What should the Basic-Medic Partnership look like?

[paramedicmike]

Any partner I have has to demonstrate to me that s/he know what s/he's doing before I trust them enough to let him/her go. This goes for a basic or medic partner. It matters not which of the two it is.

Now, I don't think a partner should have to explain why they're doing things or even ask permission first. But that person should be ready to answer accordingly when I say, "What in the world are you doing?"

For some partners this takes longer than others.

To be fair, I expect my partner, basic or medic, to treat me in the same manner in a given situation.

From a medic's perspective, anything that happens on the ambulance is ultimately my responsibility. So I feel that I need to make sure I know what's happening. And that's why I might ask why my partner is doing something.

Once we trust each other, however, it becomes more a matter of "grab me if you need something". Again, some people get there faster than others.

Hope this helps.

-be safe

[NREMT-Basic]

An interesting sidenote:

While I was putting together this thread, I decided to call a friend of mine who had been hired for a full time, paid, 24/48, 911 response service in a rather densely populated city in Wisconsin. I asked her how the job was going and she started sobbing, which went on for about a half hour. She then went on to tell me that she had quit the service after receiving so much harassment and verbal abuse from her (female) medic partner. She went on to relate that the medic constantly yelled at her in front of crowds of people on scenes, would spend two or three hours being generally abusive when they were in quarters between calls and on most days was told, and I quote "Don't even talk today. You are a Basic and I am the Medic. I am in charge of this ambulance and everything in it. It is mine. Don't ask me any questions, because you are too stupid to even know what questions to ask. Just take the cot in and out of the ambulance, carry the jump kit and med box when necessary, drive me to calls, clean the rig, collect your pay check and go home." When my friend went to the operations manager she was basically told that the medic was right. My friend the Basic, achieved perfect scores both on her practical exam and the NREMT written exam and was told that she was a pretty damn good rookie. Now, Illinois may not be the best state in the Union to receive EMT training. You pretty much have to rely on training yourself and realize that you are only actually in the class so that you can sign up to take the NREMT. Most of the instructors are horrifically underqualified, have been off the street for a minimum of 10 years and, as was the case with my instructor, can not pronounce medical terminology with more than two syllables. And yes the instructor was a Basic and the only thing that salvaged EMT school for me was the fact that she was replaced at the mid-term by a 35 year veteran paramedic. Oh and I should mention that that Medic who made her mission in life to destroy the emotions of my Basic friend...she had had her medics license for 3 months after having been an EMT for 1 year.

I know that I promised a civil conversation on this topic and will do my best to keep it that way. But any medic that treated me that way would find themselves on the end of the punishment that some of our City colleagues have said was appropriate for Basics that get "out of line" or "uppity": I would have thrown that Medic under the wheels of the rig. There is no reason, NONE, NEVER for one professional to talk to another that way, no matter that the medic is the supervising EMT on any crew. I have heard many of these kinds of stories from many EMTs. Most of us Don't mind that you tell us what to do, or even if you give us "orders" (While I am over hear dealing with this, go over there and get a traction splint on that femur."( Most of us recognize the difference in education, training and experience. But when a person gets such an inflated opinion of their worth in the world that they feel it justifies them to be abusive to those with less training, but sound skills based on their protocols, well lets just say I think anyone like that, regardless of any profession, should get the treatment that that student got at the UCLA library: set tazer to 50,000 volts, attach to genitals, pull trigger until unconsciousness ensues. REPEAT. I Don't believe that this is the attitude of the majority of the countrys medics and not the ones that proctored me, but I think that there is an undercurrent of this kind of an attitude out there, bubbling just beneath the surface and honestly, in my experience so far, it tends to come from poorly trained/educated medics who are uncertain about what they themselves are capable of. While I have heard a number of insults against basics on the City, I haven't heard anything this bad, even when the comments were directed at me. TO me, this is unexcusable BS. I am not throwing down the gauntlet here for a Basic Medic war, I would just like to hear from as many members of the medic community here at the City and see what they think. I would also like to ask the following question: If you are a medic, what is something that you have said to a Basic, especially your partner, that you now feel was totally out of line and that you made amends for. TO be fair, Basics get full of themselves too and get mouthy and argumentative. Medics and Basics who are partners should endeavor day in and day out to develop a working relationship with each other, to be able to count on each other. While it has been indicated that many medics want their Basic partner to prove themselves before giving them autonomy in interventions, I should think as has already been stated that every Basic should expect the Medic to do the same. During my clinicals I was paired with a Medic who was fond of missing IV sticks and on two separate occassions stuck an IV start into the muscles in the A/C space and then not being able to figure out why he couldn't get a flash. WIth all respect an admiration to the people that are willing to go through medic school and take on that enormous responsibility, your partner, medic or basic, doesn't work for you, he works with you, the ambulance and everything in it belong to the service and you are both professionals with your own particular skill set at a given time. That should be a chance for communication and growth as a professional on the part of both parties and not an excuse for the person with more training to be abusive. I have tried to be very respectful here (ok except for that tazer comment) and hope that the responses will be the same. If anyone feels that I have been disrespectful, please feel free to tell me in open forum and I will respond in open forum. I look forward to many constructive discussions. Remember, every partner is somebodys child or husband or wife. Abuse and insult are never appropriate as the order of the day. Thank you to all of you who have posted so far and I look forward to hearing more. Remember....whether you are a basic or a medic, play nice. And in case you are curious, I have a great deal of respect and admiration for medics, have learned a great deal from all of them that I have known and certainly from the ones who frequent the City. There are a few particular medics I look forward to hearing from so I cant wait to see if they post to this thread. Stay safe and be well. Thanks again for playing along.

