In Need of Some Professional Advice

[WVNobody]

I need some advice from you guys on here and I would like to keep it as anonymous as possible so I'm not going to mention any names or companies. To give you all a little bit of back ground, I'm a newly certified state EMT-B. When I graduated high school my plan was to go to nursing school but while I was waiting to get accepted into the program due to the long waiting list I took an EMT course and my instructor pretty much changed my mind because after thinking about it all I was really interested in was ICU or ER, emergency type stuff. Well I will be starting a Paramedic program in a couple of months, either this fall or more likely this spring. I have no experience, never even been in an ambulance prior to my current job. No firefighting or anything. Well when I passed my class and got my state card I applied at 3 surrounding counties with in driving distance and 1 private transportation service. I went to a hiring exam and interview with one county and basically got told I had no experience. Which they were correct, I had never been in an ambulance before. I went to a hiring exam for another county and am currently on the waiting list for an interview. In the meanwhile due to personal reasons I needed a better paying job then my $7.60 an hour part time job that I was working. I got called for an interview with the private transport company and got the job offer the same day. I took a few days to think about it and couldn't resist the hourly pay.

The company I started working at a few weeks ago is strictly a non-emergency transport company, unless we roll up on a car wreck or something like that. The company has a bad reputation in the EMS world where I live but I took the job anyway. The plan is to work here until I can get hired on at a county because like I said I'm really not interested in non-emergency. If I was I would of went to nursing school.

I have a few reasons why I took the job against my better judgement and against my instructor and a couple of other peoples advice. Mainly my weakness is medical calls, I thought that since its a transport company hopefully that will help some. Also I need some experience. Some experience is better than no experience I'm hoping. And I really just needed the money.

After working here for a few weeks I've started to notice a few things that are really bothering me. Now I understand that these are non emergency calls but in the back of the truck no one is really doing vitals or assessments at all. Blood pressure, pulse ox, and respiration's is really about it. No physical assessments, no checking pupils, no lung sounds. I was taught every 15 mins if the patient is stable which normally our runs are not much longer than that. So that's not really something that is bothering me that much and it wouldn't probably bother me at all if they weren't making up vitals and writing them down.

Also the second thing that is really bothering me is the cleaning of the cots and ambulance. Some of the crew members will go 3 or 4 transports without disinfecting the cot or anything. All they do is change the sheet and sometimes the pillow case that is on the sheet. I'm kind of over here just like WTF?!

So what do I do guys? I need the job, the pay, and the experience but at the same time I don't approve of a lot of things that goes on there. I guess what I'm going to do is wait until I've been there long enough that I get to ride in the back with the patients by myself while my partner drives and do everything the right way? I mean I;m still kind of new and I dont want to be that guy that tries to ruin a company by tattling on everyone but at the same time not having a clean work environment endangers my health as well as other.

So what would you guys do? Do my own thing that I know is right?

 

[CALEMT]

I'm in the same boat as you with my company. Now I'm not going to tell you to do because that is solely up to you but here are a few pointers. First off how would it look to another company if you quit your job? even though it may be a crummy job a potential employer may think "if he/she quit their job are they going to quit on me?". Second yeah the job may suck but it's still good experience getting your assessments down, how to talk to pt's, vitals and so fourth. Now as far as what I would do? Me personally, I would stick with it for a couple months to get the experience then I would apply with a better more legit company. Hope this kinda helps and best of luck to ya!

 

[JPINFV]

First things first, if you feel that a patient needs further assessment and needs their lung sounds and pupils checked every 15 minutes, than grow a set and do it. You're not going to hurt the patient by listening to them every 15 minutes. Annoying and, in my opinion (does the hospital listen to the patient's lungs every 15 minutes? Even in the ICU? Nope) unnecessary? Yes. Harmful? No. If it bothers you this much, than do what you think is the right thing. Only you can control your actions.

After working here for a few weeks I've started to notice a few things that are really bothering me. Now I understand that these are non emergency calls but in the back of the truck no one is really doing vitals or assessments at all. Blood pressure, pulse ox, and respiration's is really about it. No physical assessments, no checking pupils, no lung sounds. I was taught every 15 mins if the patient is stable which normally our runs are not much longer than that. So that's not really something that is bothering me that much and it wouldn't probably bother me at all if they weren't making up vitals and writing them down.

Blood pressure, pulse ox (assuming that also includes recording the pulse... however I'll withhold judgement right now... time/place for that discussion), respiratory rate is your vital signs. Also, a continuing assessment is not the same thing as repeating your assessment. Do you have reason to believe that the lung sounds changed? Do you have reason to believe that the patient's pupil status changed? If you did a full head to toe exam every 15 minutes you'd be completing one just in time to start all over again.

