EMS talking down to Nurse

Specialties School

Published

School Nurse Vent!!!

So, I see my nurse assist per IEP diabetic three times a day, he sticks himself but I carb count for him and help him draw up the insulin, supervise and make sure hes rotating sites,ect. Today he came in very panicked. Stating he was in DKA.

Now this kid is happy go lucky and never has a complaint...ever. So immediately I am worried. He has Large ketones in his urine, Blood glucose 390 (he usually runs low,never seen him above 180) And generally knows whats going on with his own body, He's vomiting, kussmaul respirations, fruity breathe, weakness, blurred vision, sleepiness the whole nine yards.

So I call 911, the EMS team thought I was an idiot, the paramedic informed me "390 is not even that high" I replied that he is a type one with dx hypoglycemia issues per MD and even printed out his CBG record and MD note stating this. Still the whole time they rolled my eyes made a big production and were dragging there feet on taking him. At one point when I handed them his dx list they stated that this was probably a "panic attack" because of his mental health dx. None being anxiety mind you.

I finally tell them they need to go with him to the hospital now. With some shuffling they go on. My RN supervisor (I'm an LPN) Seems to think its because I'm young and stated the same thing happened to her....I was wondering if anyone else has had the same experience.

It just frustrates me that people with mental health dx are being overlooked when its a WAY bigger issu because "Its just part of it" Anyways...very upset about the whole thing and kind of still seeing red...

Update: He's being transported to the "big city" Diabetic Peds unit...it was DKA

Specializes in Pediatrics Retired.

Our local fire department EMS is very good about listening and collaborating with how to best deal with the situation and transport. We have a city wide EMS service that has a high turnover and they're "ok." But...at the Urgent Care I work at in the "City" we sometimes have to call for transport to the ER...ugh, sometimes it gets comical. I remember one time a kid, about 5, came in with the worst retractions I've ever seen. Everything retractable was sucking in with every breath. I maxed out a NRB with O2 while 911 was called. EMS arrived and I told the EMS guys to pay attention to the retractions; they may never see something like this ago. One of the paramedics popped back with, "Oh, we see this all the time." There was a brief pause and the doctor, me, and the other paramedics burst out in laughter. One of them said, "sure we do!"

0 Votes
Specializes in Peds,Geri-Psych,Acute Care Rehab.
You advocated for your patient. That is what you are there to do. I recently sent out a post op ACL repair who had a clot in her leg and was on lovenox. She had chest pain so I sent her out to r/o a PE. Yeah, it was anxiety. Yeah, she was fine. Yeah, I would send her again. We have limited (no) diagnostic ability so we need to do what is bes t for our patient. Fortunately, our local EMS is the best. Always great with both the stidents and myself.

Lucky you! Part of me is frustrated with school nursing for that exact reason...hate having to rely on someone else when I know in an acute care setting I would get to be a part of the solution.

But that's part of why I love school nursing. Such a complicated relationship.

0 Votes
Specializes in Peds,Geri-Psych,Acute Care Rehab.
As a former paramedic, I can tell you that the education level of EMTs even paramedics, is low. No pre-requisites to become an EMT and in most states, 120 hours to EMT-B level. There is a dichotomy between public service and healthcare. Public service includes the fire services who devote a lot of time to knowing how to rush into burning buildings and break down doors, as well as cut open cars. That is a different skill set and orientation to medical assessment.

Nevertheless, as over 80 percent of fire department responses are medical, many have devoted time to the two-semester coursework required to become a paramedic. Paramedic training is as rigorous as nursing, but is limited to recognizing and dealing with immediate life threats. There is no training, and I say training as opposed to education, to chronic conditions.

The nature of the work is that 9 out of 10 calls really do not need a 911 response and are the result of the health system medicalizing social problems. Often, EMTs trained to provide emergency, life saving care, become disillusioned with the true nature of the job. Those deeply interested in medicine will move on. Many, due to lack of motivation or aptitude, and often without financial incentives to expand their experience, feel"stuck" in pre-hospital care.

Bottom line is, many have no idea of what they don't know. They are stuck in protocol based "cook-book" medicine, yet putting in brutal hours of work for very little pay. That is not to say there are not intelligent, motivated and dedicated people in EMS. But often, nurses deal with anti-education individuals who devalue "book smarts" and totally underestimate the complexity of many of the issues they deal with.

EMTs see a very small slice of the healthcare continuum, yet often believe they have seen it all. In spite of this, blatant disrespect for other members of the health care team is inexcusable. I am sorry many nurses experience this. If you get it, take it where it's coming from. It's coming from a narrow minded, frustrated individual and is the mark of an underdeveloped mind.

Edit.. PS - the question to have asked that paramedic was "You've seen it much higher? In this patient? Really?

Part of me wants there to be an in-service for EMS, if the nurse knows the patient and says somethings wrong....I promise you something is wrong. I see this kiddo x3 daily for over a year. Shaking my head at the whole situation. I'm just glad he got the care he needed. In the end that's what it is all about. He got care and my beef with EMS has nothing to do with that! :)

0 Votes

I used to have the same issues with EMS constantly. I would somewhat frequently have to call them to transport

employees in an occupational health setting. Most were not injured (although a few were), but these were low-wage

contract labor, young employees that worked too many hours (unlimited overtime and two jobs), didn't drink

fluids, and didn't sleep enough. Oh, and let's not forget about drug use. I had everything show up in the clinic

from fractures, to kidney stones, to chest pain, to a stroke, and I often had to go pick up employees having seizures,

low blood sugar, etc. If it was not a very obvious transport need, they would often try to talk the employee out of

being transported! They would hand out "diagnoses" like they were doctors. Grrrrrrrr! But, it was highly dependent upon

which crew I got when I called. There was a particular paramedic in charge that thought he knew everything, and we went head to head

about my patients all the time. Other crews were fine. I am a well educated RN and I definitely would not have called them if I

thought it was something that could wait, a family member could handle, or a list of other options was worth considering. I called them because they

needed transported. Glad you stood your ground. In my 24 year RN career, I know that I have saved a few lives by digging in my

heels and refusing to let condescending people make the wrong decision for someone that needed medical attention.

