Paramedics and EMTs

Back in 1995 when I started working fulltime as a paramedic in the city, paramedics got to choose their own partners. This was great for the paramedics and could also be great for the EMT partners. You worked three twelve hour shifts together and you always knew what to expect. You picked someone you were compatible with, liked and could work together without too many issues. Partners rarely called in sick or booked off for fear of leaving their partner with someone they couldn’t stand. On a bad call, your partner was right there. You were going to tube someone. You reached back and your partner laid the right size tube in your hand. You had each other’s back. You took care of each other.

While my first partner was assigned to me because I was new and medical control felt I needed a strong partner and an IV tech, once he moved on, I was free to choose my next partner. I remember then I was approached by another medic who offered me his partner. They had worked together a long time and had finally come to a place where they needed a change. The medic wanted his partner taken care of so he sought me out. That was how I originally became partners with Arthur, who I have written about extensively. The other medic and I shook on the deal and I gave him a Snickers bar in ceremonial payment. Years later when I moved on to another shift, I found Arthur his next partner. My payment in return was a mini Snickers bar. Arthur was upset that he had apparently lost value. I took the rap. I’m sorry, I said, I wore you out. Your the worse for the wear and tear. At least he kept a decent shift and a paramedic partner and didn’t have to hump transfers all day.

The drawback to having paramedics choose their partners was the issue of seniority for the EMTs. A medic might pick a new hire for their primo shift while a ten-year EMT might be stuck working a lousy shift. As the EMTs gained power in the union and with the service takeover by a new company, things changed. A six month bidding system was put into place. Not only did you have to rebid for your shift every six months, but you were assigned with whatever EMT won the bid for the EMT half of the shift. Needless to say, there were some mismatched pairings.

A couple years after that, I was lucky enough to gain a position in a contract town. While I still worked multiple overtime days in the city, I could pick and choose my overtime shifts to work with partners I liked. Working with someone you like wasn’t like working at all, it was getting paid to hang out. Spending a day with a disliked partner sometimes wasn’t worth the wages you were paid.

Being in the suburbs working with volunteer partners now poses its own challenges. Instead of one partner who knows your routine, you can work with multiple partners in the course of a day, much less a week. I come in at six AM and have one set of partners. At eight I might get a new partner or two, and then again at one. On my sixteen hour days, a new set of partners would also come in at six in the evening.

This can be a problem when I leave the ambulance in one condition after a call, and then on the next call find my new partner has rearranged things. The BP cuff is no longer on the bench where I like it, but zippered up into a BP cuff case and placed in a cabinet out of reach. The worst is the oxygen. I leave the portable oxygen open. A new partner comes in, checks the oxygen and then shuts it off, but doesn’t bleed it down. We get a patient, I put them on a cannula, and it is not until we get to the hospital when I disconnect the cannula do I realize the tank had been turned off.

But really, it isn’t so bad. In practice, I often have one partner for ten of the twelve hours, and since I have been out here for over ten years now, I have gotten used to most of my partners and they have gotten used to me. Some of the partners I have out here I have worked on and off with the entire time I have been out here. Thus more often than not, we are in sync.

I think it is more difficult for the EMTs to get used to the four different medics who work with them. All the medics like their stretchers put together differently. We all put electrodes in a different spot. We all have our own ways of working a call. Unless a patient needs immediate treatment, I prefer to get them out to the ambulance and on to the hospital, doing everything on the way. Some medics let their partners jump all over the patient taking vitals, asking history questions. Me, I prefer to be the one who asks the questions. I can’t stand it when a partner walks over me when I am interviewing the patient.

I pretty much insist on doing calls my way. I have been doing this for over twenty years now and have become fairly set in my style. Sometimes I will ask a partner for advice or a better idea on logistical issues, but for the most part I am comfortable with my own solutions.

Working as a single medic, I am always in charge. The calls are mine unless I turn them over to my partner to BLS it. Once I do, they are free to do the call the way they want. That said, I often will do the BLS call myself instead of turning it over depending on the patient’s issue and the partner I am working with. Some of my partners prefer to always drive, so when working with them, I tech all calls all the time, ALS and BLS.

Years ago, I saw a very funny cartoon which showed how people in EMS viewed each other. I don’t remember the whole cartoon, I just remembered how the EMT viewed the paramedic. The paramedic was drawn as Darth Vader.

I like to think I am benevolent. I rarely ever raise my voice or express displeasure. And when it comes to driving, I let my partner handle that. Unless they are driving like a mad person or unless they ask for directions, they control that aspect. I know some medics not only run the calls, but also do all the driving to the calls and from the hospitals back to town. The only time they don’t drive in when they are teching an ALS call.

This all is not to say that medics can’t learn a lot from their partners. A new medic particularly would be wise to listen to a more road experienced partner. The saying “Paramedics save patients, EMTs save paramedics” has a great deal of truth to it. A partner who knows what they are doing and what is expected of them can make or break a call for you. Even today, sometimes a partner will point something out to me I might have missed, and I am grateful for that.

A medic needs to know what their partner is capable of and plan accordingly. If you don’t think you can trust your partner’s blood pressure reading, then don’t trust it. Only assign them do what you know they are capable of. You can have them do anything, but you need to verify anything you are uncertain about. If a call goes bad, the medic has to take the rap. Publicly blaming a partner is not an excuse.

4 Comments

  • Sam Rothstein says:

    I know you don’t work the city all that often anymore, but you should consider pulling a few double medic shifts. It is an eye opening experience to see how differently another medic may choose to run his/her call. If not educational than at least interesting. Sometimes (especially after 20 years!) we don’t realize that there are other ways to do things that we never considered. It keeps you on your toes.

  • Maybe the EMTs should get to pick which medic they get to work with.

  • Matt says:

    You said it, Peter. Working with someone you like is like you’re not working at all.

    Sure would be nice if organizations managed to keep that in mind as they grow and get more complex scheduling systems in place.

    Because I sure like training a new EMT, but I love the feeling you have with a good partner, where you know they’re going to back you up on everything you go on that day even more.

  • medicscribe says:

    Thanks for the comments.

    Letting EMTs pick their partners, interesting concept. I can see the coutship begins, paramedic waiting in line with flowers and boxes of chocalate and promises like “Sure, I’ll do BLS, and I don’t mind making yup the stretcher.”

    The inability to work with other medics is a serious drawback to the one medic system because as you point it is hard to learn from others, you are sort of out on your own in a vaccumm. I have always however had long discussions with other medics about ways to handle calls and learned a great deal from them.

    Thanks, again,

    Peter

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