How an intern got sent home

Over a delicious, yet artery clogging breakfast, our student rider tells us his story: always wanted to be a fireman, but only has a real chance of getting hired if he is a paramedic first, finished EMT school and was signed up for paramedic school before taking National Registry, never worked a single day aside from intern rides on an ambulance, and 9 months into his 13 month paramedic program. Already got all the alphabet cards, CPR, ACLS, PALS, PHTLS, NRP, yada, yada, yada.

Slimm gives me the side-eye that tells me not to pre-judge this kid. I nod and shrug my shoulders in response, and the “okay, whatever…” message is received.

Whatever.

It’s a quiet day so far and there isn’t much for the kid to do.

Until some helmet-less skateboarder face plants after trying to jump over at least a dozen stairs.

Seriously, if it weren’t for alcohol, genetics, or stupidity…

This is a messed up skater. Smashed face, extremities angled in ways they shouldn’t be, a chest that doesn’t rise symmetrically, an altered mental status, and irregular respirations, with blood and teeth filling the airway.

“Slimm, toss me the airway bag and suction, lets check out that chest, and cut these clothes off. Kid, I need a good rapid trauma assessment” I call out as we walk up, with first responders several minutes away.

The kid doesn’t move.

“Buddy, I need some help here. Rapid trauma assessment. Cut those clothes off, please.”

While Slimm assists ventilations, the airway has been suctioned, several teeth removed, and the airway secured with an OPA while I am preparing my intubation equipment.

Kid is still standing there.

“Cut this shirt off, please” I say, attempting to convey just a little more authority in my voice. “He’s probably going to have a pneumo we need to stabilize, if not a big flail segment.”

Hesitantly, he begins to cut the shirt off, seemingly taking the time to sever each and every thread individually. Meanwhile, the tube is in, first responders have arrived, and Slimm takes over the duties requiring the shears, and confirming both a large flail segment and absent breath sounds on the affected side.

The rest of the trip is a whirlwind of activity with a paramedic from the fire engine riding in back with myself and the kid, and the now unconscious patient. It is a short trip to the trauma center, and the hand off is smooth.

“What was that back there about, man? We needed some help, man!” asks/exclaims my trusty partner. “Where were you at?” Slimm is typically very quiet, and raising his voice is very out of character for him.

“I’m just here to watch, man.” is the kid’s reply.

“No, you aren’t. You are here to learn and take care of patients with us.” is my reply.

“Who told you that you were here to watch?” is the quizzical response from the thin, short, obviously irritated partner of mine.

“That’s just what I’m here for. I don’t really want to be a paramedic, anyway. I just want to be a fireman.”

Slimm turned and walked away. He had nothing more to say to the kid, but says to me: “Back to the station, man. We are going back to the station.” It was a quiet ride, with Axl Rose providing the soundtrack to the tense situation.

Next stop: the station, to the parking lot, more specifically.

 

 

Comments

  1. Good for you! I’m not sure how tight-knit the Fire/EMS rumor mill is in your area, but around here these mishaps usually find their way to the ear of the area Chiefs. Employment options become scarce for young pups with this attitudinal dysfunction.

    Some of the best career advice we can give to people like this is, “Do something else!”

    • We don’t have much of a “rumor mill” around here, and his attitude is, unfortunately, prevailing around here.

      Around here, there are dozens, if not over a hundred, EMS services within a 60-minute drive, so this clown will not have too much trouble finding a job. Keeping a job is another story, however…

  2. Wow. I’m…wow.
    How does one respond to that?
    I mean, I’m not working in fire-based EMS, more LE-based (80% or so of our providers are also LE) and most of them see AEMT as their ticket to a permanent job. There are four fresh-faced LE wanna-bees headed off for a six week AEMT course in a few days. I am frightened about what will return. Some of them will certainly rival your student if this is any indication.
    God help us all.

  3. I would have been o the phone with his medic instructor before we were off the hospital property.

    • Slimm and I both wrote letters to several people: each one of the program instructors, the program director, the clinical coordinator (a physician medical director to several large services and fire departments), and the hiring/human resources people at our service.

      I’m not above phone calls, and I have made them in the past, mostly to sing praises. I feel that letters carry more permanence.

