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Should EMTs Have to Babysit Their Medics?

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I think people forget that EMT's and Paramedics are special people and we should work towards good pt. care and out comes. It's not about ALS/BLS, we all share the same skills. I have been an EMT for 3 years and my skill level is very high! I read and research tons of material. I am good at what I do,and many paramedics think I am special. I have a gift. I started at least 3 IV's in 2 months. I know what I'm doing. :wink:

I am sure you are joking, right? I feel like bringing Stuart Smalley in and having the SNL character give his daily affirmation.... "and gosh darn, I am special and people like me, for I am special ! " speech.

Our pet EMS chimp can start IV's as well. He even shows off with one foot tied his back ( prefers to start them with his feet, you know the old thumb thing". :P He gets irritated when we keep telling it is not always about the skills that count...

In reality we are not any more special than the RT that suctioned the lung cookie out the patient or the nurse tech that had to physically dig out a fecal impaction on the quadriplegic. We have a job to do and we should be educated enough to perform that job very well. We should have acquired the common sense enough by life experiences and possibly EMS experience to perform critical thinking and decision making (multi tasks) and along with this be very proficient in the skills required. Giving patient care ... not BLS or ALS .. patient care that is needed. That's it... period.

We don't need medals or pats of accomplishments, we have a job to do. It is an important job (at times, sometimes its not) and we should be above competent in performing it. Knowing when and how to apply and interpret the best care needed at that time, is what is all about.

R/r 911

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I'm special too but I don't act like I am.

When I read the comment about being special I immediately thought of Stuart from SNL also.

What a touchy feely goofball post

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I wouldn't claim I was special... I work with special people all day long, and let me tell you... it can be very challenging.

(THIS IS A JOKE... for any who don't know me, I work with adults with developmental disabilities, and this is not meant to zing them or make fun of them or say that I think any less of them...)

Not that it detracts from inherent personal worth or anything... but being special doesn't help you do your job. Being on top of your education and being aware of your limits does. I'm very good at certain physical skills... but let me ask you this... does good physical skill capacity mean you will use them correctly as warranted by a good assessment? What's that? Taking a BP doesn't teach you how to differentiate between CHF and pneumonia? Damn..



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and always at least 10-20 percent of the total bill depending on quality of service

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I'm glad that some others touched on what I was getting at. I have found that 99 out of 100 times I hear a "EMT babysitting their medic" horror story, its a matter of the EMT really wanting to believe their training made the difference on a critical patient rather than any basis in truth. Its kind of like the mall security guards who go on and on about the robberies they've single handedly foiled. We're sure you made a difference and did some good, but at the end of the day, how much can you really do with a flashlight and thermos full of coffee?

However, to prove my point, after a few days I finally realized what was missing in incognitogirl's saving the day story. Maybe you found a bleed an maybe you didn't. I wasn't there. I can't say what happened. But what I can say is that according to your account, all of you actually screwed up big time from the get go. The way you put it, the patient was hypotensive after an MVA. Because the medics were too busy trying to get an IV, they did not expose the patient. Because of you "reminding" them about exposing the patient, a critical bleed was found, the patient was uptriaged, and rather than going by ground they went by air, and the world was better place.

So let's back up. I'm not sure what state you are in, however, critical trauma criteria tends to vary little from place to place, and in almost all of those places ANY patient. whether they have that all important life threatening bleed which can only be found after exposing the patient or not, if they are hypotensive after a significant mechanism of injury should be a high priority, rapid transport to begin with, and the reason it is set up that way is because most hypovolemia secondary to trauma comes from an internal injury, which many times cannot be easily identified. Anything but a very low speed car accident is a significant mechanism of injury, and the fact he was hypovolemic ALONE pretty much made him a critical ipatient. Whether you exposed him, started an IV, sang Dolly Parton to him, as soon as that BP came up someone should have been calling for a helicopter. Remember that next time you tell your story.

(Oh yeah, and for 10 extra points, technically speaking, you should have checked for life threatening bleeds before even boarding and collaring him. One of the few things we do for critical trauma's while on scene. A...B...C..... you know the drill.)

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I had a case the other day that might help make this point, or perhaps just make me look like a bonehead…either way, here goes.

A homeless man badly beaten in an abandoned house, time of beating unknown, but blood has dried on his face.

Fire has a collar on and is applying spider straps as we arrive. He boarded and carried to the ambulance. Both eyes swollen completely closed, nose obviously deformed, left side of head- temporal/mandibular area swollen to nearly a perfect half circle, ears full of blood bilat, some fresh, some dried. Right hand has obvious deformation to all fingers and is swollen to the wrist, grunting respirations, repetitive questioning repeated approx. every 10-15 seconds.

In the ambulance I cut through the multitude of clothes to expose his chest, as I reach for my stethoscope the basic (of several years) tells me, “We need to get the rest of his clothes off and do a physical exam!”

To which I say, “Keep working on his clothes.” I listen to his lungs, palp his chest and the basic finishes exposing him. I ask the basic to spike and hang an IV and get me a 14g from the box to which he says “You haven’t finished your physical exam! You need to do that before worrying about an IV!”

So I spike my own bag, get the IV, finish my physical exam, piss off the basic, deliver my patient to the hospital.

