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new paramedic... another question for the nurses.

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 penis 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?

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

Specializes in ICU/Critical Care.

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

Specializes in ED, Flight. Has 10 years experience.

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

Specializes in Hospice. Has 10 years experience.

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

Specializes in Nursing assistant.

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

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 penis 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?

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

Specializes in pediatrics, geriatrics, med-surg, ccu,. Has 21+ years experience.

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

Specializes in Cardiac Telemetry, ED.

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

Has 13 years experience.

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.

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

Blee O'Myacin, BSN, RN

Specializes in ED, ICU, Heme/Onc.

I wouldn't have scolded you. I would have grabbed a towel and covered the guy's parts myself. Sheesh.

I think that perhaps the nurses got flack from the supervisors who flock to codes like moths to a light and if they see anything that is not aesthetically pleasing to the eye, they're all over us about it.

Just to give you a bit of perpective. The ED nurse has 5 patients, you roll in the sixth, coding. The team jumps into action and the nurse cracks the code cart and starts pushing meds. Just then, the VP of nursing comes strolling through to see why patients are in the waiting room for the five minutes that the code was running and oops, there's the patient's penis. Her twinset and perfectly coiffed hairdo wilts in the face of such horror and asks to speak to the staff nurse. The staff nurse wipes the sweat and blood and normal trauma code gore off her arms (and don't forget to take off those gloves in the hallway!!!) and goes out there to explain why no one perserved modesty (and there are three empty hall stretchers!). You, my paramedic friend, were thrown to the wolves. I think that stinks, considering that we are all part of the same team. (Upper managment included, but they don't see it that way unfortunately)

I agree with the other posters to start to work on that partnership with your co-medic. You two have to be able to trust and depend on each other "out there".

Stay safe,

Blee

mama_d, BSN, RN

Specializes in tele, oncology. Has 10 years experience.

I can't begin to tell you how many times we've coded a patient, had their "junk" and other assorted body parts hanging in the wind, and had people consistently leave the door to the room open and the curtain open.

I try to be extra careful about it b/c we had a woman rush up to the hospital after we called her in in the middle of the night to find us coding her husband with his door wide open; it took that one experience to make me extra vigilant about trying to be the one to pay attention to that kind of thing. I've even called out "curtain" or "door" when we were in the middle of coding people so that the "runner" was reminded to take care of it, if I'm not in a position to do so.

I wasn't there, but from what you've posted, yeah, you could've covered him up....but so could many other people along the way. Sometimes patient dignity takes a backseat to ABC's (just realized that D for dignity fits right on the back of that...maybe I should copyright "ABCD's" and market it to the people who write fundamentals books and make me some dough). Personally, if I'm ever being coded, I wouldn't care if people posted the video on YouTube if they managed to bring me back...I'd be thanking my lucky stars that I had competent people bring me back.

MedicalLPN, LPN

Specializes in Onco, palliative care, PCU, HH, hospice.

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

This is me, but if I were on the cart, being dead would be my primary concern :)

To the OP, just remember to throw a sheet over the patient before you take them off the ambulance. You're new at this, your adrenaline was pumping, you were more concerned about the patient being in asystole than the fact they were exposed, and for that just let it go, and next time try to keep in mind to cover the patient when transfering.

In the hospital, as other poster's have stated, the patient is naked during a code, however if the patient is revived before we start hauling but to the ICU we throw a sheet over the patient, at the same time in a hospital during a code generally you have a lot more help than when you're in the back of an ambulance, and not for nothing but hey you're partner should have made sure a sheet was on the patient as well.

The nurse that scolded you should have just pulled you aside afterwards and said "Hey, next time remember to put a sheet or garment over the patient when you're transfering the patient." instead of scolding you.

Don't beat yourself up over this, you're not a bad person or medic because you were more concerned about reviving the patient than making sure he wasn't exposed like I said just try to be more aware of the dignity thing in the future and it'll become second nature.

flightnurse2b, LPN

Specializes in EMS, ER, GI, PCU/Telemetry.

i don't have much to add except to bump up the fact that your partner has thrown you under the bus more than once and thats something in EMS that you don't do. my partner and i were thick as theives when we worked together. she would have jumped in a river of boiling snot to help me, and i would have done the same for her. thats how lives get saved. you cannot successfully run rescue with a partner that is not going to have your back. i agree completely with the people who advised you to try and form a better relationship with this person. she may be one who just needs some constructive criticism---or for you to give her a gentle reminder that you are on the same team.

i admit i've wheeled a nude patient into the ED, honestly as a medic i can say that i dont really ever notice they're naked until after i've reported off to the staff. i get in my zone. all i see is asystole, vfib, hemorrhage, resp arrest, whatever and i work on it. i'm not warm and fuzzy at that point. because if it were me, i would want a competent paramedic to not use any time covering my boobies while they did CPR.

but as someone who worked in the ED, blee makes a very valid point. there are enough people working in the ER, esp when a rescue comes in, that they could have sent another nurse or a PCT for a towel to cover the man's stuff... you did what you were supposed to. save his life.

alot of times EMS gets the bad rap for patients coming in in less than perfect condition. it's difficult to explain, without sounding like a complete jerk, that i'm sorry i broke nannie's dentures while intubating her, but i was trying to save her life. i've more than once had an ER nurse bark at me for cutting off clothes, using makeshift dressings, etc. you do what you have to do in the field.

you sound like you are on your way to being an excellent paramedic. keep up the good work, and i hope that things between you and your partner work out.

MedicalLPN, LPN

Specializes in Onco, palliative care, PCU, HH, hospice.

alot of times EMS gets the bad rap for patients coming in in less than perfect condition. it's difficult to explain, without sounding like a complete jerk, that i'm sorry i broke nannie's dentures while intubating her, but i was trying to save her life. i've more than once had an ER nurse bark at me for cutting off clothes, using makeshift dressings, etc. you do what you have to do in the field.

This is very true. I've noticed that there seems to be a rivalry between some medics and nurses. A medic gets treated bad by a nurse or a nurse gets treated bad by a medic and boom suddenly all nurses or all medics are the seeds of satan. It's really quite silly, both professions have a different skill set and different mind set. I have learned a lot from the medics I know both professionally and personally, and likewise they have learned from me. Anyway I'm off topic, just felt compelled to hop on my soap box for a moment :)

sorry to hear about your partner turning on you like that.

bottom line is that it's no one in particular's job, but any/everyone's.

and while we all acknowledge on an intellectual level, that the priority here is to save a life...

emotionally, people/pts will react to the thought of being exposed, and will, even momentarily, wish they were dead.

when a certain thought evokes such a strong reaction, you can bet that any interventions to prevent such an 'atrocity', is pretty high on the priority ladder.

unless one is a professional flasher, it's safe to say that most folks would consider it imperative to be covered at all times.

leslie

Medic09, BSN, RN, EMT-P

Specializes in ED, Flight. Has 10 years experience.

Blee, your description of the ER and VP of Nursing was brilliant! If I'd been drinking milk, it all would have come out my nose!:yeah::lol2:

That made my night; thanks!

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