EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to Nancy.Perry@cygnusb2b.com.
You're a very good paramedic, and you believe that with a kind of comfort that only comes from years of solid experience in a busy system. Due to your family's changing needs, you move to a new area and join an agency with a good medical reputation. Your first partner is a preceptor named Ken. Ken's a fine paramedic and a good teacher, and despite some protocols that take getting used to, your orientation period seems fairly effortless.
One day, you transport an MVA victim to a major city's downtown trauma center. Your patient is a 20-year-old, restrained sole occupant of a PT Cruiser that rear-ended a dump truck that was stopped in traffic while doing about 25 miles an hour. The car's front end and the leading edge of its roof are badly deformed. The patient has an odor like alcohol on his breath, a lot of frontal bruising, and his neck hurts. He recalls the incident, but he's perseverating about some of the details. You have him on mask O2 and in spinal precautions with two IVs running, you've done a thorough exam, and everything looks pretty good, except for the confusion.
You offload your patient at the trauma center, and, as you bring your stuff out to the rig, one of the city's medic units backs in. You attempt to spot for the operator, but he makes like you're invisible. You wait for him to stop, open the rear doors and greet his partner. Although there seems to be no particular sense of urgency, she blows you off as well. The two of them offload the patient, slam the cot into its travel position, disengage the safety latch and head for the ED without so much as a glance or a word for you, the patient or anybody else.
Returning to your district, you share your observations with Ken. He says that's just how it is with the city medics. Their department requires new hires to be paramedics, and some of them would rather just fight fires. As a result, a lot of their folks aren't too thrilled about running medical calls. Yet, because the department is so big, many of them treat their colleagues from other departments like hicks.
Q. Why should we have to tolerate this kind of disrespect from other departments? A. Nobody should. But there's a big difference between unhappy individuals and professional disrespect by their departments. I think it's usually a mistake to attach too much significance to a single instance of disrespect. This is a tough business, and plenty of things can happen to make any one of us cranky on any given day.
Q. But this is not an isolated occurrence. It's general knowledge that the "city" medics treat the rest of us like crap. (After all, the rest of us work in cities, too.)
A. "General knowledge" very often comes from too much general discussion, for which no one is accountable. What you have personally experienced up to this point is one occurrence. The notion that everybody in a group is bad (or good) is almost certainly a mistake, and is similar to bigotry. Professional respect has to start with each of us. As Gandhi once said, we must become the change we would like to see in the world.
Q. It seems stupid to use paramedic certs as tokens for admission to fire academies. It takes talent to be a caregiver. Lots of people who should never be paramedics get through paramedic school. This is a major waste of educational resources. I don't care what kind of certificate somebody has; if they don't have the heart for it or the desire to be a paramedic, they have no business doing it. People from coast to coast are losing their homes because they can't afford their house payments. How can anybody justify this deliberate abuse of their taxes? A. I can't argue with you, but I think the problem is bigger than the decisions of individual administrators. Sadly, even people who have dedicated their lives to EMS can't agree on what it is. Is it public safety? Transportation? Or is it medicine? Personally, I don't know how you can call it anything but medicine. But plenty of people don't see it that way. At least not until someone they love is in trouble.
Thom Dick has been involved in EMS for 37 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at firstname.lastname@example.org.