Also the second thing that is really bothering me is the cleaning of the cots and ambulance. Some of the crew members will go 3 or 4 transports without disinfecting the cot or anything. All they do is change the sheet and sometimes the pillow case that is on the sheet. I'm kind of over here just like WTF?!

What's your address? I'll physically mail you a prescription of Grow-A-Set, take 2 tablets once per day, dispense 60 pills, refill 5 times. Yes, it sucks being one of the few people who cares. Clean the unit to the point that you think it should be (and to be honest, for most patients changing the sheets and, generally, disinfecting the handrails and buckles is enough). I'll definitely admit, though, that there were plenty of times where I changes the sheets and pillowcase and called it a day (however, sheets and pillow cases every between every patient). Your partner can't leave without you up front, so if that means you pull it out and clean it yourself, than do it.

You aren't going to change their minds, so just do it instead of whining about not doing it.

 

[WVNobody]

Calemt I understand d what your saying about quitting. But the company I work for understands that I don't want to stay there for a long time. They even told me it would be a good place to work and gain experience and then move on later on. They also understand that I'm more interested in the emergency side of things.

 

[WVNobody]

[QUOTEFirst things first, if you feel that a patient needs further assessment and needs their lung sounds and pupils checked every 15 minutes, than grow a set and do it. You're not going to hurt the patient by listening to them every 15 minutes. Annoying and, in my opinion (does the hospital listen to the patient's lungs every 15 minutes? Even in the ICU? Nope) unnecessary? Yes. Harmful? No. If it bothers you this much, than do what you think is the right thing. Only you can control your actions.


Quote:
Originally Posted by WVNobody View Post

After working here for a few weeks I've started to notice a few things that are really bothering me. Now I understand that these are non emergency calls but in the back of the truck no one is really doing vitals or assessments at all. Blood pressure, pulse ox, and respiration's is really about it. No physical assessments, no checking pupils, no lung sounds. I was taught every 15 mins if the patient is stable which normally our runs are not much longer than that. So that's not really something that is bothering me that much and it wouldn't probably bother me at all if they weren't making up vitals and writing them down.
Blood pressure, pulse ox (assuming that also includes recording the pulse... however I'll withhold judgement right now... time/place for that discussion), respiratory rate is your vital signs. Also, a continuing assessment is not the same thing as repeating your assessment. Do you have reason to believe that the lung sounds changed? Do you have reason to believe that the patient's pupil status changed? If you did a full head to toe exam every 15 minutes you'd be completing one just in time to start all over again.
Quote:
Also the second thing that is really bothering me is the cleaning of the cots and ambulance. Some of the crew members will go 3 or 4 transports without disinfecting the cot or anything. All they do is change the sheet and sometimes the pillow case that is on the sheet. I'm kind of over here just like WTF?!
What's your address? I'll physically mail you a prescription of Grow-A-Set, take 2 tablets once per day, dispense 60 pills, refill 5 times. Yes, it sucks being one of the few people who cares. Clean the unit to the point that you think it should be (and to be honest, for most patients changing the sheets and, generally, disinfecting the handrails and buckles is enough). I'll definitely admit, though, that there were plenty of times where I changes the sheets and pillowcase and called it a day (however, sheets and pillow cases every between every patient). Your partner can't leave without you up front, so if that means you pull it out and clean it yourself, than do it.

You aren't going to change their minds, so just do it instead of whining about not doing it.][/QUOTE]


JPINFV, thanks for your harsh but honest advice. You were correct in assuming what my vitals consisted of. And I understand what you're saying about only checking the pupils and head to toe as necessary but not unless I have reason to believe they have changed. My main concern is they don't even get a set of baseline vitals. Or check the lung sounds at all. Also so far we haven't put o2 on any of the patients. Also the sheets we have to fill out with each transport requires us to check lung sounds, vitals, pupils and all of that.

 

[STXmedic]

Have you had any patients yet that needed O2?

 

[WVNobody]

Needed o2? No. I was just always taught that every patient gets o2.

Maybe this is just some of the things that make my lack of experience show. I know you can only learn so much from a book and after that you learn on the job what is and what isn't necessary.

 

[JPINFV]

JPINFV, thanks for your harsh but honest advice. You were correct in assuming what my vitals consisted of. And I understand what you're saying about only checking the pupils and head to toe as necessary but not unless I have reason to believe they have changed. My main concern is they don't even get a set of baseline vitals. Or check the lung sounds at all. Also so far we haven't put o2 on any of the patients. Also the sheets we have to fill out with each transport requires us to check lung sounds, vitals, pupils and all of that.

