Can Medics be wrong?

[Katie]

everybody is wrong sometimes. first rule is do no harm. if it's abundantly obvious and it is placing the pt in danger then you need to speak up (in as tactful a way as possible). if not ask questions later.

 

[emt19723]

i think i read the post from which this topic stemmed from. and although, the other post that i read was pretty much on the "WTF was that guy thinking???" side of my mind. i definitely think that this is a good post to have on here. behavior like what i read should never be tolerated.

We do this job, obviously, because we want to HELP people. when you even start to THINK about how you can get one up on, or teaching a pt a "lesson", it's time for you to find a new line of work. people call us in their time of need...no matter how petty WE may think it is, its usually a big deal to the pt. we need to be as respectful as possible.

 

[Jochempeiper]

I ran with a un-named Float Medic who let a guy go to the Hospital with only a 20 Gauge IV. The bad part is the guy was having almost constant PVC's and Tombstone T-Waves and his QRS complex was all stretched out with a slight ST Elevation.

 

[Flight-LP]

I ran with a un-named Float Medic who let a guy go to the Hospital with only a 20 Gauge IV. The bad part is the guy was having almost constant PVC's and Tombstone T-Waves and his QRS complex was all stretched out with a slight ST Elevation.

I don't understand. What is the problem with a 20 guage IV cath??

 

[reaper]

I guess he means there was no 12 lead done or is in that group that thinks every IV should be 16ga or bigger!

 

[snaketooth10k]

The pain is definitely something that might be a problem with a person with a rhythm like that... sound like a gentle breeze could put them into a full arrest...

 

[VentMedic]

2 lines are preferred since there are issues of drug compatibility during tx ine the ED, 2nd line for security as well thrombolytics need their own line. However, if one line is established the other one can be established in the ED if there are other immediate things that may need to be addressed such as airway in addition to the one IV. If it is only one paramedic and one EMT, who is driving, one may have to prioritize to get the most immediate treatment done.

There were several points not mentioned by the poster such as:

Tthe length of transport.

Whether the paramedic thought it was best to get moving if one line was already established.

Pain issues which treatment can be initiated with the first line.

If the patient is a hard stick, multiple sticks in the back of a truck has its risks.

In the ED, there are times when any established IV is an amazing thing from some crews.

 

[BossyCow]

Presentation is EVERYTHING!

I think it all has to do with how you phrase your comments. "WTF did you do THAT for?" is probably going to raise the hackles on the most patient, competent medic. Asking the medic, "Did you see this?" or "would you like me to..... (insert the task you think should have been done) for you?" will get a whole different reaction.

Most medics I know understand the team concept and appreciate me being an involved member of the team. Our ALS is from another agency and when they come into our ambulance for the transport they are unfamiliar with where stuff is and what we have with us. We have to work together.

 

[firetender]

The overall issue here is how do you handle witnessing bonehead things happening at the hands of your peers (who can include Docs, RNs, etc.) and then,

#1) keep yourself out of trouble

#2) register your personal displeasure

#3) at least letting the person involved know that his/her negligence/whatever doesn't go unnoticed, and

#4) doing SOMETHING to assure it won't happen again

This is really tricky territory. The biggest hurdle is figuring out if what you witnessed was benign or dangerous. Sometimes it's hard to figure.

Bringing it to this forum is a great step because it's a safe place to get perspective without drawing attention to the person OR yourself.

The hard part, for me, was rarely was it isolated incidents. After a while I would notice an individual's pattern, and it wasn't about good patient care.

I believe in a stair-step system.

FIRST: Figure it out for yourself if it's something that requires further action. If you're not sure, talk to someone in confidence, without naming names. Get clear on where you're going and be able to state it in just a couple of sentences.

SECOND: Unless there would be some danger involved, approach the person concerned. Starting with "Something happened that I'm not comfortable with and I wanted to check it out with you." is a good, neutral start.

(Make sure, if it's a heavy subject, that you don't set yourself up for failure by trying this on the fly, or at an inconvenient time for one of you. It shows that the subject is worthy of respect when you ask to set a short block of time where you can focus on it together.)

THIRD: If there's resistance, stonewalling or the like, don't press the issue. Give it a little time and then talk to someone else about it to help you figure the next step.

If you are reasonably well-received, then just talk about it rather than drive it to a conclusion. Listen, listen, listen.

FOURTH: If you feel you need to ask that something NOT happen again (while with or around you), be specific about your request. If it's serious enough, let the person know that you consider this an agreement between you and that you made the choice to talk to him/her directly, first and if it happens again you'll need to involve others.

