View Full Version : Pt care
Why is it that pt care has taken a back seat to convenience. It seems that too many Medics public and private are more interested in clearing the call than to provide pt. care. Im talking about the ones that actually need our care. It seems that we get so bothered by the nonsense calls that we let it influence the legitimate calls as well. How do we fix it?
hottie4fire
03-03-08, 21:56
The problem rzafire is that the system itself is flawed. We go on a lot of bogus calls because of libility. Bosses are worried about getting their organization sued.
It is even more tuff for us who respond alone on an ambulance without the fire department.
My partner and I are always burned out but we try not to let it show.
My point is that when we recognize a ligitimate call we should react. The reality is that most emt's and medic's now a days are lazy. We should be excited to actually be able to treat a real pt and utilize our skills. For example. What ever happened to starting a line enroute. Old school medics were proud to perform that skill. Now every one sits on scene and delays pt care..........Lazy! Then they complain if fire has not called it in and sit on scene instead of calling enroute. Don't forget that only a few calls justify BSC. Most calls could be made quickly directly to the ER of choice. They will tell you if their on sat. and you can quickly move on to the next without a delay in transport. I know I'm talking crazy now.
GirlMedic03
03-04-08, 22:35
I understand your perspective rzafire. Take everything that hottie4fire says with a grain of salt. She does come across as a burned out EMT just in transition until she lands a position in a nice warm comfortable hospital floor somewhere as a nurse.
I just want you to consider one thing from a private ambulance perspective. When I arrive on scene, I often feel no sense of connection with the patient since they were not mine from the start. The patient/provider rapport begins after I've been given report. I do build it up quickly, but I feel like the patients are frustrated at times having to start over with their stories.
I know that the fire medics do great assessments, but not all of them give complete and accurate pass-ons. It varies depending on skill level, time on the job, and whether or not they are burned out.
I keep my relationship with all of the fire agencies I run with (mostly LACoFD) in good shape, because I know that I will one day be a fire medic too.
But to get back to your point:
Yes we should start IV's enroute, and Yes we should make a concious effort to ensure good patient care no matter what.
The way we fix it is by teaching good bedside manners while they are in training.
I think that one of the problems is that there is a battle between fire and the private side. The private side thinks that fire is lazy and fire thinks the same of the private ambulance. Everyone needs to work together and help out. If fire has already done the assessment then the ambulance can finish the treatment while fire does the call in, and if the ambulance crew doesn't like the way fire runs the call, then they should get on scene first
Bring back the MICP...MOBILE intensive care paramedic. I agree we do waste too much time onscene. We should be providing more care enroute to the hospital whom we contacted directly and told we would be arriving in X number of minutes. We should only be taking up Base Station Hospital time on the radio or phone if we need orders or specific designations. As a sidebar, does anyone ever wonder why the person waiting at the hospital got to keep the "M" in MICN and some of the medics in the vehicles forgot about the "M" in MICP when we changed to EMT-P's?
hottie4fire
03-09-08, 10:30
I can't drive away until fire is done with their call in, right?
My partner often doesn't get a pass along until the call-in is done.
When I was working the ambulance...we used to do the call-ins enroute to the hospital, along with treatment and patient assessment and re-assessment. If you and your partner are being held up by fire...offer to do the call in for them. I don't know where you work (and don't need to know) but on my crew, the fire medic ensures a professional rapport with the ambulance medic. The ambulance crew even pitches in and helps with patient care along with packaging the patient. Sometimes it takes a while for the fire and ambulance crews to get to know each other when we only see each other every once in a while...trust builds with time...visit the stations and get to know the crews.
Hottie,
That is one of the issues I have. Ambulance crews are being trained not to leave calls until they make base. In reality they need to get enroute and call the hospital directly. Base only needs to be made for out of scope or special orders. As jude 23 said, offer to call enroute and know ahead of time what hospitals are open and closed. Fire needs to also help this process along by giving a good pass on and not making base unnecessarily just to please an ambulance crew. Lets communicate and make it better and faster for everyone.