  4. Flash Larry says:

    I’m a pretty easygoing person, even with fools, but I would not have tolerated this either. Not because he didn’t know what to do or wouldn’t do anything but because he failed to follow instructions in an emergency. A person like that is just in the way and in a hot emergency, I don’t need people in the way.

    I had a EMT-I student riding with me once and we had a decompensating 4-yr old first presentation of asthma coming from a doctor’s office. He had SQ epi and 2 albuterol at the doctor’s office and we got him to transfer to the ER. He was pretty sluggish but his color was good (no pulse oximetry in those days), but still wheezing terribly so we got him in the ambulance and made one my rare emergency rides to the hospital, which was a little ways away.

    With the patient on a cannula and a non-rebreather – and with different equipment in those days – we were blowing albuterol under the mask and I gave the student the task of keeping the albuterol flowing properly. He kept letting it slip out from under the mask, while I was getting a line in and calling the hospital.

    Finally, I thundered at him and told him that if he couldn’t do something that simple, he was in the wrong business, that I had asked him to do only one thing so I could do other things. He was shaken to the core but he did it right from that moment on. He was still shaken at the hospital when it was done. I felt a little bad but it caused him to focus and he was perfect the rest of the shift and became a good EMT with whom I had the pleasure of working on occasion.

  5. I personally wouldn’t have given him a ride back to the station…
    However, since I now work in a nursing home, he and some of my co-workers would get along just fine.

  6. Good for you. EMS has too many of these people, and I hope you’ve saved us from getting one more.

  7. He’s got no place in the modern fire service. Funny thing about when I need firefighter paramedics…they need to be paramedics.

    • It seems that too often, new guys forget the second word in their title.

      Another reason that fire services shouldn’t hire paramedics? But then there is your agency, with the EMS thing, so I guess that wouldn’t work…

    • He epitomizes the modern fire service, Justin. While you might be in a place where the fire service embraces EMS, for the most part it’s just something they do to keep jobs from going away.

      This interns attitude isn’t uncommon and it’s a big part that EMS isn’t a profession or a trade, but rather a skill set. We’ve set the bar way too low and it’s likely too late to raise it in the future.

      I’d have done the same as CCC, only I’d likely leave him at the hospital and make a supervisor go and pick him up.

      • I once had a preceptor (yes, a PRECEPTOR) give me a 15-minute dissertation at the beginning of my ride-along shift all about how he was a FIREFIGHTER-paramedic and that the FIREFIGHTER came first in FIREFIGHTER-paramedic for a REASON because being a FIREFIGHTER was the most IMPORTANT part of his job, and that the minute he was no longer required to maintain a paramedic license as a condition of his employment as a FIREFIGHTER-paramedic (and yes, I’m using all lower-case for paramedic intentionally, to try to convey the disdain with which he said the word), he would let his paramedic license lapse and never look back.

        My response: “Dude, you work for a suburban fire district that runs 9,500 runs a year, 8,000 of them for EMS. I’m pretty sure you’re a PARAMEDIC-firefighter, but if that’s honestly your attitude, then do me a favor and get the hell out of my profession.”

        I wasn’t invited back to ride there again… which was just fine with me.

  8. Good job. I would’ve done the same. And yes, our area is tight enough that I’d be having a chat with his instructor(s) and my colleagues at other local agencies. He’d probably still find a place to ride (they often do), but I’d do my part to make it hard for him.

    • I’m just a street-level grunt for the time being, so I don’t really have any pull at other agencies. But his school only contracts with our service. It has yet to be seen what will happen with him and his upcoming rides.

      • CCC- most of those school type issues occurred when I was a street level grunt. But hey, you know people. I have a buddy who’s old partner happens to be a supervisor at neighboring service. My old paramedic instructor follows us all (even though she’s retired now)…why? Because back in the day, her word alone could black-ball you from working in a dozen different states. I am glad she used that power for good.

        Point is, don’t sell street-grunt short. If we strive to be a profession or trade (either is honorable, and both have their benefits and roadblocks), the paramedics on the street have to care as much as the supervisors & managers (Too Old…I’m talking about good ones here…bad ones are too common…just like lazy/bad medics).

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