How do you deal with dinosaurs?

[DrParasite]

How do you deal with dinosaurs in EMS?

People who have been doing the job for 20-40 years, and refuse to move up to the 21st century (think fights with the NJFAC for those in New Jersey).

People who want to cling to the old ways, because that is how they have always done things, and refuse to change even for the better.

You don't want to insult what they did, because they often helped lay the foundation (sometimes literally) for the organization and are viewed as the elders, but they are now holding the organization back from actually succeeding.

any tips that can be provided (other than a boot to the *** saying "get out old man") would be appreciated.

 

[DPM]

" Keep absolutely still. His vision's based on movement "

 

[325Medic]

How do you deal with dinosaurs in EMS?

People who have been doing the job for 20-40 years, and refuse to move up to the 21st century (think fights with the NJFAC for those in New Jersey).

People who want to cling to the old ways, because that is how they have always done things, and refuse to change even for the better.

You don't want to insult what they did, because they often helped lay the foundation (sometimes literally) for the organization and are viewed as the elders, but they are now holding the organization back from actually succeeding.

any tips that can be provided (other than a boot to the *** saying "get out old man") would be appreciated.

I work with a dude @ my part time 911 gig that had been doing this for 20 years+ and is also a cop. I don't particualy like the guy. The other day, well a few months back, we had a woman with nausea / pale and diaphoretic and he refused to 12-lead her. We got into it and he threw that out there that he has been there for 20 years. I said I don't care. Now we don't talk. Well, screw him and his ancient ways. I have been doing this for 13 years. I remember Bretilyum, LP-11's and stacked shocks with Bicarb first but I have moved, for the lack of a better term into the future and I learn something new, and use it on a daily basis. I now choose not to work with him but I don't think there is an easy way to deal with this. I also work with a dude that has been doing this for 35 years and he embraces new things in E.M.S. so I think it may be laziness.

325.

 

[46Young]

What I like to do is start a conversation saying things like "It's crazy how many of the things we're doing in EMS right now will practically be voodoo in five years." Then I continue: "Remember how everyone used to get 15 LPM NRB, and now that's been shown to hurt patients?" "Stacked shocks, hyperventilating head traumas, six liters of saline for hypotensive traumas, dextrose/thiamine/narcan for the unresponsive, pacing asystole, etc."

Alternatively, if they're doing things the old school way, tell them that doing it that way is malpractice, and you're not risking your card because they choose to remain in the year 1988. I've run into this myself a few times. I start talking about the why's of what I feel we should be doing until I annoy them into doing what needs to be done. If they give me the business afterwards, I tell them that it's apparent that they chose not to continue their medical education since they graduated from their program, and they would be up in arms if a provider did outdated and inappropriate interventions on one of their family members.

 

[Veneficus]

"Poor is the student...

who doesn't exceed his master."

--Attributed to Leonardo Da Vinci

I think the problem of longevity giving credibility is largely individual.

As mentioned there are older people who love to learn and adapt.

There are also those that have security issues. Especially in Safety services.

They may have spent their whole live's and careers doing something, telling themselves they were saving lives or helping, etc. Then we learn a little bit and they are faced with the prospect they were not helping. Maybe they were even harming.

They need to be looked up to and be where the action is. If they retire they know in a year maybe 2 it will be like they never existed at all.

They hold on to the memory of their glory days. (yesterday) Wanting more than anything to relive it one more time before being given their lifetime achievement award and shunted to education administration. (The polite way to give them the boot.)

These types of personalities are generally not life long learners and they make up a majority of the population.

They have mastered "the system" in a moment of time. It was their goal. Having achieved such a finite prospect, they just want to coast at the top.

However, as anyone who is part of medicine knows, you are either gaining ground or losing it, there is no neutral.

While there are many polite ways to say, I'll just be direct, it is time to show them the door.

You cannot force them to change their personality and view of life so late in life.

A really hard position to be in is when they are not financially stable and you realize that this member who gave so much is being kicked out into the cold.

