Do the first few chapters in my EMT text book mean anything?

[tramachick]

Well, here is my thing, I am a new EMT and one of the first things I have noticed is how a majority of the EMTs, paramedics, and all other medical staff are cynical and seem to forget one of the first things I learned in my EMT class, patients are people. I know that seems like a simple concept, but from what I have seen so far it seems like that it is more of text book thing, and not really played in real life. Call me crazy, but after seeing the behavior of the crew on my first ride along, I was really disappointed and discouraged. I am now a practicing EMT and I still see it all the time. People laughing about there patients, treating there ego before the patients need, forget about such things as HIPA laws, and not giving all patients the respect they deserve. I understand that it can be tiring to see the same thing day after day, but I really don’t believe that even the most trivial of calls can ever be a waste of time. Please someone tell me that after some time I will not turn into that. Please someone tell me that there are some of you who really do love their job and their patients (even the drunks)

 

[8jimi8]

Don't lose your idealism. When you do, its time to find a new profession.

you'll find, after some time, that the phenomenon that plays out (what you are seeing in the field) is the age old


"laugh to keep from crying."

I've experienced the very same cynicism, but i keep it in check with a healthy love for all humanity.

Yes, there are people like you, who keep that optimism, but being overly sensitive will lead you to burnout.

On my first ambulance shift (as a student) a burned out paramedic told me this.

" i don't see these calls as people any more, they are just jobs. you know, like a brake job, an oil change, a flat tire..." then he added, " now then every once in a while you get a call with a little girl who's hurt... that's a person, but that's about the only ones anymore."

i promise if i get to that point, i'll hand off my uniform and figure out something else.

I know how to recognize it tho. I lasted in my first profession of crisis counselor for 11 months. At the end of that time, i'd see a homeless person and burst into tears. The savagery of humanity was too much for me. i didn't know I was burned out until my supervisor told me so.

 

[reaper]

There is a big difference in how things are precieved.

Always treat your pt's with respect and treat them as humans. Whether it is the mayor or the homeless drunk, they are all humans. Do not be rude, do not disrespect them or harm them for fun.

That said, You will have the joking,laughing and *****ing before and after a call. That is a way to let off steam. If you do not find a way to do that, you will be short lied in this job. As long as you are doing it among partners or other crews, there is no problem. Keep it away from the pt's.

This is a stressful job and it gets to the best of us. It is how you handle yourself with pt's that show how you truly are.

 

[tramachick]

That I understand, but to give you an idea of one of the situations I was referring to, a few weeks ago I responded on a call of an attempted suicide. It was a 20 year old female who said she took about 20,000 mg of Depakote ER (Valproic Acid). A medic I was with didn’t believe her, and even told her so. He started telling her that if she really took what she claims she took, then she would be forced to drink “a very disgusting thing called charcoal”. He then tried to convince her she never took anything and that she just wanted attention. We transported her to the hospital, she drank about half a bottle of charcoal, and that’s all the treatment she received. When she arrived at the ER, they immediately did an EKG and low and behold she had multiple pvcs. I hung around for a bit and that girl was in serious trouble. We had a call and didn’t get back to that hospital for the rest of the night. My next shift I asked about her to one of the nurses and fortunately she survived, but just barley. Last I heard she was doing ok, but she was still in ICU. To me that was very disturbing because one person’s arrogance could have caused that girl her life.

 

[8jimi8]

That I understand, but to give you an idea of one of the situations I was referring to, a few weeks ago I responded on a call of an attempted suicide. It was a 20 year old female who said she took about 20,000 mg of Depakote ER (Valproic Acid). A medic I was with didn’t believe her, and even told her so. He started telling her that if she really took what she claims she took, then she would be forced to drink “a very disgusting thing called charcoal”. He then tried to convince her she never took anything and that she just wanted attention. We transported her to the hospital, she drank about half a bottle of charcoal, and that’s all the treatment she received. When she arrived at the ER, they immediately did an EKG and low and behold she had multiple pvcs. I hung around for a bit and that girl was in serious trouble. We had a call and didn’t get back to that hospital for the rest of the night. My next shift I asked about her to one of the nurses and fortunately she survived, but just barley. Last I heard she was doing ok, but she was still in ICU. To me that was very disturbing because one person’s arrogance could have caused that girl her life.

sounds like something i would bring up to my shift captain.

 

[reaper]

That I understand, but to give you an idea of one of the situations I was referring to, a few weeks ago I responded on a call of an attempted suicide. It was a 20 year old female who said she took about 20,000 mg of Depakote ER (Valproic Acid). A medic I was with didn’t believe her, and even told her so. He started telling her that if she really took what she claims she took, then she would be forced to drink “a very disgusting thing called charcoal”. He then tried to convince her she never took anything and that she just wanted attention. We transported her to the hospital, she drank about half a bottle of charcoal, and that’s all the treatment she received. When she arrived at the ER, they immediately did an EKG and low and behold she had multiple pvcs. I hung around for a bit and that girl was in serious trouble. We had a call and didn’t get back to that hospital for the rest of the night. My next shift I asked about her to one of the nurses and fortunately she survived, but just barley. Last I heard she was doing ok, but she was still in ICU. To me that was very disturbing because one person’s arrogance could have caused that girl her life.

