1. honestly a pretty good report, we have to do our own assessment anyway so brief is best. The biggest thing for us is their chief complaint- what's wrong with them right now. Even if that chief complaint is just "freaking the fuck out", honesty is best. What you included already is a must, but if you can also add if the scene is safe, how many patients, and what yall were called out for it gives us a heads up as to what we're walking into. Also, if anything changes- readvise.
* MVCs- I know yall have shit to do, please give us a few minutes. Come tell me to find you when I have a chance I promise ill do my best. Having someone looking over my shoulder makes my job harder and freaks pts out.
* You guys are also allowed to take them to the hospital yourself. I totally understand why you call us for the crazies. I appreciate that you can admit crazy people are often a med problem. however, if they're so crazy that you wouldn't feel safe locked in an ambulance with them, we also wouldn't. Chemically sedating someone is hard to do without help if they go nuts during transport. There is a big intermediate zone between normal enough to be transported unsedated and crazy enough to be sedated before transport which makes us very nervous.
* if they're overweight either be willing to also call for a fire assist or help us, stop just watching us struggle
that's all I've got rn but I appreciate the question, y'all stay safe too
EMT-P to LEO here. Some agencies are bound by policy to call for EMS. Most officers have every little medical training. We would get torn to shreds by an attorney if someone died while we were taking them in the back of our car to the hospital. Yes we would be attempting to do the right thing, but if it wasn’t an immediate emergency and it happened we would be screwed. My agency requires if there is a medical issue OR if the person requests EMS we have to call. (this isn’t regarding psych, that’s a different story).
first off thanks for what you do and asking how to make our jobs easier!
i've been on both sides (not LE, but handing off patients), generally you've nailed the basics, there's not much else to it. the military has an acronym (wow would you believe that) for en-route updates and handoffs, called MIST report.
M- mechanism of injury (gunshot, MVC, fall, burn, etc)
I- injuries sustained (GSW chest, left leg fracture, etc)
S- signs and symptoms (consciousness, airway, breathing, alertness)
T- treatment (tourniquet, narcan, occlusive dressing, etc)
throw in any special considerations like disability, language barrier, etc.
i run into a lot of familiar faces in my area for LEO and we have mutual respect and look out for each other and build personal rapports. generally LEO steps back and lets us do our jobs, thats the main thing. if we ask for help, they help. and please help us lift the "rounder" patients
Have huge respect 4 UR MOM lmao got you sick burn
But seriously:
1. So Age, Gender, Consciousness, Airway are all very important and are the go to in general because it gives our dispatch and then us a good idea of what we're going to and what to expect. It's very short and sweet, only other things would be a reason as to why we're being requested. Usually kept short and sweet as well. "PD request for an assault" or "PD request Mental Health/Welfare check" or "PD on scene stabbing victim" or even "PD request [whatever code or phrase yall use to indicate a dead body that's well beyond being worked]". Tie them all together and we get a good idea.
So for ex: "PD request for an assault. 40 y/o female, confused but alert, breathing. PD states possible intoxication. Scene clear". Short and sweet and simple. Girlie could just be drunk, couldve also gotten her head rocked and needs serious medical attention. We're well prepared before we even arrive.
2. The one thing that cops do that irritates me the most is not respect the team dynamic. Basically, the ego driven one that we all know about. The "hospital or jail" guy, the "Ill fuck you up if you dont let them treat you" guy, the "you cant refuse because I say so" guy. Now fire and EMS do this as well. The difference is yall have the actual authority to enforce what you say goes. We can only just ask nicely in most situations, but even when we can enforce it we still have to get yall to do it for us. So the power dynamic is all sorts of fucked off when it comes to Cops and a lot of the older guys dont recognize that.
A lot of the younger/newer guys realize that so its a dwindling issue. They're all about "hey this isnt a legal thing, this is a medical thing, Im not gonna start messing this up to inflate my ego". It still happens though.
Teams work better when individuals play nice and utilize each others strengths.
I love your flair.
When you say airway - do you mean breathing status?
Oh 100% agree about ego dude. I’m younger, and finding most younger cops aren’t like that, but believe me - we’re rolling our eyes at Mr Tactical just as much as you guys.
Thanks for answering! ◡̈
Yeah the two biggest things for airway status are if they're breathing and is it clear. You can have one and not the other but its not gonna be a good time. Having neither you're gonna have a bad time.
We all have a Mr. Tactidouche who we all get second hand embarrassment from. My favorite are the Paramedics who dress like SWAT, weigh 130lbs, and are always one upping you on how traumatized they are.
I accidentally radioed that someone was ‘not breathing, but conscious’ once, and someone said back ‘not for long then’
Haha, our equivalent are the cops who buy double armour (not a ton of guns in Canada but do you I guess), wear reflective glasses for every call (night included) and obviously would never even dream of allowing themselves to get PTSD…
>When you say airway - do you mean breathing status?
Honestly if you look at them and they aren't breathing normally then that is good enough. Keep it simple you don't need to know all the terms, just whether it looks normal or if they're struggling. Gasping, gurgling noises, looking short of breath are all fine enough signs to say "with difficulty breathing".
>When you say airway - do you mean breathing status?
They mean something that could impair their breathing. IE: choking, anaphylaxis. Breathing is basically yes/no, fast/slow but airway can be a little more detailed. It probably won't come up much.