As I recently heard it said by a person I have the greatest respect for; "administrators do not fire employees, employees fire themselves, administrators just fill out the paperwork."

Management has a duty to progress their agencies. Employees have a duty and vested interest in remaining relevent to the needs/demands of the organization.

Just like any other toxic employee, decontamination is the only solution.

The only variable is how you go about doing it.

I suggest an award and an honorary position. (unpaid/consulting fee as your organization can afford)

That way they leave in a positive way they can be proud of with the respect, recognition, and gratitude of the organization.

The other methods are a bit more damning and leave no other impression or feeling but failure at the end of a dedicated career.

 

[mycrofft]

1. Given time in the trade and being around people generically, one sees fashions in treatment and diagnoses come and go. One becomes a little conservative when todays wonder cure is tomorrow's Dalkon Shield, Vioxx, or Rey's-causing children's' aspirin. Or, Levophed.
2. New people, and occasionally OG's, will get enthused with some new thing, and dismissive of those who do not share their enthusiasms. Makes it hard to question anything new or admit the need for upgrade when basically it is a social exercise rather than a scientific one. ("I'll accept your new idea/cool tool, just leave me my cojones, ok?").
3. Admit it: MANY if not most EMS calls, especially in urban settings, are not true code three emergencies. We are trained and indoctrinated to over-treat because even if we were trained as a surgeon or MD, we do NOT have diagnostic tools or STAT interventions available in a hospital; also, we were created in a rescue/macho medical culture, so many come to "run hot", carry a cool tool belt, and basically go overboard under license of lowest common denominator training and protocols.

There ARE obstructionists of all ages. As with any personnel issue, it has to be a case by case issue; otherwise, maybe the dinosaurs running things may wake up and make a mistake like to require ten year's experience to get full time employment because the conservative unflappable older gal or guy (OG) is as medically effective and costs far less than the hotshots.

 

[tacitblue]

1. Given time in the trade and being around people generically, one sees fashions in treatment and diagnoses come and go. One becomes a little conservative when todays wonder cure is tomorrow's Dalkon Shield, Vioxx, or Rey's-causing children's' aspirin. Or, Levophed.

So you are saying that it is ok to stay where you are at education and practice wise, because the new "trends" that arise will just as well pass sooner or later? You know, maybe like 12 leads and therapeutic hypothermia?

2. New people, and occasionally OG's, will get enthused with some new thing, and dismissive of those who do not share their enthusiasms. Makes it hard to question anything new or admit the need for upgrade when basically it is a social exercise rather than a scientific one. ("I'll accept your new idea/cool tool, just leave me my cojones, ok?").

When there is sufficient scientific evidence for an intervention from well designed investigations, I do tend to think of those who reject such interventions as stupid; unless of course they can produce formal and logical argumentation as to why they continue to practice the way they do.

3. Admit it: MANY if not most EMS calls, especially in urban settings, are not true code three emergencies. We are trained and indoctrinated to over-treat because even if we were trained as a surgeon or MD, we do NOT have diagnostic tools or STAT interventions available in a hospital; also, we were created in a rescue/macho medical culture, so many come to "run hot", carry a cool tool belt, and basically go overboard under license of lowest common denominator training and protocols.

How many true life-threatening pathologies do you miss with this attitude? There can be subtle presentations of horrible disease and attempting to justify the state of our training and practice because we do not go on as many emergencies as you would like is abhorrent. Knowledge is a tool that many forget about. If one can preform a competent and thorough history and physical, augmenting it with a strong science background and an index of suspicion obtained from decent training, one will become more sensitive in detecting emergent and urgent pathology.

There ARE obstructionists of all ages. As with any personnel issue, it has to be a case by case issue; otherwise, maybe the dinosaurs running things may wake up and make a mistake like to require ten year's experience to get full time employment because the conservative unflappable older gal or guy (OG) is as medically effective and costs far less than the hotshots.