[Asysin2leads]

NREMT, you seem to have a couple of unresolved emotional issues here. The medic you describe is a dick. He is a shallow, insecure little man who is pissed off about something in his life. Your friend worked for a place that tolerated such behavior. It is unfortunate. There are bad people all over this world, and unfortunately EMS tends to draw in people with serious psychological issues, and unfortunately has less than adequate supervisory personnel to appropriately deal with with them. I'm not sure why she put up with such abuse, or why you didn't step in to help your friend, but screaming at someone or telling them about the stuff in "your" ambulance has nothing to do with the job, its all about personality. All it takes is one phone call to bring behavior like this out in the open.

The behavior of the person you mention and the behavior of the people on this board in regard to basics are two seperate issues. Sure, we get into little verbal sparring matches here and there, but usually if someone is getting reemed out, its because they said something really stupid. I may joke around about my job, but in all reality, the consequences of making a mistake, especially at the ALS level, are dire. I may be grandstanding here, but too much is at stake to not tell someone they are being dumb when they are. The simple fact of the matter is that the EMT-B class does not give you enough information to come to the table prepared for a debate in patient care decisions, unless it is something flagarant. It has nothing to do with your intelligence, or how dedicated you are, or how well you did in EMT class, it has to do with the application of learned knowledge, and unfortunately, due to many factors, some people take the EMT course and do not recognize exactly how unprepared they are to treat critically ill and injured patients. Doctors go to school for 10 plus years to learn to treat people, you have 120 hours of training, yet there are those who believe that they are qualified to expertly diagnose and treat illness and injury. These are the people who get the brunt of the verbal tirades on this site. I've seen many, many accusations of arrogance towards paramedics, but how arrogant is it to say "No, no, no, those guys don't know what to do, I know what do!" When you say that, you are saying your knowledge and experience supersedes all of the doctors, nurses, paramedics, and state boards that regulate a paramedic, all of them were wrong, and you are right. How arrogant is that? I don't care how many years you've spent in the field, I don't care how many books you've read or videos you've watched, if you haven't been through the lessons, classes, and testing that all the rest of us poor shlups have, you are not qualified to supersede your role.

I guess what I'm getting at is of course its okay to ask me questions, I love it when people ask me questions. One real joy on my job is that given where I work, I get to chat with people who work in EMS from all parts of the country. I like answering their questions. I always have one or two brand spanking new EMTs around the station who like to ask me things. I like talking to them too. One thing that they even mention is as a paramedic, you will be expected to teach others. Its something I look forward too. On the flip side, it is not okay to question me about patient care decisions, particularly while on a job. Now, of course, there are exceptions to this, every rule has an exception, but it is the general rule. I'm glad your self educated, education is always good thing, but it doesn't take the place of a formal, professional education. If you are only self educated, how can you know for sure you didn't misinterpret something? How do you know you didn't read something that was out of date, or just plain wrong? The purpose of a formal education with all those tests and quizzes is to do just that, to make sure you read and understood the correct information and can apply it appropriately.

