Two Cases, One letter – From one Paramedic’s struggles, change can come

A letter I received from a reader recently has gotten me just as mad as he is, even more so maybe. This letter came in from someone who identifies himself as a paramedic but asks that I protect his identity and location completely. I will do so, only identifying that the letter comes from someone who works out west, somewhere between the Mississippi and Montana but not east as Maine or as far south as Amarillo.

So He comes from somewhere in the US, not the east coast, and not Hawaii. He’s a paramedic and he’s male. That’s all I’ll say. I’m going to work the things he wrote me in his letter with my thoughts and feelings on what he wrote and the situation he wrote about. I’ll rewrite the letter keeping the point of it intact. I’m fairly sure that you’ll be just as angered as I. (Note – This is LONG but it’s good. It will probably tick you off too, enjoy)

It Begins:

So the other day, I made a decision. I was transferring a patient from a small ER to a larger hospital a short distance away for an inpatient admission from the emergency room. This patient happens to be one of our regulars, and I’ve come to know him pretty well in the course of taking care of him over the time that I’ve worked here. He’s legitimately sick, and certainly has been dealt a poor hand by life. His list of ailments would confound a gerontologist but prove terribly daunting for her team of doctors taking care of him as a young adult. He has been in and out of hospitals since his adolescence and through his contact with medical care has contracted MRSA, one of the scourges of the contemporary age.

Normally, taking care of this patient is a pleasure for me as he is always a good conversation and my familiarity with his conditions has given me a comfort level while in his presence. However, something troubled me with this trip.

This time the patient was being transferred to a room number that I recognized as being on the Mother/Baby unit at the receiving facility. I knew that their policies would never allow an adult colonized with MRSA to lie in the same bed normally occupied by mothers and babies in their most tender first moments. The risk of cross-contamination and infection is too great to allow such a thing and a newborn infected with MRSA may not fare well. Transferring him into that bed put mommies and babies at risk, and I recognized the danger.

Here’s the rub though, the nurses in the small ER had arranged the transfer with the nurses at the receiving facility. They were all hospital folk, and had more experience in the hospital than I do. They arranged it, and if I had voiced my objections I would have been perceived as a troublemaker and as the bad guy. I knew what I was doing was unsafe for every patient currently on the mother-baby unit of that hospital and could pose a risk to every baby born there in the future. Sure MRSA isn’t the end of the world, but why increase the risk to a newborn?

I think that we’ve all been there, and you’re right. MRSA isn’t the end of the world these days. Pretty much everybody has it, and it’s nearly impossible to eradicate from the healthcare environment. If you’ve read my stuff on limiting the spread of nosocomial, or “Healthcare Acquired Infections” (HCIs) you’ll know that I try to keep my personal paramedic practice clean and to limit my own risk of spreading the disease between my patients as much as possible. With that said, buddy, I’ve been there. I’ve been in the position many times where I saw something improper… something that could potentially hurt someone, and have known that if I were the one to speak up, I would be the one considered to be the agitator. I would be the “Uppity” paramedic causing problems… it’s a tough call.

The letter continues:

I ended up holding my tongue and not speaking up. I knew that I wouldn’t be viewed favorably if I had said anything and I didn’t want to create problems with the receiving facility. Honestly, I’ve spoken up on some bigger issues in the past and I decided to pick my battles on this one… I didn’t need them mad at me for yet another issue that they thought to be trivial and I wasn’t in the mood for trouble. I put the patient on my cot and gave him excellent interfacility care and a comfortable ride to the receiving hospital. Then, I wheeled him right up to the mother/baby unit and put him in his bed in the birthing suite. I didn’t like it… and the nurses who worked the unit seemed to be a little spooked by the complexity of the patient’s multiple conditions. I explained it to them in detail because of my long-time relationship as an acute caregiver to the patient. Then, when they seemed satisfied with the report, I left the room. My partner and I began heading down the hallway towards the elevator when we were met by the House Nursing Supervisor who stopped us and asked us “Did you know we can’t have him on this unit? He’s got MRSA! We can’t have him up here!”

I said “I’m really sorry about that, but this is where everybody told us to take him.”