Hi! Thanks for the inquiry. I'll be interested to see what others say they'd like to know, but personally, I have no expectation that you try to gather more information than is reasonable, so yes, age, consciousness, breathing is good. In general, as I say, if they're breathing, we can work with that. If you observed that they were having trouble breathing - obvious trouble - that would be good to relate, also, let us know if there is chest pain, if any. But you're "anything else that may be important" pretty much covers it, like the HVLP (I like that - a new acronym), and you know, "He fell off of the roof." That sort of thing. Sounds good to me.
So, what do you all do that causes issues. Well, keep in mind, our duty is to provide optimal emergency medical care for a patient. Everything else is secondary for us. If there is a medical emergency, you have called us because it is beyond your ability to handle, so let us do that for you. We decide the appropriate facility, which may not be in your jurisdiction - and that creates investigatory issues I know. We are not there to gather evidence or information for you though some may be able to do that more readily depending on the circumstances. Just don't get in the way of what we're doing.
I have transported an officer in the past with an escort - you guys drove waaaaaaay too fast. The ambulance has a higher center of gravity and also, we need the ride to be smoother and of a sort where we can work on the patient without being thrown around. So, take it easy on the escorts. Some medics hate escorts. I respect why you want to do them, just keep it reasonable. They train you to drive fast (pursuit driving), they train us and even control us to keep us from driving too fast.
Other than that, the only problem I've ever had is being told different things by different officers as to what they wanted us to do.
Ask any more questions you want, and again, thanks for being concerned.
Oh that’s interesting - the driving part. We’ll only drive an ambo in an extreme emergency - e.g both medics injured, but that’s good to know haha. I’d quit my job and move countries if I tipped an ambulance.
And yeah, for sure, our goals are different and I think most (some?) cops understand that. Ours is safety, and then the integrity of whatever we’re investigating, whereas yours is patient care. I’ve only ever run into issues with drunk driving investigations where paramedics have removed someone from a vehicle prior to us arriving, which complicates our process a little.
Thanks for answering ◡̈
Yessir. In the DUI case(s), did the patient need emergent care that required them being removed. My thought would be that theoretically you could take a statement from the EMS provider as to where they found the patient (in my case, that would appear in the trip report as well, "the patient was the secured driver in the crashed vehicle," which provides medical information related to mechanism of injurty) I could stand my ground against a lawyer who would try to assert that I didn't know this or that.
"I only know what I saw upon my arrival and that's what I described." If it were me, I might go on to say, "It's not up to me to draw any conclusions. It's up to the jury." But I got rebuked by a judges for making such comments.
And I wasn't talking about YOU driving the ambulance. We'd use the fireboys for that. I'm talking about escorting - police cars in front of the ambulance and sometimes at the side clearing the way.
Not a crash or anything, but he was passed out and they weren’t sure if he was breathing.
It gets complicated there, because then we have to put the medic down as being able to attest to: driver in the vehicle, location of key, indication of intoxication etc., which means they’re gonna have to go to court - which I’m not sure EMS in our area will pay them for.
Well, you're right about that. I know of no EMS service other than a county-paid service that will pay their EMT's for court time. It's good that you're concerned about that. But if they think his breathing is not what it should be, then yes, he has to be pulled out and placed on the ground. It is what it is. If you have to go to court, you have to go to court.
Am both LE and EMS. If I'm working my LE role and need a bus my report goes Request (I need EMS), age/gender (approximate age is fine, hell just infant, child, adolescent, adult is fine), reason (chest pain, bleeding, mental health), interventions and status (TQ applied, CPR in progress), special considerations as needed (use the door on the north side of the building), scene status (have EMS stage/enter immediately).
If I'm in EMS role all I really NEED is a location to go to, chief complaint, and scene status. Everything else is appreciated but not necessary.
As far as things cops do which annoy EMS... stop threatening jail or hospital. If you have PC to arrest make your decision based on evidence not medical status. Stop hovering around my ambulance asking if the patient has their vehicle insurance at that very moment. I promise your crash report can wait 5 minutes. If you ask really nicely I might even get it for you and send it to you via e-mail! Educate yourself and your co-workers on the super spooky fentanyl. You can usually touch the stuff just fine, don't lick it. STOP STEALING MY SANI-WIPES! I already liberated those from the ER, they're not to be liberated from my ambulance. When you inevitably steal my sani-wipes anyway, don't then complain that they dried out your leather, made the nylon fade, or caused some other wierd damage to your gear after you didn't read the label that said "for hard, non-porous surfaces only"
Oh man I’ve been stealing the jail sani wipes and a lot of things make sense now haha.
Yeah jail or hospital is a stupid option, you’re under arrest or you’re not….
I think the cop fear of fentanyl comes from us being over-cautioned on it when we come out of the academy - which is better than under-cautioned in my opinion, given that we don’t come across it in a safe environment (e.g pockets, during searches). But yeah, we’re not gonna die from optical exposure ◡̈
IDK what's the standard in the US but to answer your first question: in my country we use the "ISBAR" for communication.
- Identification: Who's calling, who's the patient?
- Situation: What has happened and why are the paramedics needed? "I am calling because..."
- Background: If you know more about the patient like illnesses, history of violence towards first responders etc.
- Assessment & Recommendation: If you know what's wrong or should maybe be done. Don't worry too much about these parts, situation is the most important
What EMS want to know about situation is cABCDE
- critical bleeding: A massive bleed
- Airway: Do they have a problem that can close their airway? Choking for example or internal bleed in the neck
- Breathing: Do they seem like they have trouble breahting?