I have seen a pattern in your posts here. You have a not-so-easily disguised contempt for contemporary evidenced-based practice and the education required to master it. You lend tacit support to weak arguments in favor of the way things are (and even occasionally the way things used to be in EMS) and subtly reject true out of hospital provider competence and independence.

 

[the_negro_puppy]

 

[mycrofft]

Ha. And I thought I wasn't the subject of the post. Thanks.

Here's another way:

Three points.

 

[Shishkabob]

Nod my head, hope they have no control over my career, and move on knowing I'm right.

 

[firecoins]

I leave the museum.

 

[Mountain Res-Q]

Clone them with DNA found in Amber... Buy an island... built a theme park...

I call it "Paramedic Park"...

Then the MICNs broke through the containment area and ate all the tourists
"We need locking mechanism of the doors!"​

 

[firetender]

Don't discount the power of dead dinosaurs...

...first of all, it gets you to calls.

One thing the FOGs have that the FNGs are yet to master is the gut feeling of what is truly an emergency and what is not. Consider when you get irate is it because he/she isn't wanting to use all this new-fangled stuff that you feel is so very very, VERY essential?

They also know what does and does not kill people, and how, under most circumstances, it is the luck of the draw and things way beyond anyone's control that saves them. Perhaps they understand better than you how to set a pace that will allow the patient to get to a hospital absent of further harm.

Temper your judgments against the POSSIBILITY that the FOG is able to "tune-in" to the person's actual cry for help above and beyond the protocol you've been taught.

There's also something to be said for the fact that most real FOGs look back to the times they were FNGs and realize that the science of their youth has betrayed them; that what they used with all the certainty of the world has since been debunked. Could it be they understand you, too, may very well be betrayed 10 years from now?

Perhaps, just perhaps, they're challenging you to think for yourself, like harsh experience has taught them they must.

Remember, you are the one who leans more on the books while they are the ones who have pitted the words against reality.

First look at if what is being said may be coming from a place of wisdom and perspective which you have yet to learn.

Once you have considered these things, then you can decide if they are FOS, which, because they are human, sometimes they are!

...and don't forget, very few of you will ever get near to becoming dinosaurs. That's called survival of the fittest.

Flame away; I'm fireproof you know!

 

[medic417]

You know the funny thing is there are a whole bunch more worthless diaper wearing medics than there are worthless dinosaurs. Why? Most worthless medics decide to move on way before they reach dinosaur status, most never even make it to pullups status. The majority of dinosaurs are of extreme value if you would just stop wetting your diapers long enough to listen.

 

[Niccigsu]

"Remember how everyone used to get 15 LPM NRB, and now that's been shown to hurt patients?"

Wait, really? I'm currently in an AEMT class now and they tell us to put everyone on 15 LPM NRB. :unsure:

 

[DPM]

"Remember how everyone used to get 15 LPM NRB, and now that's been shown to hurt patients?"

Wait, really? I'm currently in an AEMT class now and they tell us to put everyone on 15 LPM NRB. :unsure:

I wont bore you with the science (if you really care you can google it ) but the aim of supplemental oxygen (simply put) is to get the PT's Oxygen sat up in the mid-hi 90's. If this can be achieved by a Canula at 4 L/Min then that's all you need.

That said, the NREMT test for EMT-B wants you to use 15 L/Min all the time. So just stick with that for the tests and you'll be fine.

 

[Veneficus]

You always bring such perspective

While I appreciate the spirit of your post, and there is a lot of wisdom in it, I would like to add some food for thought?

One thing the FOGs have that the FNGs are yet to master is the gut feeling of what is truly an emergency and what is not. Consider when you get irate is it because he/she isn't wanting to use all this new-fangled stuff that you feel is so very very, VERY essential?

Nobody knows more than I there is a disconnect between old fasioned examination and the new quantitative gadgets. In fact I write papers on it.

Many of the new fangled gadgets just add a quantitative number to make finding and interpreting results easier.

Basically, try to make up for skill with technology. But as all The FOGs know, that simply doesn't work.

The intent was noble, the idea to raise the minimum level of care in order not to miss subtle signs or sometimes add signs where before there were only assumptions.