She left to go into the room, presumably to arrange transfer of the patient to another unit that would pose less of a risk for cross-contaminating the most vulnerable of patient populations. I think that it was a good idea for her to do that. I still can’t believe that there was a breakdown in communications, forethought, or whatever on the part of all of those other professional medical people that would cause this inappropriate room assignment and an additional risk, albeit a small one, to mommies and babies.

Sure, it’s not the end of the world. I know that. However it was still inappropriate and should have been caught by someone. I’m just as guilty as everyone else because I didn’t speak up, or even ask anyone a simple question. (Insert Melodrama here) if just one baby gets infected with MRSA and has a poor outcome or even dies, am I partly responsible for that? (End Melodrama)

Well, I feel your pain. You probably aren’t a baby-killer just yet, although you’re right to think that there is a chance. Hospitals have infection control procedures for a reason and HAIs are the 4th leading cause of death in the United States. So it’s an issue. It could have been a simple oversight on the part of the small ER who didn’t work for the receiving facility, but the receiving facility should have known to follow their own polices. They could be less at fault here if the small ER didn’t inform them of the MRSA, which in turn is possible for them to have forgotten. There’s a lot of wrong here. Yes it’s a small issue… but what if the disease were, say, ebola or something. What if this were something that would immediately cause people a lot of harm? Chances are that someone would have caught it… but what again if that person were you, should you speak up?

This wasn’t the only case that the letter refers to and let me read this part of the letter to you as well. Let’s see if you can see how these two incidents tie in together:

This case got me thinking about another case where I spoke up on behalf of what I thought to be right and have been raked over the coals for doing so. I was dispatched to a private emergency call in another ambulance service’s jurisdiction to take a patient from his home to the med/surg unit of a hospital that we only occasionally transport to. It was a non-emergency request through a home healthcare agency and the patient had originally been transported back to his home via our service. In fact, we were talking with the crew who had taken her to her home originally when we got the call. They said that just a few days prior when they transported him, he was a remarkably pleasant patient and that they enjoyed taking care of him. They wanted us to say hello for them.

We drove the 25 or so minutes out to the patient’s house in an affluent part of the county and when we arrived on scene we were met by a male who identified himself as the patient’s son. He looked positively spooked and told us that the patient had been having a fit of rage for the last 24 hours or so. He said that he was paranoid, combative, and was convinced that his family was trying to kill him. He wished us luck and told us that this was going to be a tough one for us. Compounding all of this was the fact that the patient was up some steep multi-level stairs and down a tight hallway. We were going to have to use our stairchair to get her out. They also informed us a bit on the patient’s condition, which was basically intractable cancer and palliative care with a valid DNR order in place.

I’ve been in plenty of these situations before over the years, and my thought is that it is better for a patient to be mad at me if they are to be mad at anyone, lest they spend their last days on Earth mad at their loved ones. I’m a professional. I can take it. I informed the family members down in the foyer that I would play the role of the “bad guy” so that they could be the good guys in the situation and that I would be the one that the patient should be mad at, not them. They seemed to be relieved and agreed to this before we made patient contact. We climbed the stairs together and entered the room.

The patient was loud and was yelling at an obviously frazzled home healthcare provider who was trying to get him calmed down. As soon as he saw us walk into the room in our uniforms he said “Oh my God! You’re here! Take me to the hospital! These people are trying to kill me!” and began to cry. He was definitely paranoid and most definitely very agitated. I walked over to him, introduced myself, and told him that we were taking him to the hospital so they could take care of him. He immediately calmed down and tried to climb out of bed to go with us. He was still relatively healthy in the early stages of his hospice care and could almost get out of bed on his own. I asked him to wait a bit so I could take a look at him before he got up.

This is where the situation starts to go South. You see, I am a paramedic and not an ambulance driver. My job is to provide excellent healthcare to the best of my ability and scope of practice and not to just give a ride to the hospital. I assess every patient and treat them as they need me to. That’s what I did here. I found him to have tachypnea, a very low pulse-ox, and to be markedly tachycardic above 160. This was a sick man, and an unstable patient. My professional judgment was that this patient was wholly inappropriate for an unmonitored bed in a regular Med/Surg unit. Sure, the patient has a DNR, but DNR has never stood for “Do Not Treat” and this nice man needed immediate treatment to calm his symptoms and ease her suffering. My guess is that his agitation was being caused by his hypoxia and tachycardia, which was also being compounded by the fact that she was suffocating to death.

