Hiding In The Nursing Lounge

Recently my feathers became ruffled when my nursing staff shared with me that two EMT students decided to sleep in the nursing lounge rather than to introduce themselves and “dive right in.”   Despite my nurses trying to “protect” these kids, I insisted on getting details and calling the EMT instructor to make sure hell was raised in class.  I requested that these students return to perform their observation time all over again.

The two nurses who shared with me the events of that day are angels.   Both were feeling incredibly guilty over “ratting out” these two kids.  They saw my anger upon my hearing about the total disregard for learning that was displayed.  “They aren’t learning to be fry cooks – they will be responsible for peoples lives!”  I explained to my nurses that the observation time provided to these students to see what the Emergency Department staff actually does is crucial.   The students need to be aware of what information we need, how we need patient histories presented, and how EMTs and Paramedics are our “eyes and ears” in the field.  The rotation is more than just about “watching,” it is about honing skills and gathering a feeling of what processes proceed upon their bringing the patients through our sliding glass doors.

Many EMTs that I have seen over the recent years lack effective communication skills.  The ability to communicate pertinent information in a concise and efficient manner is paramount.  In no other hospital environment does rapid transmission of data in an effective matter hold such a high priority.  Did the child have access to medications before he arrested?  Was the accident victim’s car displaying a spidered windshield?  How long ago was it that the stroke victim was last seen acting normally by his family?  There have been several occasions where I personally feel like pulling my hair out  trying to tease this data out of the rescue personnel bringing in patients.

I believe the solution to the effective data transmission problem is two pronged.  First, the minimal observation time in the Emergency Department needs to be extended to more than the minimum of ten hours with emphasis on patient presentations.  A rolling four-week rotation might make more logical sense, with students actively following a physician, physician-assistant, and nurse.  Secondly, minimal standards in language skills and public speaking should also be a requirement.  Testing should be mandatory to assure these skills are present prior to be entered into an EMT program. Failure to meet these standards represents a disservice to the EMT student and to the public for which they are training to serve.

ADDENDUM:

I have created a lot of conversation/controversy  with this piece as can be viewed in the comments.  There seems to be some general themes which I would like to share based on the responses.

First off, I wish to apologies to anyone who I offended with this blog post.  The intent was never to be insulting, but rather to start a conversation regarding the issue of  effective patient care reporting and student education.  I strongly feel that effective public speaking and communicating patient reports in an efficient manner is a paramount skill needed in the Emergency Medicine/EMS arena.   As such, all comments which were submitted, both positive and negative,  have been posted as of my logging in today on 1-19-11 at 1900 EST

For clarification to those who don’t follow my blog and expressed concern that I have no in-field experience, I was a New York City EMS provider.  I was initially stationed out of Bedford-Stuyvesant, (Woodhall Hospital) and subsequently out of Queens General Hospital  (worked a tactical unit) .   I have worked in the field in EMS for years (both public and private sector),  volunteer my time as a proctor for EMS examinations, actively teach EMT programs, and was a volunteer firefighter.  I have worked both the suburban and urban arenas.  I started this blog as an effort to promote positive change and as well as  advancement of Emergency Medical Services.

Of further note, a substantial number of the  nursing staff with whom I work are EMTs, flight nurses, and paramedics themselves.  We all put in a great deal of effort whenever an EMT student rotates through our ER to teach.   I have the students follow me on a rotating basis listening to heart sounds, breath sounds, and perform examinations.   We actively discuss and teach pathology .  The nurses help the students splint, take vitals, and assist in care.  We take our roles with these students very seriously.  We aren’t mandated to do this.   We do this because of  genuine concern for the education of these students and our patients.  In this context, I believe it becomes obvious why I was so angry regarding these two individuals who were found sleeping in the lounge.

To address some key points which were made:

1)  There are communication issues on both the hospital and prehospital side of EMS care.  As was noted in one of the responses listed below, most ED personnel are overworked and there are incidences where EMS personnel are ignored.   I agree that ignoring our infield colleagues is absolutely wrong.   A vicious circle, however, ensues.   ED staff who are met with ineffectively communicated reports  tune out the prehospital provider.  This, in-turn, leads to the prehospital care provider feeling unappreciated.   A negative feedback loop is created.

