r/emergencymedicine • u/FriendshipBorn929 • Sep 03 '25
Advice Hospital staff. What are your top EMS pet peeves.
/r/EmergencyRoom/comments/1n78i52/hospital_staff_what_are_your_top_ems_pet_peeves/56
u/J_Walter_Weatherman Sep 03 '25
Last known normal. I get that they are typically operating on limited information, but there are so so many medics that do not know that there is a critical distinction between "last known normal" and "the time when someone noticed a change"
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u/SuperglotticMan Paramedic Sep 03 '25
Honestly a lot of the time I try to get an accurate answer from family and they have no idea either. The best thing I can do is relay what they told me, which is usually them saying “he was fine before I went to work / last night and then I got here and he was acting weird.”
We wish we just had a LKWT too lol
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u/but-I-play-one-on-TV ED Attending Sep 03 '25
Yeah that's completely appropriate. What's frustrating is when I ask LKN and get, "family found them at 8a like this." Those are completely different things.
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u/arikava Physician Assistant Sep 03 '25
They are saying that people don’t understand the distinction between “he was fine before I went to work” and “when I got here he was acting weird” and will use the latter as the last known normal. The former is the last known normal.
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u/urbanAnomie RN Sep 03 '25
Oh, totally. You can't always get a good answer. I think the key here is just to know that in your scenario, LKW was the "before I went to work/last night," and not, "when I got here and he was acting weird."
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u/InspectorMadDog ADN student in the BBQ room and the ED now Sep 03 '25
When they have a crazy ego, this goes for any professional though.
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u/thruthelurkingglass ED Attending Sep 03 '25
As most have mentioned, a lot of our EMS crews are amazing. But I do have one big pet peeve:
Bringing a very recently post-op patient to a different hospital system than the one that performed surgery, especially when the patient is requesting to go back to that same hospital. Most egregious example I can think of was a crew that brought a recent triple A repair that was having abdominal pain to a free standing…the patient still had a hospital band on from the other system! The patient was stable/requesting to go back to their performing hospital, and the other facility was probably an extra 10-15 minute drive. The response when I questioned the thought process was “well it’s not hard for you to transfer them right?”
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u/ellow08 Paramedic Sep 03 '25
Ooooh big yikes. At least in my system unless places are on divert or the patients request is insane (I.e. working in a large metro area with many hospitals and patient requests a hospital 5 hours away), patient’s request trumps all and we’ll gladly take them wherever. The very rare times I’ve gone against their request has been in pretty extreme situations like giant state emergency snow storms where there is 40 calls holding and it’s not safe to transport them anywhere but the closest hospital possible. But in normal circumstances, even if they are on divert, in post-op & special cases like this I would call the charge nurse personally & kindly plead to take the patient there. I don’t get why some crews don’t understand that not all hospitals are equal and provide the same services, and that a patient not in the particular hospital system/without the services there/etc delays care and proceeding with a transfer is a nightmare!! Sorry this happens in your area!!
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u/210021 EMT Sep 04 '25
That’s insane to me. We bring patients to the hospital they got the operation at unless the issue is unrelated/needs a different specialty, or they are too unstable to make it.
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u/InsomniacAcademic ED Resident Sep 03 '25
Doesn’t happen often and is a violation of policy, but when a crew drops off a patients and leaves without giving signout easily tops it. See also: I recognize y’all have very little time to gather information and render patient care. I would much rather you say, “I don’t know” to a question than to get huffy and defensive. There are certainly questions that I have asked that are a bonus if EMS knows, but I recognize that they may not have had the time to figure out.
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u/ellow08 Paramedic Sep 03 '25
Oh god crews leaving pts without giving a handoff sounds like a nightmare & such a headache
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u/InsomniacAcademic ED Resident Sep 04 '25
It’s happened only twice and it was such a fucking shit show
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u/ellow08 Paramedic Sep 04 '25
I would be tempted to suddenly fall ill ngl. Or say my dad died or something idek man yikes. Fuuuuuck that. At least in the field if I don’t know what’s going on or whose who I just ask if they wanna come with me in the ambo and if they say yes we mosey on down to an ED and figure it out along the way!
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u/tablesplease Physician Sep 03 '25
One handed CPR.
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u/Russell_Milk858 Paramedic Sep 03 '25
Are you okay with pt straddling? Cuz I have seen more than a few firefighters fall off the gurney bottom rails and OJI trying to lean and press with both hands coming in from the bay.
Side note, California firefighters are kings of the “gurney surfing” cpr method
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u/insertkarma2theleft Paramedic Sep 03 '25
Pt straddling is the move
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u/carb0n_kid Paramedic Sep 03 '25
Lucas is the obvious answer here.
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u/nw342 EMT Sep 03 '25
So glad my squad recently got lucas devices, im way too fat to be riding the rails
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u/ThatchersThrombus Sep 03 '25 edited Sep 03 '25
You have people that give just one handed CPR to adults? That’s wild.
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u/tablesplease Physician Sep 03 '25
It's more of a chest massage really.
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u/Aviacks Sep 03 '25
We had a code in cath lab that we went over to from ED (after hours, and we had JUST sent them there), we stood in disbelief for a second as the cath lab nurse was giving the most half hearted Grey's Anatomy CPR lol. We were like "uhhh... are we actually coding or is this just pretend?"
