Lame excuses

My employer runs a paramedic program. When I say that the company runs a paramedic program, what I want you to take away from that is that the company supplies a physical location for a paramedic program, and students to fill the chairs.

But, they attached the words “EMS Academy” to it, so maybe it is sorta-kinda-official.

Whatever. It’s a moot point.

My employer runs a paramedic program.

Being one of the company’s Field Training Officers, I get to see the aftermath of the paramedic program, when the newly graduated paramedics spend several shifts riding with me. Some of them aren’t prepared, but most are.

I was having a talk with another FTO, Tony, while at the hospital a few days ago. This must have been early in a shift, because I actually cared about the topic.

Tony mentioned that he rarely sees the same paramedic student more than twice, and that each student does at least twenty rides at our company. He thought it would be wise for a student in our paramedic program to be ‘assigned’ to an FTO for the duration of their preceptor rides.

While we’re on the subject…our program is putting paramedic students on ambulances for their preceptor rides after three months of school. They don’t know how to read a monitor, and they aren’t allowed to perform any ALS interventions. What the hell is the point of riding for twelve hours on an ambulance if you can’t do anything?


Tony made a good point. After ten rides or so, there should be a pretty good rapport between an FTO and a student. They should be able to communicate openly with each other, so the student can get the most out of their classroom time, and their ambulance time. After twenty rides, any bad habits should be corrected, and the FTO can feel confident in his evaluation of the student. Alongside the FTO’s confidence in his evaluation, the course director can feel confident in the evaluations he gets from the FTO.

But instead, the students just ride whenever, and wherever. Rarely more than once with the same paramedic, or even with an FTO.

So Tony and I brought it up to the director of the program.

“Assign each student to an individual FTO. We have twenty-five students, and eighteen FTOs. Surely we can come up with a list of seven competent medics to fill the roster of needed FTOs. Once a student is assigned to an FTO, that student does all of their rides with that FTO. It only makes sense.”

We got a reply:

“Well, that would just be too hard, and we don’t want to make it any harder on the students.”

This is why I don’t care.

Lame-ass excuses.

System dairymaid

I met a lady today. She’s in her late forties, and lives in a nice, government-subsidized apartment. Much nicer apartment than I could ever afford.

She has oversized, comfy leather furniture that looks new, arranged to face a large flat-screen television on her wall.

She drives a 2015 BMW.

She gets around in her apartment with a very fancy electric wheelchair.

She carries a Prada purse and has an iPhone 6.

She lives with her husband. Except she doesn’t live with her husband. They aren’t married. She proudly admitted that they never got married, because he has a good job, and she would lose her disability benefits if they got married.

We passed at least three very capable hospitals on the way to the one of her preference, because her “doctors are there.” and “they have all my records,” and “it’s close to my friend’s house, and she is going to pick me up after.”

We transported her because her knees hurt.

Of course she handed me a Medicaid card. It was underneath her EBT card.

“Ma’am, you look really healthy. Why are you on disability, and why do you use the electric chair?”

“I have fibromyalgia. Medicaid gave me the wheelchair.”


So I was served with a subpoena. Or should I say, I wasn’t served with a subpoena. I received an email from some lady I see for three minutes once a year. I don’t know what her job is, or why she works at our company.

Maybe her job is to send out emails about subpoenas.

The email is an obvious form email. How often could EMTs and Paramedics at our company get subpoenaed that we would need a form email to notify employees?

The email says that my supervisor has the original subpoena. You guys know what is going to happen next, right? You got it.

My supervisor has no idea what I’m talking about.

The email says if I am scheduled to work that day, I can use PTO. If I’m not scheduled to work that day, I don’t get paid. Of course, I wouldn’t expect my employer to pay me if I wasn’t on duty. But I expect my employer to pay me when they require me to wear my uniform. Which the email says I must.

I would prefer not to wear my uniform, especially since I have the perfect suit and tie to wear for a court appearance. If it was summer, there might be a Matlock appearance. But no seersucker yet.

I haven’t decided if I’ll be showing up for court yet, but I have decided I won’t be in uniform.

Unless someone wants to pay me.

Look here, Miss Bubbly

I get it. Your bubbly personality is part of your ‘shtick.’ Everyone understands, you were a housewife, but your husband was a meany-head, and you divorced him, and had to get a job, and for some reason chose EMS. Whatever.

And you like to make cute little jokes, thinking your personality will make up for your lack of experience or real-world knowledge. But they don’t.

Making jokes and trying to be all cutesy is just fine and dandy, at the appropriate times. But that time is not in the middle of a patient’s home while they are having a myocardial infarction. I needed a hand with vitals, IV, and meds, but you had to go pet Sadie instead.

Oh, you didn’t realize that’s what was happening?

Maybe you could shut your mouth and open your eyes. Pay attention. Look at the patient. Hell, I don’t know, maybe you could follow the cues of your paramedic partner, and the fire department medic. Our combined experience may not be exactly as many years as you are old, but we know what we are doing.

