question for nyc (or any really) paramedics .....

[emt seeking first job]

I am going to be joining a vollie bls unit in nyc.

They often call for ALS back-up.

Any pointers on not being "that guy" on scene interacting with the paramedics.

And how do I handle it if my crew chief is being that guy in front of a paramedic.

Any advice anyone?

Thank you.

 

[MrBrown]

Know what you are on about, have the fundamentals of care done and have a good, clinically objective handover.

I would expect be given a good set of vital signs and examination findings, have the patient on oxygen (if appropriate), bleeding controlled, the patient is being kept warm, moved to the ambulance if appropriate, fractures are splinted, if he's in cardiac arrest then you to have shocked at least once and have good CPR going etc

Think of it like when a House Officer talks to his Registrar or Ambulance Officers talk to the hospital; keep it brief, appropriate and professional.

A good handover would be something like this: "Hello there, here we have Bernie, he's 75 and has history of hypertension, angina and had an MI five years ago for which he takes metaprolol, captopril, GTN, aspirin and coumadin. Today he has feeling short of breath since 6am but no chest pain, and never had it before. Some bilateral coarse basal crackles and hypotension at 95/65, have him on six litres by mask and he says it helps a bit. Resp rate of 16 and pulse is 90. GCS of 15"

Does that help?

 

[94H]

As someone who has been (and I guess still is) a member of a vollie in NYC, I can tell you it is very rare that we call for ALS as most of the transport times in NYC are less than 5 mins to the hospital.

I'm not sure about your squad but mine would "buff" calls that came over the FDNY radio so we would get there around the same time as the dispatched crew, so there would be no major information to give. Usually it is whoever got there first gets the patient.

I have interacted with medics twice in two years, one was a cardiac arrest in which we arrived on scene at the same time as the BLS and ALS trucks and once when we arrived at the same time as the FDNY ALS truck.

 

[Shishkabob]

I don't understand what you're asking.


Are you saying it's bad to interact with Paramedics at your agency?

 

[ExpatMedic0]

I can only offer advise from my experience in another system on the west coast. Every system works differently but here go's....

Gather a complete medication list before they arrive, along with the patients name address DOB, SAMPLE history ect...

Introduce the Patient to the Paramedic.
Give the Paramedic the patients Chief Complaint, Any pertinent medical history or findings, and what you have done so far and how the pt. tolerated it. Do not ramble on and on. Just like a quick 15 second report. Hes probably going to redo everything you already did anyway in your initial assessment. Then find the scribe... maybe the Paramedics partner or Fire (if they do first response in your area) Whoever is holding the clipboard.
Unload all your detailed medication list, patients name, address, and SAMPLE report on that guy along with base line vitals ect ect.

The main thing I found was not wasting the ALS transporting crews time. I felt like my main job was to get all the information ready for them as soon as I had BLS stabilized the patient. That way when they arrive they have the complete patients information(name, addy, DOB) (and often long) medication list, baseline V/S, and SAMPLE history on paper ready go.

 

[emt seeking first job]

Thank you.

I am going to re-read what everyone has posted here multiple times.

 

[fma08]

I am going to be joining a vollie bls unit in nyc.

They often call for ALS back-up.

Any pointers on not being "that guy" on scene interacting with the paramedics.

And how do I handle it if my crew chief is being that guy in front of a paramedic.

Any advice anyone?

Thank you.

Please define "that guy". As long as you do your job thoroughly, there shouldn't be any issuses unless the paramedics have a stick up their @$$. But, lord knows no paramedics are like that

 

[emt seeking first job]

I rephrase the question then. In a positive frame.

How can I be that guy, where that guy is the emt-b that all the paramedics, when they roll up, are glad to see on scene.

 

[fma08]

I rephrase the question then. In a positive frame.

How can I be that guy, where that guy is the emt-b that all the paramedics, when they roll up, are glad to see on scene.