That is not quite the joking around disrespect for a pt, that you were talking about. That is an uneducated medic, that needs to have some reeducation done!

 

[DrParasite]

I understand that it can be tiring to see the same thing day after day, but I really don’t believe that even the most trivial of calls can ever be a waste of time.

After a while, when your ambulance seems more like a taxi cab, this does happen. Esp if the majority of your calls could be handled by a taxi cab and a ride to the patient's PMD.

Please someone tell me that after some time I will not turn into that. Please someone tell me that there are some of you who really do love their job and their patients (even the drunks)

I love my job. I really do. And I respect all my patients, even after 10 years.

ok, that last statement isn't true. There is one group that I don't respect anymore, and that is the drunks. Drunks (who are often homeless, yet have money for alcohol, figure that one out, and there are others who have homes, yet pass out on sidewalks) drink till they pass out, then call 911 for a ride to the hospital where they sober up in a bed (often on my dime), and once they are discharged, they do it all over again. No one forced them to drink (esp not their first drink), but they do. I do enjoy an alcoholic beverage once in a while, but I have never gotten so drunk where I passed out on someone's lawn, and when I was drunk, I slept it off in my bed, and woke up with a killer hangover.

Just remember, if the senior/experienced EMS personnel are burnt out and treat everyone like crap, than newbies will follow their lead, because "it's the cool thing to do." It's another vicious cycle, one that the newbies them-self need to decide if they can break.

 

[tramachick]

That is not quite the joking around disrespect for a pt, that you were talking about. That is an uneducated medic, that needs to have some reeducation done!

Well, that was one of the more serious incidents, but I think my original message was misunderstood. I don’t have a problem with joking around, I have my own stories. (Just ask me about the tuna lady) I have a problem with medics that seem to forget why they became a medic in the first place. The ones that see there job as more of an inconvenience then something positive.

 

[Sassafras]

I do still respect the drunk. They may be broke, but they are destitute, and have no clue how to get out of their situation. They are addicted much like the meth addict and it is their escape. My philosophy is we all make stupid financial decisions, theirs just happens to be killing them, much like the diabetic who won't stop eating candybars (which I honestly find more disturbing but still give them my respect).

I know I'm new to this deal, but that part of my character has always been. It's why I got into this field. I LOVE people. From the sex addicted teenager with 3 kids to the passed out cold drunk in the middle of the street who hasn't bathed in a week. There's a reason they are why they are where they are in life. And like Oprah said years ago and it stuck with me (even though I avoid watching the show now like the plague) "behind every prostitute is a story" (She did an episode on runaway prostitutes).

I am no privy to the hardships that patient may have endured, but I am privy to what they are experiencing now, and maybe with a tiny bit of compassion they may remember that not all of humantity sucks and perhaps it's worth working on bettering their life. Or maybe not, but that's not my call. My call is to treat them properly and as a human being.

 

[emt seeking first job]

Every profession is subject to be with a sliding scale of morality.

The suicidal girl did get to the ER on time. Is there any intervention your partner could have done to effect a better outcome ?

 

[mgr22]

You ask whether the first few chapters in your EMT text mean anything. They do, but they're not going to change most people's behavior. I don't think we get our principles from books. If you started your EMS career without a desire to treat people the way you'd like to be treated, I don't think any amount of training would change that.

I understand your concern about what you might become, but that's really up to you. It would be a cop-out, I think, to blame degradation in your values on the people around you.

 

[Hellsbells]

This is a situation where the words of Gandi apply- "be the change you want to see in the world"

 

[tramachick]

Every profession is subject to be with a sliding scale of morality.

The suicidal girl did get to the ER on time. Is there any intervention your partner could have done to effect a better outcome ?

It’s not so much the medical intervention. This girl was scared, begging for help, and he treated her like she didn’t matter. So maybe medically there was not much more to do, but as medics we need to treat the pt’s emotions as well. So that girl is alive, but that medic’s actions could leave her with emotional scars. To me, that night, he did not do his job. And to answer other questions I did talk to the QI director that night.

 

[Melclin]

It’s not so much the medical intervention...... To me, that night, he did not do his job. And to answer other questions I did talk to the QI director that night.

The suicidal girl did get to the ER on time. Is there any intervention your partner could have done to effect a better outcome ?

Our assessments mean more than simply deciding which page of the protocol book to flip too.

Assessment of living conditions/lifestyle is something that only the paramedics can bring to the table. Pushing for proper psych management after the medical management (although not so much if the pt is going to spend weeks in ICU) is also worthwhile..making sure your patient doesn't fall through the cracks.