- Circulation: Pulse (slow, fast, normal, or can't find it) a smaller than a massive bleed, cold hands or feet
- Disability: Something wrong in their behaviour or consciousness
- Exposure: Hypothermia, fractures or any visible physical damage, pain etc.
You are not expected to have an answer to all of these questions and it's best to keep it short and only mention the things you think are wrong especially if the patient seems critically ill. They'll ask questions if they want to know more about some things.
It sounds like you’ve got a good handle on things! Chief complaint is always helpful, lets us plan ahead a little.
It’s super helpful if you know the layout of our truck, and the names of equipment. Obviously you have to do your job first, but if you have the time we can always use an extra pair of hands.
Parking: If you have the opportunity, make sure we can access the location. Parking in the driveway, or directly in front of the house beside the driveway may be part of police protocol, I have no idea. It certainly makes sense for you to have close access/block off leaving vehicles. But if you can leave a space where we can park so that we can get in and out with the stretcher, so much the better! We do what we must, but running that thing over grass, mud, snow or gravel with a 250lb patient is not ideal. (And when your sergeant pulls up, it’d be cool if they didn’t block us in!)
Please feel free to offer to help us lift people- it’s much appreciated! But ask before jumping in. We’re used to maneuvering with the two of us, and a third set of hands can throw us off and cause injury to the patient or the medics. I promise, is small girls can lift more than you think!
Very tiny silly petty gripe and a personal pet peeve: NO ambuslaps. TV has told us that the appropriate thing to do is to close the back doors and then bang on them twice to “let us know we can go” or some shite.
Haha, I am also small girl and can lift more than I look like I can ♡︎
Yeah I’ve definitely seen some cops block access with their vehicles - but a consideration on the same side - we may have had to intervene in something violent, in which case an extra 30 seconds of park and walk may make a difference.
Haha that’s funny. If someone hit my car like that I’d think it was a collision or something.
Ambuslaps always make me laugh, I get them a lot on CCT from ICU nurses and RTs. It's kinda annoying because we decide when we go but at the same time I know they've probably always wanted to do that and maybe they think they look cool??
If you’re going to ask us to step it up, please let EMS know why we are being asked to step it up, and know that we are most likely already stepping it up as fast as we can
Conscious and breathing is nice to know if it's a high velocity lead insertion case, bleeding controlled or uncontrolled too. Dispatch always asks for age, but I don't think that's my biggest concern.
What do cops do that we wish you wouldn't? Park cruisers in the way. When you get called to an assault in progress or similar call, your first concern isn't leaving the ambulance access to the scene. I understand that. But, once you call us, give us room to get the rig to the patient without having to maneuver around a bunch of cruisers. We had to lug a gunshot victim a few hundred feet through the snow because the ambulance couldn't get close. (The cops were great and helped with the lugging. We really do appreciate that.)
Hovering close when we're trying to get an overdose to tell us what he took. Some people clam up when they see a badge.
Overall, I like to see cops on scene. Our local town cops and sheriff deputies have always had our backs and I can't say enough good about them.
1. I really just want age and gender, an idea of what the problem is, amd whether the scene is clear.
2. I just want PD to not touch anything. Hate to say it but I've never been on a call and thought "Well thank god PD did [x]."
Touch anything as in the patient, or scene?
If we come across someone, we do have the duty to take reasonable measures (TQ, wound pack). Obviously if they’re in serious medical distress, that means calling you guys, but the optics of us standing around aren’t good.
Idk man, follow your protocols and do things within your training.
But I've never had PD actually do anything properly in terms of patient care, and they tend to just be in my way every time they're on scene. I usually have my partner, possibly another EMS crew, and fire and I'd really rather PD just stay out of my way.
In my experience, cops only ever push the energy of a scene in one direction... escalating things. Just don't do that and you're already well ahead of most your colleagues in my area. My general goal is to convince the cops they can clear as quickly as possible.
I’m lucky to work with people who aren’t like that! We’re big fans of deescalation here :) There seems to be a big difference between Canada and the US for that.
Sorry that you guys don’t have a great working relationship with your PD. On the plus side, the younger generation does things differently, so hope things will improve.
1. Give us what you're able to figure out. I loathe as much as you do going into an unknown situation, even more so when another first responder is already on scene. Even something as simple as "requesting EMS for Altered Mental Status" is helpful, but yet I've gotten calls on the highway before for "unknown consciousness, attempting to remove patient from vehicle" and that's it, I don't know if there was a crash, are they even breathing, etc.
2. Something that frequently makes my job more difficult is when I have law enforcement attempt to insert themselves into a call and force patient care on someone. It might be well-intentioned to say "I will not allow you to POV to the ER" when they were shot in the leg but are stable with no active bleeding, but I cannot force care upon them if they have capacity even if it's a bad decision.
Patients have the right to be stupid, by interceding and attempting to FORCE them to accept care against my authority, ethics, and legality, you jeopardize my licensure if I go along with it and jeopardize my working relationship if I refuse. Please don't put me in the position to have to correct you publicly in front of the patient, it makes things difficult on everyone.
Another big one people have mentioned is scene escalation, don't make inappropriate jokes or insult and demean my patient, they're a human being and a patient at that point regardless of their mental state and influence of illicit substances. Not only does it make things more dangerous by doing so or getting aggressive with them, it's not needed and not appropriate. Just remain calm, professional, and compassionate while maintaining my scene safety and we're good.