Since this blog is intended to discuss issues in prehospital/EMS care and look for solutions, my suggestion is that if you are dealing with a hospital environment where you or your staff are being ignored, discuss this with the ED nurse manager or ED director.   Find out how to correct this problem!  Offer ride-alongs.   Offer teaching in turn.  Meanwhile, the initial premise which I was trying to convey, being that of  assuring exposure to effective patient reporting to the EMT student, might be augmented by extended ED rotations and education in honing communication skills.

2)  The issue of pay and salary was raised by several individuals.  I agree that in many areas EMS isn’t even considered an essential service.  This is absolutely wrong and does need to be changed.  I have addressed this concern in a prior blog.  However, pay and the responsibility inherent to accepting a job where people’s lives are involved are two separate issues.   There are towns where police are paid horribly and their lives are constantly at risk.  Should they, therefore not protect the public?  Since the blog addressed two of my students who were caught sleeping in the nurses lounge, should police cadets who know they will be serving in poorly paid dangerous cities not bother to learn?  Obviously not.

3) Someone raised the issue of difficult staffing in volunteer squads.  This is a tough topic.   I would argue that maintaining a standard would be of greater value than pure staffing.

4) Another individual raised the issue of how, as a medical student, he routinely has to present cases as part of his training.   He referenced how little didactic coverage is included in the current EMT course work.  He makes a valid point! I would argue that this should be addressed in EMT core curriculum

5) For clarification, my statement regarding the need for effective communication skills does not imply being a native English speaker.  Being able to relay a concise detailed report with pertinent information is my concern.

I truly like the response from paramedic George

It’s a skill that communication should be simultaneously efficient and effective. There are only benefits in seeking better cooperation between ER nurses and EMS. And between SNF nurses and EMS. Between any and all healthcare providers transferring care or working as a team. It’s everyone’s duty to keep improving their skills, for supervisors to support and encourage development of providers’ skills, including communication skills. Don’t wait until there’s a problem involving a patient outcome to recognize this. Thank you all.”.

54 Comments

  • Bill says:

    I feel the same when I see a field internship provider sign off as “satisfactory” on some student rather that write: “needs a shave, some experience with a clothes iron, some shoe polish and a clue”, which would be more accurate.

  • James Rosse says:

    It’s difficult, because in my area, either you’re a volunteer, or you’re paid, and not very well. So we have problems getting people to become EMT’s to begin with. Same goes with Fire.

    I agree that there needs to be higher standards for EMT’s in general, and medics. I had a medic walk in on a patient, sneeze all over my back, work without gloves or a mask to contain her germs, and then complain that she couldn’t understand why she was sick all the time. Demonstrated a lack of comprehension of basic germ theory, and isolation.

    Until the business as a whole, and the body of EMT’s/Medics starts demanding better standards, nobody else will, because they can’t get enough of us to do the job, as it is.

    Jim Rosse
    NY EMT-B

  • mary says:

    I too wish that ER nurses were required to spend time on the ambulance. I think this can be a valuable experience in learning just how difficult it can be to get this information and how the story magically changes once they reach the ER.

    • Absolutely agree with you. Ride time for ED personnel should be mandatory.

      Nurses and medical students often experience the same frustration. Stories change as the report goes from intern, to resident, to chief resident, to attending!

  • While I agree with your assessment, I think you’re missing a huge part of the problem. How much time is actually being spent in that 120-130 or so hours (or however much it is locally) actually covers giving report, including practice time? Thinking back to when I went through EMT school, we practiced it once, however now that I’m a 2nd year medical student, someone is up every other week or so presenting each case in our small groups after our standardized patient encounter.

    Is the problem lack of native language skills and a lack of ED observation, or simply a lack of training and emphasis at the most basic level?

    • You are absolutely right. This essential skill isn’t taught adequately in the current prehospital curriculum.

      Native language skills isn’t so much my point as effectively communicating details.

  • Jennifer says:

    Perhaps you ahould have ASKED WHY they were in there. Maybe if you would have given a little TLC to NEW people then maybe everyone wouldn’t be such an idiot to you. That being said, if they were indeed lazy, as you seem to imply, then by all means, blast them. But some people can be intimidated and if you were to take the extra time, you may actually have 2 very qualified EMTs. Oh, and EMT’s/paramedics do not belong to emergency room nurses. Perhaps the reason you don’t get concise reports is because a) the family has NO clue or b) they don’t like you. Maybe YOU should ride along with the paramedics and EMT’s to find that out. No one is EVER 100 % correct in any field they are in. try to remember that and teach instead of berate. Oh and I am a Nationally registered medic, thank you. I did not get there by being hiding and being lazy.

    • Please reference the addendum posted in the blog.