To answer your question, whether an EMT can treat according to his own knowledge or whether he should follow the paramedic, the answer is he should follow the paramedic. A person relinquishes their control once a higher medical authority is on scene. Once I bring a patient into the ER, I hand over control to the doctor. I don't keep treating them. My duty is done. When I come upon a critical patient, I take in about a billion bits of information, try and make sense of it, and come up with a plan on patient care. The best thing for this patient is for everyone to just follow the plan, do their job, and get the patient treated and transported. If you have a suggestion, that's fine if its about having a better way to get the patient out the door or a better route to the hospital or something I can do to make what you're doing eaiser, fine, good, but if its because you think the medication I'm using is not the right one because of something you read in a book somewhere, it is really not the right thing to do. While we could come up with cases where it would be, in all practical purposes, it just isn't.

[NREMT-Basic]

Asy-

While I appreciate the thoroughness of your post, I think you misinterpret a great deal of what I have posted so far. When I say I am self-educated, I mean that I was instructed for the better part of EMT training by a complete incompetent, leaving me with no other choice but to self educate. I'm not running around without any idea of protocols, treating patients within my scope, based on my interpretations of crucial material. What I am doing is applying what little was taught by the instructor, my own constant study, preparation and questions asking of those who know a great deal more than I and functioning as a Basic in the capacity allowed by the DOT,NHTSA and the Illinois State Board of Healths EMS Board. Like you in your capacity as a Medic, I passed all written and practical exams with extremely high marks. When I did my clinicals, I had one medic report on his proctor report that he felt that I was more prepared to work in the field than many of the medics he had been sent recently by the same educational system. This doesn't meant that he thought I was better than those medics at operating at a Medic level, but rather that my skills, education and training at the Basic level were more complete and applicable that many of the new medics he worked with could function at their level of training, experience and education.

When I say that I will question a medic about what he is doing, I don't mean that I am going to try to act as his little watchdog pretending that I know enough about everything to know that he is about to kill a patient. Rather I offer this as an example, albeit a rather pop-culture one. In an episode of MASH from the 1970s a doctor meant to give a patient MS and ended up giving him curare by mistake and paralyzing the patient and sending him into respiratory arrest. Do I have the pharmacological and algorithmic knowledge of a medic. Nope. Absolutely not. But what I do possess is a great deal of horse sense and an excellent set of observational skills. No, I am not going to say to a medic "are you sure you wouldn't rather give a higher dose of MS. My experience tells me the patient can handle it." I don't have that experience except to know that MS can send a patient in respiratory distress downhill like a rolling stone. But there again, I don't know how much or when it would be appropriate if ever, to give such a patient MS at all. So I don't question in regards to sizes of ET tubes, needle gauges, med combos which the medic is pushing or any other one of a million things that I don't know yet. But, if I happen to notice that the medic has grabbed the wrong vial or as was posted in another thread, that the patient is actually alive when the medic said he wasn't, I'm not going to stand by and not say anything whether we are alone in the rig or in a crowd of 200 people watching our every move. That would be stupid and also very hard to explain when asked in court if I noticed that the Medic grabbed the wrong vial, or the completely wrong med other than what he said he was going to give. If I noticed it, I am going to say so. I do not believe that I am a medic or even the most experienced Basic in the world (yet..lol) but I do know flagrant errors when I see them and medics are just as prone to them as any other medical professional.