I let my partner know that I wanted to get the patient into the ambulance so I could correct his hypoxia and take a look at his EKG tracing. I opened up the stairchair to get it ready for him and handed our standard paperwork to the family for them to fill out the demographic information and sign the proper forms for us. Then my partner and I lifted the patient to the stairchair, wrapped him up in a blanket, strapped him in, and began wheeling her out of the room to the staircase. As we did so, I mentioned to the family that the hospital may wish to hold the patient in the emergency room for clearance before admitting him to the floor as his condition may warrant that.

That’s when everybody started yelling at me.

Nobody in that room wanted the patient to be taken to the ER. They were adamantly against it and were immediately mad at me for even suggesting that he might be taken there. They were pissed. A lot of statements berating me, my professionalism, my care, and even my integrity were thrown at me in a very short amount of time. As someone who understands the grieving process that a family experiences in a time like this, I understand when they need to lash out and as a professional I’ve already mentioned that “I can take it”. A lot of what I thought to be calm, compassionate, and professional talk peppered with a lot of “Sirs” and “Ma’ams” came out of me as I struggled to carry the patient through the narrow, twisty hallway. The patient sensed the discord that was taking place and got immediately mad at me for angering his family. I had said that I would be the bad guy, and now I was. They were all hopping mad at me.

My partner and I got the patient down the stairs and out of range of the family only to have the patient balk at letting us lift him to the cot. He imagined that the papers I had given to the family were some important and shady legal documents that he absolutely needed to have in his possession before we took him away in the ambulance. Finally, seeing no way that I could convince him otherwise, I went back up into the family room to get the papers while my partner waited downstairs. I was again met by the anger of the family. I honestly, truly tried to explain to them that the patient was unstable with something that we could maybe fix in the short term that would make him much more comfortable in his last days, that I understood that he didn’t want any heroic measures, and that I was at the mercy of my medical control physician who controlled such things. They were still angry at me but agreed to handle it at the hospital. Heck, even the home healthcare provider laid into me on this one… like it was my fault that he didn’t understand the difference between a stable and an unstable patient. Isn’t it his job to provide palliative care and to keep the patient as comfortable as possible? Isn’t it his job to know that treatable suffering should be avoided and to know that hypoxia causes agitation? Isn’t it his job to work with the entire spectrum of the healthcare team to provide the absolute best patient care in any circumstance?

Oh buddy, I’ve been there. I know that these situations are just plain hard for any provider to manage when you add in the dynamics of a hostile family taking out their justifiable grief on you, the healthcare provider; I’ve been there when people interpret “Do Not Resuscitate” orders as “Let the patient suffer and die quickly from treatable conditions” orders; and I’ve certainly been there when I’ve been considered an “Ambulance Monkey” who should just “Shut up and do what you’re told!!!!”. However, let’s continue with our colleague’s letter.

After I escaped the family and got back downstairs, my obviously frazzled partner had gotten the patient onto the cot with the aid of some of his friends that had stopped by and calmed him down. We buckled the safety belts and beat feet right out to the truck. I hopped in the back with the patient and my partner got up front to just leave the angry scene as quickly as we could. Luckily, the patient was amenable to letting me treat him and I placed him on oxygen via Nasal cannula, on an EKG which showed Sinus-Tachycardia, and he even allowed me to place an IV. He appeared to be dehydrated and I checked his blood sugar for a precaution just to be sure he wasn’t hypoglycemic. He calmed down markedly with the oxygen and the fluids. His vital signs came back into more normal ranges and while he still wasn’t out of the woods as far as his acute symptoms were concerned, he was a bit more comfortable and stable with the care.

