Complacency

[jgaddis82]

I would just like to say that I have seen and heard quite a few paramedics talk about Emt's as if they are the greenest know-nothings ever. But I have also seen some paramedics who have become so much like super heros in their own minds, that they become complacent. This is how patients get improper care or interventions that cause death. Like the medic who pushed a lidocaine bolus here in my hometown. Pushed 2 as a matter of fact. Mistakes happen, but that holier than thou look at my patch attitude sometimes causes more problems than just making people not like you very much. The Emt was the one who prevented the 3rd bolus being pushed. Paramedics save lives, emts save paramedics.

 

[akflightmedic]

Guess we are all in trouble when there are only double medic trucks available....

 

[jgaddis82]

I hope it didn't sound like I meant all paramedics need an Emt to look over their shoulder. Quite the contrary. I just mean that maybe we shouldn't get so caught up in all the big stuff we know and forget the basics.

 

[Veneficus]

a very slow day at work

I don't think the behavior you describe is unique to paramedics.

I have seen it in every level of provider and in my experience it seems a prerequisite for PAs.

There is a delicate balance between confidence and arrogance that must be achieved to be a competent, if not outstanding provider. The phrase I use is:

"Confidence is believing you can succeed, arrogance is believing you cannot fail."

In medicine, people make mistakes, sometimes very harmful ones. Being in medicine does not exclude people from the imperfections of humanity.

I would like to call your attention to something not professed in EMS education. The more you learn, the less certain things become. In the books and studies I deal with many pages say something along the lines of: This is as much as we know, this is what we think, but we don't know. It is there where individual judgement comes in.

It is foolish to think EMS providers do not have to deal with that. In fact, I think it is worse for them. They often don't know what is causing the patient's problem, or do not know enough detail, but are called upon to make decisions with this imperfect information. (not that things are ever perfect for any provider)

But in some cases, inaction is just as harmful as an improper action. Not every medical error kills a patient or renders long term complications.

In medical texts, overtreatment is a medical error. Unindicated treatment is a medical error. But what if you don't have enough info to decide if a treatment is indicated or not?

You must make a decision. EMS providers are not immune from this.

The last few years I have seen an increase in the certainty in which EMT basics criticize other medical providers. It is easy to be an armchair quarterback when your knowledge and scope is limited. Things look very simple. You do not know what you do not know.

For example, there is a safety margin between the dose commonly accepted as prudent and the toxic dose. As well, some people will experience a toxic effect at the lowest dose. Then you have the safety margin built into the protocol.

http://en.wikipedia.org/wiki/Dunning–Kruger_effect

 

[mycrofft]

Discrimination between tech levels

If it is of any "help", most MD's looking at EMT-B versus EMT-P squabbles like this think it's like two school kids in the playground. Not that they are right, but there is always another group that thinks yours, as a group, is inferior.
No one should hold the blanket opinion that any group is inferior or arrogant as a group; I've seen certified nursing assistants (CNA's) with more professionalism than the MD's whose patients they care for day in and day out, and vice versa.
Every type of care is valuable and every practitioner is different. The only levelers I see are the schools, and the protocols.
EDIT: did not see the next reply before I hit SEND. Good discussion, I hear y'all.

 

[jgaddis82]

I agree with everything you just said. Again, not what I was speaking of. All of us, no matter what line of work we are in, seem to forget the basics as we learn more complicated or what are deemed better techniques. As for the confidence vs. Arrogance, oh yeah, it has to be that way. I would never presume that only higher level medics do the arrogant, stand back and watch me go thing. But by complacency and forgetting the basics, I mean everyone who doesn't look twice at the drug they are about to push, " because I been doing this for 10 years and I know what I'm doing."

 

[jgaddis82]

When I started this thread it wasn't to pit Emt vs. Paramedic. We are a team out there and need each other. It was to remind SOME people not to get so comfortable in their knowledge and skills that you throw out the basic little things. Because they are neither basic nor little to a patient who needs them.

 

[mycrofft]

Roger that.

Usually that comes with maturity, but some of us need a little more "time on the vine" than others.