      For clarification, I wasn’t on duty the day these students presented. Out of an entire rotating class, the report I received is that these two went back into the lounge and were found later in the shift asleep. What was also shared by the two nurses was they never were intimidated as they never entered the ED proper!

      I never implied that EMTs and Paramedics belonged to ED nurses. We are, however, all healthcare workers and must followed a chain of patient care.

      As for nonconcise reports or families “not having a clue,” or “not liking you,” this doesn’t subtract from the ability to relay health care information. What was the dispatch for? Where did you find the patient? What were the circumstances in how the patient was found? What did you find on your primary and secondary assessment?

      Please also note that you did not look at my bio when you responded. I was a NYC EMS worker. I was initially stationed out of Bedford-Stuyvesant, and subsequently out of Queens General Hospital. I have worked in the field in EMS for years (both public and private sector), volunteer my time as a proctor for EMS examinations, actively teach EMT programs, and was a volunteer firefighter. I have worked both the suburban and urban arenas. I take of my free time to teach these kids.

      Lastly, you have extrapolated that these two students apply to you and all EMS personnel. No such implication was made or intended.

      My apologies for my lack of clarity and offending you.

  • Mike Diebert says:

    Yes, Doc I agree with you, communication between EMT’s and the staff at the ER is of vital importence. However this is a two way street, to often the staff at the receiving facility simply don’t want to hear what the emts have to say. We are your eyes and act on your protocols, only to be looked on as ambulance drivers. good patient care is listening to your eyes in the field, to many times this does not happen. we do need better communications, both ways

  • It’s pretty rare that I find an article on EMS that I agree with 100% (especially if it was linked through facebook), but here we have it.

    In today’s world of rushing into paramedic school, and spending as little time being an EMT as possible, it seems we are encountering a tragic number of providers who just don’t seem to know how to interact appropriately with patients, let alone peers.

    For the first two years of my career and before I became a paramedic, I was employed for a company that made its business strictly off interfacility transfer runs. Although we never saw a sucking chest wound or an open femur fracture, I benefited greatly from having 10 – 15 conversations a day with all sorts of individuals, and learned a great deal by searching the accompanying paperwork for medications, allergies, and medical history.

    Being a “people person,” in my opinion, is a skill that is just as vital to patient care as being able to start an IV or interpret a 12-lead. It just doesn’t seem as easy to teach in school.

  • medic says:

    As an EMS instructor I could not agree more that these students needed to repeat their clinical time, although I wonder what state you are in that only requires 10 hours. However, I would like to remind you that communication is a two way street. I can not tell you how many times I have attempted to give a report to a nurse who couldn’t be bothered to listen to what I was saying, only to be called an hour later to be asked the information I provided both in my verbal and written report. Sadly in these situations the patient is the one that suffers.

    • The rotation occurred in New Jersey.

      You are absolutely correct. Communication is a two way street. You should be given the same respect as any other healthcare worker. Have you spoken to the ED director or ED nursing director to have the staff reeducated? Perhaps offering ride time for the staff to augment this education would be effective!

  • Mark says:

    I can appreciate and even share your irritation with the lack of motivation and irresponsibility of ems providers(and students), however the tone of your article is crap, the omnipotent doctor brashly barks out orders that things need to change or heads are gonna roll. Perhaps some deeper thought on the situation would make you come off as less of another A-hole hospital staffer and more of someone who really deep down cares about pre hospital medical care. Here are some suggestions to get the introspective ball rolling;
    1. Do I really know what its like to operate outside of a medical facility? Yes, really, I mean how many times have you been on a drug buggy in the last few years? No, perhaps its time to find a place where you can ride for a few months as an observer(with out letting on that you are super doctor, perhaps just a layman that wants to see what this EMS stuff is all about)
    2. while on said observation, talk to the staff paid or volunteer(thats right many places people do this crap for free) about thier working conditions or how many years they’ve been doing this and how much over minimum wage they’r making to do this and put them self in harms way, I bet you’d be shocked.
    3. ask them about the corporate culture of where they work, as in is the operation to cheap to buy the needed supplies? or does the joint offer Con-ed sessions or pay for additional training?
    4. Ask the staff about how they are treated, by the nurses and doctors at your facility. I bet you’ll hear a lot statements like, why do the nurses and docs always ask me why I had to bring them here or we’ll get you a bed in, well, it might be an hour or two or WHAT?!?!?! you didnt get an IV? what do you people do?(ride some calls and you see why some treatments dont get done in the field and that are just the common ones that I deal on a daily basis I’m sure there are regional variations.