When we come out he says, “I’d like to talk to you about that call.” Of course I say, “Sure.”

He tells me that the problem with new medics, particularly “zero to heros” is that "they want to do fancy stuff without doing the basics first." So I ask him to be more specific…

He say, “When you get a traum, it’s ABCs right!?!”

I said, “Mind your tone you little prick before I stomp you into a puddle!” (Ok, I didn’t really say that…..)

I said, “Of course”

He said, “We got into the ambulance, he was talking, and moving, so our ABCs are covered, you should have done your trauma exam!”

I said, “Where you and I disagree is that making sure he’s breathing is our only job. I didn’t like the grunting respirations, which made me think possible tracheal/thoracic injury, with made me wonder about possible pneumo, amongst other things. I don’t believe that the B simply stands for make sure he’s breathing now, but to make sure he’s also likely to keep breathing…right? Is it you feeling that as long as he starts out breathing that we’re OK unless he arrests?”

(I guess he didn’t hear me) He said, “ Well, medics always want an IV, but he might have been bleeding out! You don’t know!”

I said, “I swear to God I’m going to choke you to death if you are still within reach 5 seconds from now!” (Ok, I didn’t really say that….)

I said, “I takes at least a bit of blood to bleed out right? We had him naked, did you see any blood?”

(I guess he didn't hear me) He said, “But you should have looked before getting the IV!” (Actually, I should have been looking while HE got the IV, but he didn’t have time to do that AND explain trauma care to me at the same time.)

So I said, “Look. If he’s bleeding out externally, I would have noticed. He was naked. Second, if he’s bleeding internally all I can do is manage his pressure and get to the hospital. If he starts to seize from the head injury, I need access to control it. Does that make sense??”

At this point he starts walking away…and I swear, as he’s walking away he turns and says…”Well, I’m just sayin’, BLS before ALS, medics always forget that….”

To the basics…It’s this kind of thing that can make people crazy. I’m not saying Suze was referring to anything quite like this, or that she’d ever behave in this manner, but I can tell you this. After you take anatomy and physiology, all that was once perfectly clear becomes terribly hazy. Skill sheets no longer apply.

Did I want to inject this kid with retroactive birth control for asking about the call? Of course not. But he didn’t have any questions, he simply wanted the opportunity to explain why medics are ‘stupid’.

And, if you feel that people think you stop being stupid once you become a medic (student)? Watch as people explain to me what a bonehead I am for the mistakes I made in this call…But that’s ok, I can take it, I’ve never pretended to be more than that...


NOTE. A friend of mine gave me a cool word processor with an auto correct funtion. I just noticed it shortens some words and lengthens others, which I don't have time to fix before my 90 min deadline in this post. I'll be more careful in the future. No disrespect meant to those kind enough to read/respond to my posts.

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When I was about 2/3rds of the way through Basic class, my instructor said that he would be comfortable with any of us (students) taking care of him or his loved ones in an emergency. My first and only thought was - You have got to be kidding. There was NO way that anyone with the amount of education (almost nil) or training (a wee bit above nil) that we get as basics should be in charge on anyone that is sick. If you think that that class prepares you, then you are fooling yourself.

When I started anatomy and physiology, I was stunned that there was this whole world of stuff out there that I had been totally ignorant about. We would learn about cell chemistry and I would be amazed - and guess what? The RNs and the paramedics all knew it.

Then I started paramedic class. I learned that not every medical patient needs hurricane force oxygen, even though 15 LPM NRB had been burned into my brain in basic class. As basics, we are taught to put occlusive dressings on open chest wounds. In paramedic class I learned that this actually causes pnuemothoraxes.

Then I began clinicals.... thank God there were educated (note educated NOT trained) people to learn from and to make sure that I didn't hurt anyone. The more I learn, the more I learn that I don't know - I cannot imagine the gall of people with limited education thinking they can instruct people who know more... If you think as an EMT that you can tell a paramedic how to do stuff than you are self delusional and dangerous to your patients. I hope you work in a cook book protocol system where you have very short transport times and lots of people to cover your ass.

I love working with the basics in my system. They are eager, motivated and a tremendous help on scene and with patients. If any one of them talked to me the way they did to Dwayne I would kick their ass - Dwayne - you are a patient man.

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Did I want to inject this kid with retroactive birth control for asking about the call? Of course not. But he didn’t have any questions, he simply wanted the opportunity to explain why medics are ‘stupid’.

Exactly. We can discuss patients all day long, but it has to be a discussion, not a lecture.

Of course, these people are idiots with neither the education, experience, nor common sense to have a clue what they are talking about, and I prefer not to waste my breath on them except to say "do it now or clock out." But really, they are not solely responsible for this mess. The "educational" (using the term very loosely) system at the basic level is failing them by not only failing to adequately prepare them for the job, but by feeding into their egos and making them think they really have learned something in 120 hours.

Get rid of the EMT course altogether. Eliminate it from the EMS system and prepare our providers with sound educational practice from the beginning. Zero to hero, but without the separate EMT and Paramedic steps. One long, two year course to enter practice. Everybody on the same level, and then we won't have to listen to all this turf-war posturing of insecure people who have to constantly pat themselves on the back to compensate for gross inadequacies in their education and knowledge. This sort of ignorant immaturity just brings the whole field down.

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