But somewhere, something went wrong and people tried to start substituting technology for assumptions based on knowledge. The problem is the knowledge is no longer taught and then when the numbers don't meet the criteria people simply don't know to anticipate or what to do. Which means your patient must get sicker before they get help and that is a losing strategy in much of medicine. (especially in tissue that once gone is gone forever)

They also know what does and does not kill people in the short term, and how, under most circumstances, it is the luck of the draw and things way beyond anyone's control that saves them. Perhaps they understand better than you how to set a pace that will allow the patient to get to a hospital absent of further harm.

Fixed it for you.

I agree with a lot of this too, but would point out that many of the dinosaurs don't know how to set people up for success either. We cannot control who lives, dies or gets better, but we can position them for the best chance.

There is a benefit to changing position over leaving somebody how they are, even if that sometimes means forgoing an indicated treatment based on quantitative assessment or protocol.

Sometimes it is not what you do, but what you don't and a lot of FOGs figured that out with tears. It is important to learn from their mistakes and make your own new ones, not simply repeat the same.

Temper your judgments against the POSSIBILITY that the FOG is able to "tune-in" to the person's actual cry for help above and beyond the protocol you've been taught.

The very purpose of medicine is to help people, not treat diseases. They are not one in the same.

The main difference between a doctor and a scientist is a doctor uses science to help people, a scientist explores science which may or may not help people in a tangible way at the given moment.

As I have heard and repeat ad naseum, "Many people will have medical degrees, few will ever be doctors."

But that is also true of paramedics. Throughout history, the call of "medic!" has been a call for help. Not always a call for medical aid.

There's also something to be said for the fact that most real FOGs look back to the times they were FNGs and realize that the science of their youth has betrayed them; that what they used with all the certainty of the world has since been debunked. Could it be they understand you, too, may very well be betrayed 10 years from now?

I will be sorely disappointed if it does not betray me.

But I think this statement exactly shows a good dinosaur from a bad one. A good provider, no matter the title, engages in life long learning and improvement. A poor provider sets out to master the technique of today. In a few years inevitably they will succeed. BUt at that point they must decide to stay where they are at or do it again. Sadly sometimes FOGs for many reasons accept they have peaked. From then on, they become less and less relavent as the world stops for no man living or dead.

I would say the trick is to be the FOG and not the dinosaur.

Perhaps, just perhaps, they're challenging you to think for yourself, like harsh experience has taught them they must.

I have encountered such creatures, and my abilities and career are better for it. However I have also seen some who challenge in order to stall progress. The real trick is to benefit from both but only respect the former.

Remember, you are the one who leans more on the books while they are the ones who have pitted the words against reality.

But those books change, and the value of what is taught by books is not to be underestimated. But as both the old and new must realize, we don't all have the same experiences, and therefore the same insights. FOGs who have been away from the books for a while actually benefit from the FNGs professing what is in them. That maintains the required link between academics and out there on your own. It is probably way more beneficial to continuing education than a refresher course of FOGs for FOGs. For that is a closed loop.

First look at if what is being said may be coming from a place of wisdom and perspective which you have yet to learn.

Once you have considered these things, then you can decide if they are FOS, which, because they are human, sometimes they are!

Or just biased by their own experience?

Just because you haven't experienced something doesn't mean it doesn't exist or ever will.

...and don't forget, very few of you will ever get near to becoming dinosaurs. That's called survival of the fittest.

and recognize the difference between a big fish in a small pond and a great shark in the ocean.

Having said that, I stand by my earlier statement, if the old guy is holding your organization back, it is time to respectfully and in a way he can look back and be proud of, remove him from the role of steering the wheel.

 

[mycrofft]

We need a book titled "We Were Medics Once, and Young".

It's good to start out with that fire in the belly, and to match it against the older and slower heads. The older heads (dinosaurs) need to remember that as well as that every point of care is not basis for jihad. AND, if given orientation/mentoring duties, we are not here to eat our young.