In my home state of Illinois, if we are assisting the medic (which I believe is the prime responsibility of a Basic in an ALS rig) and the medic is doing something or has made a mistake which we KNOW has gone wrong, we are allowed to do a number of things, all of which would be admittedly hard to justify during and internal run review let alone a law suit. That being said: we are allowed to refuse to follow a directive given by a medic if we are confident that the medics directive will cause harm or death to the patient. We are allowed to call dispatch, request another ALS rig, and "stand down" by removing ourselves from the ambulance until another unit, usually a supervisor arrives. We are allowed to distance ourselves from the situation by getting into the drivers seat and wait to be told to get underway. We are also allowed by law, in extreme cases, to contact medical control about our concern. Obviously all of these are extreme measures which would have to result from glaringly wrong moves on the part of the medic (like something that someone with no EMS training would recognize as being dangerous). I don't go around contacting med control if the medic blows a vein during an IV start, if the medic gets a little jittery and has to take time to compose himself to continue the intervention. In that particular case, I would do nothing but ask the medic in a very professional way what I can do to assist him. I don't labor under the false impression that I know more than a medic so it is my goal to first and foremost act as that medics assistant and secondly to perform autonomous functions allowed me under our state protocol. I don't need to get permission to break out the ASA and nitro for an MI patient, but what I always do, is get these meds from the cabinet to have them ready and then take vitals signs. I then tell the medic that I have ASA and nitro ready for administration per protocol and find out whether he has a reason that he wishes me to wait, or not administer the meds at all. If I am working with a medic who is having a hard time with an intubation, I don't have a total freak out. I simply acquire an appropriately sized npa and opa as well as a combitube setup....solely for the purpose of having them ready as a measure of last resort. More than likely though I would be assisting the medic with his intubation attempt by complying with directions he may give me such as performing the Sellicks maneuver to possible facilitate intubation. Of course I'm also going to do things that I was taught in basic school like have a Yankauer standing by during the intubation. But I also know that it may be more important for me to assist the medic by providing additional lighting during a difficult intubation, say in a darkened basement or on the pavement at a nighttime MCI scene. I am proud and honored to be a Basic, and do have the desire to become a medic. However, I am also proud to have been trained for my primary function which is to assist the medic. I have no problem with being given direct order and following them and even doing so if they are given in an insulting manner due to the tension of the situation. I also pride myself that, because of training in other fields, that when the medic partner and I are alone together, we can talk and relate to each other casually. But when the rubber meets the road I take pride in the fact that when given an order, I repeat it word for word as a form of acknowledgement and to prevent any confusion and I really don't have a problem with calling someone who has been a medic for 35 years (my preceptor) sir (or ma'am as the case may be) while we are on a call. I have been picked on for it by colleagues, but many times I have been heard to respond "prepare to assist with intubation, yes sir" or 325 mgs of ASA and .4 of nitro, yes ma'am." This has alot to do with the way I was raised. People who are my elders or my superiors are to be treated with respect. I also never call a doctor Doc, or say something like "hey nurse, could we get some help over here?" Having gone through a paramilitary based private security training course and having worked in the field of personal protection and facility protection, I tend to see EMS as a sort of paramilitary operation. I am given an order and follow it unless I can prove beyond a shadow of a doubt that it was wrong and would cause harm or death. My demeanor on the radio reflects my paramilitary training, as does my interaction with my medic partner, my appearance, dress and deportment. Not only are these the polite and proper thing to do, they bring into the field an aspect of professionalism which I think we can all agree is sorely lacking. So I don't feel silly at all when I say ".30mg of Epi, yes sir." If i respect my medic partner, 9 times out of ten that will be reciprocated. I have also been on BLS rigs where, even with my limited time in the field, I expect anyone with less field time than me to act the same way. I don't care about being called sir, but experience trumps just about everything in EMS. Learn one, Do one, Teach one. Thanks Asy and I look forward to getting alot more posts in this thread.

[Dustdevil]

Okay, here is my basic (pardon the pun) philosophy on Medic/Basic crewing. And, this is ONLY my philosophy. It is not my prescription for how all medic/basic teams should function. First and foremost, a basic has no business on an emergency ambulance. Period. But, of course, this world we live and work in is far from a perfect one. And if I am not running the agency, I don't get to say how the units are staffed. That being the case, I accept that my job is to provide a service utilising whatever help I am given, even if it is only a basic. Therefore, we are indeed a team, and should work together smoothly. But the medic is the captain of that team. And more than that, he is ultimately responsible for what BOTH of you do or do not do. Consequently, it is indeed my way or the highway.

Now, this does not mean that my basic partner gets shat upon. Far from it. I am all about fairness, where possible. I go out of my way to assure that the workload is as equitably shared as possible. And, since the medic ultimately has greater responsibility, that means that I am always the one who ends up getting the greater bulk of the work. I believe in alternating positions after every run. That means if I took care of the last patient, you are taking care of the next one, and so forth. Of course, that rotation doesn't usually jibe with the needs of the patients. When it is your turn to take the patient, about half of the time, the patient will require ALS, meaning I have to take him. So, at the end of the day, I got stuck with more paperwork than you did, despite my efforts to be fair about it. So any basic partner of mine who whines about getting the shaft from me is simply a pissy little bitch who needs to go back to McDonalds. Aside from patient care, everything is shared. We check the truck together. We wash the truck together. We clean the station together. After a run, whoever was NOT taking care of the patient does ALL of the cleaning and restocking, no matter which one of us that is. It all evens out in the end. So, bottom line; my basic never gets screwed. Unless he bitches. Then he will find out what it is really like to be screwed.

