What would you have done? rant

Street Doc · Jan 4, 2007

I always enjoy hearing nurses get together and rip on paramedics or visa-versa because, for the most part they are both wrong about their stated prejudices for the other. I have been a paramedic for 15 years and got my BSN coming up on 10 years in June, so I can see both sides of either argument. In this case I have to side with the Paramedics. Except for the percieved rudeness you recieved from them, I can't see what it is they did so wrong and too to such a degree that some posters here are calling this neglect. Please! Some of my fellow RN's need to get out of their comfortable, controlled office or hospital enviorments from time to time and experience what it's like to work in the prehospital world.

To begin, you were only semi-correct to tell the father that he should have taken the boy to the ER, as a family practice office is definately not the place to go for a possible spinal injury. It would have been better, however, to tell him to call 911 next time and have the patient immoblized immediately following the accident as opposed to the next day. The reason he probably didn't call 911 initially was that the boy was probably acting fine after the initial injury and it wasn't until the next morning, after the injured muscles had a chance to swell and stiffen (which is normal for this type of injury) that his son complained that he couldn't move his head.

Secondly, if your doctor was so concerned about the wellfare of the patient she should have taken a minute out of her busy day and done her job. Even though your office is not equipped for this type of situation the fact remains that SHE'S STILL A PHYSICIAN and she should have come out and examined him!!!! At the very least a cursory exam should have been performed which would have went a long way to ruling out crepitus or deformity of the cervical spine. The area should have been visualized and palpated and a neurologic exam performed. Was it? Nope.

As for the medics not providing full spinal immobilization, telling the father he could take the kid to the ER himself and then walking him to the ambulance when dad opted to have junior transported to the ER by the paramedics - they were right! THE KID FELL THE NIGHT BEFORE!!!!

At what point are they not supposed to throw a C-collar on a person if they complain of neck pain from an injury? 2 days? 3? a week? Medics don't immobilize people ad-infinitum after an accident. If the child had an unstable cervical spine fracture it is 99.9999% likely it would have manifested itslf long before dad brought him into your office. While it does sometimes happen that people will have a catestrophic injury to the spinal collum that they initially don't realize they have, and are subsequently walking around at the scene, it is rare, and in this particular case it would be nearly unheard of. Little kids, especially boys, are bundles of energy and motion and I highly doubt that he wouldn't have presented with some neurologic deficits or total paralysis hours earlier if that were case.

In short, I think you over reacted to the severity of the child's condition and your doctor both over and under reacted. The boy had a muscle strain to the neck. The injury was old, with the long time lapse being a pertinent negative to the point of excluding the debilitating c-spine injury that you were concerned with. So, when the medics showed up and found out the accident happened the night before they probably deduced the same thing. I'm sure that opinion was reinforced when they also found out that the doctor couldn't even be bothered to examine the kid. I probably would have rolled my eyes too! The doctor over reacted by going along with the worst case scenario of an unstable c-spine fracture she under reacted by not acting upon that very concern! And if the doctor wasn't treating the situation seriously why do you fault the medics for behaving the same way?

So, were the medics wrong? I really don't think so, but then I'm only going on what you described in your posting. But please keep this in mind. Paramedics are professionals just like nurses. An ancredited paramedic programs takes just about as long to complete as an associates in nursing does and involves a hell of a lot more than just some splinting and bandaging. Paramedics perform proceedures in the field that only doctors are allowed to perform in the hospital. So if you call 911 and you don't necessarily agree with what you see the paramedics do or not do, think it through before you are so quick to judge next time because chances are good that the medics actually know what they're doing.

AnnieOaklyRN, BSN, RN, EMT-P · Jan 4, 2007

I Second the above post from street doc!

swtooth

Street Doc · Jan 6, 2007

Thanks for the support swtooth!