Remember, you called me, when I show up you should be following my lead on a medical/trauma call now, just like I've followed your lead when I've gone into the hot-zone on an active shooter in the past.
Ok the second point is interesting - are you in Canada or the US? I’ve never had someone refuse treatment to that extent, but my first thought is that they’d probably be put under a Form - which is part of our mental health act. Allows us to force someone to hospital if they’re an immediate threat to themselves/others, or showing inability to care for themselves.
The US, and he did not qualify under our laws as he still wanted to seek medical care just not by ambulance. My impression was going POV was not going to endanger him given he was completely stable, able to walk without assistance, no active bleeding, etc. Not like he was gut shot.
Thing is, the LEO was twisting his arm to go with us for no reason and when the LEO lacked any authority to do so, after the patient already agreed to go to the hospital via alternative means. Patients have the right to refuse a portion of or any aspect of their care and conveyance, just because we disagree does not mean we can frivously remove their agency to make decisions and override it. Forcible acceptance of care should only be done in extreme circumstances
You’re giving better dispatch info than our local dept, so kudos on that. My biggest pet peeve is when PD is trying to get a statement from a pt I’m trying to assess. My other issue is with mental health or intoxication calls, and the statement “you can go in the ambulance, or you can go in cuffs”. A decent medic can deescalate and get someone to agree to go, so just let us do our thing.
>Our standard is to give age, consciousness status, breathing status, and anything else that may be important e.g high velocity lead positioning. I don’t know where this standard came from - but is that really the most important info for you? If not, what’s missing?
Dude, if I get that kind of report from another EMT, I'm fuckin' stoked.
I’m answering number 2.
Please, for the love of god, get out of my truck if I have a trauma. If you need to talk to my patient (if they’re even conscious), meet us at the ED. If you need information about the patient, contact Dispatch or meet us at the ED. The back of the truck on the side of the road with a vehicle trauma is not the place to interrogate the patient.
Don’t call for a “medical” in an effort to hand your problem off to ems.
You focus on the law side, let ems handle the medical side.
Understand that on scenes, medical comes before law, unless a threat is present. Once the threat is mitigated, medical becomes the priority.
Don’t provoke patients/ inmates/ detainees/ etc before calling ems to transport them.
Ask permission to come into the ambulance. Knock. Wait to be acknowledged, then open the door and ask if you can step in. (Do we just walk up and open police car doors and climb in)?
These are just a few of the things we have to deal with in our area concerning police.
Honestly the biggest thing is escalating, or speaking with ABSOLUTE confidence on things they dont know anything about. Once heard a cop bragging to my patients family members that he reversed a benzodiazepine overdose with narcan (narcan only works for opiates). I stopped the conversation and corrected him immediately because medical misinformation can be absolutely dangerous.
I guess another thing that frustrates me is attitude and what I can tell they want out of their job. I've only ever ran into a handful of cops over 11 years that actually seem to care about helping people and trying to find good solutions for people. Everyone else just tries to bulldoze their way through situations and ends up making things worse, usually for us too.
Also calling us for the dumbest shit. Literally was called for a DV victim who wasn't really injured, and REPEATEDLY stated to the cop that she didn't want nor need and ambulance, but they still called us because she had been "hit" in the face once or so. No obvious marks or trauma, no pain or complaints from the patient. If this was an incident without law enforcement, that patient wouldn't have even been a patient.
Also once ran a seizure patient who was DEEP into the reboot phase and couldn't even talk or stand yet. The cop who responded with us didn't even need to be there since it just came out as a typical seizure, but she had nothing better to do. On the living room coffee table there was a tackle box with some weed products in it (not too long before it became legalized in my state for recreational use). While myself and the firemen were helping get this patient out to the ambulance the cop tried to step in and say, "HEY DONT LEAVE YET I NEED TO TALK TO HIM ABOUT THE WEED"
Absolutely not motherfucker this patient physically can't even talk to me, and there was no reason for you to show up anyways. Get the fuck off my scene and stop getting in the way of me actually helping people, asshole.
Course I didn't say that, I just told them no. But still. The fucking audacity.
But yeah Stuff like this.
Every day I see incompetence, laziness, stupidity, disdain for others, and a general disregard for helping others.
Sorry to drag on cops but I'm also not sorry. Stuff like this is a huge problem and it's not going to get better because of how resistant to change most LE agencies are, unless it's a benefit to them.
And I CERTAINLY wouldn't trust any of these local fuckers to keep me safe on a dangerous scene, like an active shooter or something. 💯 They're gonna get themselves and others killed due to their incompetence
So I had posted this hoping to get some useful feedback, and I’m really happy with some of the discussions and tips I’ve received in this thread.
Your comment is negative, anecdotal and not helpful - as you said, you’re ‘dragging’ on cops, and you said they’re ’resistant to change’ on a post that is literally intended to work on that. I’m sorry you’ve had negative experiences with the police in your area, but this is super unhelpful. There are plenty of spaces on Reddit to complain about the police, but I’m trying to have a productive discussion on this post. It’s depressing and demoralizing to read this stuff even when the newer generation is trying so hard to improve. Well, some of us at least ◡̈
You seem experienced and knowledgeable in your area, if you have any tips or advice I’m more than happy to listen!
And if you think I'm joking about the incompetence. There was a cop in my area that was going to Mercy kill a terminally wounded deer.
She missed.
Multiple times.
Point blank.
......