But at least the dog was happy, right?


“Hi, this is C with Local Ambulance, I have a patient report I’d like to call in.”

“We are on diversion.”

“Yeah, I know. I tried to tell my patient that, but she insisted on coming to your hospital.”

“But we are on diversion.”

“I understand, but my patient wants to be seen there, so we are bringing her in. Would you like a report?”

“I don’t think you heard me. We are on diversion. You can’t bring her here.”

“Okay then. No problem. I’ll just need the name of the physician refusing to accept my patient.”


(and later on…)

“We don’t have any beds. You’ll have to wait there by the wall.”

“Okay, sure thing.”

The ER is virtually empty. The tracking board says they have five patients and more than twenty available rooms. It’s 6:45 on a Sunday morning. I spot two nurses playing checkers and drinking coffee.

Seriously, checkers.

“Hey, C, the bed in 6 is empty.” Slimm tells me after about 15 minutes of waiting and being ignored.

“Sweet. Let’s do it.”

(and later on, after being ignored for a few more minutes, and moving the patient to the empty bed in the empty ER…)

“Excuse me, would you happen to know who the nurse is for room 6?”

“We don’t have a patient in room 6.”

“Yes, you do. If you’ll look right over my shoulder, you’ll see a patient in the bed in room 6.”

“Where did that patient come from?”

“My stretcher.”

“You can’t do that!”

“Sure I can.”

“I’m getting the charge nurse!”

(charge nurse appears, obviously upset that her game of checkers was interrupted…)

“I told you we were on diversion.”

“But you hung up on me before I could get the name of the doctor refusing to see the patient.”

“But we are on diversion. I’m not accepting your patient.”

“It’s a little late for that.”

“No, it isn’t. You had better put that patient back on your stretcher and leave!”

“I can’t do that.. That’s against the law. Sign here, please.”


“Okay. Thanks. Bye.”

My partner the bigot

Slimm and I are trying to take care of a gentleman who is a guest of the County in their local Adult Detention Facility. He’s been vomiting, has a little bit of a fever, and describes a very sharp pain that started over his right kidney, then has slowly started moving down lower in his abdomen.

So he has a kidney stone.

I’m feeling generous, so I’m planning on hooking him up with some Fentanyl and Zofran. I like giving people narcotics, especially if I think they might need some, they aren’t a jackass, and they don’t beg for narcs.

Slimm is getting an IV.

Owww, man! That hurts!” He of course yells this out just as Slimm gets flash, and jerks his arm back at the same time, blowing the IV attempt.

Come on, man, it doesn’t hurt that much, and now I have to do it again.”

He gets everything ready again after putting a 4×4 over the previous puncture.

Now don’t jerk this time, man. I need to get this IV so we can give you some pain meds.”

Whatever, man.”

Big stick on three. One, two, thr-”


Come on, man, it doesn’t hurt that bad.”

Shit, man, yeah it does.”


Man, you’re just trying to hurt me because I’m black.”


No narcs for this guy. Works for me. Less documentation, anyways.


A “person shaking and cold after having an ultrasound” according to the dispatcher and the MDT

We are going by ourselves, and a quick glance at the directions tells me it might be a 15-minute ride. Just enough time to set my fantasy lineup for the weekend.

How do we know which house it is, if we are having trouble locating? That’s right, it’s the one with all the cars in the driveway.

Four cars this time.

Sure enough, some lady is sitting on a couch, shaking. She complains of being cold, and thinks this is some sort of a reaction to the ultrasound she had earlier.

I have already checked out, but we load the nice lady up anyways, and do a full workup.

Her pressure is better than mine, 12-lead is a sinus rhythm in the sixties, blood sugar is around 100, she’s afebrile, blah, blah, blah.

So we head on over to the hospital with, you guessed it, a guy following us in his car. He’s playing it tight, too. Less than one car length behind us, and he even has his flashers on.

Instead of brood over how stupid people are, I try to decide between starting Antonio Brown or Dez Bryant in my flex spot.

Before we can get this lady out of the ambulance, the follower is all up in Slimm’s face.

“What took you so long to get to the hospital?!”

“Nothing? It took about ten minutes.”

“Why didn’t you go emergency? Use the lights and the siren?”

“Because it wasn’t necessary? Because your wife’s vital signs are all just fine.”

“Hell, I could have brought her here in less time!”


“Why the hell did I call an ambulance if I could have taken her to the hospital just the same?!”


Gotta love it when they answer their own questions.

My policy trumps your policy

Today we pick up where we left off with our previous call.

To recap; some chick doesn’t want to be at school, so she either a) is having a panic attack because she forgot her homework, or, b) just wants to go home. The fireputterouters have no idea that nothing is actually wrong with the patient, because instead of performing an assessment, they went straight for the IV attempt.

And blew up both of her ACs in the process. With 22 gauge catheters.

Seriously, a 22 in the AC? Knock it off, guys.

Slimm and I fixed the flag, and we are walking out of the classroom, ostensibly in a hurry to take care of our critical patient.

