We as pre-hospital professionals are just that; professionals. It's not to say that everyone is on the same level or on par with everyone else. Different places teach different things, instructors vary, personalities differ, and skill levels are obviously different. But we all know the basics.
What about issues when dealing with staff at sending or receiving facilities? Everyone has their favorite, so to speak, on both sides of the coin. It's nice for me to walk in to an ER and know the tech or nurse I'm talking to. If the doc's handy and not busy and I know him or her I'll go shoot the bull for a couple minutes. And I'm sure it's just as nice for the staff to know the crew bringing in or taking away patients; they know the person performing the care, maybe their skill sets, how long they've been around, are truly compassionate, those sort of things. What drives me nuts is not being listened to when I take a patient somewhere. I spit out information on the radio or phone before I get there, and again when I get there and most of what I say isn't taken down or in. Granted, it doesn't happen often but it does happen. We are a vital link in transferring and providing care to those patients. We see them in uncontrolled environments, see their first actions or reactions to treatments, and try to improve the situation and report on how things have progressed or digressed.
Another issue is the lack of proper care some people receive prior to our arrival. Several times I've shown up on accident scenes and am met by someone who identifies themself as a nurse. Okay,... are you an ER nurse? Do you know anything about pre-hospital or trauma? Several times these same people are the ones who have removed patients from cars or trucks and had them walk around the vehicle and then lay down when they should have stayed where they were in the car; they were in NO danger and should not have been moved. Do they know about holding c-spine? Did they do a primary assessment? Mind you, I'm not slamming the nursing profession but not many nurses know a lot about pre-hospital or have been through a PHTLS, ACLS, or PALS / NPR course unless it's required for their job.
What about trips to ECFs? Ever shown up to find a patient with a nasal cannula at 10 lpm? What about a non-rebreather at 4 lpm? How about CPR being done on a bed without a short board and watching those bed springs get one hell of a workout. Ever seen that? Seizure patients being held down with beds, chairs, carts right next ot them. Another one I've seen is giving cola or orange juice to an IDDM who's now hypoglycemic and completely unresponsive. The word "aspiration" comes to mind pretty quickly.
I've been to a lot of ECFs around the country and it's just like any medical facility; there's the good staff, and there's the bad staff. Same goes for pre-hospital; we have good EMTs and Paramedics and we have our bad lot as well.
One thing I've always tried to do is educate people I see who are doing something wrong, regardless where they're at. If I see a cannula on too high a setting I'll say something. If I hear of a wrong medication given to someone I'll say something or question it. I have the right to question anything I feel is incorrect because my concern is for the patient, not for the staff taking care of the patient. The same thing applies to the staff questioning what we do. We know things they don't and they know things we don't. Some of these patients have drug stores on speed dial because their med list is a mile long. Do I know every one? Nope. Hopefully the staff does and they can tell me when, how much, actions / reactions, whatever's pertinent.
They give report to me just like I give report back to them on return or to another when I drop someone off somewhere else. It has to be communicated thoroughly and completely.
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