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.
Most of the EMTs/paramedics I work with are AWESOME. We tend to see the same guys bringing pts to the ER every week, and I try to maintain a good relationship with all of them -- after all, I've cared for some of these guys in the ER, and who knows when I may be calling them to my house!
That said, my biggest pet peeve is a lousy report, either because the medic doesn't know half of what was done or else they have made a determination based on a poor assessment (example: 40-something yo female brought in for c/o seizure. Medic tells me "She's faking it. It stops and starts, plus look at all the psych meds she's on." Hmm, I thought, you might be able to fake a seizure, but it's pretty hard to fake diaphoresis! Pt had been seizing for 45 min during transport and recieved no meds! Ohter example: 30 yo black male motorcyclist vs truck. "He's very stable," says EMS. "He's diaphoretic and has decreased breath sounds," says I. Final diagnosis was bilateral pneumothorax, fractured pelvis, and lacerated liver.).
The other thing that really bugs me is a lack of critical thinking. If a patient has COPD, please do not treat her shortness of breath with 15L O2 per NRB, or we will be intubating her upon arrival to the ER because she will be breathing about 2 times per minute! Sometimes you have to think outside the protocol.
i think in this case, it's the nurse who needs to think outside the protocol. having been an emt (not a paramedic), it was a difficult concept to grasp, that low 02 is their drive to breathe. but when it means they are going to stop breathing, you need to forget the rules. when they are baseline, thier drive to breathe is driven by low o2, but when they are in distress, i would think you would want to avoid intubation.
bonemarrowrn has it right, of course; keeping the patient breathing is pretty much the point. My main complaint (this really happened to a patient of mine) was that 15 liters O2 was the first thing EMS tried for a patient whose sats were something like mid to high 80's, when 4L per NC and a breathing treatment might have helped turn the corner. As it was, we intubated upon arrival to the ER because the patient was only breathing 2-4 times per minute:o. Protocol is a wonderful and useful tool, but so is critical thinking.
bonemarrowrn has it right, of course; keeping the patient breathing is pretty much the point. my main complaint (this really happened to a patient of mine) was that 15 liters o2 was the first thing ems tried for a patient whose sats were something like mid to high 80's, when 4l per nc and a breathing treatment might have helped turn the corner. as it was, we intubated upon arrival to the er because the patient was only breathing 2-4 times per minute:o. protocol is a wonderful and useful tool, but so is critical thinking.
agreed. as my hubby (the paramedic) says, there are good medics and bsd medics (just like nurses)
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!
I was a private service medic for 6 years, and I do not remember those days with fondness. We had to be kiss-*ss sweet to all facility staff, regardless of whatever rudeness they felt like dishing out(and there were a few with soap-opera lives who liked to vent on a helpless target). The owner toadied up to these folks, because he owed his business on their good will. But, Ya know, ya can't really respect someone who kisses your *ss just to get along. We have a great relationship with our nurses, based on mutual respect and understanding.
V. Nightingale
51 Posts
Most of the EMTs/paramedics I work with are AWESOME. We tend to see the same guys bringing pts to the ER every week, and I try to maintain a good relationship with all of them -- after all, I've cared for some of these guys in the ER, and who knows when I may be calling them to my house!
That said, my biggest pet peeve is a lousy report, either because the medic doesn't know half of what was done or else they have made a determination based on a poor assessment (example: 40-something yo female brought in for c/o seizure. Medic tells me "She's faking it. It stops and starts, plus look at all the psych meds she's on." Hmm, I thought, you might be able to fake a seizure, but it's pretty hard to fake diaphoresis! Pt had been seizing for 45 min during transport and recieved no meds! Ohter example: 30 yo black male motorcyclist vs truck. "He's very stable," says EMS. "He's diaphoretic and has decreased breath sounds," says I. Final diagnosis was bilateral pneumothorax, fractured pelvis, and lacerated liver.).
The other thing that really bugs me is a lack of critical thinking. If a patient has COPD, please do not treat her shortness of breath with 15L O2 per NRB, or we will be intubating her upon arrival to the ER because she will be breathing about 2 times per minute! Sometimes you have to think outside the protocol.