    So there you have it, perhaps you are familiar with all these points, I doubt it, but I have been wrong once in my life so I suppose a second error could happen and if I am mistaken I deeply appologize for maybe you were just having a bad dayand needed to rant, perhaps we need to change the gears of this disscusion to proffesionalism, Doc.

    • You haven’t read any of my bio, have you? I was an EMT for the private sector, subsequently worked NYC Emergency Medical Services on a tactical unit out of Queens General Hospital and from Bedford-Stuyvesant, as well as a volunteer firefighter before becoming and Emergency Medicine Physician. The EMS garage, incidentally, out of Queens General happened to be right next to the morgue! I am very familiar with working in very poor conditions and did it for years. Additionally, I have been actively involved with EMS education for years. I am involved with Job Corp, helping individuals improve their circumstances. Your response was without checking the background of the author. I have volunteered my time as an skills examiner multiple times over the years. I have also tailored and provided lectures for EMS personnel out of my own personal time on numerous occasions. I take education and prehospital care very seriously.

      I believe that the prime issue addressed in the article, having to do with the importance of the modicum of observation time and the need for honing effective communication skills you have used as a spring board for some legitimate issues outside of the educational aspects being addressed in this blog post. The article, incidentally, never stated that EMS personnel were lazy. The article addressed two particular students who decided to take a nap on a table in the nurses’ lounge. I was stressing in the article the importance of the observation time to learn what the expectations and needs on the receiving end happen to be.

      Despite the tone of your reply, your points are very valid in regards to the environment that EMS personnel actually work, the salary, and I absolutely agree that some of the behavior received by EMS personnel by hospital personnel is inexcusable. I so strongly agree with the issues you have raised, your reply is posted on the blog for all to see!

  • Jared says:

    I have worked as an FTO for years teaching new hire orintation and I could not agree more with you. Infact in orintation we spent a complete day on just communication between patient and caregiver, dispatch and crew, radio nurse and crew and last hospital staff and crew. I was always amazed how shy and lacking the proper communications skills some of these new hires were. Really was this not there in the interview or skills testing portion????? After all we do test patient assessment skills. Well you cant blame these new hires if they can pull that over on our department heads… Thank you for addressing this.

  • Mark says:

    And yes I do agree with you that those shirking EMT students should repeat the observation and perhaps have a conference with yourself and the instructor to find out why infact they were hiding, you might even find out that they were intimidated by a strong personality, but then again they might just be lazy fireman

    • The report I received was that one of the individuals was actually asleep on the desk in the nurse’s lounge! My nurses know how much effort I put into educating students who rotate through and how important I feel it is. While I can understand intimidation, being caught sleeping is an entirely different matter!

  • Chris says:

    I don’t disagree with the message but maybe if the pay matched with the requirements it would be acceptable to raise the expectations of the new EMT student. I enjoyed my clinical rotations for my paramedic class and learned a great deal. It also put a tremendous financial strain on myself and my family Dr. Barnett said it himself “They aren’t learning to be fry cooks – they will be responsible for peoples lives!” Yet we are sometimes paid less then fry cooks. Where I work I make less than the maintenance guy and I have to keep up with my ceu’s and I am always attending a class of some sort, usually paying for these classes myself. I want the standards to increase but without the financial return I have a hard time justifying it.

  • april says:

    This is absolutely ridiculous. From a paramedics stand point, how you nurses stop and take time to actually listen to a report. I can tell you how many times I have personally tried to give a report to a nurse who couldnt take time to even look up at me and listen to anything I said. Communication skills among EMT’s and Paramedics is not the only problem in ER/EMS communication. The non listening over worked RN also holds a huge part of the problem. I take great offense to this article has it comes across that you believe anyone could do our jobs and that EMT’s and medics need more time in the ER for observation. Well you know it all RN’s are more than welcome to come ride on my truck. We will see if you are able to start an IV, give meds, Intubate a patient and perform CPR all by your self while in the back of a moving vehicle going down a country bumpkin back road. And have it all done in the 15 minute transport time we have to get it done in>

    • First of all, I was an EMT, worked NYC Emergency Medical Services on a tactical unit out of Queens General Hospital and from Bedford-Stuyvesant, as well as a volunteer firefighter before becoming and Emergency Medicine Physician. I have been actively involved with EMS education for years. Your response was without checking the background of the author.