For a few minutes, that is. He fixated back on the paperwork that I supposedly had given to his family and even though I gave him copies of the standard forms for him to peruse, he was convinced that I was doing something nefarious. He started to become agitated again and tried to rip his IV out. I stopped him and he grabbed my hands to restrain ME from stopping him. Owch. I figured that him holding my wrists was better than his ripping out his own IV and I let him continue. I was able to get my cell phone out and dialed up the receiving hospital to give a report. I thought that I painted a calm, cool, and detailed picture for them and suggested that I would stop in the ER for them to take a quick look at before going up to the floor, since at their small community hospital they bring every patient in right past the ER nurses’ station. As they answered me incredulously, the patient dug is fingernails into my wrists. I thought I maintained composure over the phone… but when I said”good luck” to them they must have gotten mad at me. They said that they would meet me upon my arrival, which took about another ten minutes for me to arrive there to do so.

After taking the patient out of the ambulance he was very much relieved to be back in the hospital. I explained the situation to the ER nurses and the ER physician, including the patient’s condition and the family dynamics involved. They assessed the patient and paged the admitting physician… who stated that he didn’t know that the patient was unstable and refused the admission to Med/Surg pending clearance in the ER. The ER staff wasn’t too happy about having an additional patient to attend to, and I could only imagine how mad the family was going to be.

So let me get this straight. The ER being mad about taking a patient who could have been a direct admit and would have been otherwise none of their concern is a familiar theme for me. While I don’t agree with it, I know how they can be sometimes and honestly I can see how their constant condition of being overworked and underappreciated can color their attitudes. I get that. What I don’t get is what the family and the “Home Healthcare” person had against the patient being cleared in the ER. You’re right that paramedics, EMTs, and EMS personnel are not simply “Rides to the hospital” and must use their professional judgment with every patient. You have to do an assessment, you have to provide an appropriate treatment, and you have to advocate on behalf of the patient… even when nobody wants you to. It’s your license and your career. Doing the best by every patient isn’t always easy… but it is always the right thing to do. However, don’t finish this letter because I can see where this is going.. don’t tell me what happened next.. Just don’t tell me that THIS happened.

A few days later I was called into my boss’s office. He was livid to say the least. Apparently I got a formal complaint from the family, from the hospital, and from the home healthcare organization. I was the bad guy here everyone thought, and because of it we had lost the transport contract with the home healthcare organization, lost the contract with the hospital, and ticked off the family big time. My name was mud and my butt was in a sling. Apparently I was rude, I had acted against the wishes of the family, and I had interfered with the orders of two separate physicians. They accused me of “Not thinking about the company” and told me that if they had to lay off staff because of the drop in call volume that it would be my fault when they got laid off. They mentioned firing me… but what saved me was my impeccable record, the fact that my partner who happened to be a supervisor of a lower certification level had filed a commendation in my file for the way that I handled it… and the fact that as far as patient care was concerned… I was right. It was clearly acting in the best interest of patient care and the recording of my radio report that they played for me showed that I was trying to be polite… except for the “good luck” part… they were mad at that. I explained to them about the fingernails and the fact that I had been extremely polite to everyone concerned in the trying circumstances. I ended up not having any negative sanctioning… but they were still mad… and the former contracts still aren’t calling. I may have irreparably damaged my service by doing what I thought was the right thing to do.

Man… that just sucks. It seems to me that you were caught up in a situation where you couldn’t win. Yes, you did the right thing by the patient and if everything you say is true, I commend you on your patient advocacy… but your boss is right, if the contracts don’t call and send their business elsewhere, it hurts the company’s bottom line. That’s a reality in for-profit, not-for-profit, and in all ambulance services that depend on transport revenue. I would say that if the relationship you had with the contracts was that tenuous to begin with that you aren’t the root cause… but perhaps the situation was the last straw. I would ask what the home healthcare person was doing while you were taking the brunt of her inaction to correct the patient’s immediate suffering or to communicate to the physician the seriousness of the patient’s condition… but my guess is that she was of the opinion that the patient was “Just a DNR”.

And this is the part of the letter that really gets me:

The part of these situations that really gets me? The time that I stood up for the best patient care I got raked over the coals… the time I potentially killed babies? Nothing.