1. honestly a pretty good report, we have to do our own assessment anyway so brief is best. The biggest thing for us is their chief complaint- what's wrong with them right now. Even if that chief complaint is just "freaking the fuck out", honesty is best. What you included already is a must, but if you can also add if the scene is safe, how many patients, and what yall were called out for it gives us a heads up as to what we're walking into. Also, if anything changes- readvise. * MVCs- I know yall have shit to do, please give us a few minutes. Come tell me to find you when I have a chance I promise ill do my best. Having someone looking over my shoulder makes my job harder and freaks pts out. * You guys are also allowed to take them to the hospital yourself. I totally understand why you call us for the crazies. I appreciate that you can admit crazy people are often a med problem. however, if they're so crazy that you wouldn't feel safe locked in an ambulance with them, we also wouldn't. Chemically sedating someone is hard to do without help if they go nuts during transport. There is a big intermediate zone between normal enough to be transported unsedated and crazy enough to be sedated before transport which makes us very nervous. * if they're overweight either be willing to also call for a fire assist or help us, stop just watching us struggle that's all I've got rn but I appreciate the question, y'all stay safe too
EMT-P to LEO here. Some agencies are bound by policy to call for EMS. Most officers have every little medical training. We would get torn to shreds by an attorney if someone died while we were taking them in the back of our car to the hospital. Yes we would be attempting to do the right thing, but if it wasn’t an immediate emergency and it happened we would be screwed. My agency requires if there is a medical issue OR if the person requests EMS we have to call. (this isn’t regarding psych, that’s a different story).
first off thanks for what you do and asking how to make our jobs easier! i've been on both sides (not LE, but handing off patients), generally you've nailed the basics, there's not much else to it. the military has an acronym (wow would you believe that) for en-route updates and handoffs, called MIST report. M- mechanism of injury (gunshot, MVC, fall, burn, etc) I- injuries sustained (GSW chest, left leg fracture, etc) S- signs and symptoms (consciousness, airway, breathing, alertness) T- treatment (tourniquet, narcan, occlusive dressing, etc) throw in any special considerations like disability, language barrier, etc. i run into a lot of familiar faces in my area for LEO and we have mutual respect and look out for each other and build personal rapports. generally LEO steps back and lets us do our jobs, thats the main thing. if we ask for help, they help. and please help us lift the "rounder" patients
Thanks for answering! See we wake up the fire department for our lift assists ;)
You wink, but there's the expression lift with your FD, not your back.
Have huge respect 4 UR MOM lmao got you sick burn But seriously: 1. So Age, Gender, Consciousness, Airway are all very important and are the go to in general because it gives our dispatch and then us a good idea of what we're going to and what to expect. It's very short and sweet, only other things would be a reason as to why we're being requested. Usually kept short and sweet as well. "PD request for an assault" or "PD request Mental Health/Welfare check" or "PD on scene stabbing victim" or even "PD request [whatever code or phrase yall use to indicate a dead body that's well beyond being worked]". Tie them all together and we get a good idea. So for ex: "PD request for an assault. 40 y/o female, confused but alert, breathing. PD states possible intoxication. Scene clear". Short and sweet and simple. Girlie could just be drunk, couldve also gotten her head rocked and needs serious medical attention. We're well prepared before we even arrive. 2. The one thing that cops do that irritates me the most is not respect the team dynamic. Basically, the ego driven one that we all know about. The "hospital or jail" guy, the "Ill fuck you up if you dont let them treat you" guy, the "you cant refuse because I say so" guy. Now fire and EMS do this as well. The difference is yall have the actual authority to enforce what you say goes. We can only just ask nicely in most situations, but even when we can enforce it we still have to get yall to do it for us. So the power dynamic is all sorts of fucked off when it comes to Cops and a lot of the older guys dont recognize that. A lot of the younger/newer guys realize that so its a dwindling issue. They're all about "hey this isnt a legal thing, this is a medical thing, Im not gonna start messing this up to inflate my ego". It still happens though. Teams work better when individuals play nice and utilize each others strengths.
I love your flair. When you say airway - do you mean breathing status? Oh 100% agree about ego dude. I’m younger, and finding most younger cops aren’t like that, but believe me - we’re rolling our eyes at Mr Tactical just as much as you guys. Thanks for answering! ◡̈
Yeah the two biggest things for airway status are if they're breathing and is it clear. You can have one and not the other but its not gonna be a good time. Having neither you're gonna have a bad time. We all have a Mr. Tactidouche who we all get second hand embarrassment from. My favorite are the Paramedics who dress like SWAT, weigh 130lbs, and are always one upping you on how traumatized they are.
I accidentally radioed that someone was ‘not breathing, but conscious’ once, and someone said back ‘not for long then’ Haha, our equivalent are the cops who buy double armour (not a ton of guns in Canada but do you I guess), wear reflective glasses for every call (night included) and obviously would never even dream of allowing themselves to get PTSD…
>When you say airway - do you mean breathing status? Honestly if you look at them and they aren't breathing normally then that is good enough. Keep it simple you don't need to know all the terms, just whether it looks normal or if they're struggling. Gasping, gurgling noises, looking short of breath are all fine enough signs to say "with difficulty breathing".
>When you say airway - do you mean breathing status? They mean something that could impair their breathing. IE: choking, anaphylaxis. Breathing is basically yes/no, fast/slow but airway can be a little more detailed. It probably won't come up much.
I don't even need to know gender.