      I always ask for report from the EMTs and Paramedics on arrival. With rare exception in the years since finishing residency can I think of a time I didn’t approach the EMS personnel or the police for a direct account of what happened. I get incredibly frustrated when the EMS personnel come in and I ask what happened, why is the patient here, and a one word response is obtained and no ability to provide any details, vitals, or a physical examination.

      You are correct regarding the nurses being overworked. What happens very frequently is if a concise effective report isn’t transmitted within the first few moments, ED staff has a habit of tuning out. Is that fair? No. I agree it isn’t. Interns are given grief during their training on the importance of effective communication. The same standard is expected from nursing students as well.

      There is definite room for improvement from the hospital side. The improvement, however, needs to start from the ground level. The importance of exposure to how reports are given, relaying pertinent details, and effective communication would be reinforced by being in the ED environment for longer than this minimal standard. Hence, I return to my initial premise – the pair of students who were caught sleeping in the back and didn’t take the time to learn on the rotation need to repeat it. Education from the ground level is imperative on the first responder level as to the expectations of ED personnel for the prehospital personnel. This would partly address some of the concerns you raised in your reply. As to the issues of your treatment by healthcare workers, have you approached the ED director or the ED nursing director at your facility to address your concerns? Perhaps offering ride time to educate the staff you are having frustration with might pose a solution! The intent of this blog is to raise concerns as to problems within EMS and creating a forum for discussion as to correction.

      As for ride-time for hospital personnel, most Emergency Medicine residencies now mandate it as part of their curriculum. I trained at Thomas Jefferson University Hospital in Philadelphia. Ride time was mandatory. I know for a fact that the other Philadelphia Emergency Medicine residencies also demand ride-time.

      Incidentally – the nursing staff at the facility I work for are also mostly dual trained as EMTs and many do inter facility transports. Many are EMTs as well in the community and several are flight nurses.

      • april says:

        Doc, We appreciate your interest and service in the EMS departments and your desire to make everything and everyone work together for the better of the patient. However, this blog would of been better served if you had of broken it up into two different blogs. 1st being the issue with the students hiding… I agree they should of been made repeat there clinical if not been kicked out of the program all together. 2nd. Communication between EMS providers and ER staff members. You came across with a smart a** attitude and as if you were blaming EMT’s and/or Paramedics for all the issues of poor communication between EMS and and thats just not true.

        • Thank you for the feedback. I was attempting to use the two students sleeping during a rotation I consider very important as a bridge into discussing effective communications. Obviously I failed at “effectively communicating!”

          I never intended to imply that all communications problems are EMT/Paramedic based. I do see a problem, however, with many individuals unable to report a patient assessment.

          My apologies to anyone I offended

        • I appreciate your feedback. I have added an addendum to the initial blog. Rather than rewrite the block, I have decided to post all comments and add the addendum. The points that were made need to be discussed by the EMS and ED communities in order to affect change.

          Again, thank you for taking the time to respond!

          Sincerely,
          Jordan

  • edgar brennen says:

    The doctor is right on.

  • N. Smith says:

    Great post, but from the field side I see too many ED personel just plain ignoring the presentation from EMS. I think ED staff, both md’s and RN’s need mandatory ride time with EMS to see life from our side. If we work together and have some experiences from the “other side” pt handover will be better.

    • I agree with you, that there are individuals who ignore presentations too. You are absolutely correct. Many of my colleagues “have given up.” This is an absolute shame. There is definitely room for improvement on both sides!

  • Todd says:

    No offense to the the doc but an average emt earns less than a fry cook. Give them a break and try to show some understanding from your soap box

    • My apologies, but I disagree with your point.

      Two students who are assigned for observation choose to not enter the ED but sleep in the back, who are taking advantage of a staff who wants to teach them should be excused because of expected pay-rate?

      This is a fallacious argument. These individuals have accepted training to potential care for people’s lives. Should police cadets who will be assigned to knife and gun club cities sleep during their training because the pay isn’t adequate? What about soldiers?

  • Allan says:

    Seriously Doctor, do you really think that a few hours spent wandering aimlessly around the ED getting treated like second-class citizens from the nursing staff is THAT critical to future communication? EMS has many, many problems, and the way that EMS personnel are treated by ED staff often leaves much to be desired. I hardly think making EMS students endure more hours in ED “observation time” is the answer to these problems.

    I’ve been both a paramedic and an ED nurse for many years. While I certainly wouldn’t defend the behavior of these students, I would say that if their experience was anything like what I’ve seen many EMT students go through (and what I went through myself years ago), I completely understand why they did it.

