My BIGGEST pet peeves

[Sasha]

While responding? That defeats the purpose of gloves, which can also be to protect the patient from the ickies you brought from the truck to them.

I wear gloves for pts on neutropenic percautions, when im dealing with body fluids (i may take a bgl without gloves, its fairly easy to do without touching blood) or open wounds or wet sheets

Be smart about glove use and not counterproductive.

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[Sasha]

Ps i probably wash my hands more than my glove wearing counterparts

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[usalsfyre]

I'd argue that the basis of all our practical testing begins with stating we're taking body substance isolation precautions, so not only are gloves recommended, we're trained and certified in their use.

I didn't say there wasn't a reason for the insanity, or that it's not deeply rooted in our psyche by tradition, but:

I agree that many of us don't practice appropriate precautions. What gets under my skin is watching EMTs handle blood and bloody items, insert IVs and touch nasty things without gloves on.

While we shouldn't be doing any of these, your intact skin is a wonderful defense against blood borne pathogens. That's why we don't wear a full body condom. The issue with you hands specifically is that you skin is often non-intact due to microabraions and cracks from dryness (like the kind that comes from wearing gloves to much).

Personally, I put gloves while responding. I don't think doing so is insane, I consider it appropriate. Heck, I'd even recommend it! It just makes one less thing to remember when on scene, and it means I can work faster because I don't have to stop and put a pair on (which is darn near impossible if I worked up a sweat carrying a patient anyway).

As I'm walking up to the patient I can make a pretty good assessment on the need for gloves. It only takes a couple of seconds to put them on.

Do you see physicians, nurses or other allied health professions putting gloves on for every patient encounter? My opinion on why gloves are stressed so much in the EMT curriculum is they consider is too uneducated to make a good needs assessment with regards to PPE.

Every profession has its idiotic holdovers. Nursing has nursing diagnosis, we have this ridiculous notion that saying "scene safe, BSI" while waving our hands is a substitute for real education in these areas.

 

[JPINFV]

Yes. Critical criteria on each practical station of the NREMT certification begins with stating you're taking BSI. So if you don't say it or demonstrate it, you fail the station.

1. BSI!=gloves.
2. Trained in BSI!=certified in the use of "gloves."
3. This entire line of thought exposes everything wrong with the piecemeal approach to interventions and knowledge that EMS has.
4. JPINFV is proud to introduce 2 new courses. Advanced Glove Life Support and Basic Glove Life Support. Sign up today to get your card! We're also currently designing an International Glove Life Support class too!

 

[usalsfyre]

Yes. Critical criteria on each practical station of the NREMT certification begins with stating you're taking BSI. So if you don't say it or demonstrate it, you fail the station.

Any service worth its salt is going to give you the boilerplate "BBP" course "certifying" you in the use of PPE anyway. NR's hand wave is in a word, insulting. If they REALLY wanted to test whether you knew about BSI, they'd have someone start projectile vomiting blood in the middle of a scenario and see if you stopped to don glasses, mask and gowns.

 

[usalsfyre]

Ps i probably wash my hands more than my glove wearing counterparts

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Agreed, the lack of hand washing I see among EMS providers sometimes is, in a word, disturbing.

 

[usalsfyre]

1. BSI!=gloves.
2. Trained in BSI!=certified in the use of "gloves."
3. This entire line of thought exposes everything wrong with the piecemeal approach to interventions and knowledge that EMS has.

Similar to the reasons trying to teach why the renal system is important in heart failure beyond "fluid overload" and "lasix" makes me want to claw my eyes out at times.

4. JPINFV is proud to introduce 2 new courses. Advanced Glove Life Support and Basic Glove Life Support. Sign up today to get your card! We're also currently designing an International Glove Life Support class too!

Don't forget CC-Glove...

 

[mikie]

2 pet peeves, as a student

"You don't need to know that as a paramedic..." - usually a RN preceptor during ER clinicals...I'm there to learn!

and my biggest:

"The protocols says..."

 

[JPINFV]

"You don't need to know that as a paramedic..." - usually a RN preceptor during ER clinicals...I'm there to learn!

...which is why paramedics should spend the majority of their time following physicians instead of nurses. I'd even argue that paramedics have more in common with emergency physicians than emergency nurses.

