The continuing saga of nurses vs. EMTs...

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I know this topic has been hashed and rehashed until everyone is probably sick of it, but I had an encounter with an EMT yesterday that left me so mad I had trouble sleeping last night. I had a lady with chronic COPD and pulmonary fibrosis who was so sick she was messing allover herself and smearing it all over the place because she was too weak to get to the toilet, which is totally unusual for her. Her O2 sats were in the 70's to low 80's and you could hear coorifice wheezes before you even got into her room. I pulled out a breathing treatment to give while I called the doctor but in the meantime I had another COPD patient going down the tubes so I had to call for TWO transports to the ER. SO, in the midst of all this the Albuterol was left on my med cart. They got there pretty quick, and I was telling them about the lady, and one of the EMTs (with this smug-looking smirk on his face) says, "Can you tell me why she hasn't had a breathing treatment this morning?" I was totally caught off guard but I mentioned that at this point an Albuterol neb tx wasn't going to help this woman, she needed to get to the hospital because she obviously has pneumonia. He went on to argue that it would have helped and she needed an antibiotic ordered and to be given her breathing tx's instead of the ambulance...and he just kept running his mouth. They both rolled their eyes as they were rolling her out. Turns out they admitted this woman with bilateral pneumonia, put her on IV antibiotics and all that (we don't do IVs here).

Why do these guys feel the need to be confrontational and antagonsitic? Little Man Syndrome???

Specializes in ICU.
recently my mom (who is also a nurse) had to call an ambulance because her stage IV esophageal cancer husband with hepatic dysfunction became acutely confused and tried to leave the room in the middle of the night. The responding EMS personnel didnt listen to dispatch and separated them, saying she wouldnt be able to ride because it was a "domestic dispute". Then on the ride over, he told my mom that they should be available for more acute cases and my step dad was wasting their time.

My mom used to work EMS prior to nursing and was an ED nurse and I felt so bad that my mom had to go through these dick personalities on top of everything else.

I hope that your mom filed a complaint with the EMS agency and/or its medical director. Sounds like a little "retraining" is needed.

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well, this is something that needed to be fixed... Hope somebody can forward this threads to the EMS sites so that they can react or be aware of and hopefully someday a formal body be created to find solutions to this problems regarding EMTs. A joint body (from BON and EMS) will be much helpful. EMTs and Nurses should work together as a team for our patient's sake.

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Specializes in Trauma ICU, Peds ICU.

I try never to make broad statements about any group of professionals I work with... neurosurgeons included. That's hard sometimes, but we have to remember that every profession has it's bad eggs. As both an RN and an EMT I've seen it from each side.

For every bad story about EMTs in this thread I can tell you a bad story about a nurse, physician, respiratory therapist, etc. Take your pick.

Sometimes you just run up against a difficult person, and that has to do more with the individual himself than the credentials after his name.

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Here are some comments from an EMS responder website. Clearly the EMS responders feel they are not respected professionally, are under paid etc. as compared to (in their view) providers with similar skills.

http://www.emsresponder.com/article/article.jsp?id=2337

(link to entire editorial)

Updated: July 8th, 2008 05:26 PM EDT

From the February 2004 Issue of EMS Magazine

EMT-Paramedic: A Different Type of Nurse?

Guest Editorial

More on EMSResponder.com

By David W. Powers, NREMT-P, BCETS, BCECR

"When Florence Nightingale wrapped her first roll of gauze and emptied her first bedpan, the occupation of nursing evolved into one of the most respected in the world. When Johnny and Roy shocked their first ventricular fibrillation and dropped their first endotracheal tubes, they were thought of as nothing more than glorified firemen. Like it or not, we are the stepkids of nursing."

". . . Many nurses will probably cry foul and say that nursing courses provide more in-depth knowledge than medic courses. This is true. Nurses learn more pathophysiology; they also learn nutrition, which is not taught to paramedics. Nurses need to learn these subjects because their patient care is often long-term, hospital-based and calls for more in-depth knowledge of those subjects. Rather than contradicting my point, it emphasizes it.

