Should EMTs Have to Babysit Their Medics?

[CBEMT]

Now that I said that, after this bleed was noticed, you immediately applied pressure at the femoral pulse point right? And constant pressure was held until surgical intervention at the trauma facility? Or did you just give up and tie a tourniquet? Just wondering how it turned out.

Well, I hope she followed local protocol.

If, like mine, they don't specify a technique, I hope she followed current PHTLS recommendations.

And used a tourniquet if direct pressure to the wound failed to tamponade the bleed.

[AnthonyM83]

Maybe there are people out there with patches on their shoulders who have such a lack of basic knowledge about medicine that they don't know what they don't know. Maybe that's it.

Exactly. In Los Angeles, they're called LACoFD Medics (with many exceptions). But seriously, fact is, there are bad medics out there AND there are average/good medics who make mistakes. By stating one has helped one out, does not mean they're implying they're better medical providers than medics.

[Asysin2leads]

Is it just me, or does anyone else see something wrong here? IF you have heard this same ole story time and again……then WHY I ask you is it happening TIME AND AGAIN?

Hhhhmmm just a thought. Again, just pointing out the obvious.

AND as far as what happened, thanks to Early Activation an Aircraft had already been launched and was 5 minutes out. What was a mention of “cancel that air craft this one can go by ground” just became a “thank GOD this one needs to go straight to the vasculiar surgeon”. As for what we did, it was the Popliteal artery BEHIND the Knee so yes direct pressure was applied the knee was bent to raise the laceration ……

And as for YOU Asysin……well I will refrain from what I REALLY want to say out of respect for others…

Oh, give me a break sister. First off, you nicely missed my point, AS USUAL, which is that I hear these stories over and over again, NOT because they are ACTUALLY HAPPENING, but because stupid ass EMT's with more hours spent watching MASH then being in the field think every single time someone has blood on them its a life threatening bleed, and as soon as the value of saline replacement was called into question, every single person who couldn't pass static cardiology said "YEEEEEHA! I DONE TOLD YA THEM MEDICS WERE NO GOOD ON THE TRAUMA!" and the stories about the life threatening bleed and the trauma, and the IV came about. In short, its BULLSHIT. But I guess my irony was just a little to subtle for you.

Oh yeah, and until you can quote me Starling's Law, hematocrit, or tell me where the femoral artery becomes the popliteal artery, don't start in with the "blood turning pink" or "blood turning to Kool-Aid" crap.

If you don't want to go to medic school, fine, that's your choice. But don't try to act like there is some value in having less knowledge about your job than others do. There isn't. Maybe in the movies, the day is saved by the folksy hero with some sort of homespun bit of wisdom, but in real life, things get done by people who studied, practiced, and persevered.

I reiterate, this is what drives me up the wall about my job. Its never "Hmmm, these guys actually worked really hard to better understand prehospital care. Let's listen to them." No. Its "DAAAAHHHHH YEAH THAT THAT LARNIN' AIN'T NUTHIN ITS ABOUT HAVE A KEEN EYE AND A FOOT FER THE GAS PEDAL!"

Or something. I'm going to use my diploma and certifications to make a big doobie and then sew some more patches on my uniform. Maybe then I'll know what I'm talking about.

[Dustdevil]

Okay, I been offline and out of town for the last week, so I missed this party. Even though it has been pretty well discussed by Asys and Rid, I want to address a few points by the OP myself, just so I can say I got involved.

• 1. I'm guessing that "I run with a fire company" means she's a low-time volunteer. No paid professional uses that kind of terminology.

2. Quality patient care is NOT your number one concern if you have FAILED to progress your education in fifteen years of practice.

3. Rehashing the same old weekend-long card courses every few years does not count as education. For that matter, neither does EMT school. ACLS is not going to give you anything of value until you have an educational foundation, which you seem to believe is out of your reach.

4. As stated, if you really think paramedic education is important, you will find a way like the rest of us did. Trust me, few of us were rich either, but we figured it out. I guess you just don't want it bad enough. Or else, quality patient care simply isn't as big a priority as you say it is.

5. Paramedic practice is not about "skills," and your liberal use of the word in this context -- as if they were the Holy Grail -- is indicative that you have learned very little in fifteen years.

6. As ERdoc and others pointed out, just because you took a few hours to read the ALS protocol book does not mean you really have the slightest clue what you are talking about. Just like paramedic practice is not about skills, it is also not practised from a cookbook. The medics you are questioning know a lot more than what the cookbook says. They know how to fully and properly evaluate an individual patient's condition and needs, and judge what is appropriate for them. Sometimes that isn't exactly what the book appears to say. If you decide to question this, you are treading VERY thin ice, because there is nothing more annoying or disposable than an EMT who thinks she knows more than she does.

