Omg dont touch me!

[VentMedic]

This is a great example of why the EMT-B program needs to be at least 1 year with no less then 200 hours of clinicals with direct patient contact and not 8 hours at an ambulance station having coffee.

During that time any personal issues like this can be identified and dealt with. That may also mean that you would find out early that healthcare is not for you.

It would be a benefit to the patients who would not have a provider with issues. It would also prevent a person from continuing in a profession that they are not suited for.

 

[MissTrishEMTB08]

I would rather make the attempt to get that hospice patient to their home to be surrounded by loved ones in an eviroment they loved. I have transported patients with respirations of 4-6..... one very memorable man who died as soon as we put him in his bed at home..... people who were not expected to make to our destination.... All so they could be anywhere BUT a cold unfamiliar hospital bed that was not "home" for them. It humbles you.

As far as the right to be uncomfortable.... You absolutely have the right to feel uncomfortable. The point everyone here is trying to make to you is touching happens. If you are so distraught and upset about a scared old lady thats FTD seeking comfort during her end, then perhaps you shoudl rethink what your doing. You are going to be touched a lot more ways. Pretty much everything from your feet to your hair will be touched by a patient at some point. Your legs will be rubbed, arms stroked, breasts grabbed, butt massaged. Some intentional, some "accidental."

If you are this creeped out about a desperate old lady, you are going to have serious issues, very quickly. Some of my worst "offenders" are little old dementia men. I have been felt up more by those guys than the drunk homeless ones. Its all a matter of accepting it, redirecting their hands (usually to mine, and I HOLD THEIR HAND!), or depending on what they are touching just letting them.

the patient who died was not going home, she was leaving home to go to the Hospice House. Had we not transported her, she would have died at home. McFeely wasn't going home either, she was leaving the hospital to go to the ame hospice(coincidentally in the same room that we dropped the dead one off in.). 99 percent of our hospice transfers are going to the same hospice house and leaving nurses qho had cared for them weeks or family at home and going to a place they have never been before. if they are circling the drain I would think they would want to stay where they are familiar.

 

[Tiberius]

I'd rather not have hands on my knees either....but, while on the truck I put these issues on the back burner. Also it's easy to "take command" of the situation. I would just hold her hand, talk to her about whatever she wanted and continue to provide reassurances in that manner; I'd never say anything like "get out of my personal space", etc. In this industry, compassion is a big part of the game. It's best to sit beside the pt in these situations rather than behind them, especially if you sense that (or if they tell you) they're scared.

 

[BossyCow]

Trish, you need to sit back, put your defensiveness on hold for enough time to actually read what is being posted here. That includes the posts you are making. When you first started this thread, you were using exclamation points, phrases like OMG and asking the forum what they thought, and how they handled similar situations.

When you were given very honest responses to that post you immediately became defensive about your right to set your own personal boundaries and the inappropriateness of the pts behavior, the inappropriateness of the facility for putting these types of pts in your rig, the unfairness of us responding and a reiteration of the righteousness of your position.

In some ways you are correct. You have every right (I said so in an earlier post) to determine your own personal boundaries. You absolutely have the right to refuse to be touched. No one is arguing with that!

Where we disagree is the expectation that the injured and dying will have the ability to operate within those parameters. Your expectation that you must be respected and treated in accordance with your own personal rules is an unreasonable expectation given your chosen line of work.

People will die on their own timetable, not at your convenience or when and how you think they should. Families will make determinations for the care and transport of their loved ones based on their own personal needs, desires and motivations, not yours. Facilities will decide who goes where, when and how as is appropriate in their eyes only.

These are facts. They may be unfair, inconsiderate, inappropriate, not what you deem correct, uncomfortable to endure, but they are still the working conditions of EMS. We have all been where you are. We have all had to reconcile our personal histories with the day to day operation of our duties in EMS. What pretty much everyone here has been telling you is that this is going to happen again and again and again. It doesn't matter how justified your feelings are, because they truly do not matter to your pts.

So, the real issue here is, do you want to continually subject yourself to something that is so uncomfortable? Are you going to be able to overcome your issues with touching? Because if you can't, no matter how unfair that seems, EMS is not for you.

 

[Jon]

I think Bossy said it best.

Trish... I don't like to be touched either... but, as others have said, my threshold is a little different between the 3am drunk and a 90-year-old woman who is on the way to hospice and looks like she's going to kick the bucket any minute.

When I take a blood pressure on many patients, I rest the patient's arm on my leg... it reduces some of the motion noise. I usually put the arm back on their lap... but I've had some patients... like yours, or older patients with dementia, or other major life changes... and they just want some human contact and comfort.

I've held hands... I've had patients hold onto my knee. If they are scared... and it makes them a little more comfortable... I'm not going to be a ****.