    Maybe a the right question to ask is, why did these EMT students feel that their clinical time was better spent in the lounge than in the unit?

    • If you are dealing with a hospital system which treats students as second class citizens then this is a problem which needs to be addressed with administration.

      When students rotate through the ER at my institution, they follow me or another doctor, we discuss pathology, we listen to lung exams, heart sounds, with the students assisting the MSTs and nurses with splinting and vitals. I have them listen to the reports from police, firefighters, and EMS workers as patients come in. I believe this is how it should be. I am open to suggestions for improvement.

      As it turns out, the three students who rotated with me the day before were performing CPR, bagging the intubated patient, and were actively involved in patient resuscitation.

  • George, paramedic says:

    It’s a skill that communication should be simultaneously efficient and effective. There are only benefits in seeking better cooperation between ER nurses and EMS. And between SNF nurses and EMS. Between any and all healthcare providers transferring care or working as a team. It’s everyone’s duty to keep improving their skills, for supervisors to support and encourage development of providers’ skills, including communication skills. Don’t wait until there’s a problem involving a patient outcome to recognize this. Thank you all.

  • SkipK says:

    Personally, I have a gripe with training programs that send students, without a teacher, to a hospital and expect learning to occur. Doesn’t happen with physicians, nurses, other allied health professionals – they go with “clinical instructors” who teach, supervise, and evaluate. In EMS, as usual, we are too cheap and too unmotivated to meet the professional norm.

    Second, to those who are whining about the ED nurses – STOP! They are professional, full-time multi-taskers. Just because you THINK they aren’t listening to you doesn’t mean that it’s so. Get over it, do your job and be a professional.

    Last, stop whining about low pay. No excuse for being a putz, or less than a professional. If they pay is too low for you to do the job professionally, QUIT and let someone else who cares to be professional do the job.

    38 years in the business – urban, suburban, rural, hospital, fire, municipal service, SWAT, cop, etc……

    • Thanks for submitting your input. I have spent the last hour or so reviewing each of the comments and have been posting them all.

      Your point about students being sent without a teacher is a valid point. Arrangements should be made ahead-of-time with home they should be following. While the presence of an actual instructor isn’t necessary, having assured that “Dr Jones is expecting you guys” maybe adequate. during these hours.

  • Jbran says:

    Doc, it would seem you’re getting a lot of negative feedback that you simply don’t deserve. I think perhaps a little too much of your frustration with these students showed through, causing it to sound as if you were lumping everyone in EMS into the same category as the two students. I for one did not take it that way.

    You are correct in your statement that communication is an important part of patient care. In my opinion, not enough time is spent on teaching the average EMT student the art of relaying information to the persons receiving the patient. I understand the frustration of some of the posters who stated that sometimes nurses and doctors seem to ignore EMS, but its not helping our case when we have students who choose to sleep rather than learn. I for one am proud of my profession, and am not about to take up for ANY individual who makes it less than what the rest of us strive to make of it.

    “SkipK” summed it up pretty well. Don’t expect to be treated as a professional unless you hold the new guy to the same strong standards that you hold yourself to. Remember, if you feel comfortable taking up for these two students “catching a few zzz’s, at least they’ll be well rested when they transport YOUR family member to the hospital!!!

    • Thanks for the feedback and constructive criticism. When I wrote the piece I had no idea that the blog sounded like a generalization applying to all EMS workers. I did note that I am seeing a great deal of EMTs recently who have difficulty/are unable to provide an HPI. This is absolutely true. As an ED physician, I find this a very bad trend.

      Seeing that I am involved with EMS education, I try very hard to get students to report cases they see with me in the ED as if they were bring them in fresh from the field. We critique the reports from other 911 personnel as well discussing if pertinent information was provided or not. With time windows being an issue for many illnesses (i.e. CVA), efficiently relaying information is paramount.

      For those individuals who are instructors who read this blog and comments, perhaps I will have succeeded in what I intended to do – getting the skill of patient assessment reporting honed.

      Again – thank you for taking the time to post your reply. Thank you for the constructive criticisim!

