LTC Nurse Haivng Problems with and EMT (super long!)

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I’m not really sure how I should handle this…or if I should just shut up and smile. :) Wednesday night, I worked night shift…not my normal shift (I am a pencil pusher with an office with a view), but I know the residents and the routine well and I still have pretty decent clinical judgment. Anyway…it was a wonderful shift and things were smooth sailing until 0430. One of our alert and oriented residents, who has a history of pathological fractures started screaming for help. Well…there she was on the floor. She denied pain, but is a very stoic lady. I can honestly see her chopping off her leg and rating her pain at a 2 or a 3…while smiling and patting the nurse on the hand and telling her how sweet she is. So…there are no real deformities, but her right arm just didn’t look right. No bruising, no swelling, nothing that looked like it shouldn’t look. We positioned her for comfort,made sure pulses were still there, and placed pillows to position (but not immobilize) the arm. I called the doctor (seven times before he picked up instead of the answering machine) and got orders to transfer to the 10 bed hospital across town. I called 911 and forty minutes (and two phone calls to dispatch) later, one EMT and a police officer showed up. I met the EMT at the door and gave report as we walked down the hall toward the resident’s room. I told the EMT that this resident is very fragile and that we handle her like eggshells because of her history of pathological fractures. The EMT said, ”Well, I think I know how to package a patient and I don’t even know what a patho-whatever fracture is.” I then said, she fractures really easily…and without known cause…she broke her wrist just picking up a water pitcher last year. The EMT rolled her eyes and sighed. She went into the resident’s room and asked me why I hadn’t put her back in bed. I again stated that she fractures very easily and because her arm didn’t look right that I didn’t want to move her without proper splinting. The EMT then informed me that she hadn’t brought any bandages in and that I needed to get her some Kling or something to immobilize her arm with. I could find any Kling, so I suggested using a pillowcase to splint. The EMT then informed me that pillowcases are not appropriate splints and that she would just splint her in the ‘bus.’ When I was in paramedic school, we learned to splint with all kinds of “inappropriate” things like pillowcases, magazines, duct tape, etc, so I said…”Oh…they taught us how in paramedic school.” She asked me if I am a paramedic and I admitted that I am. She informed me that I am “not a paramedic here, so it doesn’t count.” The EMT and the police officer then rolled the resident onto a sheet and lifted her onto the cot, letting her right arm flop to the side. I stepped up and tried to move her arm and the EMT held her arm up and told me to let her do her job…she then said, “I really don’t think there is anything wrong…you people call us all the time for nothing.” The EMT took her O2 off and the EMT and the police officer wheeled her out head first and with the cot flat, despite her extreme kyphosis. She resident had three fractures…one to her humerus, another to her ulna, and the last to the pelvis. The resident reported to me (when I took her glasses to the hospital) that the EMT was rude to her in the ambulance and that she told her that there was no way she was fractured because she had very little pain. So…my DON told me that she wants me to handle this one…I was there, I am a department head, and I have the EMS background to really know what was done wrong. They are a volunteer squad (and this EMT is their rescue captain and is married to the fire chief), so there is really no one above her to go to. Should I just call her and ask if we can talk or what?

I really feel like I should have been more assertive about it when the patient was still there...I dropped the ball there for sure. The patient didn't have any additional harm done, but the potential was certainly there. I just don't feel good about the way the thing played out, but I'm not sure what to do about it.

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Specializes in nursery, L and D.

Oh man, I think you better call and talk to her before you have to deal with her again. I would let her know that the pt was fractured, and have a talk about the way she talked to you, and that you felt the pt did not receive the best treatment from her. Are you sure there is no one above her to speak with? Sounds like a bad situation.

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Cant you file a formal complaint with the state board of EMS?

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Specializes in SICU, EMS, Home Health, School Nursing.

Sounds like a bad situation to me! I am in EMT school right now and they stress all the time that you need to get creative when on scene and use whatever you have available if you need to.

