new paramedic... another question for the nurses.

casperx875x · Nov 28, 2008

In an inpatient setting, the last thing we worry about subconsciously is a patient's privacy in a code situation. That gown is off in seconds so that compressions can be given, pulses adequately assessed, and central access can be obtained. While rolling the patient down the hall, someone could've covered the area until you got to the trauma room. I'm sure your adrenaline was running, but just something to keep in mind the next time. Imagine being a visitor or another patient, having to see an exposed patient being rolled in.

RN1982 · Nov 28, 2008

It's one thing to be in an ER trauma room and the patient is naked away from the eyes of the other patients in the ER. Its another when you are rolling them in and the patient is naked for everyone including visitors and patients to see. You should have covered the patient up when rolling them into the ER. It doesn't take much effort to throw a sheet or something over them to cover them. This is just my opinion, even if I have a patient that is in cardiac arrest, I still try to maintain what dignity they have.

Medic09, BSN, RN, EMT-P · Nov 28, 2008

Okay, I'm answering as a medic more than as a nurse.

Preserving your patient's dignity is a fine, important thing to learn. I've always worked on it with all my students and crews in the field over the years. I think it isn't emphasized enough in medic school. So, work on that. Don't beat yourself up over it; just work on the habits that make it happen. Right now you're all distracted just learning to really be a medic, so it will take a little time.

NOW, I think you have a problem with your partner. For one thing, if she is more experienced then she ought to see that she has a role to mentor you. For another thing, you all need to talk to each other and determine who's doing what. I talk with my partners constantly. It makes them a little crazy sometimes :rolleyes: , but there is never any doubt as to who is doing what.

WHAT's more, your partner lacks loyalty. If it becomes necessary during a closed door, professional review to 'assign blame' then it's appropriate. But if a nurse in the ED 'scolds' you, your partner should step in and shoulder the burden with you. "WE didn't have time to get to it." "WE'LL try to do that next time." "Thanks for giving US a heads-up." ALWAYS. You all are partners, and you need to be in the habit of supporting each other. The best feeling in the world on a tough or risky call is knowing my partner has my back. The worst feeling is...well, the opposite. As an EMS partner, you must always shoulder your own responsibility AND help your partner shoulder theirs. All emergency personnel understand this.

So, now what? Buy your partner a coffee or even lunch. That helps open the door. Then tell her something like, 'you know, I've been thinking about a few things that might really help me more on calls.' Talk to her about communicating more, and more clearly. Talk to her about how you'd appreciate it if she didn't leave you holding the blame alone in front of others (except with the medical director, etc.). She may just get the message. I hope so.

I've been blessed over the years with mostly good partners. That has helped me provide better patient care. One of my partners (an EMT-B and ED tech) hasn't ridden the bus with me for probably about two years; but she still calls me her partner. That's a great feeling, to know that we share that mutual respect and dedication to our patients. Makes me proud. I hope she feels the same. Even in the ER, as a nurse, I've sort of partnered up with a couple of nurses who I respect and know will help without leaving me standing alone. What's more, I like their attitude towards colleagues and patients. It has made my job much better. After family, a good partner is the most important person in your life. You two need to create that partnership, and it sounds like she needs a nudge in that direction.

vampiregirl, BSN, RN · Nov 29, 2008

I've been an advanced EMT for 11 years. I know it was about a year before I was comfortable... and a paramedic has a lot more things to get comfortable with than an EMT. Give yourself time to get all the details down. It's the big things - ABC's and scene safety for example that are always going to be the priority.

It sounds like your partner and you haven't quite fallen into a groove yet. You probably have very different styles from the way your post sounds. When working with challenging partners, I try to identify their strengths and weaknesses. Then I look at my own and figure out how we can best work together as a team. Some times I try to communicate this to them, other times I just try to find my niche in that team on my own.

As for not being so by the book, I don't agree. First of all, if you have a methodical approach to assessment, you are not as likely to miss something. I am a by the book person for the most part, but it does have its benefits. Many of the medics I've worked with over the years appreciate that I'm thorough and predictable. Also, it's kept us out trouble a few times (and got me in trouble with my partners a few times too, but it's all about providing the patient the best care and coming home alive).