 

[epipusher]

well said veneficus. a question to ts, is it not possible that the medic was stepping outside of protocols or textbook treatment for a reason?

 

[Veneficus]

All of us, no matter what line of work we are in, seem to forget the basics as we learn more complicated or what are deemed better techniques.

I do not think that is true.

As mycrofft said, it may be just time on the vine.

When people first start out or advance in levels, they have a lot of information/knowledge but have not yet mastered how to apply it, when to apply it, or the balance of aggresiveness.

For example, when you go to a cardiologist, almost for certain they will find something wrong with your heart. (afterall if nothing was wrong with your heart, why would you go?) Your condition may not be related to your heart, you may have nonpathologic variations, and when they are found, they will be identified as the problem 9/10 times.

The same thing happens to EMS providers. They have new knowledge and treatments, ways to look for various conditions and tools to alter those conditions. But not everyone needs a cardiac monitor, Not everyone needs an emergent medication. Not everyone needs to be intubated.

But until people become comfortable and experienced enough to determine the difference in what is important and what is not and confident in their diagnostics and treatments, they do tend to get tunnel vision or overwhelmed and go large.

The long and short, it is all about recognizing need. Not every patient with a laceration needs sutures. Not every person who needs sutures needs a complex or deep closure.

Just like not every patient who has CHF needs furosimide when they call you. Not everyone in afib needs cardioverted.

What you are describing as arrogance looks to me like lack of comfort and confidence. Not really a question of forgetting where they came from, but not knowing where they are going.

It takes a lot of experience (not in chronology, but in quantity of patient contact) to become a skilled enough clinician to be able to pay attention to every detail of treating a patient. The truly masterful do it without conscious thought to much of it.

But by complacency and forgetting the basics, I mean everyone who doesn't look twice at the drug they are about to push, " because I been doing this for 10 years and I know what I'm doing."

Honestly, I couldn't tell you how many times I look at a drug before I push it. It could be once, it could be 10. But when I do give a drug, I have no doubt it is the one I meant to give and when I meant to give it. Not because I have been giving drugs since the days of wooden ships and iron men, but because my actions are deliberate.

 

[bstone]

Pet Peeve:

EMTs=plural of EMT
EMT's="EMT is" or denoting possession by the EMT

 

[Shishkabob]

Like the medic who pushed a lidocaine bolus here in my hometown. Pushed 2 as a matter of fact.

Without context, I see nothing wrong. Infact, I see an EMT who stopped a medic doing a procedure that the EMT most likely had minimal, if any, knowledge of.

Paramedics save lives, emts save paramedics.

That's a saying for EMTs who are insecure in their job. That saying implies that EMTs are failproof. No, EMTs don't save Paramedics. Good partners help partners. Doesn't matter what level.

 

[Trevor]

Without context, I see nothing wrong. Infact, I see an EMT who stopped a medic doing a procedure that the EMT most likely had minimal, if any, knowledge of.



That's a saying for EMTs who are insecure in their job. That saying implies that EMTs are failproof. No, EMTs don't save Paramedics. Good partners help partners. Doesn't matter what level.

Quick!!!! Where's the "Like Button"??? Awesomely put Linuss!

I too, see nothing wrong with the Lidocaine dose... Could it have been wrong? Sure, but it could have been, and probably was, right... My dose for Lido is 1.5mg/kg. My supplied amount is 100mg/5ml (bristojet). Soooo... If i am giving a bolus (which NEEDS to be given prior to a drip), for a 100kg (220lb) patient, its at least 150mg... So i would push 1 AND 1/2 of the bristojets (and obviously many people weight more then 220#)...

I very smart RN I know (who's been a RN for about 30 years) once told me, "the scariest nurse isnt the one who doesnt know anything, its the one who thinks they know everything and dont..." Like Veneficus said, the people who dont know, what they dont know... Dunning-Kruger!!!