7. Medics do indeed make mistakes. And sometimes those mistakes can be so blatant that even a n00b EMT can see it. If this is within your scope of knowledge (based upon what, a whole 120 hours of night school a decade and a half ago?), and you feel strongly that this will be adverse for the patient, it's time to mention it. If you are incapable of doing that diplomatically, then again, you aren't half the provider that you think you are. There is a darn good reason that most paramedic degree programmes include a speech-communications course in their curriculum.

8. When in doubt, STFU. Taking ACLS and reading the ALS protocol book is about as useful as taking a week of karate. It's just enough knowledge to get you or someone else seriously hurt. And if you freak my patient out by questioning my judgement based upon that, you're definitely not going to be able to afford medic school, because unemployment doesn't pay that well.

[wbgraidermom]

I read through some of the comments made on this subject. I agree with some and not with the others. Been in EMS for 14 years and I am still learning some of the ALS stuff. But I do know when a paramedic is not using his BLS skills he/she had to learn first. There is a saying that I go by and it works. BLS BEFORE ALS!!!! ALWAYS ASK QUESTIONS TO FIND OUT THE REAL PROBLEM. People are not going to tell you everything at first. You need to be nosey and keep asking questions. Sometimes the same questions over and over again to see if they will answer it the same.

I have worked with EMTDON970 on many calls and we have seen this one medic do nothing for a patient that should have gone to a hosptial with light and whistles, but said no lights. I didn't ask questions then, but I did after the call. He tried to explain why he did what he did, but I pointed out the BLS side of it and he saw it mine and Don's way. But then again this medic is just lazy.

I have also seen medics over treat patients, too. When in EMT school, the teacher was a medic and a very damn good one at that, she always said that it is better to over treat than to under treat. I still follow that to this day.

I know people are going to and read this and post what they think, and that is ok by me.

That is why I wrote this, to get people thinking and talking.

Can't wait to see what they will say next.

till next time.

[ERDoc]

BLS BEFORE ALS!!!!

ABSOLUTELY NOT. The two should be practiced together. As I have said in the past, in the real world of medicine there are no such things as ALS and BLS. There is patient care. The mantra you bring up is what is used by people that try to make themselves feel better about their position. BLS really is nothing more than first aid practiced in the back of an ambulance.

As for your story about the medic who went to the hospital without "lights and whistles," I'm not sure what the point was. Are you being critical of his decision not to use lights and whistles? If you consider that decision poor patient care you might want to review some of the literature on the use of lights and sirens. I am not sure if there is any literature to support the use of whistles in an ambulance but I would guess that they would not be very effective since traffic may not be able to hear them. I don't know if there is any state that recognizes the use of whistles as an emergency device either.

[ccmedoc]

5. Paramedic practice is not about "skills," and your liberal use of the word in this context -- as if they were the Holy Grail --...

Read this....'nuff said.

But I do know when a paramedic is not using his BLS skills he/she had to learn first.........<snip>Been in EMS for 14 years and I am still learning some of the ALS stuff...

Its not about BLS/ALS skills..the education needed to realize when to use them or not is. Just because the medic didn't want to bust backside to the hospital, doesn't mean he/she was lazy. It is most likely that it was not as serious as you anticipated. Why get the patient all jacked up for nothing?

Reread Dustdevil's post please!!

[Scaramedic]

Once about every two months I go to the barber to get my haircut. Now cutting hair seems to be a pretty easy skill. I never understood why the barber would do the pull the comb thru the hair and trim the ends thing. It seemed really tedious and unnecessary. Just cut my damn hair, don't worry about the ends. That and the constantly combing it out looking at it and trimming some more.

It wasn't until I tried cutting my own hair that I found it is harder than it looks. If you don't know what your doing the hair just doesn't lay right. You always have little pieces that stick up or you can't get behind your ears right. I even read the instructions that came with the shears but in the end it never looks right.

I'll tell ya cutting hair is harder than it looks.

[ERDoc]

Once about every two months I go to the barber to get my haircut. Now cutting hair seems to be a pretty easy skill. I never understood why the barber would do the pull the comb thru the hair and trim the ends thing. It seemed really tedious and unnecessary. Just cut my damn hair, don't worry about the ends. That and the constantly combing it out looking at it and trimming some more.

It wasn't until I tried cutting my own hair that I found it is harder than it looks. If you don't know what your doing the hair just doesn't lay right. You always have little pieces that stick up or you can't get behind your ears right. I even read the instructions that came with the shears but in the end it never looks right.

I'll tell ya cutting hair is harder than it looks.

Maybe this would help.

[Don1977]

I notice once again that the 'S' word keeps coming up again. As has been stated about a 1,376 times on this forum it is not about 'skills' it is about education. I can teach a monkey to start an IV, I cannot educate it to understand why it is starting the IV.

I totally agree with this.