 

[Elk Oil]

You sure are one argumentative bunch of folks. Your collective desire to pounce on someone and call him wrong, insane and idiotic speaks to larger issues I'm not going to address. It also speaks to an issue I despise in EMS: calling others wrong simply because they don't do something the way you would or see it the way you do. In my experiences, those who are so quick to tell others how wrong they are lack more than those they call wrong.

I cannot believe I'm in a position to defend reasonable statements promoting the use of gloves in EMS. But then again, on another thread, I had to defend kindness and compassion, too :sad:. But I feel particularly up to a challenge, so if I have to, here 'goes:

While responding? That defeats the purpose of gloves, which can also be to protect the patient from the ickies you brought from the truck to them.

If I correctly recall a subject of another thread you started, whose safety comes first? The purpose of BSI is to benefit the EMT, not the patient. Would you also use a DuoDote on a patient???

1. BSI!=gloves.
2. Trained in BSI!=certified in the use of "gloves."
3. This entire line of thought exposes everything wrong with the piecemeal approach to interventions and knowledge that EMS has.
4. JPINFV is proud to introduce 2 new courses. Advanced Glove Life Support and Basic Glove Life Support. Sign up today to get your card! We're also currently designing an International Glove Life Support class too!

Am I supposed to believe that somehow by wearing gloves I am not taking BSI precautions? I've handled many body fluids with gloved hands and am still living to tell the tales.

your intact skin is a wonderful defense against blood borne pathogens. That's why we don't wear a full body condom. The issue with you hands specifically is that you skin is often non-intact due to microabraions and cracks from dryness (like the kind that comes from wearing gloves to much).

Every profession has its idiotic holdovers. Nursing has nursing diagnosis, we have this ridiculous notion that saying "scene safe, BSI" while waving our hands is a substitute for real education in these areas.

There are many levels of BSI and PPE. Gloves are simple and effective. If the situation dictated, wouldn't you wear gown, mask, goggles, etc.? Plus the fact that clothing provides a small measure of protection and our hands are always exposed. We've all been bled or vomited on and haven't contracted anything because our shirts or pants took the brunt of it. I think you're over-complicating a very simple concept here.

And I, for one, don't contend that the notion of drilling into our minds the concept of BSI and scene safety is ridiculous. Perhaps the cursory way of presenting it during our testing could be emphasized more, but the idea behind it is that it hopefully gets people to take the time they need to consider they myriad of safety variables at a call; to keep your eyes open; identify potential problems before they turn into real ones.

Any service worth its salt is going to give you the boilerplate "BBP" course "certifying" you in the use of PPE anyway. NR's hand wave is in a word, insulting. If they REALLY wanted to test whether you knew about BSI, they'd have someone start projectile vomiting blood in the middle of a scenario and see if you stopped to don glasses, mask and gowns.

Agreed, but they don't. You can spend time in the "shoulda, coulda, woulda" mind set, but you're only spinning your wheels. We've been given simple tools. Don't talk yourself out of using them.

If you guys want to analyze every call to the Nth degree, deciding exactly at what point to put on gloves, be my guest. But throwing a pair of gloves on shouldn't be the subject of a major debate.

 

[crazycajun]

Speaking of pet peeves, this is one of mine. Everything you touch with gloves on increases the chance of the glove ripping or tearing. Not to mention gloves are not even recommended unless you expect to come in contact with bodily fluids. It's insane for you to put gloves on in the ambulance on the way to the call. Unless I'm doing invasive procedures or expect my hand might go in somewhere nasty I often don't put them on at all.

For all the emphasis put on gloves when was the last time you saw an EMS provider put on eye protection and a mask when controlling an airway? EMS doesn't practice appropriate precautions. EMS puts on gloves....

WE are required to wear safety glasses on every call. We are also required to glove up upon arrival and use mask and face shield for any invasive airway procedures. Our shift supervisors will ride to calls on occasion and do check.

 

[usalsfyre]

Elk Oil,

The idea that gloves are appropriate to put on prior to ever touching a patient IS wrong. The CDC publishes guidelines on the subject of PPE. For physical exam, which is 90% of what we do, what's recommend? Hand hygiene. Not gloves, gown, mask, ect. Does your PCP put gloves on to touch you? Do you put gloves in to shake hands? Why does arriving in an ambulance make you more susceptible to disease? It's perhaps not insane to don your gloves prior to arrival, maybe merely dumb. What happens when you rip a glove on the door and have to perform an invasive procedure? Do you carry an extra pair with you? Do you touch the ED keypad with contaminated gloves, then touch it again barehanded? You've defeated the purpose.