0 Votes

Way to go, heynurse1996! :yes:

0 Votes

GREAT CALL! For all the new nurses out there, this is what we mean by critical thinking, and treating the patient, not the lab number.

0 Votes
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

I also think it would be worth following up with the EMS supervisor... what if the next patient doesn't have someone to advocate for them?

What if it's a relatively newly diagnosed T1D kid whose parents don't yet feel 100% comfortable with diagnosing their kid, and the EMT talks them out of transporting?

What would the EMS company's insurance company think about their EMTs delaying treatment and exposing them to a huge lawsuit if a kid ends up in a coma because they transported too slowly?

IMO, this is something that the EMS company needs to know about, if only to protect future patients.

0 Votes
Specializes in Psych, Addictions, SOL (Student of Life).
It just frustrates me that people with mental health dx are being overlooked when its a WAY bigger issu because "Its just part of it" Anyways...very upset about the whole thing and kind of still seeing red....[/font]

People with mental health diagnoses get treated this way all the time. Medical needs are routinely ignored as "All in their head." It's a sad world we live in.

Hppy

0 Votes
As a former paramedic, I can tell you that the education level of EMTs even paramedics, is low. No pre-requisites to become an EMT and in most states, 120 hours to EMT-B level. There is a dichotomy between public service and healthcare. Public service includes the fire services who devote a lot of time to knowing how to rush into burning buildings and break down doors, as well as cut open cars. That is a different skill set and orientation to medical assessment.

Nevertheless, as over 80 percent of fire department responses are medical, many have devoted time to the two-semester coursework required to become a paramedic. Paramedic training is as rigorous as nursing, but is limited to recognizing and dealing with immediate life threats. There is no training, and I say training as opposed to education, to chronic conditions.

The nature of the work is that 9 out of 10 calls really do not need a 911 response and are the result of the health system medicalizing social problems. Often, EMTs trained to provide emergency, life saving care, become disillusioned with the true nature of the job. Those deeply interested in medicine will move on. Many, due to lack of motivation or aptitude, and often without financial incentives to expand their experience, feel"stuck" in pre-hospital care.

Bottom line is, many have no idea of what they don't know. They are stuck in protocol based "cook-book" medicine, yet putting in brutal hours of work for very little pay. That is not to say there are not intelligent, motivated and dedicated people in EMS. But often, nurses deal with anti-education individuals who devalue "book smarts" and totally underestimate the complexity of many of the issues they deal with.

EMTs see a very small slice of the healthcare continuum, yet often believe they have seen it all. In spite of this, blatant disrespect for other members of the health care team is inexcusable. I am sorry many nurses experience this. If you get it, take it where it's coming from. It's coming from a narrow minded, frustrated individual and is the mark of an underdeveloped mind.

Edit.. PS - the question to have asked that paramedic was "You've seen it much higher? In this patient? Really?

This is so extremely well-said. I am printing it out so I can read and re-read it, over and over and over.

0 Votes

Poor kid, hope he's alright.

Its not a new nurse thing its a nurse thing in general, Every where I have worked it is a common trend with them, even dated a paramedic (friend of the family and not my finest moment) a nice enough guy until our chosen professions came into topic. He told me, in more inappropriate terms, a nurse was only good in a "sterile environment" and couldn't handle a real emergency if it "bit us in the ass"

I have had them tell me before to "Call the doctor and cancel the order" and throw a fit in front of my residents when I said no. On the other hand myself and coworkers have been pounding on residents chests during codes and they stand back and watch getting mad when we invite them to take over. I have had to call them for assistance and ended up filing complaints with the city over how they talked to my residents. I even reminded them that my residents are just a call number to them, I know a hell of a lot more about them then they do. I made it a habit now of requesting a squad number for "Documentation purposes" and also asked where they got their doctor degree from (Never in front of residents I promise).

0 Votes

You did the right thing and stood your ground. You advocated for the child and don't worry about the paramedic, there will be a few like that who will be that way. There are seasoned paramedics that do listen and take into account what fellow allied staff tell them. Not all paramedics are like that and there are good ones. If they ever ask you, documentation is there for the reason you called EMS so you are fine.

0 Votes

Because so many diabetics can have "normal" high BGs in the 300s and 400s, a lot of various medical personal don't think of it as high or a medical emergency. I had a patient (ED nurse here) who had been feeling sick for 2 weeks. Went to urgent care a few days prior to coming to ER, they drew blood work and sent him home and two days later called and told him to go to the ED for DKA. They didn't send him straight to ED b/c the sugar was only in the 300s and they thought type 2 diabetics couldn't get DKA. So he spent two days at home prior to being treated...

when he came into ER he had *all* the classic symptoms including the ketone breath and tachypnea, etc.

0 Votes
+ Add a Comment