When I was in EMT training, I had the good fortune to work with medics who observed me, knew what I was able to do, trusted me to know what I was supposed to do and capable of doing and we were able to just work together in a flow of each crew member working together toward the best possible outcome of the patients emergency.

That's what it's all about!

I was not required to ask before gaining a set of vitals, nor did I have to ask when i chose to repeat them en route. I didn't have to ask before beginning my assessment of a patient, but rather to gather information and pass it along to the medic who is admittedly saddled with the more complex tasks and has a great deal more training and experience.

Excellent. That is exactly how it should work. Teamwork. But optimum teamwork requires a specific plan. Both of you have to know and understand what the other's role is going to be. No, you don't need to ask to take vitals. I encourage it. I want you to do it as soon as we get to the patient's side. But on the other hand, don't make me ask you to take vitals either.

As for assessment, it depends upon whose patient it is. Don't start asking MY patient a bunch of questions. Taking a history is the job of only ONE person. It may be me this time. It may be you. But only one person needs to be asking the questions at a time, unless you are screwing up, or the patient is serious enough that I need to take over.

I didn't have to ask if I should administer oxygen, give ASA, assist with nitro because these were parts of my basic protocol and the medics with whom i worked trusted that I have learned what I was supposed to learn and would not do anything to harm the patient or impede more complex, difficult and consuming interventions.

You will not do any of that without my direction. I do not want anybody treating my patient with "protocols." If you do not know exactly what is wrong with the patient, what he needs, why he needs it, and how it works, then I don't want you doing it. If you go giving my costochondritis patient NTG and ASA, you will never work with me again. In fact, you will never work for that service again, if I have anything to say about it. ALS is for paramedics, and protocols are for monkeys. Period. Invasive measures of any kind, including ASA and "assist" medicines are ALS, regardless of who is administering them. I realise that YOUR personal education is exceptional, and that is great. But until you have the MEDICAL education to fully understand the five W's and pathophysiology of those drugs and the conditions that require them, you have no business administering them without direct orders from a higher level provider (and, of course, I maintain that most medics in the US don't have any business doing it either, but I will try not to digress).

It wasn't until I got to this forum that I started hearing medics say things like "MY ambulance, MY patient, MY treatment." In my field training, the entire situation was a matter of the basic and the medic working together, side by side, complimenting each others skills for the good of the patient. It was not until I got hear that I heard that a basic shouldn't question the medic about ANYTHING, and if so not while on scene.

I think a lot of this has to do with the fact that, as you admit, you were lucky enough to work with a great partner. Had you been paired all that time with a 120 hour EMT-B who thought he knew it all (as most seem to think), you too would feel that way. You'd think, "Dude, these guys don't know dick! They need to just shut up and drive!" And since that is indeed the rule, not the exception, obviously that is going to create the feelings that so many of us have. So think of it this way... if you did not have all of the foundational education, experience, and understanding that you personally have, and all you had was the thirty-percent of knowledge that is typically retained from 120 hours of night school by the average moron, would YOU want you making medical decisions without direct supervision? I doubt it.

Again I was trained that if something being done by the medic really concerned you, that you were allowed to ask him as your PARTNER if he wanted to do this or that,or could something else work. Its not a matter, as I have seen so many medics indicate in these forums, that the basic is trying to undermine the medic in anyway. Like the medic, the Basic is only concerned with what will produce the best outcome for the patient. During my clinicals, I also established enough of a trusting working relationship with my medic partners that they didn't feel they needed to question me regularly either and when they did it was more like a pop quiz than what the hell do you think your doing.

I'd say that the vast majority of medics in the US need to be questioned constantly because they suck. Seriously. But, like you, I feel like I am smarter, more experienced, more educated, and have a little more on the ball than most of my peers. Consequently, I personally do NOT want to be questioned by my partner. And, since those medics who frequent this forum tend to be those who take a greater professional interest than other medics, it is not surprising that you will see this attitude here more often than on the streets. What you find here, for the most part, are secure, intelligent, experienced medics who don't suck.