medsurgnurse, RN · Jan 6, 2007

I always enjoy hearing nurses get together and rip on paramedics or visa-versa because, for the most part they are both wrong about their stated prejudices for the other. I have been a paramedic for 15 years and got my BSN coming up on 10 years in June, so I can see both sides of either argument. In this case I have to side with the Paramedics. Except for the percieved rudeness you recieved from them, I can't see what it is they did so wrong and too to such a degree that some posters here are calling this neglect. Please! Some of my fellow RN's need to get out of their comfortable, controlled office or hospital enviorments from time to time and experience what it's like to work in the prehospital world.
To begin, you were only semi-correct to tell the father that he should have taken the boy to the ER, as a family practice office is definately not the place to go for a possible spinal injury. It would have been better, however, to tell him to call 911 next time and have the patient immoblized immediately following the accident as opposed to the next day. The reason he probably didn't call 911 initially was that the boy was probably acting fine after the initial injury and it wasn't until the next morning, after the injured muscles had a chance to swell and stiffen (which is normal for this type of injury) that his son complained that he couldn't move his head.
Secondly, if your doctor was so concerned about the wellfare of the patient she should have taken a minute out of her busy day and done her job. Even though your office is not equipped for this type of situation the fact remains that SHE'S STILL A PHYSICIAN and she should have come out and examined him!!!! At the very least a cursory exam should have been performed which would have went a long way to ruling out crepitus or deformity of the cervical spine. The area should have been visualized and palpated and a neurologic exam performed. Was it? Nope.
As for the medics not providing full spinal immobilization, telling the father he could take the kid to the ER himself and then walking him to the ambulance when dad opted to have junior transported to the ER by the paramedics - they were right! THE KID FELL THE NIGHT BEFORE!!!!
At what point are they not supposed to throw a C-collar on a person if they complain of neck pain from an injury? 2 days? 3? a week? Medics don't immobilize people ad-infinitum after an accident. If the child had an unstable cervical spine fracture it is 99.9999% likely it would have manifested itslf long before dad brought him into your office. While it does sometimes happen that people will have a catestrophic injury to the spinal collum that they initially don't realize they have, and are subsequently walking around at the scene, it is rare, and in this particular case it would be nearly unheard of. Little kids, especially boys, are bundles of energy and motion and I highly doubt that he wouldn't have presented with some neurologic deficits or total paralysis hours earlier if that were case.
In short, I think you over reacted to the severity of the child's condition and your doctor both over and under reacted. The boy had a muscle strain to the neck. The injury was old, with the long time lapse being a pertinent negative to the point of excluding the debilitating c-spine injury that you were concerned with. So, when the medics showed up and found out the accident happened the night before they probably deduced the same thing. I'm sure that opinion was reinforced when they also found out that the doctor couldn't even be bothered to examine the kid. I probably would have rolled my eyes too! The doctor over reacted by going along with the worst case scenario of an unstable c-spine fracture she under reacted by not acting upon that very concern! And if the doctor wasn't treating the situation seriously why do you fault the medics for behaving the same way?
So, were the medics wrong? I really don't think so, but then I'm only going on what you described in your posting. But please keep this in mind. Paramedics are professionals just like nurses. An ancredited paramedic programs takes just about as long to complete as an associates in nursing does and involves a hell of a lot more than just some splinting and bandaging. Paramedics perform proceedures in the field that only doctors are allowed to perform in the hospital. So if you call 911 and you don't necessarily agree with what you see the paramedics do or not do, think it through before you are so quick to judge next time because chances are good that the medics actually know what they're doing.

screen name says it all. although you had one or two reasonable points. like why the doctor didn't assess.

Danilpn69 · Jan 8, 2007

Hello. I was an EMT as well as being an LPN. You did the right thing, well done. If EMS was called to the scene they should have been required by their state to obtain a signed refusal of care document by the father and if the father refused to sign it the ambulance is responsible to take him to the ER. If this did not happen and the EMS personnel touched the patient in any way they can be gotten for abandonment/neglect at least in the state of MD. If you are called you have to treat even if you feel that the only reason you were called is for a ride to the hospital because they have no other way to get there unless the patient signs a refusal and it is witnessed by two people either two EMS personnel or a police officer in cases of motor vehicle accidents. I hope that your DR. takes action because many paramedics and EMTs enjoy making LPNs or nurses feel beneath them when actually they are beneath nurses in level of skill. Dani

Danilpn69 · Jan 8, 2007

I need to add something to my above statements. I do not want anyone to think that EMS personnel are beneath Nurses in any way because they are not but some do make others feel that way. It is important to remember that we are all professionals with different skill levels and expertise. Street Doc you make many good points in your post it is just that a 4 year old can crash as you know quickly and it is important to check them out but yes the Dr. should have done more assessment prior to calling EMS but EMS should have just completed the assignment and taken the patient to the ER without incident instead of causing termoil.