  • Heather says:

    I have been an ER RN for almost a decade. But just like the author, I remember a LONG time ago when I ran as a volunteer EMT… And WAY before I was a life member, I was a complete newbie!
    I sorely remember some students from my program scoffing at the ER clinical time like it was a waste when I was doing vital signs over and over, listening to lung sounds and practicing assessments and helping/ talking to patients… going through scenerios in my mind about how I would be responsible for this person for some amount of time on the street.What would I do?
    I also recognized the importance of listening and asking questions, taking advantage of learning time. That way I could make DAMN sure I knew at least the basics. I accepted the responsibility and wanted to save lives. There were other students that had almost ZERO interest in doing ANYTHING remotely close to learning how to communicate effectively with patients when that is the BULK of your care, listening and gaining information. I was embarrassed!
    What were they doing there?
    It was almost like it was “just a job.”

    (Don’t get me talking about the pay. That is a never ending debate and it was never an excuse for many of the old-timers who had alot to teach me. So who am I to make excuses?)

    I think laziness in this particular case is further PROMOTED when WE do NOT expect thorough evaluations from our prehospital personnel AND give them the respect and open ear they deserve. Its really sad when I give a report to a transport EMT (as an example) and they look at me with a smile and say “Thanks, we usually don’t get a report.”
    OR- If we completely ignore the Medic/ EMT as though they offer no vital information. When in fact, they were there first and have exclusive information that we don’t have! There is NO doubt that if ED personnel including MDs, RNs and even Mid level care providers did mandatory ride-alongs their care would only improve. Their respect for the work done before the patient hits the door would be priceless! It should be mandatory!

    If we continue to just let students observe as though they are there to watch the nurse start an IV, when clearly they should be getting the OPQRST…they will learn nothing…but really where is THEIR motivation to learn…back in the staffroom SLEEPING?

    This article bolstered alot of responses to support that there is a communication issue. WHERE exactly is this communication issue? People who are uninterested in communicating effectively or LEARNING to do so do not belong in the medical field. And those people who make excuses for their unprofessional work ethic unfortunately are out there teaching the next generation of EMTs how to “just do it” because “its a job.”

    Final note- Thank you for writing this!
    And thank YOU to our proud and dedicated Prehospital providers. I KNOW some of you that helped me grow are reading this blog and I appreciate every minute of your time!
    I am a better provider because you drilled it into my head!

  • NJMedic says:

    WOW!

    I can’t believe the amount of crap that people came up with to try to defend these two students! I must say, though, that looking at the responses from the negative side, it gives a clear indication of the “GENERAL” mindset of many EMS workers overal, particuarly in NJ. “I don’t make enough, so I don’t have to do what’s expected,” “It’s the nursing staff’s fault,” or maybe “If the ED staff were more accomdating, then maybe they wouldn’t have done that.” Excuses are constantly made, rather than owning up to personal responsbility and accountability. I believe it all comes down to the individual. You might not like the teacher or preceptor, but you still do your best regardless.

    I for one would never dream of doing something like that. However, I can remember students in my medic class that did JUST THAT. Slept in a back room, during their clinical times. Come to think of it, NONE of them are working as a paramedic to this day, not even sure if they are involved in EMS anymore.

    You defenitley struck a nerve for sure. And this is only the surface my friend.

    • Thank you for the input.

      Your response has been posted on the blog for public review and further response.

      Hopefully by striking a nerve corrective changes will be instituted from both the ED staff and prehospital providers!

  • It seems like people are making the argument, “I shouldn’t have to learn how to give a flawless patient care report because the Nurse will never listen to me.”

    That is about as sound logic as saying, “Paper is white. The clouds are white, therefore paper must be made of clouds.”

    I work in a busy city system. I can stand on the top of my ambulance and see four Boston trauma centers. There have been times when it doesn’t seem like anyone is interested in listening to my report, but there have also been times when an ER attending has hushed everyone in the room, citing, “The paramedic is giving a report.”

    The point is, we’re all human – our patients and ourselves. If we encounter an apathetic nurse or a grumpy physician or a lazy paramedic, that should not give us an excuse to be deficient in our practice, it should motivate us to be better.

  • Vikki Lyn says:

    I’ve just did a rotation,via My EMT class at a Well known Cardiac Hospital on Chicago’s South~Side, the nurses were rude,the person I was assigned to was a CNA, and she broke every law possible, she inserted Caths, drew blood etc. I asked her If this E.D let you do that? she said they know I’m in school for Nursing, I didn’t respond, but by the same token, I was on her heels (with a lot of questions) she didn’t like it I called her on a few things, she walked me to the breakroom and said I’ll be back, she left and later I found out that she stated that I was too nosy and she didn’t want anyone to ever shadow her again!!!…she no longer works there.

