Stress from a co-worker on scene & how to control the situation.

[Mellowdnb]

Some on scene stressful situations are unavoidable but a situation involving a co-worker loosing her/his cool can be best prevented by constant training for practical situations. Throwing various stresses in training, such as low light, should be added to bring a more realistic training environment.

So, how does one handle a co-worker who looses his/her cool? I'm afraid I don't have the best answer.

I have had a preceptor/station manager scream wrong orders and mismatch protocols on a difficulty breathing call. Pt was in severe respiratory distress. I tried to get a history of any respiratory conditions from the wife but when my preceptor lost control, I thought the best thing to do would be to get off scene ASAP. I was only able to obtain a history of childhood asthma, with no history of recent attacks before she screamed at me to "STOP WASTING TIME & MOVE IT!" The expression on the wife's face was now frozen with a scared expression. I cursed the preceptor in my mind for now making a scene worse.

Diminished lung sounds auscultated in all 5 posterior lobes. Unsuccessful attempts where made to try and control the scene. She wanted to administer epi in the back of the ambulance, which she couldn't explain why she thought it would be an appropriate medication. I was confused as to why she wanted to administer the epi. It is rare that a Pt who has had childhood asthma would have another attack 50 years from the previous asthma attack. My preceptor grabbed the epi when I wouldn't give her the vial.

Turns out the Patient had a severe history of stage 4 lung cancer. This information was given by the wife to the ED staff upon her arrival. I often wonder if the preceptor hadn't acted like she did, this vital information might have been obtained. How was the wife supposed to continue giving me information after what my preceptor did? I often wonder if I could have brought this the preceptors attention and it might have prevented the administration.

I since have left this service and I am obtaining my RN.This call weighs heavy on me and it frustrates. This preceptor/station manager continues to be employed. I was informed she was kicked out of a previous EMS system and she had to go to anger management training. It had no positive effect on her.

I often wonder, can one regain a calm demeanor in a co-worker?

 

[akflightmedic]

It sounds like you are dealing with multiple issues here and this can be a challenging coworker/situation to manage.

First, we all should train and educate regularly. People often think these terms are synonymous however they are not. To clarify the definition, education gives us the knowledge to know the how, when and why we do something or even more importantly when NOT to do something. Very few people obtain education in the current EMS initial education structure.

Training is more simplistic and glosses over the above. It is more of "if you see this, do this" type approach. While these two things are not the same, they are both needed and do work hand in hand. Training needs to be done repeatedly repeatedly however because it is the default. It is muscle memory, it usually requires not much thought. Training is the "safety" often times when are education lacks or fails in a moment. When you suddenly have that oh crap I forgot what to do or I know nothing about this condition, what should I do...you then default to the most basic steps right or wrong and hope that it keeps you out of trouble or improves/worsens or changes the patient condition to something which then triggers your education part. (The old joke of keep shocking them until you see a rhythm you recognize applies).

When someone lacks in education and relies on training too heavily, you will often see them react negatively on scene...such as your preceptor who it sounded like only knew a diesel bolus in this moment. Losing their cool and yelling or displaying panic was very poor form. Panic IS contagious. Sounds like the preceptor might have been lost in that moment, however felt the need to do something in the right direction which basically meant load and go. How the plan was executed was horrible.

So not only are you dealing with a personnel issue, you are also dealing with a system issue. As in why is this person a preceptor? What kind of in house education and training is ongoing or even offered? How did this person get promoted, how did this person remain on the department? This issue above is a much more difficult one to change or address as it needs to be a top down analysis which is often most unwelcome in certain organizations.

As for how to address the issue on scene in the moment, you have to decide is it the right time or do you discuss it later. If you absolutely think it is in the patient's best interest to not move yet, then you need to address it. Even being the low man on the pole, you still have the ability to influence the situation immediately, it all depends on how confident and strong you choose to be. You can tell your colleague to please be quiet, you have it under control and you will give direction on how you wish to proceed in a moment (basically assuming all command from your preceptor) to which they may comply and realize they were out of control or they might react angrily which while not ideal to do on scene, it could hopefully lead this person to a new job or re-education within the company.

If you do not have the testicular fortitude to snatch scene control in a professional way, then you absolutely should debrief after the call. Do not delay, address the issues immediately after patient care is handed over and you have privacy to discuss. I might even go so far as to call in a supervisor to mediate (all dependent on how the partner was acting).

You have a lot of options at your disposal, only you can decide what was right for that situation in that moment. We can armchair quarterback this, however much of it will boil down to you communicating more effectively, more promptly and being more assertive overall.

I used to sit back and let people cruise when this stupid stuff occurred...over the years I have learned this is not the best way to handle it. I became way more vocal and I have zero issue involving those higher up the chain sooner rather than later. It makes a more compelling case and keeps you out of the storm. I have little tolerance the older I get for silliness and unprofessional behavior.

 

[ERDoc]

From my experience, the ones who scream and panic the most are the ones that are least capable of doing the job. I can't imagine how this person managed to become a preceptor. If you know what you are doing, there is no need to panic. Unfortunately, in a situation like this it is hard to regain control since you never had it to begin with. Sometimes, encouraging them to take a deep breath or telling them that their pulse is higher than the pt's will get the point across but it all really depends on the person you are dealing with so it is a case by case situation.

 

[RocketMedic]

Background: I know this preceptor. She was placed in that position by longevity, volunteering and toeing the party line.

The attitude and performance are, sadly, par for the course and are accepted.

 

[Mellowdnb]

I was watching a documentary about Trauma Docs in Iraq. One of the docs would calmly say "This is the Pt's emergency, not yours"

Has anyone tried an approach that works?

 

[RocketMedic]

I was watching a documentary about Trauma Docs in Iraq. One of the docs would calmly say "This is the Pt's emergency, not yours"

Has anyone tried an approach that works?

I have two answers: kicking them to the front of the truck (works if you're in charge) and commanding them to do what you need them to.