". . .I never proposed that paramedics be the same as nurses or vice versa. My proposal is for paramedics to become a different type of nurse. As shown, the two professions are astonishingly similar. It is a shame that one is a full heir and the other is a prodigal son from the streets. To achieve full stature, the current classification for paramedics must change. Points of change include:"

"* More pay

* More respect

* Licensure rather than certification

* Increased opportunities for education and certification

* End to certificate programs

* Ability to diagnose (perhaps an alternative list of NANDA diagnoses, which are approved nursing diagnoses)

* Removal from fire department systems.

And most of all, the satisfaction of finally being a welcome.

In our world, we perform the jobs of each member of the allied health team, including the nurses. EKG technician, phlebotomist, respiratory therapist, LPN and RN— we do it all. Face it, paramedics are the nurses who perform outside the fluorescent-lit hallways of the hospital. "

FROM THE EMSRESPONDER.COM WEBSITE

By David W. Powers, NREMT-P, BCETS, BCECR

---------------------------------------------------------------------

So - some of the "attitude" may be driven from feeling devalued and disrespected.

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Now as an Emt/Paramedic for almost 20yrs and an ED RN, I think I can shed some light on this issue. First the copd pt needed a neb, but they still needed transport. Now what the ems crew saw was a pt in need of a neb that didn't get one. Now what the didn't know or understand was that this is deteriorating pt that has been getting managed at the ltc facility that had an acute change and needed transport. Try telling them this next time and if you still get attitude then write them off as morons and be done with it, there are too many people in ems with big egos and no brains to match.

Having worked in many different EMS systems over the years, I'm going to tell you that the type of service in your area makes a big difference. Emt's get very little education on chronic conditions other than asthma,copd and diabetes, and then only the life threatening complications. Paramedics get more but still woefully inadequate in my opinion. Now most of the 911 calls in this country are handle by volunteer ambulance corps, and fire departments or god help you if you are serviced by a volunteer fire dept ems system. The attitudes described are rampent in theses types of systems who see chronic care as not real emergencies. I have found that the staff of private ambulace services have a much better depth of knowledge for pt care, alot of which is self taught out of necessity because they do every thing, 911 calls(real emergencies), interfacility hospital to hospital for higher level of care (ie the pt having an active MI going to a cath lab with any assortment of drips) and routine dialysis trips, hospital to home or LTC. All of which are important in todays modern medical world but not real emergencies for the sparky adrenaline junkies who need to go if prehospital medical care is to progress like I believe it should.

No you can find EMT's with attitudes in every type of system not just those I singled out, they are just more common there.

The bottom line is that unlike nursing education which continues to progress, EMS education for the most part has not, skills have been added but true medical knowledge has not grown and in many cases has gone backwards, especially at the Emt B level, I know because I teach and the national standards have been slashed. There is a big desire by those who help write the curriculum standards to keep education to a minimum. If all paramedics were required to have degrees, which they aren't and less than 50% do, then it would become increasingly difficult for the volunteer and fire depts to staff themselves. up until now most of the input for ems education has come from the national academy of physicians and the fire services, hopefully now with a bigger focus on EMS since 9/11 changes will be made to improve and advance the profession.

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I neglected to say that the knowledge for hospital based EMS services is also very good with all types of pts, primarily because most hospital based ems providers work in the ed when not on calls giving the a bigger understanding of the whole picture.

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That article from emsresponder.com was... hideous.

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well, this is something that needed to be fixed... Hope somebody can forward this threads to the EMS sites so that they can react or be aware of and hopefully someday a formal body be created to find solutions to this problems regarding EMTs. A joint body (from BON and EMS) will be much helpful. EMTs and Nurses should work together as a team for our patient's sake.

Actually, is the same story that is inversely related to the topic at hand on most EMS websites. Meaning, multiple threads of complaints about nurses. Unfortunately, I have experienced equal levels of ineptitude on both sides. Therefore, both points of view have merit.