Jon

 

[SmokeyBear]

I've had this happen many, many times. Most of the time its because of the height of the stretcher relative to where you are sitting in the ambulance--especially when taking vitals like BP in which the patient will often stretch their arm out towards ones knee. I have also found the LARGER patients are the more often they tend to try to "rest" their arms on your legs or what ever is parallel to the stretcher, this seems especially the case with obese patients (at least in my experience). The fact that they are "touchy-feely" isnt unusual either. They generally mean nothing by it and if the patient feels scared or anxious they may ESPECIALLY want to hold your hand or grasp on to your shirt side. When a patient is in trouble and if it helps them, they can reach for my hand, grab my knee, as much as they wish as long as it doesnt effect my ability to provide proper care. This is a touchy type job. But if it bothers you that much sit at the head of the stretcher and stand when working the patient.

 

[MissTrishEMTB08]

Trish, you need to sit back, put your defensiveness on hold for enough time to actually read what is being posted here. That includes the posts you are making. When you first started this thread, you were using exclamation points, phrases like OMG and asking the forum what they thought, and how they handled similar situations.

When you were given very honest responses to that post you immediately became defensive about your right to set your own personal boundaries and the inappropriateness of the pts behavior, the inappropriateness of the facility for putting these types of pts in your rig, the unfairness of us responding and a reiteration of the righteousness of your position.

In some ways you are correct. You have every right (I said so in an earlier post) to determine your own personal boundaries. You absolutely have the right to refuse to be touched. No one is arguing with that!

Where we disagree is the expectation that the injured and dying will have the ability to operate within those parameters. Your expectation that you must be respected and treated in accordance with your own personal rules is an unreasonable expectation given your chosen line of work.

People will die on their own timetable, not at your convenience or when and how you think they should. Families will make determinations for the care and transport of their loved ones based on their own personal needs, desires and motivations, not yours. Facilities will decide who goes where, when and how as is appropriate in their eyes only.

These are facts. They may be unfair, inconsiderate, inappropriate, not what you deem correct, uncomfortable to endure, but they are still the working conditions of EMS. We have all been where you are. We have all had to reconcile our personal histories with the day to day operation of our duties in EMS. What pretty much everyone here has been telling you is that this is going to happen again and again and again. It doesn't matter how justified your feelings are, because they truly do not matter to your pts.

So, the real issue here is, do you want to continually subject yourself to something that is so uncomfortable? Are you going to be able to overcome your issues with touching? Because if you can't, no matter how unfair that seems, EMS is not for you.

I have overcome a tremendous amount to stay in the EMS program. I used to be painfully shy and quiet to the point you would forget I was in the room, my school is murderously expensive because its an AS degree at a private college and I am young, single with no children but no parental help. I have over come a deathly fear of needles. I -hated- needles. I bawled my eyes out the first time someone stuck me (but I cried harder when I stuck them because I wasnt ready to try on a real person yet, and my instructor was forcing me too, and I really really didnt want to hurt them and had no earthly clue what I was doing.). Ive grown a thicker skin to the taunting and teasing of my classmates (They call me the blood god now! I tend to forget to pop the tourniquet and tamponade which creates a fountain of blood.) and I have been working for a very long time on my own mental issues and have began to overcome them and its not a dislike to being touched, its a dislike to having specifically ONE area of my body touched, which are my knee/upper leg. I dont mind hugs, they can touch my face (if they arent too infectious or fluidy), waist, shoulders, stomach, hand, arm, anywhere else.

EMS IS for me. I love every single minute of it, I think its fascinating and love taking care of patients, its also my stepping stone into nursing school and eventually med school. Im not interested in it because its a cool or respected job, and certainly not in it for the money. I know I can be a great medic and I know right now Im a fantastic EMT. This is a little road bump, it really didnt bug me that much, I just kinda vented after a rough day and I guess I picked the wrong patient to vent over.

I started getting defensive when people told me to reconsider career paths, it sounded so condescending and it ticked me off more than it should because I worked so hard to stay here and Im not going to give up and throw in the towel now.

You can say im in it for the wrong reasons if youd like, or that I shouldnt be in EMS and reconsider my career path, but it really doesnt matter because Im in it to stay.

Regarding the woman who died in transport, considering the thread I had posted about it and how people were saying refuse transport and all of that, plus the staff at the hospice house even said that the woman should NOT have been transported, I dont think Im unfair in saying that people minutes from death shouldnt be transported, at least not on a BLS truck.

 

[rmellish]

Regarding the woman who died in transport, considering the thread I had posted about it and how people were saying refuse transport and all of that, plus the staff at the hospice house even said that the woman should NOT have been transported, I dont think Im unfair in saying that people minutes from death shouldnt be transported, at least not on a BLS truck.

