Superzilla

     EMS Reruns addresses dilemmas in EMS. 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 and your partner, Rob, respond to the neat little suburban home of Charles Graves, allegedly for a syncopal episode. Your supervisor, Dolores Umbridge, radios that she will also be responding. You both groan and plot to get your patient out of there before she arrives.

     You encounter a 60-year-old guy with good color, lying in bed snoring and surrounded by family members. He tolerates an NPA, but readily localizes and removes it with either hand. You're suspicious he probably took too much Ambien and is otherwise stable. Your partner goes to get the stair chair while you start an IV. The patient doesn't seem to need fluids or medications, so you opt for a saline lock; you're on the second floor, and an IV bag will just get in your way as you carry him downstairs.

     Alas, you're just not slick enough. Dolores arrives, and she wants to know why you haven't hung fluids. She ignores your explanation as she invades your med kit, spikes an IV bag and hands it to you while she personally connects and secures it. She asks if you remembered to check a blood sugar, which you did (although she never asks you for a value). Then she asks if you've given Narcan. You reply no, that didn't seem necessary. She goes on to explain to you, in front of the family, that any overdose with AMS warrants Narcan—which she promptly administers, and, of course, it has no effect.

     As you carry the patient downstairs (without her help), the IV bag falls and gets yanked out. You pause to clean up the bloody mess and eventually get the patient loaded. The spouse rides up front, and before you depart Dolores condescendingly reminds you to have your airway equipment ready in case you need to intubate.

     Q. Grrr! How are we supposed to recover our credibility after somebody so thoroughly shreds it for us?
     A. Not easy, is it? You can do it, though; the best way is to stay focused on the patient and their family. Do your best to maintain your composure, as though nothing had ever happened. If the patient presses you for an explanation, look them straight in the eye and let them know they're getting the best care in the world, supervisor or no supervisor.

     Q. How can I get it across to Dolores that she's impeding my medicine, rather than facilitating it? I've talked to her privately more than once, and she just doesn't seem to get it. She's even worse in triage situations, because she gets everybody confused.
     A. Dolores' behavior on this scene suggests that she doesn't have a sense of respect for you. This is never appropriate in a leader. If you've honestly confronted her one-on-one and her behavior persists, it's time to seek the advice of another supervisor whom you respect.

     Q. But Dolores is no exception; all of our supervisors treat us pretty much the same. It's not safe to consult another supervisor, because our management would surely retaliate.
     A. Dolores' disrespect is all hers. But if you seriously believe your supervisors are generally inclined to behave as she does, you may need to address them with your chief. Decide for yourself whether you trust the chief, because he or she may be the source of the problem. If you don't trust the chief, you should arrange that meeting as part of a group of at least five people who agree there's a problem. It's a good idea to meet at a neutral site, not in the chief's office.

     Q. What if our chief is not approachable, or if we're sure he will retaliate as well? I don't want to leave. We have a great medical director and protocols, our equipment is good, we make enough money, and our stations are comfortable.
     A. Actually, your doc may be an answer. What if a group of you were to approach him and ask for some support? No medical director wants to see his system fall apart, and chances are he knows your leadership people well enough to lay down some guidelines.

     Bottom line, though—leaders like the ones you describe can destroy your love for this important work of ours. We all have to tolerate disrespect, but not routinely—and certainly not from our own people. You may need to find yourself an agency that values and appreciates you.

Thom Dick is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Reach him at boxcar_414@yahoo.com.