The new folks need to remember these points too and if they are not getting the mentoring they need, they should speak up the ladder to it if their mentor will not allow them to practice. Get an uninvolved view, like their supervisor.

This isn't Congress-like partisanship, (no matter how much that seems the norm due to the news and reality TV), it's more of a "circle of life" thing. IF they stay long enough, the young turks will find they are the FOP's (F'ing Old Persons) to the newer ones.

(neener-neener note: Dinosaurs predominated for 135 million years; mammals, 35 so far and working upon self-annihilation. Insects, however,

outspan both and are far more necessary for life on earth than either).

 

[Veneficus]

It's good to start out with that fire in the belly, and to match it against the older and slower heads. The older heads (dinosaurs) need to remember that as well as that every point of care is not basis for jihad. AND, if given orientation/mentoring duties, we are not here to eat our young.

The new folks need to remember these points too and if they are not getting the mentoring they need, they should speak up the ladder to it if their mentor will not allow them to practice. Get an uninvolved view, like their supervisor.

This isn't Congress-like partisanship, (no matter how much that seems the norm due to the news and reality TV), it's more of a "circle of life" thing. IF they stay long enough, the young turks will find they are the FOP's (F'ing Old Persons) to the newer ones.

(neener-neener note: Dinosaurs predominated for 135 million years; mammals, 35 so far and working upon self-annihilation. Insects, however,

outspan both and are far more necessary for life on earth than either).

Perfect title for a book

 

[DrParasite]

Temper your judgments against the POSSIBILITY that the FOG is able to "tune-in" to the person's actual cry for help above and beyond the protocol you've been taught.

There's also something to be said for the fact that most real FOGs look back to the times they were FNGs and realize that the science of their youth has betrayed them; that what they used with all the certainty of the world has since been debunked. Could it be they understand you, too, may very well be betrayed 10 years from now?

while that may be true, the standard is set at a certain level, and right or wrong, that is the level we should be providing to our patients. in 10 years when all the voodoo changes, I plan on doing all the new voodoo, until that gets debunked, because that's the new standard.

and if the FOG can pick up on the person's actual cry, great, my issue is when the dinosaur no longer has any clue what he is supposed to be doing, and as a result, either downplays every patient as minor, or panics because he has a sick patient and he doesn't know what to do.

Perhaps, just perhaps, they're challenging you to think for yourself, like harsh experience has taught them they must.

Remember, you are the one who leans more on the books while they are the ones who have pitted the words against reality.

that's the problem. they wrote the book, and I am trying not to throw that book out. but when they wrote the first edition in the 70s, and we are now working on the 14th edition, which completely contradicted everything they said, than what?

Their book, which helped lay the foundation for the current system, no longer applies, yet they are clinging to what it teaches, and using it as the standard.

I would say the trick is to be the FOG and not the dinosaur.

That's pretty much the crux of the issue.

Just because you are old (like mycrofft) doesn't mean you are a dinosaur.

the dinosaur doesn't want to change; and sometimes holds back progress into the modern age.

I can respect an older, senior EMT or paramedic who has been doing the job for 30 years, who continues to stay educated on the up to date trends.

I have a very hard time respecting a 40 year veteran of EMS who is a volunteer EMT, thinks going on EMS calls in civilian clothes (and a squad jacket) is appropriate, has no problem letting other EMS agencies take calls in his primary, refuses to have helmets on the ambulance (and forbids me from bringing my own), forbids me from using my own stethoscope (says the cheap ones on the truck that everyone uses are good enough), and insist that his way is the right way, despite everyone else in the state (since that is the common standard) doing things a different way.

some stuff changes, some stuff advances, some things stay the same.

I hope to become a FOG one day (give me 50-60 years), where i can sit with the rest of the FOGs, complain about all the youngins, and remember what it was like back in the day. But I don't want to become a dinosaur, where my presence in the organization hampers it from becoming a modern top of the line agency, and I hope if that does happens, I have enough cojones to step aside and let the younger crowd do their thing.