Make sure you document on an incident report about where you found the patient, what you did, what the patient said, what the EMT did, etc. Just put the facts. You could call and talk to the EMT or the chief and let them know how disappointed you were in the care, but it doesn't sound like it would make much of a difference. Just make sure you document, document, document so that it won't come back to bite you in the butt someday!

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Specializes in Peds, ER/Trauma.

Even a volunteer squad has to have a physician who is their medical director- it is usually an area ER physician. Find out who this squad's medical director is, and get in touch with him/her about your concerns.

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You should follow up with her superior. I agree with the above poster who says to find out who it is and contact them immediately. I aslo agree with filling out an incident report if you haven't already. She could have done more damage to this poor woman with her awful care. She needs to know flat out that this woman had not one but three fractures. She was out of line. I absolutely believe that she was rude on the ride as well.

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

So nice to know that they now teach X Ray vision in EMT school !! Geez, I wish they'd have taught that in my degree program.;) That would have saved a lot of time....:angryfire

Seriously, this chick is an idiot. :angryfireShe needs to have attention drawn to her before she kills somebody. Yes, call the medical director. He needs to know the kind of people he's responsible for. Yes, call the chief and inform him of her attitude problem to say the least. So she's his wife?? Ughhhh... I'd also call the state EMS authority, just to give them a heads up.

She's an EMT. And I don't mean to offend anyone really but EMTs don't even know what they don't know...and what they don't know is A LOT. Obviously this woman didn't care - as evidence by her crappy attitude when rolling up. Regardless of WHY she was called, she's there to do a job. She needed to just shut up and do it. Sounds like things started off well, when you gave report, but then when she began to take over care of the patient things went awry.

You have the authority to say "I don't think you should just let her lay there like that without splinting her or packaging her appropriately." You have the authority to stop her from doing something that you know or believe is detrimental to the patient's well being.

Yes, call her and see if you can talk about things. Maybe she was having a bad day. Or maybe she's just a bad egg and needs to get her crap straight before she really hurts someone. Either way, she needs a talking to. Best of luck.

vamedic4

Disgusted at her lack of knowledge and compassion.

What would you have done if this patient were your mother??? Take it from there.

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Please do not think that all EMT's are idiots. Most have a wonderful bedside manner, great assessment skills and common sense. You will occasionally find the ego that can't get over themselves long enough to put the patient first, but it's been my experience you can find them on both sides of the fence.

I would not waste my breath talking to someone so full of themselves. She has a director within the service. I would call that person and let them know how she is representing them. If she treated your patient wrecklessly in a controlled setting, imagine how she could jeopordize the safety of a patient in a true life or death emergency. If you don't feel any satisfaction with the way her director handles it, google your state board of EMS. You can call them directly.

There are small towns all across America who rely on EMT's as their only means of life support. Please be cautious when you tell people EMT's know nothing. Nothing could be further from the truth.