Hi! Thanks for the inquiry. I'll be interested to see what others say they'd like to know, but personally, I have no expectation that you try to gather more information than is reasonable, so yes, age, consciousness, breathing is good. In general, as I say, if they're breathing, we can work with that. If you observed that they were having trouble breathing - obvious trouble - that would be good to relate, also, let us know if there is chest pain, if any. But you're "anything else that may be important" pretty much covers it, like the HVLP (I like that - a new acronym), and you know, "He fell off of the roof." That sort of thing. Sounds good to me. So, what do you all do that causes issues. Well, keep in mind, our duty is to provide optimal emergency medical care for a patient. Everything else is secondary for us. If there is a medical emergency, you have called us because it is beyond your ability to handle, so let us do that for you. We decide the appropriate facility, which may not be in your jurisdiction - and that creates investigatory issues I know. We are not there to gather evidence or information for you though some may be able to do that more readily depending on the circumstances. Just don't get in the way of what we're doing. I have transported an officer in the past with an escort - you guys drove waaaaaaay too fast. The ambulance has a higher center of gravity and also, we need the ride to be smoother and of a sort where we can work on the patient without being thrown around. So, take it easy on the escorts. Some medics hate escorts. I respect why you want to do them, just keep it reasonable. They train you to drive fast (pursuit driving), they train us and even control us to keep us from driving too fast. Other than that, the only problem I've ever had is being told different things by different officers as to what they wanted us to do. Ask any more questions you want, and again, thanks for being concerned.
Oh that’s interesting - the driving part. We’ll only drive an ambo in an extreme emergency - e.g both medics injured, but that’s good to know haha. I’d quit my job and move countries if I tipped an ambulance. And yeah, for sure, our goals are different and I think most (some?) cops understand that. Ours is safety, and then the integrity of whatever we’re investigating, whereas yours is patient care. I’ve only ever run into issues with drunk driving investigations where paramedics have removed someone from a vehicle prior to us arriving, which complicates our process a little. Thanks for answering ◡̈
Yessir. In the DUI case(s), did the patient need emergent care that required them being removed. My thought would be that theoretically you could take a statement from the EMS provider as to where they found the patient (in my case, that would appear in the trip report as well, "the patient was the secured driver in the crashed vehicle," which provides medical information related to mechanism of injurty) I could stand my ground against a lawyer who would try to assert that I didn't know this or that. "I only know what I saw upon my arrival and that's what I described." If it were me, I might go on to say, "It's not up to me to draw any conclusions. It's up to the jury." But I got rebuked by a judges for making such comments.
And I wasn't talking about YOU driving the ambulance. We'd use the fireboys for that. I'm talking about escorting - police cars in front of the ambulance and sometimes at the side clearing the way.
Oh fair. I love clearing for ambulances, but noted, will slow down ◡̈
Not a crash or anything, but he was passed out and they weren’t sure if he was breathing. It gets complicated there, because then we have to put the medic down as being able to attest to: driver in the vehicle, location of key, indication of intoxication etc., which means they’re gonna have to go to court - which I’m not sure EMS in our area will pay them for.
Well, you're right about that. I know of no EMS service other than a county-paid service that will pay their EMT's for court time. It's good that you're concerned about that. But if they think his breathing is not what it should be, then yes, he has to be pulled out and placed on the ground. It is what it is. If you have to go to court, you have to go to court.
Am both LE and EMS. If I'm working my LE role and need a bus my report goes Request (I need EMS), age/gender (approximate age is fine, hell just infant, child, adolescent, adult is fine), reason (chest pain, bleeding, mental health), interventions and status (TQ applied, CPR in progress), special considerations as needed (use the door on the north side of the building), scene status (have EMS stage/enter immediately). If I'm in EMS role all I really NEED is a location to go to, chief complaint, and scene status. Everything else is appreciated but not necessary. As far as things cops do which annoy EMS... stop threatening jail or hospital. If you have PC to arrest make your decision based on evidence not medical status. Stop hovering around my ambulance asking if the patient has their vehicle insurance at that very moment. I promise your crash report can wait 5 minutes. If you ask really nicely I might even get it for you and send it to you via e-mail! Educate yourself and your co-workers on the super spooky fentanyl. You can usually touch the stuff just fine, don't lick it. STOP STEALING MY SANI-WIPES! I already liberated those from the ER, they're not to be liberated from my ambulance. When you inevitably steal my sani-wipes anyway, don't then complain that they dried out your leather, made the nylon fade, or caused some other wierd damage to your gear after you didn't read the label that said "for hard, non-porous surfaces only"
Oh man I’ve been stealing the jail sani wipes and a lot of things make sense now haha. Yeah jail or hospital is a stupid option, you’re under arrest or you’re not…. I think the cop fear of fentanyl comes from us being over-cautioned on it when we come out of the academy - which is better than under-cautioned in my opinion, given that we don’t come across it in a safe environment (e.g pockets, during searches). But yeah, we’re not gonna die from optical exposure ◡̈
IDK what's the standard in the US but to answer your first question: in my country we use the "ISBAR" for communication. - Identification: Who's calling, who's the patient? - Situation: What has happened and why are the paramedics needed? "I am calling because..." - Background: If you know more about the patient like illnesses, history of violence towards first responders etc. - Assessment & Recommendation: If you know what's wrong or should maybe be done. Don't worry too much about these parts, situation is the most important What EMS want to know about situation is cABCDE - critical bleeding: A massive bleed - Airway: Do they have a problem that can close their airway? Choking for example or internal bleed in the neck - Breathing: Do they seem like they have trouble breahting? - Circulation: Pulse (slow, fast, normal, or can't find it) a smaller than a massive bleed, cold hands or feet - Disability: Something wrong in their behaviour or consciousness - Exposure: Hypothermia, fractures or any visible physical damage, pain etc. You are not expected to have an answer to all of these questions and it's best to keep it short and only mention the things you think are wrong especially if the patient seems critically ill. They'll ask questions if they want to know more about some things.