Why not a BLS truck? I'm assuming pt was DNR. Even with comfort measures, pt can be dosed prior to ems transport. Why take a paramedic out of service to transport a pt which ALS cannot do much for from a legal and ethical standpoint?

 

[daedalus]

She better be damned glad she is NOT one of my nurses or any of the hospitals I have worked in. Nursing as well as all of medicine is a compassion business. Science is ONLY one part of it. If you can't handle the "humanistic part" then you need to get the heck out! We have enough cold, insensitive persons .. (hence usually physicians) and that is why they have very little trust from patients. Maybe, that is why we are getting the same reputation?

Wow! I would be insulted that a patient would have to ask to touch me? My space? WTF? .... Get over yourself QUICKLY! The business is a people and caring business. Those patients are clients and those clients are our patients and those patients are humans! If you can't deal with that; it's time for a career change. Really the business is NOT ABOUT THE PROVIDER IT IS ABOUT THE PATIENT!. This is not to say we should allow inappropriate contact nor abuse, but for the patient not to express appreciation or have personal contact because.... the medics personal space? Ludicurous!

If you need "your space" I believe they have some openings in the Parks and Recreation or some "factory" .. where one can be in touch with themselves and do us (the profession) and the patients a favor...get the hel* out!

Remember, we are in the business of caring for humans, and I agree with that. Humans, by virtue of being human, vary! Some are uncomfortable being touched on the leg, and are otherwise wonderful compassion filled providers!

I know that, getting into EMS, most have the best of intentions. And if your not a whacker, etc, but a true EMS provider with a passion for medicine, you care about your patients and your responsibility to them. Medicine is as much about curing the body as it is caring for the person. I still think there can be boundaries.

 

[BossyCow]

I have overcome a tremendous amount to stay in the EMS program.

Again Trish, how much you have overcome is not the issue. It's not about you! How often you cried during class is not the issue, what personal demons you overcame is not the issue. The issue is that EMS is tough, hard, annoying, life or death stuff and you still seem invested in getting people to appreciate what this all means to you.

In the back of the rig, the only one who's history matters is the patient. And I still stick by my initial assumption that you need to get clear on your role in the back of the rig. Please stop attempting to show us how tough this has been for you. You are not the one on your way to hospice. You are not the one getting CPR. Quit whining "oh poor me" and move on.

 

[MissTrishEMTB08]

Why not a BLS truck? I'm assuming pt was DNR. Even with comfort measures, pt can be dosed prior to ems transport. Why take a paramedic out of service to transport a pt which ALS cannot do much for from a legal and ethical standpoint?

Because the patient technically didnt have a valid DNR. The family couldnt locate it, so when she died she should have been worked but instead my partner illegally chose to let her die and got a copy of the DNR that was signed after she was already dead.

Edited to clarify, after she was already dead for a couple of minutes and before anyone knew she was dead except the RN at the hospice house is when hospices DNR got signed. We waited around in her room with the nurse, and the door closed for about 20 minutes and then OOPS LOOK SHE DIED to cover his butt.

Edited again to add, Im sure the husband probably already knew she was dead, but still.

 

[John E]

Please just stop now...

there's an old saying about being in a hole and realising that the first thing to do is to stop digging.

Stop slandering people on a public forum. Stating that your "partner" illegally allowed a patient to die is a legally actionable offense. You're clearly not qualified to be making those kinds of comments.

Stop thinking that your ability to overcome psychological issues is a valid reason to remain working in EMS.

Get some counseling, please.

John E.

 

[imurphy]

And that is why they made recipe books for EMTs and Paramedics.

If you can not use your own judgement or don't have the clinical skills to know when a patient is frightened or has just spent the last several months inside a hospital and is now on their way to hospice to die, then find a career with cadavers. At least they won't reach out and touch you or express some form of human emotion.

VentMedic. You haven't been working around corpses enough! They sometimes touch you! Now THAT's bad touch!

To the OP: I have to tell you that I have done my fair share of hospise runs in my years. And after pretty much any of those patients have hugged me, held my hand or anything, I felt disgusted after.

Disgusted at myself that I couldn't do anything more to help these poor people. Remember, with any patient ever, even Jane Doe with the cold, you could be the last person they see.

Whenever I did Inter-facilities, I always looked at these people AS people. Not patients. People, with families. And would you not like your Mom or Dad looked after in the same way? Or would you rather the last people they see be uncomfortable with them being people?

 

[Ridryder911]

VentMedic. You haven't been working around corpses enough! They sometimes touch you! Now THAT's bad touch!

If they reached out and touched you... they were not dead. Dead people do not reach out...

R/r 911

 

[MissTrishEMTB08]

there's an old saying about being in a hole and realising that the first thing to do is to stop digging.

Stop slandering people on a public forum. Stating that your "partner" illegally allowed a patient to die is a legally actionable offense. You're clearly not qualified to be making those kinds of comments.

