College EMS and Respect

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frankcfromny

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I'm an EMT-B at my college campus. We are considered a non-transport BLS agency servicing only the college campus and are dispatched along with the fire department (transport) for all emergency medical calls on campus. (ALS is dispatched when necessary)

Anyways, our agency is comprised of students ages 18-22, all of which hold their EMT-B cert besides for trainees.

Does anyone else in a similar position have trouble getting respect from other agencies? I can't tell you how much the FD, campus PD and village PD give us a hard time over nothing. I swear it is because they feel threatened by college-aged kids.

For example, I got a call from the village police chief saying that he's received several complaints of our jeep speeding on the way to calls. He proceeded to tell me that he spent the last week gunning us, and on two instances we were going 15 over the limit. State protocol says we can go 10 over. He told me that he's instructed his officers to embarrass and pull us over enroute to a call the next time it happens. No, we are not following protocol but are you serious??? 5 over in a couple instances? I don't think he would be having this conversation with ALS or other providers.

This is the most recent problem...of course we always get the disgruntled police officers that won't leave an intox patient alone despite us asking or the paramedic that told one of our patients that "first responders don't know anything".

Can anyone relate? Any advice?

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I can totally relate. When I first started as an EMT on an ambulance service, I was 19 and I looked like I was 14. I got a lot of looks of disbelief and even some snide comments from various other agencies (law enforcement, first responders, etc) when I showed up to assume patient care. I'm 24 and I still do occasionally, even though I'm the 2nd most senior EMT on our whole department. The fact that you guys are young-looking college kids is probably part of the problem. I've found that two things work best for overcoming the young-looking stereotype: being competent and being assertive. You have to know your stuff, because if you don't, you'll quickly lose the trust of those around you. Be knowledgeable in your role and your skills. The second part is being assertive, and that takes practice. Be very assertive, but don't overdo it, especially when working with law enforcement.

Another reason why you might be getting flack from other agencies is that you're "young college kids" who are involved with their professional careers. Sometimes that bugs people. Again though, just be competent and assertive and hopefully you'll see some respect.

That's my interpretation, but there could be many other reasons that other agencies are not showing you guys respect. Make sure your EMTs aren't speeding to calls. Regardless of how ridiculous the police chief is being, it does make you guys look bad if people are in fact complaining. Disgruntled police officers... honestly there isn't a lot you can do about that one. I've confronted cops on scenes before and it ALWAYS makes things worse, even if you're 100% correct. If you have a problem with what an officer did on a call, take it up with the police chief or just brush it off. Paramedics talking badly about you guys... again, not a whole lot you can do. Do your best to be competent and assertive and they shouldn't have a reason to say those things.

If all else fails, just keep plugging away and do your best to ignore the crap. Your situation isn't unique - there's ALWAYS some sort of drama among EMS, FD's, and PD's. Get some new experiences, learn some new things, help some patients out, and keep climbing the ladder. Don't let cranky/dramatic people drag you down. :)
 
Let me put this in perspective from "the other side of the tracks". As stated, 18-22 y/o college students, BLS only, speeding to calls. When you get there, you are there with professional rescuers.

Although the truth may hurt sometimes, we can parse this out a bit. First, 18-22 y/o college students. What is a common factor of the student body for schools that grant bachelor's degrees? Many, or most, students are not "locals", and, anecdotally, even the "locals" might be trying to shed that label, as, being young adults "out in the world" for the first time, they might want to appear (or actually be) more urbane. So, even though the vast, vast majority of Americans are "locals", or "townies", the uni students - aren't. Second, 18-22 y/o, with book, but no or negligible practical, knowledge. That can add to the "kid is bigger than his britches" mentality - especially the one loudmouth who thinks he is smarter than everyone else (and he maybe is, but doesn't have the hands to go with the brain).

So, young smarty pants kids that think they're better than everyone else - not intentionally, but as a product of how society is shaping them.

Now, add to that BLS - if you're BLS, to be blunt (as I was a paramedic for 9 years, and EMS for 13), if you're not the first one there, you are only good for labor. If you ARE the first one there, you step aside and work with the professionals, and there is a pecking order: first is the paramedics. Second is the transporting agency. Then, there is you. That is, if the co-responding agency is a BLS ambulance, they will be going to the hospital, managing the patient, so they are ahead of you. This isn't written down - this is just how it goes. One company for which I worked was the transport agency for municipal paramedics. One day, I was on a call with them (I was a med student, but also a paramedic). A guy had slipped on ice and twisted his knee. They evaluated the patient, and directed that they would not accompany, and a bone of contention is whether they could dictate how we went to the hospital, if they weren't riding along (like, "code 2", "code 3", "hot", "red", or whichever manner is used to indicate emergency mode). Not trusting them, I also examined the guy, and found his foot to be cool and pulseless. (Remember, good BLS beats bad ALS 8 days a week, and, as a paramedic, I was a better EMT than most EMTs.) So, I took the guy to his hospital choice emergently. Long story short, within 1 hour, in the OR with vascular surgery to repair a disrupted popliteal artery. One of the paramedics was STUPID enough to raise a stink about me going hot to the hospital, until the chief of paramedics told him that my actions possibly saved the guy's leg, and that they had affirmatively mismanaged it, even if that only means not going along. In that case, the pecking order was moved around a bit, but that is how it went in that town. The BLS volunteer firefighters got there first, and then the paramedics. Then, the transporting agency, and, if the paramedics didn't go along, the transporting agency was in charge. If fire got there after the paramedics, they were hands.