These are just some tips from my experience, use them as you will, but don't just sit on things that need to be expressed.

 

[Jochempeiper]

He didn't use the chest pain protocols. He didn't do anything except take vitals and run a IV

 

[himynameismj]

Honestly,
there is no reason not to confront ALS if you believe they are wrong, but do so afterwards unless you see the patients life at risk. Also, rank and experience helps. I know captains that have been doing this for longer than the paramedics have even been alive. It's those guys who can come off abrupt and/or hostile and be heard, more or less out of respect of their age. If you haven't even hit CC yet, don't even bother but tell your own CC.

 

[Ridryder911]

What is a CC?

 

[himynameismj]

What is a CC?

crew chief, sorry

bottom line is though, medics are people and all people can be wrong.

 

[BossyCow]

Honestly,
there is no reason not to confront ALS if you believe they are wrong, but do so afterwards unless you see the patients life at risk. Also, rank and experience helps. I know captains that have been doing this for longer than the paramedics have even been alive. It's those guys who can come off abrupt and/or hostile and be heard, more or less out of respect of their age. If you haven't even hit CC yet, don't even bother but tell your own CC.

I have an issue with the term 'confront'. Its always possible to address an issue without being confrontational.

 

[marineman]

After reading all those posts I forget what the OP even said but I remember I felt like you should say something. There is a real fine line you can walk but don't cross. In general using a needle larger than necessary basically goes on a case by case basis depending on the mental status I gather from the medic at the time and if it's a recurring behavior or not.

A couple fun tricks we learned in class that can be used that I usually don't have a problem with unless they're abused.

If you think a patient is faking being unconscious/unresponsive hold their hand straight up in front of their face and let go. If it hit's them in the face you can be about 99% sure they're out, if it misses they're faking.

If a patient is drunk and you don't mind cleaning or better yet if they're at their own house, have one person stand on each side of him and each time you ask a question alternate who's asking it. If you use this method pray that the patient is facing your partner when the game ends, it's kind of like EMS Russian roulette.

 

[reaper]

After reading all those posts I forget what the OP even said but I remember I felt like you should say something. There is a real fine line you can walk but don't cross. In general using a needle larger than necessary basically goes on a case by case basis depending on the mental status I gather from the medic at the time and if it's a recurring behavior or not.

A couple fun tricks we learned in class that can be used that I usually don't have a problem with unless they're abused.

If you think a patient is faking being unconscious/unresponsive hold their hand straight up in front of their face and let go. If it hit's them in the face you can be about 99% sure they're out, if it misses they're faking.

If a patient is drunk and you don't mind cleaning or better yet if they're at their own house, have one person stand on each side of him and each time you ask a question alternate who's asking it. If you use this method pray that the patient is facing your partner when the game ends, it's kind of like EMS Russian roulette.

Have fun explaining how your pt recieved a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!

 

[Onceamedic]

Have fun explaining how your pt recieved a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!

Well that there would be your self inflicted injury.

 

[BossyCow]

Have fun explaining how your pt recieved a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!

Broken nose from a hand drop? I don't think so not unless the patient is holding a brick in that hand!

I've also heard a way to check on fakers is to have that discussion loudly with your partner about whether or not you will need to do the large bore IV with the 'really big needle' or some other invasive or painful sounding procedure. "Gee... you know, if we could just hear a moan or something to know that they didn't need this"... "No, lets not do that, its really painful" ... "I think we're going to have to if they don't come to..."... Amazing how many fakers will feel much better all of a sudden

 

[Ridryder911]

Have fun explaining how your pt received a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!

Arm or hand drop are acceptable ways of checking level of consciousness. Also cornea reflex, eye lash reflex and even a mirror... One cannot resist looking at themselves (taught by a neurologist in ASLS).

Personally, I have found that most instances are "attention seeking behavior" for some reason or another. I will whisper in their ear, that I know they can hear me and that I also know that they are not really unconscious and knock the poop off. If it is they want out of the environment, to continue such behavior otherwise they need to awaken.

I don't know how many will suddenly start coughing, appear that they are awakening. If they do continue their behavior, I will inform that I will be transporting them to the hospital and load them into the EMS unit. Then I inform that they are alone, they again have the chance to awaken or I must proceed with the treatment of such. These treatments can and will be extremely painful, and they may have tubes in every orifice.

I have very few that did not "suddenly revive"; and some that actually never flinched from a IV. Although, I never have seen one that did not flinch from a nasal trumpet.

Again, I attempt to get the reason of the behavior.

R/r

 

[Outbac1]

As the Sweathogs said

"Up your nose with a rubber hose!"