Know your stuff, keep the education going. And as stated above, do your job thoroughly. Otherwise, it'll just take time time for the medics to get to know you, know what you're capable of. If you do a good job, and do it consistantly, you'll be that guy ^_^ There are some first responders in my service area that I'm happy to see on scene because they are good at their job, and others that seem to be in it for the pager and the title. But, it all begins with education.

 

[Shishkabob]

How can I be that guy, where that guy is the emt-b that all the paramedics, when they roll up, are glad to see on scene.

Easy:

Don't say something you don't know, don't try to use a word if you don't know the definition, don't give a field diagnosis if you can't back it up, and don't act like you know the best course of treatment if you don't understand what's going on.


All else will fall in to place.

 

[DrParasite]

I rephrase the question then. In a positive frame.

How can I be that guy, where that guy is the emt-b that all the paramedics, when they roll up, are glad to see on scene.

know your stuff. know the NYC protocols (they differ in NYC than in the rest of NYS, as well as in the surrounding states). Know what you can handle, and what you need help to handle.

know the difference between sick and not sick, and know if the patient is not sick, than no need for ALS, and if the patient is sick, then no need to wait around on scene.

remember, the two basic interventions BLS can provide at oxygen and transport. that and good documentation for the ER so they can treat appropriately. so on sick patient, make sure you apply oxygen, and are already thinking about how you are going to get the patient packaged for transport.

most paramedics you deal with will already have their preconceptions about you before they even meet you, and some will be accurate, but most not. accept and understand that you aren't going to convince everyone that you know what you are doing. also keep in mind you will meet paramedics who don't know their *** from a hole in the ground, and despite this, they will still think they are better than you. accept it, deal with it, remember, do what is in the best interests of the patient. and also remember, there will be some medics where nothing you can do will ever change your mind about you.

 

[46Young]

+1 on schultz and Dr.P. Also, please refrain on asking questions during the call for learning purposes. Most medics will be happy to answer your questions and teach you a thing or two after delivery to the ED, but during the call they need to think and act without unnecessary distraction.

Another thing, some medics get tunnel vision and may also be new and preoccupied with certain things during a call. They may forget to direct you to initiate/resume chest compressions, give O2, replace a neb with an NRB or NC after the med finishes, etc. You can ask the medics if they want one of those things done if they forget to tell you.

If you're called to the arrest, be it peds or adult, and the pt is breathing and has a pulse, relay that over the radio immediately. Some crews may be driving recklessly, especially for the peds arrest (usually just a seizure in my experience). They can 10-20 at their own discretion, or at least drive more safely. A simple radio report of "Central, advise incoming units that this is not an arrest," will suffice.

Some medics skell out and walk everyone down, or won't board and collar certain pts that need it for liability purposes. You can offer to take the pt to the bus via stair chair, reeves, or B&C, whatever the case may be. If they tell you no, at least you offered and it's on them if something bad goes down.

 

[somePerson]

Like others said, give a short,concise, and a partinent turn over. If you're rambling about stupid stuff the medic is just going to ignore you anyway and start assesment over, and if you keep rambling it just takes that much longer for him to start doing his whole assesment again.

 

[46Young]

Like others said, give a short,concise, and a partinent turn over. If you're rambling about stupid stuff the medic is just going to ignore you anyway and start assesment over, and if you keep rambling it just takes that much longer for him to start doing his whole assesment again.

I advise the OP to sick with gender, age, mental status, C/C, V/S, and demographics if you got that far. Example, the medics walk in, you say: female, 66, verbally responsive, oriented to name only, family advises her BGL is 40, BP 156/92, P 92, RR 20, we're getting their name, SS#, med list, etc. That takes all of 30 seconds. That's actually how I begin my face to face report to the triage nurse. They want a long winded story from EMS as much as medics want a long winded story from EMT's.