Finally, you have been clocked, officially noted to be at least breaking the rules, if not breaking the law. Every state has a law on the books regarding emergency vehicles stating that, while the siren and emergency lights are activated, the vehicle may exceed the posted speed limit, if it is safe to do so. However, as you say, you are violating the protocol. By your very words, you state you are breaking the rules. If you don't "get it" that you are submarining your own case, then that is advice I can't give you.

So, to summarize the "wall of text", the PD are paid professionals. If the fire department is paid, they also are career people. The college kids are, by definition, transient and not career. Add to that lacking "life experience", and that gives you the dismissive attitude from the professionals.

Advice? 1. Slow down. 2. Muzzle the loudmouth(s). 3. Be gracious and collegial with the others that are, de jure or de facto, higher on the food chain. This will be difficult, because it will need a "sea change" within your organization - for example, "Baird Point Ambulance" was the EMS for the University at Buffalo, North Campus. Of any former Baird Point people I've found online, bar none, they're all lawyers now. So, the uni kids are pre-law and pre-med types, so they have healthy egos, and those need to be put in check on location of the incident.

If the village PD notes that they consistently have found you under 10 miles over on the gun, that will add a LOT of respect to your cachet.
 
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I don't know what kind of "advice" I can give you, but I can give you my experiences and perspective of campus (student) run EMS services. I worked as an Paramedic for the government run 911 only service for a major metropolitan city (population about 600k), within that city is a very well respected university (student body of about 13k) that has it's own BLS service that DOES TRANSPORT BLS level calls - and therein lies one of the problem.

Since they do have an actual fully staffed BLS ambulance, they do transport BLS level calls. Unless they are told specifically it's an ALS level call, they make the decision to transport, get a refusal, or call for ALS. Generally, they don't have any experience prior to working for the student run EMS - so their knowledge can be ... limited. I've seen them transport a code before, because they didn't want to wait for an ALS intercept, but they probably didn't know that the standard of care is to work the code on scene for 20 minutes as ALS vs transporting a medical code prior to 20 minutes. Also, they have transported chest pains before without calling for ALS. So they roll into the ER with nothing more than demographics and blood pressures, granted the patients are usually students, and the chance of any "real" cardiac problems in someone that young is a lot less than the general population - chest pain is still chest pain, and they need an EKG. What I'm trying to say is, sometimes when the patient needs ALS, they don't make the attempt to call for it.

On the otherside of that argument, sometimes they call for ALS when it isn't needed. This doesn't bother me all that much, because the university is still in our coverage area, and if it wasn't for them, we would have been called there initially anyway. So this is just a minor nuisance that bothers my co-workers more than me. If some 20 year old male falls down 2 steps, has no LOC, no AMS, no obvious trauma, not intoxicated, no evidence of drugs, physical exam is unremarkable, and the patient is AOx4 and not wanting to go to the hospital - they probably don't need a full ALS assessment if everything else looks normal. On that note, if they are ever unsure, or want a second opinion go ahead and give me a call (that sounds contradictory to what I just wrote, but sometimes there ARE basic level skills/calls).

They haul a s s to calls, I could set up a video camera in a tree overlooking part of campus, and sell the video to Nascar if the ambulance goes by.

There are always 50 of them on the scene, and 50 of them in the ambulance responding. If they transport to the hospital, there is literally a minimum of 4 FOUR people at all times. It may be a rush to them, and be exciting and a new experience, but from the outside perspective of people who actually do this line of work as a career, it just looks kinda silly. And for a cut arm call, you don't need a sprint car, two ambulances, and a bike team to respond.

Last point - they are BLS level providers, when a paramedic, or physician comes on scene (we have MDs who ride pretty frequently), I can respect and appreciate their report, and I'll honestly listen to what they have to say, but if I come to the conclusion through my ALS assessment that something else is going on, I'd rather not the 4 emts sit and argue with me about what it is. Their AMS is probably not a diabetic problem if their CBG is 156.

With all that being said, it is hard to garner respect from the agencies who cover the "actual" 911 for the area around you, and hard to earn the respect from the PD and FD who responds, because to them your "just a kid". It's just something that is earned overtime.
 