Sippy

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I'm not really sure how I should handle this...or if I should just shut up and smile. :) Wednesday night, I worked night shift...not my normal shift (I am a pencil pusher with an office with a view), but I know the residents and the routine well and I still have pretty decent clinical judgment. Anyway...it was a wonderful shift and things were smooth sailing until 0430. One of our alert and oriented residents, who has a history of pathological fractures started screaming for help. Well...there she was on the floor. She denied pain, but is a very stoic lady. I can honestly see her chopping off her leg and rating her pain at a 2 or a 3...while smiling and patting the nurse on the hand and telling her how sweet she is. So...there are no real deformities, but her right arm just didn't look right. No bruising, no swelling, nothing that looked like it shouldn't look. We positioned her for comfort,made sure pulses were still there, and placed pillows to position (but not immobilize) the arm. I called the doctor (seven times before he picked up instead of the answering machine) and got orders to transfer to the 10 bed hospital across town. I called 911 and forty minutes (and two phone calls to dispatch) later, one EMT and a police officer showed up. I met the EMT at the door and gave report as we walked down the hall toward the resident's room. I told the EMT that this resident is very fragile and that we handle her like eggshells because of her history of pathological fractures. The EMT said, "Well, I think I know how to package a patient and I don't even know what a patho-whatever fracture is." I then said, she fractures really easily...and without known cause...she broke her wrist just picking up a water pitcher last year. The EMT rolled her eyes and sighed. She went into the resident's room and asked me why I hadn't put her back in bed. I again stated that she fractures very easily and because her arm didn't look right that I didn't want to move her without proper splinting. The EMT then informed me that she hadn't brought any bandages in and that I needed to get her some Kling or something to immobilize her arm with. I could find any Kling, so I suggested using a pillowcase to splint. The EMT then informed me that pillowcases are not appropriate splints and that she would just splint her in the 'bus.' When I was in paramedic school, we learned to splint with all kinds of "inappropriate" things like pillowcases, magazines, duct tape, etc, so I said..."Oh...they taught us how in paramedic school." She asked me if I am a paramedic and I admitted that I am. She informed me that I am "not a paramedic here, so it doesn't count." The EMT and the police officer then rolled the resident onto a sheet and lifted her onto the cot, letting her right arm flop to the side. I stepped up and tried to move her arm and the EMT held her arm up and told me to let her do her job...she then said, "I really don't think there is anything wrong...you people call us all the time for nothing." The EMT took her O2 off and the EMT and the police officer wheeled her out head first and with the cot flat, despite her extreme kyphosis. She resident had three fractures...one to her humerus, another to her ulna, and the last to the pelvis. The resident reported to me (when I took her glasses to the hospital) that the EMT was rude to her in the ambulance and that she told her that there was no way she was fractured because she had very little pain. So...my DON told me that she wants me to handle this one...I was there, I am a department head, and I have the EMS background to really know what was done wrong. They are a volunteer squad (and this EMT is their rescue captain and is married to the fire chief), so there is really no one above her to go to. Should I just call her and ask if we can talk or what?

I really feel like I should have been more assertive about it when the patient was still there...I dropped the ball there for sure. The patient didn't have any additional harm done, but the potential was certainly there. I just don't feel good about the way the thing played out, but I'm not sure what to do about it.

Being a new grad nurse and an EMT for 10 years I can sympathize with you ... this EMT was entirely in the wrong! Perhaps if you contact her just regarding this incident, explaining that the patient did in fact have fractures, and letting her know that teamwork is very important in providing the appropriate care for you residents she will understand you are in this together. I would like to add that volunteer or not shouldn't make a difference in a situation like this. I am still a volunteer for my local squad and this attitude of hers is very unacceptable.

Jen

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

Sounds like she could use an attitude adjustment. Bad day or not that does not give her the right to speak to you or treat you patient in the manner that she did. That was totally unacceptable! I would definatly report that sort of behavior to EMS board or a superior. She obviously was not only rude to you but also to your patient and that is crossing the line. It also sounds like she was neglecting maybe even boarderline abusing the patient by how she was handling her, and ignoring your report as to how fragile this patient was. Everybody's pain tolerance is different and I'm assuming that they teach that in EMS training. She does not have the right to judge how much pain this patient or any patient is in. Diciplinary action needs to be taken before this woman carlessly handles any more patients.

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Specializes in ED.

This EMT needs to be reported, toxic attitudes hurt people. VAMedic4 I can tell you in my exp working urban EMS there are just as many junk medics with poor attitudes and horrible pt care/skill sets as there are EMT's. That also goes for nurses and docs, it's not the level of medicine you practice, it's how you practice that level.

D

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

You are not the only LTC nurse that has had problems with EMTs and paramedics. I'm a LTC nurse who has dealt with obnoxious EMS staff on several occasions while in the process of sending elderly residents out to the hospital. I created a recent thread in the geriatric/LTC forum entitled "Rudeness from EMTs and paramedics," and received over 100 responses from both nurses and EMS personnel regarding this issue. Click on the link below if you want more insight into the issue.

https://allnurses.com/forums/f22/rudeness-emts-paramedics-268561.html

In all fairness, some LTC nurses have been rude to EMS, too. The problem goes both ways.

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