one of THEM. GOOD LUCK!!!!
As a paramedic who did not renew their certs, I understand both sides of the story. I used to get jumped on by nurses for not telling them patient had something like scabies or lice before telling them that the patient was allergic to what ever and treatment given. I was taught ABCD. Thats how I always gave report. Then some nurses would appriciate that. It was the nature of the nurse.
I now work OB and some ER. I look at the medics as one of the best friends I could have. If they have a line that is in place great if not thats something I know needs to be done. Starting it is no peice of cake going down the highway. I know when I came off the streets that I could not start an IV unless I bounced the hand up and down. I still do it from time to time without realizing it.
I have worked with some snotty paramedics and some that were awesome. I have worked with the same in nurses. I value a medic that keeps his/her head when everything else is going down the tubes. I value that medic that helps at the same time. I wish medics who didn't know would ask and those that do know, and want to brag that they know, would shut up. I don't need a medic telling me that the patient is fubared, I need to know what you have done and how they responded, what you saw, and mech of injuries.
I take my hat off to you. I no longer do the job due to injuries. Take care of yourself and your partner. Remember you first, partner second, and patient third. You seem to have a good head on your shoulders. Give respect when due and demand the same. Each side of the coin has a roll and from time to time, they overlap.
As someone who has worked both sides of the sliding ED doors, what a beautiful post. Thank you.
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
As a RN in many previous hosptial subspecialties, critical care transport RN, and current now SRNA, the tube movement comment strikes home. Perhaps it happens on occasion in your ED (and for that I am sorry), but tube movement, either into the bronchial mainstem or actual dislodglement is no joke. Yes, it should be the first thing noticed, as A is the first in the ABCs, but it is hard to comtemplate first arriving at your patient in a drainage ditch in the rain at midnight, intubating, then running a code by yourself (paramedic + a fireman if you are lucky), then bouncing up and down in the back of an ambulance. Ever notice how running a code is a hospital is such organized chaos? Try for an instance running it by your lonesome in a moving environment. Tube displacement occurs in the relatively stable environment of the OR on numberous occasions and I am sure the ambulances are more prone to it than lying or turning in the OR.
Tube displacment is no joke, it happens to MDAs and CRNAs in the OR.
I work in LTC as the charge Nurse it is frustrating when I need to call for an ambulance.
You must remember that most of our residence have some form of dementia and can't always tell us what is wrong .
We know our residence and we must us our nursing skills and usual habits of our residence.
Nothing burns me more then when a paramedic walks in and says. Well what did you call us for.Resident is DNR. Well just because they are old and demented doesn't mean they have to suffer.
One of our residents goes into CHF often we have orders. Asprin 81mg chewable. Nitro patch o.6mg; Im lasix 40mg; repeat Lasix if not resolved. Call ambulance if not resolved in 20min.
Paramedics arrive on scene and say why did you call us?
Just because our resident has dementia doesn't mean they have no quality of life
When she is well she attends the hairdresser, church crafts etc.
Just because they don't know where they are or what year it is doesn't mean they deserve to suffer
Sorry for the rant
My point is that my job is to make sure they have optimal care. In a long term facility we are limited in what we can do and the eqiupment we have.
Please don't look at me like I'm a complete idiot. I get that enough from the ER docs.
I even had one DOC who sent a Psycotic resident back to me with an order to only give him plastice utensils. Couldn't understand the problem of sending him back to a secured alzhemiers floor. He said "it's a secured unti isnt it"
A secrue unit in LTC isn't a secured unit at a psych.
Didn't seem to understand that i had 37 other dememted people walking around and that he posed a risk. P>S> the paramedics called for police escort so why would we be able to handle him???
Please advocate on behalf of these people. Believe you me I wouldn't call for you if Our facility was equipped to deal with the problem at hand
Most of you are great to work with and I appreciate the hard work you do
why oh why don't they start iv's on seizure patients?
Their main objective is to get the pt to the er asap. Many do try. Try starting an IV on a pt who may be seizing while going down a bumpy road or a busy city street. As a nurse, I have all the respect in the world for paramedics/emts. I dont wear their shoes and they dont wear mine. Just try and get an IV the second they come through the door.
HATS off to any medical professional that can respond to an uncontrolled scene and stabilize a pt while at the same time trying to get them to the ER.