When you get onscene, say hello to them from across the room, and see how they respond. Go up to them, and slowly grab their wrist for a quick pulse check while you speak to them. Now you have the start of a mental status eval, a pulse, skin CTC, and how they're breathing (are they talking in complete sentences, etc). Have someone knock out a BP and resp count while you determine a chief complaint, and get a third provider to secure meds and demographics, if available. Meanwhile, you can open up the stair chair, lay out a sheet, place them on the chair, and put them on O2. That takes all of three to five minutes. Now you look like superstars to the medics. If the medics had a greater than 10 min ETA initially, if the pt and their condition can tolerate a chair, then you should have them downstairs or on the way down (radio this to the medics when you leave the apt), The medics will heart you big time if you can do that.

Occasionally the medics will radio for pt info as they arrive onscene, before they come inside. Now you have something to say other than "we just got here, we haven't had a chance to do anything yet".

 

[citizensoldierny]

As a soon to be EMT-CC on Long Island my opinion would be don't delay and just wait to hand your patient off to the next level of care. Have them packaged and have implemented your BLS measures i.e. splinting, O2, vitals, and whatever else your systems protocols allow. And obtain a decent pt. history, meds , etc. before my arrival. When I worked AMR in Mass. nothing pissed off the medics more than arriving on scene and having to wait for the pt. to get on the stretcher, or having no O2 on etc.

 

[82-Alpha599]

not to change the subject, but what is the EMS system like in New York City?

sounds like multiple ambulances racing to calls??

 

[firecoins]

not to change the subject, but what is the EMS system like in New York City?

sounds like multiple ambulances racing to calls??

Not really. NYC is way short on ambulances.

 

[DrParasite]

Not really. NYC is way short on ambulances.

haha, that's pretty funny.

I would say NYC's manciple EMS system is waaaay short on ambulance, and has to relay on non-municipal EMS units, as well as a first responding FD that wants nothing to do with EMS, in order to maintain some type of reasonable response times. Probably one of the more screwed up systems in the US, as well as mismanagement and underfunded.

NYC has the highest overall EMS call volume in the US, but it's # of call per unit is much lower than most people would think. There are much busier systems in the midatlantic and the northeast than NYC

IIRC, ALS goes to ALS coded calls, BLS goes to BLS coded calls, ALS & BLS go to cardiac arrests, and the FD goes on ALS calls and other calls where their services can be useful.

 

[46Young]

haha, that's pretty funny.

I would say NYC's manciple EMS system is waaaay short on ambulance, and has to relay on non-municipal EMS units, as well as a first responding FD that wants nothing to do with EMS, in order to maintain some type of reasonable response times. Probably one of the more screwed up systems in the US, as well as mismanagement and underfunded.

NYC has the highest overall EMS call volume in the US, but it's # of call per unit is much lower than most people would think. There are much busier systems in the midatlantic and the northeast than NYC

IIRC, ALS goes to ALS coded calls, BLS goes to BLS coded calls, ALS & BLS go to cardiac arrests, and the FD goes on ALS calls and other calls where their services can be useful.

That's accurate. Also, if the ALS has an ETA > 10 mins, BLS will be dispatched as well.

 

[46Young]

not to change the subject, but what is the EMS system like in New York City?

sounds like multiple ambulances racing to calls??

See above. Also, vollie units try to buff (steal) jobs from paid units. In general, regarding paid units only, they're all equiped with AVL's. So, the closest unit is recommended. If you're returning to your cross street location to post, you can be tagged for a job. When a good one comes over the air, other units will try to buff. They must give an eta better than the dispatched unit, and it must be accurate. Typical air traffic - "I don't know where 46 Charlie is coming from, but we have a 2-3 min eta." 46 Charlie: "we have 4-5, 46 Eddie can have it." Vollie units can't do this, however. Units will also swing by the call location, not L&S, and get themselves "flagged" for the job, and then get added on. This is typical for shots, stabs, bad MVA's, violent EDP's, etc.