There is so much at play here that transcends the experiences of the person that wrote the letter that I don’t know how to address it without turning what has become a very long article into a chapter of a book. The way I see it, this is a breakdown on so many levels. However what slaps me in the face is the fact that apparently nobody in those situations respected your professional judgment. You were seen exactly as you put it, as little more than an “ambulance monkey” who they thought was supposed to do exactly as you were told. While the first case was a mild example, you did what you were told to do and the hospital caught the mistake after possibly no damage had been done. While you could have voiced objections, you’re very much right that you would have been seen as the troublemaker and would have been told to mind your own business. I can’t even imagine that you would have been vindicated when the nursing supervisor caught the error… although that may be because your letter has left me with an aura of generalized cynicism. Sure, the potential existed to cross contaminate a neonatal unit with MRSA due to a medical error; you knew about it and did nothing due to internal politics. That’s bad… but understandable because I’ve been there.

The second case is worse. What do people expect when they call an ambulance? Do they expect you to just throw the patient on the cot and take them to the hospital as they told you to without giving an assessment, using professional judgment, or doing anything the way you’re supposed to? What about when you stood up, and you were punished for being an “uppity” paramedic?

I’m so mad I can’t see straight. I gotta take a break in writing this….

What we need as a profession is to be out there earning our professional respect. Obviously nobody you were dealing with had any respect for EMS and you and your service have paid the price for it because apparently they hold all the cards.

What this harkens me back to is the representations of the “Ambulance drivers” I’ve seen on every TV show or movie I’ve ever seen. They’re portrayed as bumbling idiots who run real fast, take orders from the shows main characters eagerly, and then scream off into the night doing exactly what they’re told to by whomever they just met that seems to be in charge. Look at how the paramedics are portrayed in ER as intense, harried people that are just waiting to tell the doctors “I can’t do that, I’m just a bambilance driver” and can’t seem to treat even the simplest of conditions. I’m actually pretty sure that is what some medics do in order to avoid confrontation, they do exactly what they’re told and figure that the consequences are someone else’s problem. In fact, that may work out well for them as they never make waves and never get into trouble that way.

I tell my students that I’ve been doing this for more than ten years, and in this job when you’ve been doing it for as long as I have, working around a bunch of type “A” personalities whose jobs depend upon them being “right” the first time every time, that if a person hasn’t ticked some people off they must be doing it wrong. I believe it. Anyone who advocates tirelessly for the best interest of their patients is going to tick some people off sometimes… It offends the most tired and or laziest among us when they are involuntarily compelled to do the right thing sometimes less they end up looking foolish.

I don’t have an answer for you, anonymous paramedic… just keep doing right by every patient. And be sure to BE NICE. That’s all I got. Well, that and push for professionalism and education. Push public education and perhaps set up a meeting with the people involved. Continue being the most professional and caring paramedic you can be.  You may not fix it fast, but collectively we all can make a difference.

We have to.

  • http://notesfrommosquitohill.com mack505

    Wow, do I feel fortunate after reading this. Our service has a very strong and proactive online med control presence. They encourage us to toss the hard ones to them, and they usually take our recommendations. In either of these situations, I can call the Doc, explain the situation, and make HIM the bad guy. It's a cop-out, but for some reason people listen more to the MD than the 'ambulance driver.' Sad, but it works.

  • http://firefighterparamedicstories.blogspot.com/ FFPM

    Wow! I don't know what else to say to that! I agree with Ckemtp, all you can do is do what is right by your patient. Sometimes you're going to make enemies. It's a choice you made when you decided to become a good medic and not just an “ambulance monkey.”

  • http://twitter.com/jedifire11 Joshua

    I agree with all that is said above, how is it that folks out there who are less educated than what a paramedic is are still viewed as professional just because they are wearing scrubs and work in a (insert health-care facility here). Unfortunately, due to the nature of my service, I feel like “just an ambulance monkey” most of the time. When performing BLS discharges out of hospitals, I have noticed that most of the EMTs in my service just pick up the necessary paperwork and the patient and leave without talking to the nurse and getting a history on the patient. On the rare occasion that I work with a new employee, I try to explain to them that it is our job and responsibility to know what is going on with the patient, whether they're going to another hospital or just to a nursing home. I have also had difficulty with all kinds of staff members at facilities, saying that I don't need to know about the patient's history (even to the point of saying that it is against Hipaa to tell me!), or giving me an attitude when doing so. I'm tired of being an ambulance monkey and so should every other self-respecting member of our community, we are professionals, we are paramedics (or EMTs)!

