paramedics in the ED

[xdismalx]

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I'm a paramedic for a fair sized city with an average call volume of about 40-50k call a year. As EM Docs, how do you value the paramedics in your area? Do you feel they should just load and go? Or do you feel their skills performed in the field are helpful to patient care? Do you listen to their assessments? Or do you take them with a grain of salt? Do you feel as though they should be able to persorm more skills in the field with standing orders? Or do you, yet again, feel as if they should just load and go and maybe check vitals?

I ask these questions because I get such a wide range of responces from doctors regarding my patient care. From "thank you so much. very helpful" to "Why is this good for nothing AMBULANCE DRIVER babbling in my ear?"

 

[edinOH]

I'm still pretty new at being the "doc" but I have had quite alot of quality interactions with EMS thus far. I'm on the radio with them many times a shift as well as interact with them alot when they bring in pts. I value the medic's assessment and insight regarding the pt's status on the scene or in the home as well as tx given and response to tx in the field. They have been professional and knowledgeable in all of my encounters with them. I can tell by observing my attendings and senior residents that they are respectful towards EMS and value their input as well.

 

[DrDre']

I think this issue is very geographical. It depends a lot on where the ED doc trained and what they have experienced with EMS providers. If they trained in a system where it was "mother may I" and the paramedics were weak or could not do much, they often have less respect.

Conversely, if a region or city has a strong EMS tradition, it is great for all involved.

Where I worked as a paramedic, the ED docs loved us. They knew they could trust us, our judgement and our treatments. We rarely had to call for verbal orders. When I did, they rarely listened. They knew they could trust me and just said OK (they weren't burn outs). It was always interesting to have a fresh, new residency graduate come in, especially from areas where EMS was relatively weaker. They always seemed worried or bothered by our SWOs and how much we could do (We only call to leave codes at home with the coroner- everything else is SWOs). Eventually, they adapt and always say, "why'd you bring 'em in?, you've already done everything"

I hope with the newer EM graduates and additional EMS exposure that relations improve and EMS training improves so paramedics can do more with a firm knowledge of pathology and such.

Sorry for the long post.

 

[trauma_junky]

This depends on the area and EMS training. I've worked all over and basicly had to ask a MD for everything in the past. Where I work now, we consult ( a supervisor, who is a paramedic) only for RSI, pain managment, and a couple of other things. We only consult a MD if we have an MI confirmed on 12-lead and then send it to the MD to confirm for Retavase treatment (we are only 1 of three services in the US to carry fibrinolytics). A lot of the time we deliver patients only to be observed following our treatments, which the ER's LOVE!!! The only time we get some crap is if we deliver a pt to a hospital that is not familar with us. I once got chewed for paralysing a pt for RSI, I simply handed him my medical directors card.

All in all, I think the system around here would not function with out our advanced prehospital treatments.