Berdoo Beau
03-16-08, 11:37
rzafire - couldn't agree more. I don't believe in "burn-out". It's attitude and professionalism. Treat each call, no matter how routine or b.s. you THINK it is, as an adventure. It's your job/career. Treat it as such. Does not matter how tired or pissed off you are. Work the call and work with those on scene. If the pass-on is not delivered in a timely matter - ask politely/respectfully for it. It will NOT be denied. When the patient is loaded - make all preparations for getting under way and then... GO. All treatment and contacts can and should be made en route. If the fire medic is yacking and holding up the parade then ask them to make contact in the ambulance while you scoot. Guaranteed the medic will either hand it over to you or will jump in. This will only happen a few times as word spreads that the ambulance crews are back in the swing of things. Try it and see what happens.
YOU can make ANY call interesting.
Glad to see we are getting on the same page!
Berdoo Beau and rzafire, I think most everyone on this website is on the same page and agree with your views...the one dominant nay-sayer is hottie4fire...and let's not forget the thread she started was about how she "hates running calls as a single resource". Maybe she could have shortened the title to "I hate running calls." I am proud to serve in my CHOSEN profession alongside professionals with the attitude that Berdoo Beau and rzafire promote. I know that I got into this job to RUN CALLS and SERVE the public. Let's all work together to do it better and more efficiently. Remember, be safe and have fun. This has got to be one of the best jobs in the world!
I agree. Base does not need to be contacted for every call. That is such a waste of time, it delays the pt geting transported, and keeps units tied up. Maybe for just 2 or three minutes at a time, but that all adds up in the bigger picture. If the transporting unit can, and feels a need, then they should make the call in enroute. If they feel they need to, and don't have the time due to the cir**BLEEP****BLEEP****BLEEP**stances of the call, then fire will most likely notice and offer to help. If not just ask. I am almost certain that no fire medic will say no.
Don't do drugs.
RedBloodedAmerican
04-21-08, 22:40
I realize I'm a little late on this thread but I'm new here... Anyways I agree that Medics should be more Mobile. I see both sides of the argument as I am currently full time "fire-medic" and part time private ambulance medic. My reasoning for staying part time there is that I can continue to improve/refine/refresh my medic skills; as well as the fact I thoroughly enjoy being a paramedic.
My stance is that scene times for any calls shouldnt be more than 10 or fifteen minutes, with extinuating cir**BLEEP****BLEEP****BLEEP**stances calling for extended scene times. In this, that if its "routine" call a decision is made on scene after an initial assessment to get en route to the hospital. (Thats why they called right? To get to the hospital in an expedious manner?, I could be wrong) With this, a crititcal call seems more routine because youre in the habit of getting on and off scene and performing everything en route, such as IVs, calls ins, a continued thorough assessment, as well as the fact you should develop a strong rapport, and maybe even make the patient smile. Its our job, we're privelged that our citizens have put so much trust in us. We've spent a lot of time building that trust, medical aids and such are our time to make our people proud, happy, healthy, etc.
And finally, as far as hottie4fire goes, shes a great person, we all love her. We've all been a little burnt and jaded at times, but the woman does an outstadning job on scene. Ive seen it from both sides, she treats patients with diginity and respecT no matter what background said patient comes from.
hottie4fire
04-22-08, 11:04
Thank you RedBloodedAmerican!
That was a nice comment. I think that most private ambulance peeps have good bedside manner. We just get tired a little with system status, covering other areas and transfers.
We try!
First let me say I agree with most everyone on this post. However, having worked both private & public ems/fire in some of the most busiest & crapiest areas, I have ALWAYS tried to give the pt's the best care possible, no matter how minor the emergency.