Let me put this in perspective from "the other side of the tracks". As stated, 18-22 y/o college students, BLS only, speeding to calls. When you get there, you are there with professional rescuers.

Although the truth may hurt sometimes, we can parse this out a bit. First, 18-22 y/o college students. What is a common factor of the student body for schools that grant bachelor's degrees? Many, or most, students are not "locals", and, anecdotally, even the "locals" might be trying to shed that label, as, being young adults "out in the world" for the first time, they might want to appear (or actually be) more urbane. So, even though the vast, vast majority of Americans are "locals", or "townies", the uni students - aren't. Second, 18-22 y/o, with book, but no or negligible practical, knowledge. That can add to the "kid is bigger than his britches" mentality - especially the one loudmouth who thinks he is smarter than everyone else (and he maybe is, but doesn't have the hands to go with the brain).

So, young smarty pants kids that think they're better than everyone else - not intentionally, but as a product of how society is shaping them.

Now, add to that BLS - if you're BLS, to be blunt (as I was a paramedic for 9 years, and EMS for 13), if you're not the first one there, you are only good for labor. If you ARE the first one there, you step aside and work with the professionals, and there is a pecking order: first is the paramedics. Second is the transporting agency. Then, there is you. That is, if the co-responding agency is a BLS ambulance, they will be going to the hospital, managing the patient, so they are ahead of you. This isn't written down - this is just how it goes. One company for which I worked was the transport agency for municipal paramedics. One day, I was on a call with them (I was a med student, but also a paramedic). A guy had slipped on ice and twisted his knee. They evaluated the patient, and directed that they would not accompany, and a bone of contention is whether they could dictate how we went to the hospital, if they weren't riding along (like, "code 2", "code 3", "hot", "red", or whichever manner is used to indicate emergency mode). Not trusting them, I also examined the guy, and found his foot to be cool and pulseless. (Remember, good BLS beats bad ALS 8 days a week, and, as a paramedic, I was a better EMT than most EMTs.) So, I took the guy to his hospital choice emergently. Long story short, within 1 hour, in the OR with vascular surgery to repair a disrupted popliteal artery. One of the paramedics was STUPID enough to raise a stink about me going hot to the hospital, until the chief of paramedics told him that my actions possibly saved the guy's leg, and that they had affirmatively mismanaged it, even if that only means not going along. In that case, the pecking order was moved around a bit, but that is how it went in that town. The BLS volunteer firefighters got there first, and then the paramedics. Then, the transporting agency, and, if the paramedics didn't go along, the transporting agency was in charge. If fire got there after the paramedics, they were hands.

Finally, you have been clocked, officially noted to be at least breaking the rules, if not breaking the law. Every state has a law on the books regarding emergency vehicles stating that, while the siren and emergency lights are activated, the vehicle may exceed the posted speed limit, if it is safe to do so. However, as you say, you are violating the protocol. By your very words, you state you are breaking the rules. If you don't "get it" that you are submarining your own case, then that is advice I can't give you.

So, to summarize the "wall of text", the PD are paid professionals. If the fire department is paid, they also are career people. The college kids are, by definition, transient and not career. Add to that lacking "life experience", and that gives you the dismissive attitude from the professionals.

Advice? 1. Slow down. 2. Muzzle the loudmouth(s). 3. Be gracious and collegial with the others that are, de jure or de facto, higher on the food chain. This will be difficult, because it will need a "sea change" within your organization - for example, "Baird Point Ambulance" was the EMS for the University at Buffalo, North Campus. Of any former Baird Point people I've found online, bar none, they're all lawyers now. So, the uni kids are pre-law and pre-med types, so they have healthy egos, and those need to be put in check on location of the incident.

If the village PD notes that they consistently have found you under 10 miles over on the gun, that will add a LOT of respect to your cachet.

First off, 95% of the time we are the first on the scene. This is because the transporting agency is a volunteer fire department. Furthermore, there is only one paramedic on duty at any given time for the ENTIRE county. He could be 20 minutes away. I understand the pecking order and I have no problem with that.

Also, no where in my post did I say that we were egotistical or loud mouths. Although many of us are only BLS, I will 100% not tolerate a CPR, first aid certified campus police officer harassing myself or the patient on scene. Call me egotistical or a loud mouth, but I don't want to deal with a police officer telling me I should/shouldn't call off ALS or hounding the patient about where he/she drinking. What grinds my gears even more is when police officers try to do a mental hygiene arrest without consulting with EMS providers.

I'm just complaining about the unwarranted lack of respect shown by other officials. I take pride in my agency and realize that we are only non-transport, BLS providers but we always work together and never over step our boundaries.
 
Also, no where in my post did I say that we were egotistical or loud mouths.

but we always work together and never over step our boundaries.