Meanwhile, how often do you see mask, glasses ect being employed when appropriate? You want to really protect yourself wear glasses, the eye is the one constantly exposed mucous membrane in our body. I've been through an eye splash exposure. Not fun.

As far as being argumentative? Yep, guilty as charged. Arguing that EMS dogma is wrong. Arguing that the ridiculous idea saying "BSI and scene safe" at the start of a scenario (which is as far as most programs take it) somehow prepares students to accurately assess the need for PPE and the safety of a scene. Arguing that inappropriate donning and use of PPE decreases it's effectiveness. Arguing against the idea that it's somehow acceptable for companies to skip out on OSHA mandated training. I'm an argumentative @ss. I personally think EMS needs more argumentative @sses to make anything of itself. But then that doesn't fit with some people's rosy world view, and others are afraid to run against the prevailing dogma. I prefer to be a heretic myself.

 

[Shishkabob]

Honestly, I put gloves on 90% of the time before touching a patient.


People are icky.

 

[JPINFV]

You sure are one argumentative bunch of folks.

What sort of discussion board would this be if there wasn't any discussions.

It also speaks to an issue I despise in EMS: calling others wrong simply because they don't do something the way you would or see it the way you do. In my experiences, those who are so quick to tell others how wrong they are lack more than those they call wrong.

...however not everything can be chocked up to "personal preference" or the "art of medicine."

Am I supposed to believe that somehow by wearing gloves I am not taking BSI precautions? I've handled many body fluids with gloved hands and am still living to tell the tales.

The problem with the EMS mentality with gloves is that gloves protect against everything and that gloves are always needed. Sometimes gloves aren't needed. Often gloves aren't enough, but unless the patient is under isolation precautions then a lot of providers won't take appropriate precautions for an acute onset disease.

 

[DesertMedic66]

The only patient I have not put gloves on for was my grandma. I wear gloves for every patient that I am going to have to touch. We are required to carry another set of gloves, CPR mask, N95 mask, earplugs, hand wipes, safety glasses, and alcohol prep pads with us whenever we are on duty. As we unload the gurney from the ambulance I put gloves on. In my normal life I don't wear gloves when I shake peoples hands. But I'm only shaking hands with my friends and not total strangers. I've never seen a medic or EMT at my service not wear gloves when doing any kind of patient care.

 

[Elk Oil]

Honestly, I put gloves on 90% of the time before touching a patient.


People are icky.

And really... it doesn't have to be any more complicated than that.

 

[Sasha]

Putting yourself before the patient in life or death situations is reasonable. Spreading disease to immunocompromised patients because you dont know when its appropriate to put on your gloves is negligent. You are failing to protect your patient when it is prudent and safe for you to do so.

Dont wear gloves before you even make contact, its really simple. You are being counterproductive and making the situation worse.

It is as silly as using a paper towel on a water faucet then opening a door with your barehand.

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[Elk Oil]

Putting yourself before the patient in life or death situations is reasonable. Spreading disease to immunocompromised patients because you dont know when its appropriate to put on your gloves is negligent. You are failing to protect your patient when it is prudent and safe for you to do so.

Dont wear gloves before you even make contact, its really simple. You are being counterproductive and making the situation worse.

It is as silly as using a paper towel on a water faucet then opening a door with your barehand.

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I'm just going to go ahead and continue to be wrong.

And I ALWAYS put on a pair of gloves before licking a door knob.

 

[ffemt8978]

And I ALWAYS put on a pair of gloves before licking a door knob.

Uh, wait...what?!?!?

 

[Epi-do]

You wear gloves regardless. What other percautions do you feel you should be taking?

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It isn't just about gloves. There's more to PPE than slipping on a pair of gloves, but if you don't know there is a reason to use a different form of PPE, how are you going to know you should even use it?

What if you show up to find someone with active TB who is coughing every 5 seconds, refuses to cover their mouth, and thinks they need to invade your personal space to speak to you. Gloves won't do a darn thing to protect you in that instance. However, if you are made aware of the situation, there are other things you can do to help prevent exposure or the risk of spreading the infection.

The need for any type of PPE is situation dependent. Not every patient requires the use of all PPE available to us. Heck, despite what is drilled into us in EMT class, not every patient requires gloves. It's a shame that as a whole, EMS doesn't truly understand what PPE is or how to effectively and appropriately use it.