Some guy approaches. This guy looks official. He has grey hair and a lanyard, AND a whistle.

“This is Missus Whatsherface. She is going to ride with you.”

“She will have to follow us down to the hospital, we can’t take riders.”

“Well, it is the school policy that a staff member accompanies any student.”

“Okay. She can accompany the student at the hospital. Slimm and I will accompany her in the ambulance.”

Now, mind you, I’m not really against people riding in the ambulance with patients. Frankly, I don’t care. Except in cases like this. First, this guy is being a mega-douche, and second, we don’t take riders in the ambulance with fakers/anxiety attacks. We give them quiet rides, with vital signs monitored. And third, I don’t like the cut of this guy’s jib.

“Umm, one of our staff members has to ride in the ambulance with her. It is our policy.

“I am terribly sorry, but it is the policy of the ambulance service that will be transporting her that only immediate family members ride in the ambulance with any patient, and that is at the discretion of the ambulance crew.”

She followed in her car. With her flashers on the whole way. Later, I find out that Lanyardman called and complained. And lo and behold, my supervisor stood up for me.  “Yes, sir, I understand, but the paramedic made the right decision, and followed our company policy.”

Maybe the third time that has ever happened.

Keep it simple

Look, y’all. I’m interested in your reports and everything, but let’s try to keep it simple, okay?

I don’t care that the patient had her gallbladder removed in 2004. It has nothing to do with the tibia sticking out of her skin.*

I sure as hell don’t care that the patient got bitten by a spider eighteen weeks ago.*

I don’t care that the patient stopped taking Lisinopril three years ago when his doctor switched him to Cozaar. And I don’t care why the doctor made the switch, because it probably had something to do with the cough the Lisinopril gave him.*

I don’t care that the patient speaks Spanish, because we are communicating just fine with her in English. Also, working in the Southeast United States, I’m pretty good at spotting Hispanic people.*

Just tell me what hospital they want to go to.

And don’t bother with the vitals. Because we both know you need them only to write them on your report, and I am going to take my own.


*all things I have actually been told by first responders

Are all FTOs ignored?

A few days ago, I had a new-hire employee riding along with me, for her evaluation rides. My company seems to think that 3 rides with a Field Training Officer is enough to prepare new EMTs for the field, and this was her third ride. So, ostensibly, it was also her last. Her two previous rides were with a different FTO, on the other shift

In the morning, I got an email from Topper, the other FTO that she rode with the previous day. His email was purely objective, and simply stated that the employee drove only for a short while, but was proficient with radios, the MDT, the computer, and checking the truck off.

Essentially, she was going to spend the day with me, driving, and she would occasionally ride in the back with me to the hospital. I like to have a game plan with new employees. We don’t get a lot of time with them, so I try to focus on the things they need the most.

When she introduced herself to me, I noticed something was ‘off’ about her personality. I couldn’t tell exactly what it was, but she was pleasant, and that’s always a good start. She needed some prompting to check the truck off, and to log into the MDT, which I thought was strange, remembering she was with Topper just the previous day, and she did all of this stuff.

Then the day just spiraled downhill.

Her driving was terrible. Not in the rough sense, but in the sense that she was scared to drive. She consistently drove 10 miles an hour under the speed limit. On every road. She was driving on the interstate, complaining that the tractor trailer in front of her was going 45 miles per hour. For several miles. Yet she never tried passing, even though there was virtually no traffic on the interstate. She stopped completely at a green light while we were traveling to an emergency, because “I thought that car was going to turn in front of us.”

She wasn’t interested in patient care, at all. While at an accident scene, with two patients quite some distance apart, I looked for her. I needed some extra hands, and she was standing at the back door of the ambulance, looking around, with her hands in her pockets. After loading a patient from the scene into the ambulance, she had to be told that Newguy needed vital signs taken, and then had to be told to take them when she failed to act.

Typing all this out makes me feel like I am lamenting my position as an FTO. I really don’t want that to be the case. But what we had here was a person who obviously was not Local Ambulance Company material, and maybe was not cut out for EMS at all.

Newguy and I tried talking with her several times throughout the day, but she was either not interested or couldn’t comprehend what we were saying. Neither Newguy nor I are rude, but this girl simply didn’t get it.

So I wrote as much in my evaluation of her. I have never had to give a negative evaluation on an employee since I have been an FTO at this company, and I suppose my naivete’ got the best of me. In my review, I explained what I explained here, and in further depth. I suggested the new employee receive some more FTO-monitored third rides, and perhaps not be hired full-time.

I guess I expected the Training department to call me or email me and want to discuss my concerns. I think most of my readers will know that I wasn’t contacted at all. Of course not. My review was essentially ignored, and the employee was scheduled to ride on her own the next day.

Which lead me to ask the questions: if FTOs aren’t listened to, what is the point of having us out there? Is it like this at every service? Is the joke really on me, because I expected more out of my management team?

Is this just another straw on the camel’s back, causing more burn out, or do I feel slighted because I’m burned out?