  • ETH says:

    “EMS in New Jersey isn’t even considered an essential service like police, fire, and municipal services are.”
    Basically EMS is a service that the municipalities do not want to deal with, or have to pay for. Unless they find a pot of gold the municipalities will to have to generate the money meaning a raise in taxes, and that is where competent care come in as well. The N.J. EMS system needs a total overhaul.(N.J. EMT 30 years) Other states seem to be able to educate well, and I see first hand with the knowledge level, and care given by EMT/Bs-EMT/Ps in California.
    In the begining the concern should be Beans, Backboards, And Bandages. Then responders should have some knowledge of appearance having some bearing upon their caregiving as well. A uniform, iron, and some black shoes polish on appropriate footwear is a real attribute.
    Little steps are better than no steps at all. Progress needs to be achieved.

  • Trish says:

    I think that's rather funny. I work in a very busy, very famous hospital, and happen to see the EXACT opposite happen all the time. Nurses brushing these students off. A friend of mine actually took the EMT course and was told by the charge nurse to "get out of her face." When standing in the ambulance bay her, and her observational partner were both told they were "not there to learn what EMT's did, but to see what the nurses did and to leave the area."  The overall concensus in this level 1 trauma center is the emergency room staff in general need to fix their attitudes. I am also an EMT, but don't make it my career for exactly that fact. Why would I willingly want to deal with people who lack social skills, yet choose to work with people? Students shouldn't be put in the emergency room, at least not in any busy facility. Emergency room nurses go to the emergency room because they can't handle being floor nurses, nevermind ICU nurses, and instead choose to see patients and pass them off, with techs doing all the leg work. I think this "pass them along" attitude unfortunately manages to seep into their normal social skills in general. I wouldn't wish a day in our emergency room on any student.

  • JOHN LAUDERMILCH says:

    IF I WOULD HAVE BEEN THE INSTRUCTOR OR COURSE COORDNATOR. I WOULD HAVE EXPCETED A CALL FROM THE DOCTOR, AND THERE WOULD HAVE BEEN HELL RAISED AT CLASS THAT NEXT TIME WE MET. THEY WOULD HAVE REPEATED THE TIME AND I WOLD HAVE BEEN THERE WITH BOTH OF THEM TO SEE THAT NO SLEEPING WAS DONE.

  • Abby says:

    I’m several years too late, but I found these posts interesting. One, the students were clearly in the wrong. Their behavior can’t be justified. In any profession you’re bound to have good days and bad. People are going to say rude things that are going to make you angry. However, you still must do the job. You can’t walk into a hospital and assume everyone there will treat you poorly or act as though you aren’t needed. Your main focus has to be the patient and performing the tasks required of you. You can’t get caught up in your emotions and anger whenever someone disagrees, is inconsiderate, or shows disrespect. You would surely go crazy. My best advice is try not to take things personally. Words hurt, but we all have bad days. Don’t lose focus. Show that you can stand taller than the person who is being unnecessarily “jerk-like.” You will be the better person, and truth be told, an onlooker will commend you.

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Jordan Barnett

Jordan Barnett, MD, is an Emergency Medicine Physician in the Philadelphia Suburban Region.  He has previously worked as a volunteer firefighter, was a member of New York City EMS, and provides Medical Command for several ALS Ambulance Services. Dr Barnett provides EMS consultation services. Additionally, he is actively involved with EMS education.
Comments
Abby
Hiding In The Nursing Lounge
Agreed. Very well said.
2013-08-19 00:46:31
Abby
Hiding In The Nursing Lounge
I'm several years too late, but I found these posts interesting. One, the students were clearly in the wrong. Their behavior can't be justified. In any profession you're bound to have good days and bad. People are going to say rude things that are going to make you angry. However, you still must do the…
2013-08-19 00:34:56
Olive
Time for Intelligence in Implementing EMS
I am extremely impressed with your writing skills and also with the layout on your weblog. Is this a paid theme or did you customize it yourself? Either way keep up the nice quality writing, it's rare to see a great blog like this one these days.
2013-04-15 20:21:25
dan chambers
EMS System in NJ
Hey, really appreciate the post.  Its good to give real life accounts of what it is like to be an EMT and work for the EMS, good and bad.   I really think that would-be students would really love reading this post and others you have written.  Anyway, I have an info blog myself that…
2013-02-18 20:54:03
bank mandiri terbaik di indonesia
Time for Intelligence in Implementing EMS
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2013-01-23 23:44:45
January 2011
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