    /end_rant

  • http://twitter.com/Jeramedic Jeremiah Bush

    You speak for all of us Anonymous Medic, I feel your pain. Ck, You also speak for all of us. This is just one of many, many, many examples of why our “health care” system is just plain embarrassing. But things will change, they have to. And sometimes I think that the only way is to just let it all crumble fail so spectacularly that we have a clean sleight to start over from. that is of course if it hasn't already failed.

  • http://twitter.com/Jeramedic Jeremiah Bush

    You speak for all of us Anonymous Medic, I feel your pain. Ck, You also speak for all of us. This is just one of many, many, many examples of why our “health care” system is just plain embarrassing. But things will change, they have to. And sometimes I think that the only way is to just let it all crumble fail so spectacularly that we have a clean sleight to start over from. that is of course if it hasn't already failed.

  • http://davidkonig.com Dave Konig

    These are two interesting cases.

    I really have nothing substantial to add to the first, other than maybe giving a report on the patient before placing them in the bed could have saved some trouble. The sending facility surely would have seen you as the uppity paramedic, but the receiving facility would have considered you a hero.

    The second case I do have to say that the description of “intractable cancer and palliative care with a valid DNR order in place” plus the fact that it was a direct admit indicates to me that the patient was enrolled in a hospice program. Hospice programs operate under very different guidelines than regular medical services. Their mission is not to extend life, but to make whatever life the patient has left as comfortable and dignified as possible. They assume all responsibility for the patient's care, and taking the patient to an emergency room means that they may very well have been disqualified from continuing in the program that they wanted.

    I think that's an issue in EMS that we fail to recognize. Too often we become enraged because we think we are not being considered as “professional” or “competent” and that we in fact know what the patient needs… and then we live up to those labels by not listening to what the patient actually wants and making that happen for them.

  • Kimmedic

    I have worked for three different services in the past 17 years, and each one operated the same way as the one in this letter. At the first company I had a stack over an inch thick of thank you letters, but one complaint trumped them all. I got past this tendency by remember that I go to work each day to help people. To give something back to society. I choose the path that will help me sleep best at night, knowing with every call that there's a good chance we're gonna piss someone off along the way. Heck, at this point I figure if I haven't pissed someone off I probably haven't done a very good job today!

  • ParamedicDave

    Years ago at a private service I worked at we got a call from the cops for a suicidal patient. We get there and she is very agitated and paranoid and did not want to go to the hospital. After talking calmly to her for a while I convinced her to go to the hospital with us. During the whole trip she was calm and cooperative with us and then we arrived at the ER. That particular hospital had a room for psych patients and we were instructed to put here in there. We got the patient in the room and moved over to the bed and the nurse came in. The patient started saying she was claustraphobic and asked that we not close the door. The nurse as rudely as possible says “We have to close the door.” At this point I could see the patient getting upset again and I tried to intervene because I was sure I could have convinced the patient that it was their policy that they close the door and she would have been ok with it. Before I could get a few words out the nurse said again “The door has to be closed!” rather loudly. At this point the patient got off the bed and ran out of the room and out of the ER, the nurse looks at me and says “See what you just did!” Then everyone in the ER was pissed at me, not the nurse that caused the problem.

    The cops managed to find her and bring her back a few hours later and I called my boss and explained everything so I didn't get in any trouble at work, but for weeks when I came into that ER you should have seen the dirty looks I got.

  • http://firstduemedic.com The Gate Keeper

    My companies mission and my mission are not on an even plane…not even close. My goal is not to make as much money as possible, the companies' is. My goal is to be a patient advocate and treat them as if their life (or that of anothers) depends on it, the company does too as long as they can bill ALS and it makes them look good.

    I have come to realize that this is MY profession. I did not get into this line of work because Medicare and Medicaid pay out some decent rates and there is a steady line of work for the foreseeable future due to an increasingly aged population. I decided to dedicate myself to the preservation of life with dignity and honor regardless of the patients financial state, current or past medical history or even what crime they are accused of having committed.