There are two types of medics that get all bent out of shape when questioned by their partners; there are those who are insecure and probably suck. And there are those who are not insecure and are exceptionally competent medics who simply do not want a lot of chatter going on in front of their patient when the chances of it being productive are slim to none. And all of us out here have experienced this from basics that are not nearly as tactful as you. Yes, I am sure that you have the social skills to discuss care options in an innocuous manner without alarming the patient, offending the medic, or simply being annoying to all. But, believe it or not, that seems to be a rare quality among basics. You've been here long enough to have read the horror stories about the things that basics say and do, despite direction from the medic. They're convinced that all the "protocol" they *think* they memorised from night school is the Holy Grail, and are willing to defy a medics orders in order to do their own thing. The list of all the stupid things I have had basics argue with me about is shockingly long and pointless. So really, don't blame medics for their attitudes. Blame your peers who, unfortunately, earned the reputation that you now are forced to live with. If it makes you feel any better, we all had to live with it at one point.

Do certain medics actually want their Basic partner to bow and scrape to them.

Oh yes, some definitely do. As you have seen, I am certainly not here to defend medics. Not in the least. As many of them are arseholes as are basics. And as many of them are incompetent as are basics. No doubt about that. All I can do is speak for myself here. And yes, if I tell you to do something in the line of duty, I expect it done immediately without a lot of lip. If you have some sincere questions about it because you seek greater understanding, then by all means, ask away. But do NOT do it in front of the patient/family/cops/firemonkeys/news media/supervisor/other crews/ER doc, etc... And do not delay doing what I asked you to do in order to discuss it first. When the time is proper, I will happily discuss it with you to your complete satisfaction. Just remember, that I personally am not going to ask you to do something that is illegal, immoral, incompetent, or unfair. And just because you don't want to do it doesn't make it any of the above.

As for our personal relationship on the job, I don't want to be bowed to. Yes, I have encountered some n00bs who worship the golden disco ball, on whatever shoulder it may hang. They walk lightly, call me 'sir' and generally kiss my arse because they believe that a paramedic is some sort of deity to be worshipped. And there are medics out there who eat that stuff up too. Not me. I want to spend my 12 or 24 hours with somebody whom I can be friends with. I'm not looking to boss anybody around, personally or professionally. If you're hott, of course, I have a whole 'nother set of expectations from you. But that does not include worship.

When there is a basic on the crew, ultimately the partnership must be very much like a good marriage. We both have the same responsibilities to be concerned with, yet we have separate duties to perform to maintain those responsibilities. We must work to not only achieve our respective duties, but to assure we don't cause extra work or problems for the other in the process. We must be open in our thoughts and communications, but careful not to air our dirty laundry to others. We're both part of the team. And we both work hard to get the same job done. But ultimately, only one of us wears the pants in the family. That is me, the paramedic.

[KSEMT122]

Hi there, I voted No, and I"ll tell you why. Although I am not a basic anymore, for the most part, that is what I"m considered while on a rig with a Paramedic. So I speak with experience when it comes to this issue because my partner and I have discussed it.

It is true that we have a scope of practice that we operate under. The bottom line for me as a healthcare provider is I must do what it best for my patient. Often that is Paramedic level care. A Paramedic is responsible for what happens to that patient period. In my opinion you shouldn't be doing an assessment on a patient if you have a Paramedic partner who SHOULD be doing an assessment of his own. If you are in a situation with multiple patients, then you can go operate under your scope of practice and inform the Medic of what you have on your end. In the end it all falls down on the Medic, and I don't blame a Medic for wanting to know about any patients I have or running an idea by the medic for review before I do it, since I understand he is responsible EVEN on a BLS call.

I must admit it has been frustrating to me before, and I have gone ahead and done things while on a transfer without consulting my Paramedic partner, however on First out calls, it is the Paramedics responsibility to assess that patient and determine what level of care is appropriate. That's how it was at my department. I view it from their perspective, once I become a Paramedic I need to know my partner is there for me, they can question me if they wish, that's all part of the system. Paramedics save Patients, EMT's save Paramedics. Or something to that effect.

