Rudeness from EMTs and Paramedics

DutchgirlRN, ASN, RN · Mar 4, 2008

do not belittle someone because you have a piece of paper that says you were able to bs your way through 2-4 years of college. by the way i am 47 y/o, working full time, in my third semester of an asn program, and carrying a 4.0 gpa. how smart am i and where do i fit in the "pecking order"?

i did not bs my way through college and it doesn't sound like you are either. congratulations!

please don't make assumptions.

CapeCodMermaid, RN · Mar 4, 2008

No man is an island. We can't do this alone no matter who we are, what our title is, where we went to school, what degree we have....

Treat rudeness with a smile and a kind word. Don't give back rude or mean behavior.

I suggest we all get over ourselves and get back to the business of taking care of our patients.

flightnurse2b, LPN · Mar 5, 2008

wow.

i cant believe how many nurses have resentment towards medics and how many medics have resentment towards nurses. it just doesnt make sense.

i knew it was bad, but my lord. it makes me sad to read this stuff. i have never disrespected a nurse in LTC. once i calmly explain what assessmts and paperwork i need to complete to cover my own rear, nurses were usually very understanding and helpful. i have utmost respect for LTC nurses.

seriously, im sorry there are alot of rude medics out there, but there are alot of good ones too, so can we kinda lay off the medic trashing guys?

i worked very hard for my associate's in EMS, and i am proud to be a nationally registered paramedic. i am also working just as hard to become an RN, and will be a very proud nurse one day. no one is smarter. we are just different.

can't we all just get along?

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · Apr 1, 2008

Haven't read every post in this thread. I know I am probably going to catch a lot of crap for this but here is my input. Please let me clarify that I am in no way defending EMTs' bad attitudes, just some reasons why they are the way they are. And these don't make it right, either.

1. The large majority of EMT's are very young, most of them at my company are ages 18-22, and that's how most young people are.

2. People get into EMS thinking that all calls they respond to will be true emergencies, such as codes, MI's, CVA's, MVA's, gunshots and stabbings. The reality is that fire departments respond to those type of calls, but private services do not unless they are contracted with a city or township to provide transport. Fire departmets will not hire an EMT or Paramedic unless they are cross-trained in firefighting also. It's disappointing and a rude awakening when you're employed at a private company, because it entails LTC and inter-facility transfers, and they usually don't get to utilize the skills they learned in school.

3. The pay really sucks for as much physical work as they do, and they are also treated like crap, so they take it out on others.

What most of it boils down to is each party (the ambulance company and the LTC facility) not knowing about each others' protocols, policies and operations.

I will agree with most of you, there ARE a lot of very rude and condescending EMTs and Paramedics, and the EMTs aren't the only ones guilty of it. A lot of paramedics are "Paragods" because they think they can fix anything and have complete control over a scene or situation. Yes, they do have a certain extent of autonomy, they can give medications per standing orders listed in the protocols, they are ACLS certified and much more, but they don't know as much as Drs and nurses. (But they are convinced that they do.)

On the other hand, I have seen some disturbing things on residents I have transported from LTC facilities:

1. Whenever we ask for a report about the pt, we are usually told: a) "this resident is new to us." b) "I noticed this at the beginning of my shift." (the pt is usually critical, the shift began at 2300, it is now 0200 and the Dr just ordered to have the pt transferred out.) c) "I already called a report to the hospital." You may have called a report to the hospital, but we were called to your facility and we need to do an assessment on the patient to determine the prehospital treatment and to document on our run report. We can't just take the pt to the ER and tell them "The pt is ________ (whatever the complaint may be) and it's not normal for him/her."

2. I can't tell you the number of times I have come across a patient on an oxygen mask with only 2-3 liters per minute running.

3. I once transported a patient in septic shock whose foley bag looked like it was ready to explode.

There are countless others I have seen over the years but these are some that I remember off the top of my head at this hour. (I'm really tired right now.)

I would like to conclude that I am not defending EMS nor am I bashing LTC nurses and CNA's. I have also seen some very good ones and very helpful, knowledgeable ones too. Three years ago the LTC facility in which my husband's grandmother was in before she passed away was a good one. Our family never had any complaints about staff, the nurses were always on top of things, knew the residents and their family and friends well, and were always quick to respond to the residents' needs. I for one do have respect for you all because I know how hard you work and do as much as you can especially with the understaffing. No hard feelings. :loveya:

chiya · Apr 1, 2008

OK I have to agree with everybody. There are good EMTS/Paramedics and there are bad ones. I have seen them all.

The good ones actually listen to your report. The bad ones just shove you out of the way and do their thing or argue with you.

I do think some of the confusion here is that the rules and titles mean different things in different states. In my state EMT has a basic emergency first aid course, The paramedics have the schooling. For the most part the paramedics are great, the EMTS mainly in it for the adrenaline rush.

Now for the bad ones. I have found that rudeness doesn't just apply to LTC. I arrived at a patients home while working Home Care to find an ambulance crew, (EMT's) walking out the door, When I asked what was going on they told me. "He just took too much meds and is sleeping it off." I said so you aren't transporting? answer was no. I went in put my stethscope on the patients chest and found acute CHF. I called the dispatch and ordered an ambulance. The dispatcher said but they were just there. Yeah I know that send them back and by the way is it your protocol for an EMT to decide whether to transport or not?

Being home health and on the road a lot I also frequently was the first at the accident scene. Stood in a ditch in 3 feet of ice water during the winter to keep an accident victim calmed down and NOT MOVING after this gal had been t-boned and the car shoved over a hundred yards over a bank. (She was later life flighted to a regional trauma center with severe head injuries) Only to have the EMTS and paramedics who responded just shove me out of the way and basically ignore the report I attempted to give them.