    I am overworked and more underpaid than any ER nurse thinks they are. I go to work in places that are not climate controlled. I go to work in places that people should not even live. But I will be damned if I will lay my ethics down at the time clock and act like the rest of the health care profession thinks I ought to.

    Regardless what THEY think or how OTHERS may act, I AM A PROFESSIONAL and I will conduct myself accordingly. Yes I need my job; the kids need to eat and we like riding insted of walking, but my integrity can not be paid off.

    I like to compare the struggles with or profession with the struggles against injustices of the civil rights movement. Somebody will have to stand up and make some noise and be heard…somebody may have to take the “bullet” for speaking out about what is wrong. But where will we draw the line? Who will speak up for integrities sake if we won't?

    We have a long way to go to “cross the tracks” to get to the professional side of town, but that long journey starts with us ALL taking a step!! I take mine now…will you?

  • CBEMT

    I would've been fired, because we use cellphones to contact the ER, not radio- no recording. Would've been their word against mine.

    Doesn't sound like a place I'd want to work anyway- and I've worked for one of the douchiest privates anywhere. On the other hand, around here it would take a lot more than one paramedic bringing in one patient for a hospital to cancel a contract. Nor is it my fault that the company depends so much on one facility and one home health agency. Does the owner have his retirement portfolio invested in only two mutual funds or stocks? Of course not.

  • CBEMT

    I would've been fired, because we use cellphones to contact the ER, not radio- no recording. Would've been their word against mine.

    Doesn't sound like a place I'd want to work anyway- and I've worked for one of the douchiest privates anywhere. On the other hand, around here it would take a lot more than one paramedic bringing in one patient for a hospital to cancel a contract. Nor is it my fault that the company depends so much on one facility and one home health agency. Does the owner have his retirement portfolio invested in only two mutual funds or stocks? Of course not.

  • jcfmedic

    Lots of good comments above. Here is my two cents. First, although I routinely rant about other healthcare providers not understanding our profession, what we are capable of and, at times, what we have to do, it is not in their job descriptions to educate themselves about us. We must become much more proactive in educating professionals and the public about who and what we are. Granted, in a situation like described with the cancer patient, with heated emotions, educating someone is not easy – if possible. However, we need to begin to relate one-on-one during down times and talk about what we do and the things we come up against. Will it solve all of the problems? Obviuosly not, but it may crack open a door for dialogue in the future that can help defuse a tense situation.

    Second, as both the letter writer and I have learned you have to pick your battles. Would it have done any good to bring up the MRSA issue with the sending hospital? Probably not. They could have simply said, “We told them.”. Or more abrasively, “Are you questioning our professional ability to give a simple transfer report?” I think the suggestion of Dave Konig represents the best of both worlds. You let it slide with the sending facility and keep your relations there happy while letting the receiving facility know about the MRSA before the patient reaches the room. “I just discovered this in the medical history on the way over and I wanted to make sure you knew.” Everyone wins.

    Dave also makes a good point about hospice programs. Many hospice contracts require a patient to agree not to go to the ED in exchange for the hospice services, including in-patient care when appropriate. Under those circumstances an patient who goes to the ED is dropped from the program and becomes responsible for all medical bills. Whether that was the case with the patient in this instance is unknown. One service that I worked for had the director of a hospice service come out to a meeting and give us a presentation (did someone say education?) on the various services of hospice, why they may need a patient transported, and what we could do – within our scope of practice – to make things go as easy for the patient and family. It's about communication folks.