In addition, the OP made a poor choice when naming this thread IMHO. The OP was rubbed the wrong way by an individual and now we have a thread about an ongoing "saga" of nursing versus EMS. I say EMS because it collectively includes EMT's and paramedics. With the new national SOP changes, a paramedic is no longer considered a technician, hence the reason I no longer say EMT-P.

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Specializes in Critical Care.

I worked EMS for 5 years before recently leaving the field. While in nursing school I became extremely aware of how woefully uneducated EMS providers are, and only then saw the flaws in the system and the lack of education that surrounded me in the field.

Someone said earlier in this thread that "Paramedics have an AS degree, the same as an RN..." While that is true, the CONTENT of that degree program is ENTIRELY different...that person as an RN should understand and appreciate the difference. At NO point should a Paramedic be considered an RN, and at no point should an RN be considered a Paramedic, they are two COMPLETELY different professions.

As a medic I ran into situations where I saw incompetence at LTCs, Hospitals, and within my own organization (Mostly within my own organizations) It's everywhere, and is not mutually exclusive to EMS or nursing.

That being said, most people in EMS I find get tunnel vision, it really cannot be avoided in most cases, as they only see the patient for at most 30 minutes. They don't get to see the patient's baseline, only focusing on the emergent situation at hand, and often times if they feel the situation is not emergent, it gets brushed off. While it can be frustrating, the best thing to reinforce to EMS providers is that you have taken care of this patient for an extended period of time, this is not normal, and needs to be evaluated. Some may take your report seriously, others perhaps not, but you will be doing your job and doing your best to help your patient...and in the end, isn't that why we're all here?

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Specializes in med/surg and Tele.
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document.png Re: The continuing saga of nurses vs. EMTs...

I'm a BSN graduate from a foreign school. While waiting for my credentials to be verified, which would take awhile, I worked at a nursing home as a Certified Nursing Assistant and joined the local First Aid and Rescue Squad as a Certified EMT.

I don't like the idea of "Nurses versus EMTs". Nurses and EMTs are in one team. They should work together. Based on your statements, I can see you are having a not so good day. And maybe that EMT too had a not so nice sleep. You being the more educated person in the story has the capacity to control the situation and make it a bit less confrontational. Use the techniques in communication and ways to manage stress control emotions in which we were taught in the nursing school. The situation started when the EMT asked you "...Why hasn't she had her breathing treatment...?" Your answer to the question counts a lot to manage the situation. What do you think is the best response to avoid such incident to get worst?

I believe that in health care field, THERE IS NO LITTLE PEOPLE. Everybody plays an important role as a team to provide quality care and to ensure patient's survival. "

I find this answer to be quite naive and a little bit patronizing. I don't imagine that with 2 COPD'ers going down the tubes and EMT's who were wasting time asking provocative questions, the OP had time to humor the pretensions of the transporters.

I dont think that this poster was patronizing anyone here. Also how is naive? im sorry but I do not see it. I think she is saying that the nurse with MORE education on how to diffuse certain situations should hae been the bigger person and ended it right there. Saying thats how its going to be, and be done with it. They are right again by saying that she didnt know what kind of da they might have had. We all have bad days and we cannot know whats going on with someone radomly at all times. So please before saying someone or something is naive and patronizing read between the lines, and dont make yourself sound like a brat. :)

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When I worked in the field as a home health nurse, I dreaded having to deal with any EMT crew. They were typically rude, dismissive, and arrogant. Just my personal experience.

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Specializes in Rehab, Infection, LTC.

ugh, i dread dealing with some of these guys too. i think i'm lucky tho that our EMS guys in our town are pretty awesome. although there are a few you'd just love to whack on the head, most of them are respectful, listen to us and care about the patients. i try to help them as much as I can by letting dispatch know when i call if i need emergent transfer or just a transfer for more acute care. that way i try not to waste the paramedic's time. i also always make them a seperate packet of copies from the patient's chart. i tell them the name of the nurse at the ER i called report to so they know who to talk to. i try to give them a good report of just whats going on thats pertinent for them.

yep...ive figured out if i spoil them, they dont give me any crap, lol

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