Often times we forget why we are here. That is to SERVE the community. Yeah we all get burned out at times and when that happens take a step back, go on vacation, or transfer to a slower station. The people we serve do not deserve being mistreated because we are pissed off that its 3am and we are on our 18th "BS" call of the shift.
About 16 yrs ago I had my own family members treated poorly by "brother" Fireman. Not once, but twice! The last time my wife asked the capt if he could talk to me on the phone, he said why? My wife replied, because he is at work and unable to leave his FS! Man how the attitudes changed after that.. how pathetic!
Remember, the person you are treating could be your own family member someday, dont they deserve the best care possible???
When I first started this career path, my FTO told me he stood by the "Grandma Rule". He said that is the rule that you treat every patient like they are your grandma. Or treat them how you would want someone else to treat your grandma...one caviat: you have to love your grandma for this rule to work. Someone else told me that there more (unsuccessful or not) lawsuits against good but mean medics, than against mediocre but nice medics. The way we treat people can come back to help us or hurt us. I don't know if that is true, but I see the point.
I use the same theory: treat every pt as if it was your Mom or g-mother. As far as the lawsuit goes, I call BS! I have yet to have a lawsuit filed against me for being nice, then again, I am not a medicore medic either! I have had fellow medics get letters of reprimand for being a-holes and some that have gone to court because a pt. felt the medic was in-competent. The dept always pays out and the medics walk!
deceptacon
06-03-08, 23:38
I love the back seat....
I use the same theory: treat every pt as if it was your Mom or g-mother. As far as the lawsuit goes, I call BS! I have yet to have a lawsuit filed against me for being nice
I didn't mean that they were sued for being nice. I think what the guy was saying was that even if patient care was equal across the board, the guy who was a jerk stood out as what the patient or family perceived to be the problem for a less than hoped for outcome.
sansoofireman
06-05-08, 18:33
I get excited if I have the opportunity to speak ENGLISH on a call. The area I work in is predominately spanish-speaking and we base half of our treatments on vital signs only. Then some of them look at you all PO'd when no one on the crew speaks spanish... sorry to get off on a tangent, but patient care IS compromised by the language barrier.
RedBloodedAmerican
06-05-08, 23:54
I agree with sansoo, Our dept runs alot of non-english speaking calls, and a good amount of those arent even spanish (at least i can fake spanish), including a handful that Ive ran on that speak Pharcee<sic>? (Arabic/Mid-East)..i mean i cant even spell that let alone understand a lick of it, not just basing your assessment off vitals but trying to get across to a moderate to sometimes critical patient the need for paramedic intervention / MD care via translator can be a challenge.
I love the calls where everyone is trying NOT to speak English and they are conversing back and forth - family to patient to friend, etc. - and then they look at you in horror when you speak to them in their language. "Has he understood everything we have been saying behind his back, in front of his back this whole time?!"
sansoofireman
06-06-08, 20:17
When I go to Mexico, I at least try to speak the language. I don't expect everyone to know English, but a lot of them do because they want our money. I have the unfortunate opportunity to run calls on idiots who don't even attempt to speak the English language. I've even delivered some 1st generation Americans. How in the hell do you say "DON'T PUSH!" in espanol???
"!No Empuje!" [noh em/pooh/hay] My keyboard doesn't have those upside down exclamation points or the little accent thingies...but it was made in China and the tech support guy is in India, so I guess I'm just glad I can read the numbers and letters that are on it.
sansoofireman
06-07-08, 01:34
Excellent! Thanks for the advice. Now, how do you say, "Stop mooching off the hard-working American folks and go back where you came from." If I could just learn that, that'd be bitchin'.
Getting back to the thread... what the hell were we talking about?
Now, how do you say, "Stop mooching off the hard-working American folks and go back where you came from."
"ree puh bli ken"
If used in the right context it should work for just stopping Americans from mooching, too.
Oh yeah, let's get back to patient care.
Excellent! Thanks for the advice. Now, how do you say, "Stop mooching off the hard-working American folks and go back where you came from." If I could just learn that, that'd be bitchin'.