Street Doc · Jan 9, 2007

:angryfire hey, danilpn69! i see you made the effort to quote my post, but i have to wonder if you took time reading it! the issue here isn't "neglect", the original poster didn't claim that the paramedics abandoned the patient, just that they didn't place him in c-spine immobilization or act concerned enough about his neck injury in the eyes of the lpn. on that issue, i stand by my earlier post. and while i applaud differences of opinion on this, or any other issues on this web site, what i absolutely will not stand for is the ignorant stereotyping of any medical profession. your quote "i hope that your dr. takes action because many paramedics and emts enjoy making lpns or nurses feel beneath them when actually they are beneath nurses in level of skill" is the kind of inflammatory and inaccurate bs that i'm talking about. beneath nurses in level of what skill exactly??? as i stated in my post, i've been a paramedic for 15 years and an rn for 10 and for you to try and state that a paramedic skill level is below that of a nurse is a load of crap! as an lpn, can you intubate? can you perform a thorasic decompression of the chest? can you do a needle cricothyrotomy? insert a chest tube? put in a central line? can you even give a medication without an rn's blessing and signature? paramedic's can do all of these things. what skill level is it then that paramedics are "beneath" you? you should be real careful about spouting off on subjects you have little or no idea what it is you're talking about, it makes you look boorish and uniformed while taking away any credibility you might have on an issue. that was the point of my post. the lpn overreacted because she didn't understand the thought process of the paramedics so she automatically questioned their professionalism. exactly the thing you're doing now. and just so you don't think that i'm being unfair, i would go off just as big on any emt or paramedic that said something equally as stupid about an rn or lpn that you just did about ems. if you really were an emt you should realize this and be able to see both sides with spewing out such a derogatory and false comment!

Danilpn69 · Jan 9, 2007

When I was writing this I did not mean to demean any profession rather it be a nurse, paramedic or EMT. I should have typed slower and unfortunately my 4 year old was being a brat at the time. Yes, I have been an EMT and was one for 15 years as a matter of fact I was Captain for my station for 2-3 years before going through a divorce and needing some time off. I am sorry for the statement that I made about them being beneath us, we all have different skill levels rather you do EMS or Nursing but I have had many EMS personnel come into the nursing home which I have worked and made the nurses feel bad about calling them for different emergencies because they felt that we did not do the proper care or take the proper action of taking care of the patient and they were inappropriate and yes I was inappropriate for saying what I did and I take full responsiblity for the wrongful statement that I made. EMS is a very hard and stressful career as well as nurses and we all deserve to be respected for the care that we provide at the time of our patient need. None of us are perfect and if we were we would not have disciplinary action taken when necessary.

Dani

Street Doc · Jan 10, 2007

Dani,

Sorry if I was harsh in my last post. If I would have actually scrolled down far enough to see the second part of it I probably would have been less angry. So, I apologize. As for the way some EMS crews treat nursing home staff, I agree with you whole-heartedly. And, as happens quite often, it is a fundamental lack of understanding about LPN's job that is the source of much of the problem. For the most part, nursing home staff is underpaid and over worked. Anyone who works in an extended care facility has my greatest respect because it is an incredibly difficult and thankless job and one that I couldn't do. That's why I find myself defending the nursing home staffs quite often when I hear co-workers putting them down, just as I defend the EMS profession when nurses try to rip on medics for things that they don't understand.

Just as most EMS personnel make snap judgments about nursing home staff based on ignorance, the LPN that made a snap judgment about the paramedics in her original post was wrong! To say that what the medics did was neglect or warranted them losing their certifications is ludicrous. A large part of what goes into making a good paramedic is common sense and that's what I feel the medics in this case exercised. Why their customer service skills may have been lacking, there was no reason for them to act like mindless automatons and board and collar someone, even a child, with an old neck injury. This LPN worked in a doctor's office, she self admittedly wasn't used to situations like the one she was faced with, and she simply overreacted. The paramedics that showed up figured this out and acted accordingly.

As an EMT of 15 years you have to remember all the times EMS is called out 911 for BS. For me it is the most frustrating thing for the general public to call 911 for a ride to hospital, taking an emergency response crew out of service, for things that are clearly not emergencies and do not warrant an ambulance. So when a medical professional does the same thing it compounds the aggravation of the EMS personnel because they feel that the medical person should know better. In this case the fact that the doctor was disinclined, for whatever reason, to examine the patient and instead simply dump the responsibility on the medics is the clearest example of this. My biggest question is why isn't the doctor being held to a higher standard than the medics? Why have I not read one post asking for the doctor's license or job? If anyone dropped the ball in this case it was the physician! She's a physician for crying out loud! The highest level of care in the medical system. If she would have taken 5 minutes and examined the little boy she could have ruled out a catastrophic neck injury and not wasted the paramedic's time. And the fact that the office didn't have an X-ray machine is irrelevant, doctor's clear spinal injury patients out of collars and off spine boards all the time!

So, hoping the doctor in this case takes action against the paramedic's isn't going to happen because she knows that if she does, the first thing the medical director is going to ask her is, where were you and what did you do for the patient? And when she says she never even saw the patient that will be the end of that.