Some are bette than others - but thats true in any profession.
**********paramedics/emts - LOVE you guys****************
1. please give a full report of what you found at the scene, or what the nursing homes concern was in a patient who can't or is poorly able to give a history. You are our eyes and ears!!!
Context is everything! Hang out until you can say hello to the doc, unless the case is bogus.
2. Please quickly run down the interventions you did en route.
3. Ask the family the code status if you have any chance to, and bring in DNR papers and meds!
1. please give a full report of what you found at the scene, or what the nursing homes concern was in a patient who can't or is poorly able to give a history. You are our eyes and ears!!!
Context is everything! Hang out until you can say hello to the doc, unless the case is bogus.
2. Please quickly run down the interventions you did en route.
3. Ask the family the code status if you have any chance to, and bring in DNR papers and meds!
Please remember (because most don't realize)- there is a difference between an EMT and a Paramedic...and It's a big difference!!
Good point! If any of you have read Jane Stern's book "Ambulance Girl", she talks about her experiences as an EMT-B. (And it's a fascinating read!) Although she can assist at the scene, she cannot do all that the paramedics can do--this requires special training. Anyway, the book gave me an insider's view of the world of medics and EMTs. They have a tough job.
Please remember (because most don't realize)- there is a difference between an EMT and a Paramedic...and It's a big difference!!
Good point! If any of you have read Jane Stern's book "Ambulance Girl", she talks about her experiences as an EMT-B. (And it's a fascinating read!) Although she can assist at the scene, she cannot do all that the paramedics can do--this requires special training. Anyway, the book gave me an insider's view of the world of medics and EMTs. They have a tough job.
I'd like to comment on rn29306's post regarding tube movement.
I can offer some advice regarding intubation in the field. On most incidents you will have to move the patient from the floor to a backboard to the stretcher into the MICU, then take a (usually) bumpy ride to the hospital while running code, take the stretcher out of the MICU and then roll it into the ER. All the tube has to do is move a couple of millimeters and it is dislodged from the trachea. That's a LOT of movement and a very LITTLE distance!
When you intubate, visualize the cords, place an ETCO2 on the ET tube, note condensation in the tube while ventilating, secure the tube, note the reading on the tube at the patient's teeth and place a C-collar on the patient!! This will reduce any movement of the head during all that movement. ALWAYS check breath sounds, ETCO2 reading, the reading of the tube at the patient's teeth (sometimes people will push down while ventilating with a BVM and it will push the tube into the right mainstem) and tube condensation anytime the patient is moved. And always document all of those points in your report.
I have intubated patients sitting up in cars, on the side of the road in the rain at night - I haven't tubed one upside down yet :chuckle but give it some time....and I have never lost a tube. I think the C Collar really helps.
Also, if you have access to mannikins, practice intubating every shift. I practice 5 tubes every morning at the beginning of the shift, so if I have to intubate or RSI that day - I'm already warmed up! I haven't "tubed the goose" yet and I contribute that to all the practice!
If you don't have an airway, you don't have a patient!
GOOD LUCK!!!!
They have a tough job.
ladytraviler
187 Posts
As a paramedic who did not renew their certs, I understand both sides of the story. I used to get jumped on by nurses for not telling them patient had something like scabies or lice before telling them that the patient was allergic to what ever and treatment given. I was taught ABCD. Thats how I always gave report. Then some nurses would appriciate that. It was the nature of the nurse.
I now work OB and some ER. I look at the medics as one of the best friends I could have. If they have a line that is in place great if not thats something I know needs to be done. Starting it is no peice of cake going down the highway. I know when I came off the streets that I could not start an IV unless I bounced the hand up and down. I still do it from time to time without realizing it.
I have worked with some snotty paramedics and some that were awesome. I have worked with the same in nurses. I value a medic that keeps his/her head when everything else is going down the tubes. I value that medic that helps at the same time. I wish medics who didn't know would ask and those that do know, and want to brag that they know, would shut up. I don't need a medic telling me that the patient is fubared, I need to know what you have done and how they responded, what you saw, and mech of injuries.
I take my hat off to you. I no longer do the job due to injuries. Take care of yourself and your partner. Remember you first, partner second, and patient third. You seem to have a good head on your shoulders. Give respect when due and demand the same. Each side of the coin has a roll and from time to time, they overlap.