Stop thinking that your ability to overcome psychological issues is a valid reason to remain working in EMS.

Get some counseling, please.

John E.

Sorry, I thought everyone knew not working a patient in arrest with out a DNR IN HAND, signed and on its colored paper, was bad mojo, at least in my protocols.

 

[JPINFV]

Sorry, I thought everyone knew not working a patient in arrest with out a DNR IN HAND, signed and on its colored paper, was bad mojo, at least in my protocols.

Bolded the important part because that patient would have been considered to have a legal DNR (family request to withhold resuscitation) where I worked.

If they reached out and touched you... they were not dead. Dead people do not reach out...

R/r 911

"I don't want to go on the cart."

 

[MissTrishEMTB08]

Bolded the important part because that patient would have been considered to have a legal DNR (family request to withhold resuscitation) where I worked.



"I don't want to go on the cart."

Thats kinda scary, like what if the family is waiting to move in on Grandmas savings accounts and now that shes in arrest ask you not to do it? Or people changing their mind later saying NOOOO I WANTED HER WORKED.

In Florida you HAVE to have the DNR, on its colored paper, signed. If you dont have it, you have to work it unless there are obvious signs of death like a missing head, dependant lividity, or rigor. Even then, only certain protocols allow the paramedics to call it. And in return, if they have a valid one the family cant suddeny decide, no, I want you to save her. Well if you wanted that then why did you show the DNR??

 

[JPINFV]

Thats kinda scary, like what if the family is waiting to move in on Grandmas savings accounts and now that shes in arrest ask you not to do it? Or people changing their mind later saying NOOOO I WANTED HER WORKED.

Any disagreement or concern over the wishes of the family means that the decision on DNR gets kicked up to medical control and the patient worked pending the outcome. Of course if the family is trying to get Grannie's savings accounts, then why call EMS to begin with? As far as people changing their minds, the first thing that goes in my narrative is "Pt DNR per _____, patient's [relationship]" followed by the relative's signature AND that relative gets to sign the runsheet at the bottom as well. It's great for hospice discharges.

 

[Flight-LP]

Because the patient technically didnt have a valid DNR. The family couldnt locate it, so when she died she should have been worked but instead my partner illegally chose to let her die and got a copy of the DNR that was signed after she was already dead.

Edited to clarify, after she was already dead for a couple of minutes and before anyone knew she was dead except the RN at the hospice house is when hospices DNR got signed. We waited around in her room with the nurse, and the door closed for about 20 minutes and then OOPS LOOK SHE DIED to cover his butt.

Edited again to add, Im sure the husband probably already knew she was dead, but still.

Yea it would have been nice to have the papers, but what your partner did (more specifically didn't do), was exactly as the pt. wished. THE PT. WAS A HOSPICE PT! They do not go to hospice as a full code. They do not want to be worked. There is advanced directive paperwork, durable power of attorney's, and DNR's stating that very thing. The cookbook attitude of "if I don't have the papers I have to work him/her" is total b.s. Ask the family their wishes, contact the physician, contact the hospice, they will have the precious piece of $.05 paper that you see as the ultimate decision whether or not to resuscitate a person that does not wish to live.

Even outside of the whole "my issues" drama that you are having difficulties with, you seem to be clueless to a large aspect of your job. If the hospice pt's. are a large percentage of your population, then maybe you need to research a little into their operation; how they work and what they are about. The hospice folks know what they are doing; they look at all aspects from family to quality of life. It is not your place to worry about who gets access to grandma's money and your opinion on the matter is again irrelevent. Focus on what needs to be done, i.e. learn your job without all these personal opinions, feelings, and emotions. Listen to what others have to say. You may not like it, it may not be correct, but at least listen to it. Otherwise, your EMS career will be short lived. That my dear, is a guarrantee......

 

[Hastings]

Yea it would have been nice to have the papers, but what your partner did (more specifically didn't do), was exactly as the pt. wished. THE PT. WAS A HOSPICE PT! They do not go to hospice as a full code. They do not want to be worked. There is advanced directive paperwork, durable power of attorney's, and DNR's stating that very thing. The cookbook attitude of "if I don't have the papers I have to work him/her" is total b.s. Ask the family their wishes, contact the physician, contact the hospice, they will have the precious piece of $.05 paper that you see as the ultimate decision whether or not to resuscitate a person that does not wish to live.

Wanted to add that from a legal perspective, you can be in as much trouble for working someone without a written DNR in situations similar to this one. Use common sense. I know of one instance where a medic was sued by a family for successfully working a hospice patient that died en route. Seriously. Even though there was no paper, the family argued that it had been implied under the circumstances and expressed by those involved. I can't say how it turned out, but just know that it's not always so by-the-paper. I think it this specific case, your partner did the right thing, though it's not the textbook answer from EMT/Medic school.