If they're not getting baseline vitals, then they're bad children that you shouldn't follow. That said, only on rare cases did I get a set of vitals on non-emergent EMT level transports (i.e. anything not going to the emergency department) before departing. Vitals were the first thing I did in the back, but when you're taking someone back and forth to dialysis 3 times a week, you're playing chauffeur. These are patients who are, by and large, acutely stable. That doesn't mean that it's OK to become complacent, but gestalt/spidey sense plays a role in immediately categorizing whether the patient is sick or not.

 

[MMiz]

I think you'll find that heart rate, respirations, and BP are the essential vitals for stable medical patients. This is the standard for most services and medical practices. When patients were unstable or presented with new symptoms you'd do a more thorough medical assessment.

In EMS you're most concerned with major changes in patient condition. As an EMT-B I'd challenge your knowledge of breath sounds / pupil reactivity, and challenge you to examine how what you determine to be abnornal would change your treatment.

I agree with you about the cleanliness issue, but it also seems to be the norm at many services to just throw a new linen pack on the cot and call it a day. In my few years working in private EMS I never saw the units or cots thoroughly disenfected. Still, I wonder in the big picture how much it harms our patients.

I encourage you to fight the good fight and maintain your standards. Because I only worked a few shifts a month I'd show up early, thoroughly check out the unit, almost always have to add oil, stock supplies, and would clean it as best as I could.

Use this as an experience to learn, but realize that where you're working (against the advice of the world). Work hard, provide superior patient care, and hold yourself to a high standard.

Good luck!

 

[WVNobody]

If they're not getting baseline vitals, then they're bad children that you shouldn't follow. That said, only on rare cases did I get a set of vitals on non-emergent EMT level transports (i.e. anything not going to the emergency department) before departing. Vitals were the first thing I did in the back, but when you're taking someone back and forth to dialysis 3 times a week, you're playing chauffeur. These are patients who are, by and large, acutely stable. That doesn't mean that it's OK to become complacent, but gestalt/spidey sense plays a role in immediately categorizing whether the patient is sick or not.

Basically all we do is chauffeur patients but I understand what you are saying now. I guess my main concern is making up vitals to put in my narrative on our sheets to send in to insurance companies for billing..

I think you'll find that heart rate, respirations, and BP are the essential vitals for stable medical patients. This is the standard for most services and medical practices. When patients were unstable or presented with new symptoms you'd do a more thorough medical assessment.

In EMS you're most concerned with major changes in patient condition. As an EMT-B I'd challenge your knowledge of breath sounds / pupil reactivity, and challenge you to examine how what you determine to be abnornal would change your treatment.

I agree with you about the cleanliness issue, but it also seems to be the norm at many services to just throw a new linen pack on the cot and call it a day. In my few years working in private EMS I never saw the units or cots thoroughly disenfected. Still, I wonder in the big picture how much it harms our patients.

I encourage you to fight the good fight and maintain your standards. Because I only worked a few shifts a month I'd show up early, thoroughly check out the unit, almost always have to add oil, stock supplies, and would clean it as best as I could.

Use this as an experience to learn, but realize that where you're working (against the advice of the world). Work hard, provide superior patient care, and hold yourself to a high standard.

Good luck!

I appreciate the kind words. I'll be sure to do that.

I guess I'm just going to be "That Guy" that's a stickler to the cleaning procedures.

 

[Jim37F]

Much better to be That Guy who insists on getting a full baseline vitals (skin signs, lung sounds, pupils, GCS/A&O, BP, Respiratory and Pulse rates) every patient every time and full disinfect, then That Guy who never takes any vitals relying on last sets in the chart (which could be hours or even days old) and doesn't pay any attention to the patient in back

 

[EMTnurse]

I guess I'm not really seeing anything wrong. We don't fully disinfect the cot after each call unless we have reason to. Sheets always and a quick wipedown usually, but not always. I don't know who taught you everyone gets O2, but that is very wrong. Particularly in non-emergency transport. I work in a hospital, and many pts on my floor get transferred to SNFs. If they weren't on oxygen in the hospital, they aren't going to suddenly out them on it. I have no idea if the transport folks do baseline, but I'm certain they don't do a full head to toe.

My suggestion, if you want to gain emergency experience, is to find a volunteer agency and run with them. Also, remember, often what you learn I'm class is the "ideal" way, but often not what really happens. Most of healthcare is using critical thinking and being able to decide what the or needs, actually needs not what you memorized and are just doing without any idea why.