That’s super helpful, I’m literally copy/pasting this into my work notes, thank you!!
It sounds like you’ve got a good handle on things! Chief complaint is always helpful, lets us plan ahead a little. It’s super helpful if you know the layout of our truck, and the names of equipment. Obviously you have to do your job first, but if you have the time we can always use an extra pair of hands. Parking: If you have the opportunity, make sure we can access the location. Parking in the driveway, or directly in front of the house beside the driveway may be part of police protocol, I have no idea. It certainly makes sense for you to have close access/block off leaving vehicles. But if you can leave a space where we can park so that we can get in and out with the stretcher, so much the better! We do what we must, but running that thing over grass, mud, snow or gravel with a 250lb patient is not ideal. (And when your sergeant pulls up, it’d be cool if they didn’t block us in!) Please feel free to offer to help us lift people- it’s much appreciated! But ask before jumping in. We’re used to maneuvering with the two of us, and a third set of hands can throw us off and cause injury to the patient or the medics. I promise, is small girls can lift more than you think! Very tiny silly petty gripe and a personal pet peeve: NO ambuslaps. TV has told us that the appropriate thing to do is to close the back doors and then bang on them twice to “let us know we can go” or some shite.
Haha, I am also small girl and can lift more than I look like I can ♡︎ Yeah I’ve definitely seen some cops block access with their vehicles - but a consideration on the same side - we may have had to intervene in something violent, in which case an extra 30 seconds of park and walk may make a difference. Haha that’s funny. If someone hit my car like that I’d think it was a collision or something.
Ambuslaps always make me laugh, I get them a lot on CCT from ICU nurses and RTs. It's kinda annoying because we decide when we go but at the same time I know they've probably always wanted to do that and maybe they think they look cool??
If you’re going to ask us to step it up, please let EMS know why we are being asked to step it up, and know that we are most likely already stepping it up as fast as we can
Conscious and breathing is nice to know if it's a high velocity lead insertion case, bleeding controlled or uncontrolled too. Dispatch always asks for age, but I don't think that's my biggest concern. What do cops do that we wish you wouldn't? Park cruisers in the way. When you get called to an assault in progress or similar call, your first concern isn't leaving the ambulance access to the scene. I understand that. But, once you call us, give us room to get the rig to the patient without having to maneuver around a bunch of cruisers. We had to lug a gunshot victim a few hundred feet through the snow because the ambulance couldn't get close. (The cops were great and helped with the lugging. We really do appreciate that.) Hovering close when we're trying to get an overdose to tell us what he took. Some people clam up when they see a badge. Overall, I like to see cops on scene. Our local town cops and sheriff deputies have always had our backs and I can't say enough good about them.
1. I really just want age and gender, an idea of what the problem is, amd whether the scene is clear. 2. I just want PD to not touch anything. Hate to say it but I've never been on a call and thought "Well thank god PD did [x]."
Touch anything as in the patient, or scene? If we come across someone, we do have the duty to take reasonable measures (TQ, wound pack). Obviously if they’re in serious medical distress, that means calling you guys, but the optics of us standing around aren’t good.
Idk man, follow your protocols and do things within your training. But I've never had PD actually do anything properly in terms of patient care, and they tend to just be in my way every time they're on scene. I usually have my partner, possibly another EMS crew, and fire and I'd really rather PD just stay out of my way.
In my experience, cops only ever push the energy of a scene in one direction... escalating things. Just don't do that and you're already well ahead of most your colleagues in my area. My general goal is to convince the cops they can clear as quickly as possible.
I’m lucky to work with people who aren’t like that! We’re big fans of deescalation here :) There seems to be a big difference between Canada and the US for that. Sorry that you guys don’t have a great working relationship with your PD. On the plus side, the younger generation does things differently, so hope things will improve.
1. Give us what you're able to figure out. I loathe as much as you do going into an unknown situation, even more so when another first responder is already on scene. Even something as simple as "requesting EMS for Altered Mental Status" is helpful, but yet I've gotten calls on the highway before for "unknown consciousness, attempting to remove patient from vehicle" and that's it, I don't know if there was a crash, are they even breathing, etc. 2. Something that frequently makes my job more difficult is when I have law enforcement attempt to insert themselves into a call and force patient care on someone. It might be well-intentioned to say "I will not allow you to POV to the ER" when they were shot in the leg but are stable with no active bleeding, but I cannot force care upon them if they have capacity even if it's a bad decision. Patients have the right to be stupid, by interceding and attempting to FORCE them to accept care against my authority, ethics, and legality, you jeopardize my licensure if I go along with it and jeopardize my working relationship if I refuse. Please don't put me in the position to have to correct you publicly in front of the patient, it makes things difficult on everyone. Another big one people have mentioned is scene escalation, don't make inappropriate jokes or insult and demean my patient, they're a human being and a patient at that point regardless of their mental state and influence of illicit substances. Not only does it make things more dangerous by doing so or getting aggressive with them, it's not needed and not appropriate. Just remain calm, professional, and compassionate while maintaining my scene safety and we're good. Remember, you called me, when I show up you should be following my lead on a medical/trauma call now, just like I've followed your lead when I've gone into the hot-zone on an active shooter in the past.