Getting back to the thread... what the hell were we talking about?
Dude, are freakin kidding?? You would do the work they do on a daily basis? I bet you wouldnt. Matter of fact most americans wouldnt. I know I wouldnt! Thats why they are here. If Americans did do that type of work, most illegals would probably not come here.
Why do you think most farmers are moving to mexico now, because Most americans dont do fields, shitters, etc.
And last time I looked, there are just as many "americans" mooching off of us as the illegals.
Dude, are freakin kidding?? You would do the work they do on a daily basis? I bet you wouldnt. Matter of fact most americans wouldnt. I know I wouldnt! Thats why they are here. If Americans did do that type of work, most illegals would probably not come here.
Why do you think most farmers are moving to mexico now, because Most americans dont do fields, shitters, etc.
And last time I looked, there are just as many "americans" mooching off of us as the illegals.
I know the grammar discussion is old, but can we please put the capital "A" back in "America". We do have a lot of Americans mooching off of the sytem, but what if we let them earn the money by doing the less glamorous jobs as you mentioned; at least the money would stay in America and not get mailed elsewhere.
Now, back to patient care...
Do you feel that your local EMS authority is piling on equipment that costs tons of money, takes up lots of space on the engine and will rarely get used? Case in point: CPAP machines, autovents, thumpers, etc...break out the rolling luggage. A lot of that stuff is great on ambulances, but on a fire rig?
sansoofireman
06-07-08, 12:36
Okay, okay, we're all entitled to our opinion. I'll respect yours if you respect mine. You can win me over to your way of thinking with some meaningful dialogue, but striking back puts me on the defensive, arouses resentment, and makes me strive to justify myself.
So I will.
Illegal immigration is a cancer. They take but they don't contribute to the system. Is society a better place because someone does the hard labor? Yes. If he illegals weren't here, would the work still get done? Absolutely.
I am all for immigration. Most of us are descendents of them. This country was built by them. But it was done legally. The idea behind the American culture is that people should assimilate to it. I can't go to Japan and become Japanese. I can't go to Russia and become a Russian. But anyone can come here and be an American, as well they should.
Cesar Chavez actually despised illegal immigration. It is a lesser known fact that he fought for the rights of LEGAL migrant workers, not illegals. The fact that he is being honored nowadays is awesome. I think he'd cringe if he were alive today, seeing the demands of people that aren't even citizens of this country. If anyone else tried that in any other country, they'd get run out. The French recently did it to a bunch of African immigrants.
I have no hard feelings towards anyone that feels otherwise. I respect your opinion. But, how much better off would society be if taxes were paid on every dollar that was earned, illegally or not?
Sansoo, I totally respect your opinion. And I agree that illegal immagration is a problem that needs to be fixed.
But I also believe that there are just as many Americans mooching off of US as there are illegals that do.
Case in point: Many Americans will have as many babies possible to earn WIC, just so they dont have to work!
There we are again supporting people that should get their fat A**** to work.
Sorry my Tangent.
You brought up some good points and maybe someday our elected officials will actually get something done about this.
Take care and have a good evening
sansoofireman
06-07-08, 21:41
Thanks for keeping the conversation even-keeled. All of your points are well taken.
And to paraphrase one of the posters on here...
I noticed you're white trash. I'm pretty white trash myself.
Patient care was the topic. Lets get a political/social activism thread started in the off-topic section, not in the EMS section.
Back to the subject...
We all chose to do this job and to work our asses off to be in this profession. So when it gets stressful and the bs and mundane calls start to wear on us, I think it is good that we remind ourselves of a couple simple facts. We can quit our job if we dont like it, and, when the few calls do come through where we get to use all of our skills and actually make a difference, it makes it all worth it. Patient care is lacking, but its up to us to rise above, even when society doesn't. Come on guys, we're firefighters and ems professionals. Lets stay professional and remember who we work for, our local communities and cities.
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