In LTC I have handed a DNR order to an EMT only to have them look at it and say this doesn't mean we can't bag them. Off they went to the hospital very dilegently working that ambu-bag. The hospital called a half hour later to chew my butt for sending a dead patient with a DNR to the ER. My response- I showed the EMT's the same DNR you have in front of you and they chose to bag and transport so go talk to them about it.

I have been treated profesionally by EMT/paramedics and I have also been called honey shoved out of the way and had my judgment questioned. So now my rule is you arrive at my unit to transport, I will be standing there with my report ready for you and will treat you the same way you treat me. Respect that RN after my name and you wil get nothing but respect from me and I will even help you transfer the patient to your litter. Call me honey and start an argument with me and we will have a problem.

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · Apr 1, 2008

by the way is it your protocol for an EMT to decide whether to transport or not?

No, it isn't. Under most protocols, if the pt is alert and oriented to person, place, and time and is his or her own legal guardian, then the pt has the right to refuse treatment and transport. The pt must sign a refusal (and from your post it sounds like the pt probably didn't) otherwise it is abandonment.

DutchgirlRN, ASN, RN · Apr 1, 2008

the pay really sucks for as much physical work as they do, and they are also treated like crap, so they take it out on others.

and it was their choice to become an emt rather than a nurse. people make choices, people must live with the consequences. :twocents:

ok i have to agree with everybody. there are good emts/paramedics and there are bad ones.

i think that pretty much sums it up... and that goes for any profession not just healthcare.

EricJRN, MSN, RN · Apr 1, 2008

The thing to keep in mind is that our negative interactions with each other are probably not isolated, one-time events. Each time that EMS and LTC nursing deal with each other, they bring the memories of their past dealings.

This weekend in the ER, we received a complicated, obtunded LTC patient via EMS. The medics said they were called for altered mental status. A clerical employee handed them copies of labs (which included an Na+ of 170 and a glucose of 563) and an H&P summary (which discussed Huntington's dz, seizures, CVA, HTN and DM). No LVN or RN could be located for the patient. The housekeeper did tell EMS that the patient normally didn't talk but was usually more alert.

Maybe these situations raise more questions than answers, but I couldn't help but think that there had to be some explanation for the perceived "hiding" of the nurses. It's likely that they remembered a previous confrontation with an EMS crew when their care was questioned harshly.

Similarly, I think many of us in EMS struggle to be polite to LTC staff because we go in expecting to encounter a patient care disagreement. Will the nurse talk to us? Will there be anyone in the room at all attending to this emergent patient? Will this be another cold, asystolic patient that was "fine a minute ago?"

I'm not sure how you fix it, but the issues on both sides represent a vicious cycle that rears its head with alarming frequency. In the end, it should be about the patient rather than about a test of egos, but this is much easier said than done.

JeanineLPN1984 · Apr 5, 2008

I just wanted to my 2 cents in. I have always been in LTC and in 23 years, I have come across this a few times. It usually would happen with a new EMT and it did'nt matter that I had all the paperwork, was with the patient the whole time or giving him a full report, including history.

I use to work at an LTC in the parking lot of a major hospital, my wing was sub acute- PICC'S, IV's, and anything hospitals used to keep for 7 days or more. I used to get post radical mastectomies done THAT morning, AA repairs less than 24 hrs before- anything the HMO's would'nt cover. The paramedics and EMT's that used to transport them to us were frequently the one's who answered the calls.

Over the years they knew me and if I was sending someone out, they were staying at the hospital. One day a new EMT training with a Paramedic I knew well came to the call. He started to question me why I thought the patient needed to be sent to the hospital- I went thru everything, history and the kitchen sink, the EMT continued to ask me the same questions again and why was he transporting the patient. At that point I told him I could get the patient to the ER faster by rolling him thru the parking lot and if he did'nt get moving I would. The Paramedic laughed and said " Son, you better do what she says, she's the boss" (he was being nice and I worked with him many times).

It all worked out well and as the new EMT came to our facility for our calls, he was really good and helpful and the nurses liked him. I think training with a thoughtful and experienced Paramedic who had a high regard of nurses made him a great EMT.

catnip · Apr 5, 2008

At our facility we have a couple of ambulance services that we use to transport residents for appointments or non emergent trips to the ED for labs being off etc. We love them, they know us and we treat each other with absoulte respect. 911 on the other hand is a whole different kettle of fish. A resident choked one night, good ole heimlich (sp?) got the obstruction out but had called 911 any way d/t it taking a couple of tries and the resident not responding correctly after wards. EMS walks in, looks at him, looks at us and with eyes rolling asks "why are we here." Took everything i had not to be sarcastic when i reviewed the facts that the resident is still grey, is NOT able to speak, may be breathing but not in an even or rhythmic manner. At the end i simply stated that unless they are able to see with their own eyes if the chest is clear and nothing is still lodged somewhere, i wanted him examined at the ED.

Nursenikilpn · Sep 3, 2023

Amen to last post!! Screaming from the mountain!! Some emts take some serious risk when they make a decision not to transport a septic patient because they are dnrcc arrest, non responsive , unable to obtain bp ( which is low bp is a sign of sepsis) which they don't even attempt to get. Md made this patient full code just so next paramedic would transport the patient because in long term care we do not have the diagnostic equipment to obtain information needed to treat a patient in septic shock quick enough to stop them from coding... this would of ended this patient life prematurely because paramedic decided since she was a dnrcc arrest she could be treated at LTC facility.... Since when is dnrcc arrest a reason for 911 not to try to save a persons life because this patient was non responsive, tachycardic, and unable to obtain low bp!! Oh next emts took her but gave the patient narcan without looking at provided med list which patient never received any narcotics. It was the craziest thing I ever seen. Complete incompetence and disrespect from paramedics to patient, family and nurses!!