So, once again, I'm sorry if I rode you a little to hard but I feel that most of the responders to this post haven't thought the situation through and are simply damning the medics without just cause. When that happens, I can't just allow it to pass.

Nursingangel · Jan 14, 2007

I work in a large family practice office and had a situation this week that I would like some info on what you would do.
I was called by our front office cordanator and told that a 4 yr old boy was just brought end and that his father states that he feel off a trampaline and could not move his neck. I stated that the pt should have gone to the ER as we are not set up to deal with this type of injiry. I imedatly went to my suppervisor and one of our doctors and aprased them of the situation. We do not even have a c-coller in the office so the doctor asked that we call 911 and get the perimetics out to help stablize the pt. We called and went out to the waiting room and I held the boy's head and talked with the father of the boy. It turns out that the boy had fell the night before, turning flips and landed on his Head. The EMT's got there and my superviser and spoke with them and explained the situation. The EMT then asked if a doctor had seen the pt and when I said no that we don't have the equipment to deal with this type of inujury, He ROLLED HIS EYES AT ME THEN TOLD THE FATHER THAT there was no reason for them to transport. At this point I went and told the Doctor what was going on and she went out and dealt with the situation. The next thing I know my office manger is coming and griping at me because I did not call her BEFORE I called the peramedics and went out to the pt. Luckly the doctor backed me up and said that she had told me to get out there an imobilze the pt as best I could. Neddles to say the EMT's Refused to put the child on a c-collar and WALKED him out to the ambulance telling the dad that he could just drive the boy over if he wanted that the child was fine. The doctor has filed a complant about EMS and the back talk they gave us and I seem to be off the hook as far as not calling the office manager but was told that next time to CALL HER FIRST!!! I am sorry but isn't more important to take care of the PT not her dang paper work!!!:angryfire

Street Doc if you will read my post above you will see that I NEVER ONCE said that the EMT should lose there license! My main problem with them was that they ROLLED there eyes at me. I a professional JUST as they are and WAS DOING MY JOB!! and I DO NOT desurve to be DISRESPECTED in this way. I did not agree with their handling of this case but I GAVE THEM THE RESPECT TO NOT SAY THAT THERE!!!!!! I was also as much our more up set about my office managers statement that I was TO CALL HER BEFORE taking care of MY PT. Quite frankly I find you post over the top.

Nursingangel · Jan 14, 2007

As for the rest of you thank you very much for you constructive coments. I have not been a nurse long and needed the CONSTRUCTIVE advise. Not put downs. If I sounded as if I was putting down all EMS I appoligize that was not my intent. I was simply upset at being so disrespected. Why does it have to be us against them? We are all or should be on the same team.

Street Doc · Jan 20, 2007

nursingangel,

just thought i'd reply to your last post per point.

"street doc if you will read my post above you will see that i never once said that the emt should lose there license!"

i did read your post, but you must have not read all of the ones that follwed yours because i wasn't refering to your original post on that subject. i was directing those comments to other people who had replied to your original and where urging you and your doctor to make trouble for the medics by reporting them and such.

"my main problem with them was that they rolled there eyes at me. i a professional just as they are and was doing my job!! and i do not desurve to be disrespected in this way. i did not agree with their handling of this case but i gave them the respect to not say that there!!!!!!"

in my original post i acknowleged that "except for the percieved rudeness you recieved from them (the medics)" that i didn't think they did anything wrong. i completely agree that they should not have acted unprofessionally. as both an rn and a paramedic, i can see both sides of the issues but in this particular case i sided with the medics, on other issues i strongly side with the nurses involved.

"quite frankly i find you post over the top."

what's over the top about my posts? when you read all of them in context of when and who i was relpying to at the time, there's nothing that should be considered "over the top".

"as for the rest of you thank you very much for you constructive coments. i have not been a nurse long and needed the constructive advise. not put downs. if i sounded as if i was putting down all ems i appoligize that was not my intent. i was simply upset at being so disrespected. why does it have to be us against them? we are all or should be on the same team."

i was simply stating my opinion - which you asked for in the first sentence of your original post. now you may not like the opinion i gave but it's the opinion of an ems professional and it was given with the intention of educating you and other nurses as to the scope of a paramedic's education and skills as well as providing some insight as to the bs ems has to put up with day to day. it was never meant to disrespect you or any one else and shouldn't be taken that way. if you only want people to agree with with you or tell you things you want to hear then make that clear up front so people like me won't waste our time trying to provide another perspective! :banghead: