At Least Say Thanks

I listened quietly as the man poured out his tale of woe. Just a few weeks earlier, he'd flown to see a family member who was quite ill. About 45 minutes before his plane was due to land at its destination, another passenger became sick, and after repeated calls requesting a doctor, nurse or paramedic got no takers, he finally raised his hand. No, he had told the flight attendant, he wasn't exactly what she had requested-he was only certified as an EMT-Basic-but he told her he would be glad to check the sick passenger out and see if he could be of assistance.

Once the plane landed, a number of passengers were deplaned and two paramedics came on board. They ignored the EMT-B completely, promptly removed the oxygen and walked the patient to the jetway where they had parked their gurney. At no point did they see the need to apply the cardiac monitor.

As the EMT-B told me, "It's bad enough that these two paragods treated me like I wasn't there, but even I know better than to walk a potential heart patient to the gurney. If that's not enough, they weren't even courteous enough to say thanks."

When someone, whether in a formal first responder situation or simply working as a Good Samaritan, steps up to the plate and provides care, they deserve to have their efforts recognized and be treated professionally. Following are some observations on how EMS providers should treat first responders in the field.

Recognize the First Responder/Patient Relationship

When people suddenly find themselves scared and in the middle of a traumatic event or medical emergency, especially in a strange setting, i.e., away from home, the stress they experience is almost palpable. Irrespective of whether the first responder who makes initial contact with the patient is part of an organized EMS response or simply a Good Samaritan stopping to render aid, this first-on-scene person immediately establishes a relationship with the patient. The patient needs help, and the provider is there to do his best to provide it.

If for no other reason than being the first semblance of help in a time of need, that first person on scene usually finds himself looked upon by the patient as the cavalry riding in to the rescue. It is essential for subsequent caregivers to recognize this relationship, take time to listen to the hand-off report and pick up patient care as quickly as possible without having to re-ask the same questions the EMT-B asked during his assessment. It is professionally courteous and can make patient care move along much more smoothly.

In the instance on the airplane, the EMT worked up the patient and felt certain that he was very sick, with a number of markers pointing toward a cardiac emergency. Because he was only a Basic EMT, the gentleman could not use the on-board emergency kit, but instead was left to do little more than administer oxygen and try to keep the patient calm.

By this time, the plane was getting close to its original destination and the decision was made not to re-route for an emergency landing.

Don't Alienate First Responders

Aside from compromising the call at hand, there are other long-range complications that arise from treating first responders unprofessionally, e.g, barging in with little or no introduction, not taking the hand-off report and re-asking the very same questions that were just asked moments before. I mean, let's be realistic here. How hard is it to take 30 seconds to make introductions and listen to the hand-off report? Not very, is the answer that leaps to mind.

For the sake of discussion, let's say that a first responder provider agency gets regular and repeated doses of unprofessional treatment from the ALS transport agency they regularly work with. At some point in time, they will almost certainly get fed up with the way they are being treated and will decide to avoid calling the ALS agency whenever possible, just to avoid the hassles on calls.

This may be a formal decision by the agency, or informal where the providers themselves set an unofficial policy. Whatever the case, the call to ALS does not go out.

Whenever situations like this occur, a certain percentage of patients will not get the care they need and deserve due to the toxic, nonworking relationship that has evolved. Potentially, lives could be lost, as would be the case of critically ill or injured patients who are in need of ALS interventions to support the initial BLS efforts.

I know of one case where a volunteer BLS squad transported a 13-year-old girl in the throes of a critical asthma attack, with an ETA of about 30 minutes to the receiving facility. En route, they gave two radio reports to update the receiving facility. The base station nurse quickly recognized deterioration in the patient's status and twice asked if they wanted an ALS rendezvous. Twice, the nurse was told no. A few minutes later, the base station was contacted a third time to inform them that CPR was in progress.

In spite of aggressive and continued efforts by the hospital's ED staff, the girl could not be resuscitated. As it turned out, the BLS crew had previously experienced repeated run-ins with one of the paramedics from the provider agency in their district and had simply decided to "never call them again." This unfortunate decision, reached as a result of battling egos, cost the young girl her life.

At Least Say Thank You

After I heard what had happened to the EMT-B on the plane, I told him that I'd experienced two almost identical occurrences with airport-based paramedics over the last couple of years. Thinking back, I couldn't recall hearing the words "thank you" either. And maybe, just maybe, it wouldn't be too hard to shake hands either. Until next month…