I gave you an outsider's perspective. I don't have to be there to know that there is at least one person that rubs people the wrong way - and, since you are in the group, you do not see it. You are portraying your group as a bunch of Cinderellas - you're all good, and the others are coming down on you. You asked for advice, I offered my 2 cents (such as they are), and you slap away the hand I offer. So, well, good on ya.
 
I gave you an outsider's perspective. I don't have to be there to know that there is at least one person that rubs people the wrong way - and, since you are in the group, you do not see it. You are portraying your group as a bunch of Cinderellas - you're all good, and the others are coming down on you. You asked for advice, I offered my 2 cents (such as they are), and you slap away the hand I offer. So, well, good on ya.

I appreciate your advice.

To me, your post made several assumptions. In addition, your advice is to be "gracious and collegial" to those who are higher on the pecking order. I never said that we weren't. That is the most frustrating aspect of this whole thing. Isn't it a respect a two way street?

No offense, but speaking strictly on EMS terms, you, too, are portraying paramedics and transport agencies as cinderellas.

One of our lowly BLS members suggested to a paramedic that an older patient go in hot to the hospital as she suspected triple A. The paramedic refused and basically told our member to piss off citing the patient's vitals as being normal for an older patient (BP was a little low). Ambulance ride went fine. Later on that day, she found out that the patient died due to triple a not 30 minutes after he was admitted to the hospital.

I guess egotistical pre-med/law students really don't know a thing.
 
Reread what you've written, then tell me that you don't sound petulant and passive/aggressive.

I'm telling you - telling you - that 20 y/o college providers rub people the wrong way, and, in most cases, an analysis reveals one or two key people - and, if that person is higher up in their system, it cascades down.

YOU used the term "lowly" (with YOUR italics) - what did I write above? "Good BLS beats bad ALS 8 days a week". I SAID it. Your anecdotal case? Well, good work. To return it to you, even a broken clock is right twice a day. Maybe your lowly (your word) provider had a stroke of genius, and was somehow prescient. View it from the paramedic's point: "I am transporting, so it is my decision". It ends there. Any heat goes to the paramedic; there are no incidental props for some EMT that suggested saving two minutes in getting to the hospital. You want some good research? Dig up the number of AAAs to go to the OR emergently (instead of electively), and what percent survive. I don't know the numbers, but, anecdotally, I can only think of patients that didn't make it out of the OR.

And, as your last line was:

I guess egotistical pre-med/law students really don't know a thing.

Do you know what "splitting" is? And where did I throw the baby out with the bathwater, as you just did?

And just think about why the FD and the PD treat you guys like they do. Maybe someone (or several people) that preceded you poisoned the water.
 
Reread what you've written, then tell me that you don't sound petulant and passive/aggressive.

I'm telling you - telling you - that 20 y/o college providers rub people the wrong way, and, in most cases, an analysis reveals one or two key people - and, if that person is higher up in their system, it cascades down.

YOU used the term "lowly" (with YOUR italics) - what did I write above? "Good BLS beats bad ALS 8 days a week". I SAID it. Your anecdotal case? Well, good work. To return it to you, even a broken clock is right twice a day. Maybe your lowly (your word) provider had a stroke of genius, and was somehow prescient. View it from the paramedic's point: "I am transporting, so it is my decision". It ends there. Any heat goes to the paramedic; there are no incidental props for some EMT that suggested saving two minutes in getting to the hospital. You want some good research? Dig up the number of AAAs to go to the OR emergently (instead of electively), and what percent survive. I don't know the numbers, but, anecdotally, I can only think of patients that didn't make it out of the OR.

And, as your last line was:



Do you know what "splitting" is? And where did I throw the baby out with the bathwater, as you just did?

And just think about why the FD and the PD treat you guys like they do. Maybe someone (or several people) that preceded you poisoned the water.

I don't know about the survival rates but when an older person is brought into the ER by BLS no one ever rushes over to them. They'll wait and wait. I'm not saying that had the paramedic transported to the hospital that this patient would've survived, but they definitely would have had a higher chance.

I apologize for sounding aggressive and/or childish but I just felt like you were giving absolutely no credence to us thereby falling into the same category of people that I wrote this post about in the first place.

In addition, I just recently dug up some information about my organization. Apparently in the early days our response times were atrocious (Transporting BLS was beating us to calls--we're on campus and they're off) and other things that made others look upon us unfavorably.

It was not my intention to jump down your throat and I apologize for that.
 
...I worked as an Paramedic for the government run 911 only service for a major metropolitan city (population about 600k), within that city is a very well respected university (student body of about 13k) that has it's own BLS service that DOES TRANSPORT BLS level calls - and therein lies one of the problem.
...
Last point - they are BLS level providers, when a paramedic, or physician comes on scene (we have MDs who ride pretty frequently), I...

New Orleans?
 
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