 

[Mariemt]

Needed o2? No. I was just always taught that every patient gets o2.

Maybe this is just some of the things that make my lack of experience show. I know you can only learn so much from a book and after that you learn on the job what is and what isn't necessary.

I've had many many calls and can tell you well over half do not need o2.

Stick to your standards.

My cot and rig gets disinfected between every patient, not only for good patient care but for my safety too.
Be that guy. Rally for your patients
But to be truthful, I only do one full assessment with pupils temp etc. If they don't have a head injury or stroke symptoms I won't do pupils again. I rarely do pupils on a patient with a hx of seizures , unless they have a head injury .I do temp once in beginning, once at end, unless they have an infection then I do it every 15. That is for the patients comfort. The less I mess with them the better

The rest I do every 15.

 

[Medic Tim]

I need some advice from you guys on here and I would like to keep it as anonymous as possible so I'm not going to mention any names or companies. To give you all a little bit of back ground, I'm a newly certified state EMT-B. When I graduated high school my plan was to go to nursing school but while I was waiting to get accepted into the program due to the long waiting list I took an EMT course and my instructor pretty much changed my mind because after thinking about it all I was really interested in was ICU or ER, emergency type stuff. Well I will be starting a Paramedic program in a couple of months, either this fall or more likely this spring. I have no experience, never even been in an ambulance prior to my current job. No firefighting or anything. Well when I passed my class and got my state card I applied at 3 surrounding counties with in driving distance and 1 private transportation service. I went to a hiring exam and interview with one county and basically got told I had no experience. Which they were correct, I had never been in an ambulance before. I went to a hiring exam for another county and am currently on the waiting list for an interview. In the meanwhile due to personal reasons I needed a better paying job then my $7.60 an hour part time job that I was working. I got called for an interview with the private transport company and got the job offer the same day. I took a few days to think about it and couldn't resist the hourly pay.

The company I started working at a few weeks ago is strictly a non-emergency transport company, unless we roll up on a car wreck or something like that. The company has a bad reputation in the EMS world where I live but I took the job anyway. The plan is to work here until I can get hired on at a county because like I said I'm really not interested in non-emergency. If I was I would of went to nursing school.

I have a few reasons why I took the job against my better judgement and against my instructor and a couple of other peoples advice. Mainly my weakness is medical calls, I thought that since its a transport company hopefully that will help some. Also I need some experience. Some experience is better than no experience I'm hoping. And I really just needed the money.

After working here for a few weeks I've started to notice a few things that are really bothering me. Now I understand that these are non emergency calls but in the back of the truck no one is really doing vitals or assessments at all. Blood pressure, pulse ox, and respiration's is really about it. No physical assessments, no checking pupils, no lung sounds. I was taught every 15 mins if the patient is stable which normally our runs are not much longer than that. So that's not really something that is bothering me that much and it wouldn't probably bother me at all if they weren't making up vitals and writing them down.

Also the second thing that is really bothering me is the cleaning of the cots and ambulance. Some of the crew members will go 3 or 4 transports without disinfecting the cot or anything. All they do is change the sheet and sometimes the pillow case that is on the sheet. I'm kind of over here just like WTF?!

So what do I do guys? I need the job, the pay, and the experience but at the same time I don't approve of a lot of things that goes on there. I guess what I'm going to do is wait until I've been there long enough that I get to ride in the back with the patients by myself while my partner drives and do everything the right way? I mean I;m still kind of new and I dont want to be that guy that tries to ruin a company by tattling on everyone but at the same time not having a clean work environment endangers my health as well as other.

So what would you guys do? Do my own thing that I know is right?

Only you can control your own actions. If you feel something should be done that isn't... do it. Working non emerg. pt transports is a really good way to practice assessments.

Needed o2? No. I was just always taught that every patient gets o2.

Maybe this is just some of the things that make my lack of experience show. I know you can only learn so much from a book and after that you learn on the job what is and what isn't necessary.

Like any medication O2 has indications. It is bad medicine to give a pt meds or treatments just because................that said follow your protocols but realize they are not always what is best for your pt.

 

[Wheel]

I say congratulations for not going with the flow on some less than ideal behavior. You're new, so you'll provably need a while before you get in a groove with your assessments, what you need to do and when. This job will be a good time to practice.

Don't be ashamed for taking the job though. Lots of people start out in IFT for the experience to get on a 911 rig. You're doing what you have to do to pay the bills and that's plenty for you to be proud of. My advice for you would be to keep up,your enthusiasm, learn everything that you can, and apply to every 911 company that you would possibly commute to.