Remember I AM an EMT. So please don't bash me for my EMT views that support Paramedics! lol,

[whit72]

I can only respond with past experiences. I work in a tiered system now. In the system I work in now partners are paired by certification, if we are dispatched to call that requires an ALS intervention we request them. However I have spent a lot of time in a paramedic basic situation. For the most part we never had any of these issues that I have read bout here, no fights, no blowouts, no "I am better then you are discussions". The fact that we didn't have much time to sit around debating the aspects of are training an education, we were to busy getting are ass handed to us. In that system we averaged about 15 calls in a 24. There is plenty to do on scene we dont have to be looking over each others shoulder. I would say yes the ultimate responsibility would lie with the medic.

Respect is not earned by discussing the aspects of treatment on a CHF pt. If you prefer lasix and nitro as opposed to morphine and nitro. Wake up the diabetic in the house or treat them in the truck. If you rather administer the narcan IV or IM that is up to you and frankly does not concern me. Whatever. That is your aspect of the call. There is a hundred things that need to be done on scene. We can either do it together, or we can do it butting heads the whole way. I have been lucky I haven't had the experienced listed in this post.

As far as disagreements on scene, I would never question a providers decision on scene. EMT or medic, unless it would compromise the well being of a pt, If we have suggestions those are reserved for a more private setting. There are a thousand ways to get from point A to B. My only concern is that we get there. I do not get my rocks off showing someone up. I expect the same from my partner.

If I call for an ALS intercept and the medic that shows up and feels he needs to spend his ten minutes or so going over everything I have done, asking the same questions that I asked before he arrived, thats his prerogative, have at it. They don't say "EMT get a blood pressure, get a pulse, re-splint that arm and stand back allow me the room I need to save this persons life" It dosent happen in real life, at least not in my area.

The problem, I believe in this whole situation is most EMTs crave respect or acceptance from there medic counter parts, they feel the need to constantly prove to someone that they are competent, knowledgeable and experienced. They tell war stories of MVAs and shootings, stabbings, and codes. They feel the need to prove through actions or words that they belong.

If you can get by the aspect of the perception of what the "MEDIC" thinks of you, I believe you will find more respect, and acceptance, if that is what you crave. If you have spent any amount of time in EMS, we all have stories of fatals, and stabbings, pedi codes, and shootings. The location might not be the same, or the events leading up to them, however we all have them. You shouldn't be trying to impress anyone. If a medic with any kind of experience walks into my station and sees that I work on a 911 truck he can assume that I seen a few things. I don't spend the day trying to impress or prove to him how competent or experienced I am with stories of what I have seen or done.

I might have 200 hours of "training" as an EMT and over ten years of experience in this field. If there is anything I know, its the aspects of "my job." I am not overly concerned with the aspects of yours(medic). I will not offer up comments of "I read somewhere that you can give that pt more morphine in this situation"., "Why are you not doing 12 lead?" "I think we should bag, or intubate." I read in JEMS that we should do it this way" You are an educated/trained individual who should know the aspects of "your job." If my opinion is asked, what do I think, or have you had any kind of experience with this situation, its not uncommon. I am happy to help, what you do with it is your decision.

I am however am a pt advocate. So if your fishing for a tube for 10 minutes and not allowing me to ventilate, trying to stick a ambulatory on scene 95yo that was involved in a minor MVA with two 14's, 10 times because that what it states for trauma pts., staring blankly at a monitor expecting the answers to pop up on the screen, or chasing your tail around the truck trying to catch up with a pt that went south because you decided it was more important to go over the aspects of appealing c-spine immobilization. Yes I will speak up, and it probably wont be in the fashion you enjoy. However, it will be between me and you. I don't perform for the crowds, and I don't drop dimes on my partners, medic or EMT. If it happens between us, it gets settled between us. As I would hope if the roles were reversed.

[AZCEP]

I will say that I'm glad there are some EMT's out there. By "some" I mean that a few, select individuals that are capable of critically thinking through a situation without my oversight.

Several are actually capable of putting a coherent thought together, and communicating the what/why of this same situation. I applaud each and every one of them for achieving a level of education that the current state does not provide much of.

While there is much discussion, worthwhile though it may be, of when a lower level provider can do something the fact remains that while a paramedic is on scene, they are the highest level of care. When you do something right the medic gets praised for it. Do something wrong that the medic isn't aware of, the medic takes the full blame for allowing it to. In the off chance that a flight nurse, depending on local rules, arrives on scene they would be considered a higher level of care, and they will be held accountable for the actions of everyone.