Being arrogant is something that occurs in all job fields, and isnt unique to EMS... Its usually a character trait and has nothing to do with the rank/billet/job title... I would be willing to bet, that before they got their Paramedic, they were probably just as egotistical as they now are... Just like Vene said, I know that when I finished my Paramedic degree, more so when i finished my B.S., and still even more the more I further my education, I become EVEN LESS arrogant then I was (which wasnt very much to begin with), because the more I learn, the more I realize I dont know...

 

[jgaddis82]

I will never know enough. I try to learn something every day. Thanks for all your help. The lidocaine I spoke of, the guy thought he was giving 500ml of normal saline. I feel bad for him and I was told that the patient was lucky that it didn't stop his heart since he was injured in some kind of fall. Again, I'm still learning.

 

[Trevor]

I will never know enough. I try to learn something every day. Thanks for all your help. The lidocaine I spoke of, the guy thought he was giving 500ml of normal saline. I feel bad for him and I was told that the patient was lucky that it didn't stop his heart since he was injured in some kind of fall. Again, I'm still learning.

Giving a drip of Lido, as a 500cc bolus is a little different... That probably would be an error. Our premixed Lido bags, have "LIDOCAINE" printed on them in Bold, large font, and Red color...

 

[medic417]

Paramedics save lives, emts save paramedics.

That is the stupidest statement ever posted on a a t-shirt, I can't believe you just stole it and posted it. Anyone that owns that t-shirt or bumper sticker or poster should automatically loose their certification.

 

[jgaddis82]

Thanks. It's been a while since I've been called stupid. I was starting to miss it. Now can you kindly remove your teeth from my rear end and teach me something helpful?

 

[Tigger]

No, it's still a stupid statement. Linuss said it best, partners help partners, regardless of level. There is no reason to think that a competent paramedic needs and EMT for any help, another paramedic could probably do a better job if we want to be honest here.

 

[jgaddis82]

Finally! You got my point! A COMPETENT paramedic. And yet how do you judge who is and who isn't competent? I really joined this forum to learn more about the profession I chose. To get better and be better at what I do by learning from others. What I see a lot on here is one giant pissing contest after another. When the truth is, we all sign up to do things and see things daily that most people don't ever want to see. We should be helping each other be more competent and less stupid ( as I'm now known).

 

[Veneficus]

might i offer some advice?

Finally! You got my point! A COMPETENT paramedic. And yet how do you judge who is and who isn't competent? I really joined this forum to learn more about the profession I chose. To get better and be better at what I do by learning from others. What I see a lot on here is one giant pissing contest after another. When the truth is, we all sign up to do things and see things daily that most people don't ever want to see. We should be helping each other be more competent and less stupid ( as I'm now known).

Firstly, please relax.

On this website as in reality, yo uwill find people whom you do not get along with. I have discovered the ignore feature works well. (just like in the real world)

When I first started teaching I was paired with a more senior collegue. To call him a dinosaur would be to understate his age.

He was one of the first US paramedics ever, and his resume would be more than a lifetime achievement for some.

Everytime I tried to discuss newer medical techniques or science, he would offer the strongest of resistance. Out of respect, I never argued with him.

One day I was having a particularly bad day, and he challenged me on something I was very sure of. To say the least, I made no effort at diplomacy to tell him exactly what I knew and what I thought of his resistance.

He smiled, and told me I finally got it.

He wasn't going to accept somebody's word on medicine. He wanted to hear the argument. He wanted me to present my evidence and wanted convinced, not simply told something was newer or better.

It had to stand up to the sniff test and I had to know enough about the topic to be able to tell if it was valid or a biased opinion.

Since that day many years ago, we have become good friends, but we still argue, sometimes he even wins. (but not often)

It is not the statement that makes one better. It is the fight to back it up.

The plea for comraderie is not impressive to many of us. We were thrown to the wolves and expected to be able to fend for ourselves. It is said in emergency service, we eat our own young. I think that to be true.

Like a good number of people here, I have seen a great many things. Some magnificent, some terrible. But I didn't just get to sign up to be in this club. I had to earn it.

So do you...

If you don't like what somebody says to you, show them what you got and make a stand.

Sometimes you will be right, sometimes wrong, sometimes win, sometimes lose. Sometimes you will contribute a new perspective, but you will always learn.