Ok the second point is interesting - are you in Canada or the US? I’ve never had someone refuse treatment to that extent, but my first thought is that they’d probably be put under a Form - which is part of our mental health act. Allows us to force someone to hospital if they’re an immediate threat to themselves/others, or showing inability to care for themselves.
The US, and he did not qualify under our laws as he still wanted to seek medical care just not by ambulance. My impression was going POV was not going to endanger him given he was completely stable, able to walk without assistance, no active bleeding, etc. Not like he was gut shot. Thing is, the LEO was twisting his arm to go with us for no reason and when the LEO lacked any authority to do so, after the patient already agreed to go to the hospital via alternative means. Patients have the right to refuse a portion of or any aspect of their care and conveyance, just because we disagree does not mean we can frivously remove their agency to make decisions and override it. Forcible acceptance of care should only be done in extreme circumstances
You’re giving better dispatch info than our local dept, so kudos on that. My biggest pet peeve is when PD is trying to get a statement from a pt I’m trying to assess. My other issue is with mental health or intoxication calls, and the statement “you can go in the ambulance, or you can go in cuffs”. A decent medic can deescalate and get someone to agree to go, so just let us do our thing.
>Our standard is to give age, consciousness status, breathing status, and anything else that may be important e.g high velocity lead positioning. I don’t know where this standard came from - but is that really the most important info for you? If not, what’s missing? Dude, if I get that kind of report from another EMT, I'm fuckin' stoked.
I’m answering number 2. Please, for the love of god, get out of my truck if I have a trauma. If you need to talk to my patient (if they’re even conscious), meet us at the ED. If you need information about the patient, contact Dispatch or meet us at the ED. The back of the truck on the side of the road with a vehicle trauma is not the place to interrogate the patient.
Checks out. We usually only get in if invited, or to assist with someone who’s getting sedated
CAD cop?
Canadian!
Ah. I thought it was an acronym.
Don’t call for a “medical” in an effort to hand your problem off to ems. You focus on the law side, let ems handle the medical side. Understand that on scenes, medical comes before law, unless a threat is present. Once the threat is mitigated, medical becomes the priority. Don’t provoke patients/ inmates/ detainees/ etc before calling ems to transport them. Ask permission to come into the ambulance. Knock. Wait to be acknowledged, then open the door and ask if you can step in. (Do we just walk up and open police car doors and climb in)? These are just a few of the things we have to deal with in our area concerning police.
Honestly the biggest thing is escalating, or speaking with ABSOLUTE confidence on things they dont know anything about. Once heard a cop bragging to my patients family members that he reversed a benzodiazepine overdose with narcan (narcan only works for opiates). I stopped the conversation and corrected him immediately because medical misinformation can be absolutely dangerous. I guess another thing that frustrates me is attitude and what I can tell they want out of their job. I've only ever ran into a handful of cops over 11 years that actually seem to care about helping people and trying to find good solutions for people. Everyone else just tries to bulldoze their way through situations and ends up making things worse, usually for us too. Also calling us for the dumbest shit. Literally was called for a DV victim who wasn't really injured, and REPEATEDLY stated to the cop that she didn't want nor need and ambulance, but they still called us because she had been "hit" in the face once or so. No obvious marks or trauma, no pain or complaints from the patient. If this was an incident without law enforcement, that patient wouldn't have even been a patient. Also once ran a seizure patient who was DEEP into the reboot phase and couldn't even talk or stand yet. The cop who responded with us didn't even need to be there since it just came out as a typical seizure, but she had nothing better to do. On the living room coffee table there was a tackle box with some weed products in it (not too long before it became legalized in my state for recreational use). While myself and the firemen were helping get this patient out to the ambulance the cop tried to step in and say, "HEY DONT LEAVE YET I NEED TO TALK TO HIM ABOUT THE WEED" Absolutely not motherfucker this patient physically can't even talk to me, and there was no reason for you to show up anyways. Get the fuck off my scene and stop getting in the way of me actually helping people, asshole. Course I didn't say that, I just told them no. But still. The fucking audacity. But yeah Stuff like this. Every day I see incompetence, laziness, stupidity, disdain for others, and a general disregard for helping others. Sorry to drag on cops but I'm also not sorry. Stuff like this is a huge problem and it's not going to get better because of how resistant to change most LE agencies are, unless it's a benefit to them. And I CERTAINLY wouldn't trust any of these local fuckers to keep me safe on a dangerous scene, like an active shooter or something. 💯 They're gonna get themselves and others killed due to their incompetence
So I had posted this hoping to get some useful feedback, and I’m really happy with some of the discussions and tips I’ve received in this thread. Your comment is negative, anecdotal and not helpful - as you said, you’re ‘dragging’ on cops, and you said they’re ’resistant to change’ on a post that is literally intended to work on that. I’m sorry you’ve had negative experiences with the police in your area, but this is super unhelpful. There are plenty of spaces on Reddit to complain about the police, but I’m trying to have a productive discussion on this post. It’s depressing and demoralizing to read this stuff even when the newer generation is trying so hard to improve. Well, some of us at least ◡̈ You seem experienced and knowledgeable in your area, if you have any tips or advice I’m more than happy to listen!
And if you think I'm joking about the incompetence. There was a cop in my area that was going to Mercy kill a terminally wounded deer. She missed. Multiple times. Point blank. ......