In a more pressing medical sense, a good assessment in this case might mean the difference between expedited transport to an appropriate facility, notification to the hospital of a potentially serious OD coming so the pt can roll straight into a resus bay with a team waiting to receive your handover; OR; wandering down to the local ED, no notification and chatting to the triage nurse about some attention seeking girl who took some pills and you don't really think its serious, leading to a reduced triage category and a significantly worse outcome.

What do you mean by "got to the ED on time"? The fact the patient was alive doesn't mean the job was done well.

 

[firetender]

Please someone tell me that after some time I will not turn into that.

Heya, Tramachick; after some time you will not turn into that!

Unless, of course, you choose to.

You not only encounter the depth and breadth of humanity in your patients, but you encounter it in your partners as well! You're an FNGal (I guess) in a high volume area (guessing again) and you're surrounded by burnouts (Bingo?).

Emergency Medics are Actors. Many of them bray like Donkeys off-call but on-scene, they're spot on and responsive to the human being. The hard asses are sometimes the ones who cry into their pillows at night in despair at what they witnessed. Others still harden every part of their hearts one little trauma at a time in a losing effort to protect themselves from feeling their own vulnerability, it goes home with them and hearts get broken. And yes, there are some out there who, somewhat protected by prior spotless records, actually become dangerous.

What I'm saying is you are going to be exposed to all sorts of examples, bad and good. You may end up at a station whose culture is all about excellent patient care as easily as you end up doing a stretch in a station that (through peer pressure) makes it easy for you to be abusive to drunks.

What you are now outraged at is that people could possibly be like this at all! Here's what you will learn, if you really pay attention to your patients, your partners and your own life; Given the exact circumstances of their lives, you, too might make the same choices.

"Might" is the operative word, (as he ducks the spear-chuckers!) but I think you get my point. The Glory and the Muck lives in each of us, just waiting for the proper circumstances to bring it out.

Ten years from now you will have learned what it feels like to have "lost" three patients in a row as they struggled with everything to stay alive, and you gave everything as well and they died in your hands, and then the next week have to handle three attempted suicides in a row made by perfectly healthy people who simply just don't want to live anymore.

...and then, you're called to your 4th attempted suicide. Who's example will you follow?

 

[clibb]

That I understand, but to give you an idea of one of the situations I was referring to, a few weeks ago I responded on a call of an attempted suicide. It was a 20 year old female who said she took about 20,000 mg of Depakote ER (Valproic Acid). A medic I was with didn’t believe her, and even told her so. He started telling her that if she really took what she claims she took, then she would be forced to drink “a very disgusting thing called charcoal”. He then tried to convince her she never took anything and that she just wanted attention. We transported her to the hospital, she drank about half a bottle of charcoal, and that’s all the treatment she received. When she arrived at the ER, they immediately did an EKG and low and behold she had multiple pvcs. I hung around for a bit and that girl was in serious trouble. We had a call and didn’t get back to that hospital for the rest of the night. My next shift I asked about her to one of the nurses and fortunately she survived, but just barley. Last I heard she was doing ok, but she was still in ICU. To me that was very disturbing because one person’s arrogance could have caused that girl her life.

That medic should be reported immediately. Trust me, the agency would rather fire a bad medic then getting a bad reputation for someone's stupidity.

I'm lucky that I ride with awesome medics. I haven't met one EMT-B or Medic at my agency that I'll argue with.

It’s not so much the medical intervention. This girl was scared, begging for help, and he treated her like she didn’t matter. So maybe medically there was not much more to do, but as medics we need to treat the pt’s emotions as well. So that girl is alive, but that medic’s actions could leave her with emotional scars. To me, that night, he did not do his job. And to answer other questions I did talk to the QI director that night.

This is exactly why some people who have been trying to take their lives and then regrets it don't call 911. The embarrassment and regret that they'll face afterwards.
People who think of patients as objects, those people should hand their uniform in.

What did the director say?

 

[Old Road Dog and Sidekick]

"sidekick" here..
as a former drunk, now 10 years of blessed sobriety, i gave many 24 hour tokens out to patients. and a few times showing my AA token to a combative etoh patient was all it took.
i've also hugged and held prisoners, gang members, those of the gay hiv pos community, battered wives, suicidal ceo's, drugged up white collar professionals, and the list goes on. they are just people. its your job to do the best you can for them while you have them. thats all you can do. you have to go to sleep at night with whatever you did that day, so do your best and then walk away. emergency medicine is just that. triage, treatment, transfer to the next step. it did seem that in a great many of our calls, 80% of the care was how we treated a person with respect, kindness and no judgement.
some of our patients were frequent transfers we got to know well and enjoyed.
my hubby would work a shift and come home to tell me about "so or so" he had and what was going on with that patient. i never stopped in saying a quick prayer for them, even silently, and mostly for me, so i could do a good job for them.