We are all borrowed servants, and most jurisdictions have laws specifically designed to clarify these situations.

[mediccjh]

As long as the EMT is competent, by my standards ( I have seen them work before and can trust them), on BLS assignments I become their 'bitch', where they do the interview, etc, while I do the vitals and stuff.

On ALS assignments, I do the interview while they set up the monitor, get vitals, etc, AS LONG AS I TRUST THEM.

Either way, it is a TEAM.

[Asysin2leads]

NREMT, the one scenario you provided, I'll answer with a yes and no. I understand what you're getting at, but in practical purposes, its not that easy. You provided the example from M*A*S*H where someone gave a paralytic when they meant to give Morphine Sulfate. Medication errors are a real danger in medicine. Of course you have a duty not only as an EMT but as a decent human being that if your really in your heart believe that a serious error is about to be made, to speak up. Lets look at a scenario where a paramedic has drawn up the wrong medication and is about to give it, and giving it will have a serious detriment to the patients well being. The worst thing of course is for the patient to get the wrong drug. However, the best solution is not the EMT making mention of it, the best solution is for the paramedic's partner, who is also a paramedic to do so, which is why I'm a big fan of the two medic trucks. Actually, the best solution is for the medication error to not be made at all, but that's beside the point.

To treat people in the field well, you really have to be able to achieve and maintain confidence in not only your patient but the family and whoever else cares about them. You can only treat people if they let you, so you have to get them to let you, and to get them to let you, they have to be confident that what you are doing is necessary and that you are a capable person. People do not like getting stuck with needles, they do not like having people come into their house and tell them they are sick, especially when they are scared. If someone starts questioning the abilities of the person who is treating someone, that confidence is lost, and really there is no getting it back. In fact, losing that confidence can in some ways be worse than giving the wrong medication. If you don't believe me, you need to be up at 2 a.m. with an 80 year old person full of rales with her arms folded saying "YOU'RE NOT TOUCHING ME!" This real need for confidence is probably why paramedics get such a bad rap about being uptight and egocentric. I don't get on my high horse about roles in EMS because I need to think of myself as a life saving god, but I do need my patient to think somewhere along those lines if I am going to get my job done.

Secondly, NREMT, you are obviously a dedicated, intelligent, rationale human being. That being said, you're unfortunately the exception when it comes to EMTs rather than the rule. For everytime you might be on the ball and politely mention the fact that I picked up the syringe full of etomidate rather than the one full of saline, there will be 8,000 times that some poor medic has to try and save face because Skippy the 16 year old EMT decided he was going to be in charge that day. So when I say no, EMT's should really not question medics on scene, I'm not saying You, NREMT-B (I mean you the poster personally, not the title in general) should not pose a concern to me if we working together, I'm saying as a general rule, it fits.

Lastly, NREMT, I think really something you need to learn is how to let go. Its a really hard lesson and one it took me a long time to learn. Lets say you think the paramedic is about to give the wrong drug but you're not sure and you don't say anything, and he gives it, and the patient dies. Who's fault was it that the patient died? Its the paramedics fault, and his medical directors fault, and its the fault of his instructors and the state board for certifying him. Your responsibility is to do your job and do it to the best of your abilities, no more, no less. Its commendable that you want to go the extra mile and that you care about the patients who are under your care, but don't go overboard or I'm telling you, it will eat you inside and either burn you out or kill you, which ever comes first.

I'm saying this because at my level I accept that fact and my responsibilities are far greater than yours. If I pull off a save and I get the patient to the hospital who promptly screws up and kills him, thats not my fault. I do not blame myself because I brought them to the wrong hospital. I had a responsibility to that patient and I fulfilled that responsibility. I once had a patient go from being conscious and talking to me to going into cardiogenic shock and die because my Lifepak decided it just wasn't going to pace anybody that day. I felt bad that he died. I was frustrated. But I didn't blame myself for his death, I am not a Lifepak technician, if I check all the connections and replace the pads several times and it still won't recognize there is a human attached to the other end of it, that's Medtronic's or the people down at the Medical Equipment Unit's or maybe God in heaven above's fault, not mine. By the same token, you have to let go a little. Take the weight of the world off your shoulders. Do your job, do it well, have a little fun and go home at the end of the day. No one can ask you for anything more.