    Third, like others here I have been in the situation where I needed to be a patient advocate. I was doing an interfacility transport of a trauma patient who still rated pain at 9 out of 10 after meds. I asked the nurse about additional meds and she said the patient had already received everything. I could have taken a chance, loaded the patient and called for pain management en route but I chose a more direct approach. I tracked down one of the ED docs and asked him to check on the patient with me since I did not feel comfortable accepting the patient in her current condition. When he saw the girl he readily agreed she required more meds and not only ordered more immediately but gave me orders for addtional meds en route if needed. No arguments with the nurse, no bad feelings and the patient got what she needed. However, there are those times when feelings be damned. I transported a cardiac cath patient, with a hx of a previous MI to a hospital. Nobody knew where he was supposed to go because there was a question about which of 2 procedures were to be done first. We were finally sent to one location only to find it empty. When we were redirected we got to a hospital room with no monitor and an aid told us to put the patient in the bed. I asked about the monitor and she said there was none and since he was not going to be there long he did not need it. I explained that he came from a monitored bed, he required a monitor in the ambulance and he was not leaving my litter until he could be placed on a monitor. She huffed out of the room and came back with a nurse who restated that a monitor was not available. When I explained that I would wait until one could be found she left in a huff to get a nursing supervisor, which I incidently thanked her for doing. She came back without a supervisor, but with a monitor. When I asked her to sign the receiving sheet, she rather rudely declined but the patient's wife who witnessed everything was more than willing to witness my note that the nurse refused to sign.

    If we and the rest of the medical community (and/or the public safety community) want to be polite, we are the red-headed step-children. In not so nice terms, we are the bastards. Either way, we are the new kids on the block and we still have to prove ourselves everyday. It has not been easy nor will it likely get any easier, but there are ways we can stop shooting oursevles in the feet. 1. Look professional. If you wear a hat – one that is appropriate – wear it correctly. How you chose to dress/look on your own time is your business. If your dress impacts me and my professional it becomes my business. 2. Act professional. Everyone likes a joke. And God knows many times with what we see we need humor to get through. However, remember what your parents said about a time and a place for everything. The parking area outside the ED is not the place to have water fight with syringes. Nor is it appropriate to run up and bang on in-coming units. 3. Talk professionally. You do not need to be a walking dictionary or memorize Grey's Anatomy. For the most part just dropping the slang and cursing would go a long way. “Thank you.” You're welcome” Have a nice day.” would not hurt either. 4. Respect your patients. If you call your patient any one of the nasty words used in EMS to refer to, especially nursing home, patients, go get a job for FedEx or UPS. You will make more money, not have to put up with mouthy nurses or winey patients. These are people were are supposed to be caring for. Many times there may be nothing we can do except listen or hold a hand – and many times that is enough.

    There are many things all of us can point to and complain about EMS and the systems, institutions and people we work with. I for one would not want to work anywhere else, as it sounds lilke the people who wrote before me feel.

    Sorry this got to rambling but as the article stated, this pushed a lot of buttons.

  • anon

    Just yesterday, I had a unit clerk give me serious grief because I wouldn't just take the patient without getting a report from the nurse. I nearly told him to call the patient a cab, but I overcame that urge in the name of professionalism! :)

  • anon

    Just yesterday, I had a unit clerk give me serious grief because I wouldn't just take the patient without getting a report from the nurse. I nearly told him to call the patient a cab, but I overcame that urge in the name of professionalism! :)

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    Ckemtp
    I Got Attacked – A Paramedic Speaks About Public Trust
    I somewhat agree, though I assure you I didn't set out to waste your time. I probably should have broken this down into two separate points as the second point was the one I most wanted to emphasize. My bad on this one, I'll do better next time. Thanks for the feedback. If you'd like,…
    2014-12-16 20:25:00
    hawk4080
    I Got Attacked – A Paramedic Speaks About Public Trust
    Wow. That was a total waste to read.
    2014-12-16 19:20:00
    retired ems medic
    I Got Attacked – A Paramedic Speaks About Public Trust
    The radios should have had a trouble button to eliminate the need to key the Mike and talk. Maybe the dispatchers need to be rotated out to the streets to get out of the mode of just getting the calls out and only half listening to the radio.
    2014-12-16 14:50:00
    HybridMedic
    I Got Attacked – A Paramedic Speaks About Public Trust
    We use "Signal C" as a code to relay a crew in distress. Takes a second for the dispatchers to confirm it, but it sends the nearest engine, battalion chief, fire investigator (who are sworn LEO's) and makes an officer in distress call to Memphis Police. The arrival of all those resources is quite... Dramatic.
    2014-12-15 14:29:00
    exmedic
    Welcome to the Club
    Not me anymore
    2014-12-15 09:17:00

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