One more thought for you, before I get out of the ambulance with a patient, I always do a quick survey to make sure I'm not going to get any lines, cords, cables, etc caught or dislodged. During this quick survey, I also make sure the patient is covered for the transition - it just takes a few seconds and it's part of my routine.

chadash · Nov 29, 2008

Yes, cover your patient quickly next time, but you sound like you have a poopy partner.

rhondaa83 · Nov 29, 2008

hello, i've been at this paramedic thing for about 3 months now. I posted not too long ago about my partner getting angry with me about making an unconscious patient trauma naked.
anyway, we talked things through and she took back her harsh comments, and told me that i dont always have to go by the book... but it seems we've run into problems again for the same reason.
I had an 19 y.o male pt this week with multiple gsw's who flatlined in the ambulance. We began CPR on the patient who's clothes we had already been cut off. Upon arrival at the E.R we removed the patient and continued cpr while rolling him down the hall to the trauma room. Clearly, there was little time and little priority to cover up his member before moving him (nor did my partner instruct me to).
However, afterwards a nurse scolded me for not covering him before moving him and my partner did not even defend me in the situation. She told me that she was busy giving the pt air and that covering him was my job.
Is it really that big of an issue to move a patient in cardiac arrest without covering them? What makes me most angry is that the pt survived and i did not recieve any credit!
some feedback please?

How would you feel if you were the one on the cart, showing all of your junk to the world?

mscsrjhm · Nov 29, 2008

How would you feel if you were the one on the cart, showing all of your junk to the world?

I don't think he was feeling anything at that time, and he hopefully felt very grateful after he returned from "the light".

Remember- the guy was dead.

Over-the-hill-Nurse · Nov 29, 2008

Saving the patient was the first piority. Which, from you said, you did. Covering the gentleman up would have been a secondary thought and sometimes does get missed. Like one of the other posters said, it is a good practice to do a quick look to see that all the lines are intact, not going anywhere, and to ensure that your patient has some dignity.

What if the gentleman's family or other people who know him saw him rolling down the hall flapping in the wind... it would have been horrible for them and your patient, even though he didn't know it, since the gentleman survived, I would not want to be him and walking out of the hospital with people thinking " Hey you were that guy that they rolled down the hall butt naked!"

Put yourself in that situation and think about how you would feel about it at that point.

Your Partner should back you up, And the nurse could have pulled you aside and just said "I know that this was a tough patient to bring in, but it really is important to try and maintain their dignity".

Your reward from this particular case was that the patient lived and you had a hand in ensuring that. The biggest reward of all is Giving life back to those that lost it. Feel proud of yourself that you did a good job in achieving that.

Virgo_RN, BSN, RN · Nov 29, 2008

You sound like a conscientious person who would not intentionally violate a person's dignity. You did the responsible thing to continue CPR uninterrupted. If I were the nurse, I would have just covered him up when I saw him rolling in naked. I would not expect the person performing chest compressions to stop doing so in order to find a suitable covering.

On the other hand, to play Devil's Advocate, it doesn't take more than a second to flip a piece of clothing, a towel, or something over the person's private parts prior to taking them out of the ambulance.

Live and learn, and keep up the good work!

honey75 · Nov 29, 2008

I agree the patient should have been covered, BUT in the heat of the moment and the adrenaline flowing, if you didnt notice someone else could have covered the patient.

Also if I had been a relative in the A&E department I would have been more upset at seeing someone getting CPR than seeing their "bits"

BTW you did a great job. Good luck.

Pacman RN · Nov 29, 2008

I have to go with the masses on this one. I spent 30 years in EMS...3 as an EMT and 27 as a medic. Finishing up my RN at the end of this year. Obviously I have a bias towards the EMS point of view.

Giving proper care obviously comes first! The point, which your partner fails to deliver with any tact, is the limited time required to throw a sheet or bath blanket over the patient before exiting the ambulance. It simply should be done in my opinion. What if the patients family was called and is waiting at the hospital. Forget about seeing him naked... the site of the gunshots, etc. You can still do compressions and what you need to do with a sheet thrown over your patient and your hands.

Remember your patient is not the only client you are there to serve. Remember the family members and their feelings. That too is a big part of the job!!

You should speak to a supervisor about getting a different partner / mentor. The job is hard enough without being crucified all the time. Constructive criticism makes you grow...but constant tearing down is not good.

I hope this helps:

Paul:typing