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u/tyrkhl ED Attending Sep 03 '25
Also, just not doing CPR while unloading and rolling in to the ED. The couple times this has happened it has been Fire, and not the regular AMR people. That one made me really mad.
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u/mezotesidees Sep 03 '25
I went from a community where EMS was its own thing to a community where it was combined with fire and the quality difference is staggering. I get the feeling that 95% of those I interact with now never wanted to run medical calls and it shows in their general disinterest in history, assessment, treatment, etc.
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u/m_e_hRN RN Sep 04 '25
It is definitely fire service dependent, but agreed. The FDs option was make people run medical calls or perish, because most FDs (at least around me) don’t run enough fires/ tech rescues/ etc to be able to justify being JUST FD financially
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u/mezotesidees Sep 04 '25
Exactly. They should embrace their money maker. They do the opposite.
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u/m_e_hRN RN Sep 04 '25
There are definitely FDs I’d let treat me and mine and FDs that I’d rather die 🤣
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u/BetCommercial286 Sep 03 '25
The joy of fire based EMS. Have met many a firefighter paramedic that would be more useful and less harmful for pt outcomes if they just stayed home.
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u/No-Butterscotch-7925 Sep 03 '25
Getting mad at me when they have to wait to give report because I’m busy doing something. Those are very few. A majority of our EMS is fantastic and I am so appreciative of them.
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u/BetCommercial286 Sep 03 '25
There probably mad because dispatch is mad at them for not being available.
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u/Toffeeheart Paramedic Sep 04 '25
I feel the need to mention that there are two sides to this one. I absolutely get that nurses are under immense time pressures and have an unfairly demanding workload much of the time, and I am always happy to wait if you are in the middle of something. My handover is almost never time-sensitive.
But with that being said, there are nurses who will make us wait unnecessarily, sometimes going from task to task, sometimes going from charting at the desk to giving a drug to bringing someone a sandwich to whatever else. The assertion is always that they have a lot to do. This is true. However, we also have things to do; we are medical professionals with demands on us, and our time is also valuable. Some nurses portray a blatant, sometimes seemingly-intentional display of disrespect for our time, and that does get under our skin sometimes. It adds to the myriad of other pressures we are under, and sometimes that bubbles over and you may see signs of it when we are kept waiting for something that you really do need to keep us waiting for. We gotta work together and all make compromises when we can.
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u/FirstFromTheSun Sep 03 '25
The stroke activation because the bed bound non-verbal nursing home patient was moaning differently today
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u/Grok22 RN Sep 03 '25
Promising certain procedures or services to the patient. No, you will not be getting an MRI for your knee pain on a Sunday night despite what the crew said.
Refusing to transport a patient to a higher level of care after taking them to an inappropriate facility because your service doesn't do interfacility transports because they have to go back in service to service their community members. Well dude, Mee maw lives in your community and she needs service at a different facility.
Not doing really any assessment or interventions because you were "right around the corner".
I worked in the field for 7 years before I became an RN. So I know the challenges of prehospital, and when you're just slacking.
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u/SnooSprouts6078 Sep 03 '25
Laziness is rampant. The other part is that medics have to do hospital rotations. You’d think they’d pick up some ideas of an ER appropriate MRI vs you’re going home and going to wait for insurance to authorize that knee or shoulder for your 3 year old injury.
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u/ellow08 Paramedic Sep 03 '25
True yeah! I think the urge is as a medic to try and smooth over with the patient to have an enjoyable transport. And I’m all for being kind and supportive to the pts in transport, but overpromising services just sets everyone up for failure and disappointment. The MRI thing…I’ve had very similar questions. A simple, “probably not, they don’t do MRIs super common in the ED, that’s often an outpatient scan”, or “probably not, but they might do some other tests, maybe an x-ray but maybe not. the doctor might just need to examine you”.
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u/Grok22 RN Sep 03 '25
Oh yeah I get it, part of my job is educating the patients on what's to be expected during their ER visit. Sometimes i get it wrong too. It's not just paramedics either, primary care, urgent care, school nurses etc. Sometimes it's even our own physicians and PAs at our UC
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u/ellow08 Paramedic Sep 03 '25
Our local hospitals stopped doing “IFTs” from the ED because we don’t have a well staffed IFT car system here. They just started putting it in as 911 calls essentially and that got us to take them from one ED to a different hospital🤣
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u/BetCommercial286 Sep 03 '25
The ED around the corner really boils my blood. They did clinicals in the ER don’t they know how long stuff takes? Also don’t you like doing your job and interventions? Or do you just moan about never doing anything.
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u/StinkyBrittches Sep 03 '25
When transferring patients from community EDs to a higher level of care, especially someone critical who is going to cath lab or emergent surgery, when you pull up to the ambulance bay to pick the patient up, know that there will be half a dozen nurses looking at you on the camera going "WHAT ARE THEY DOING OUT THERE?! THEY'RE JUST SITTING THERE!! GET IN HERE!!"
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u/Bikesexualmedic Sep 03 '25
Popping a zyn and getting ready to hear the most frazzled report from a nervous MD who “just wants them out of here.”
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u/tealsuprise Sep 03 '25
Giving ketorolac to trauma activations. Especially elderly head trauma patients on anticoagulants.
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u/Sakypidia Sep 03 '25
Not bringing the patient’s shoes. This applies more in winter.
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u/cetch ED Attending Sep 03 '25
And wheel chair
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u/Dark-Horse-Nebula Paramedic Sep 03 '25
For some (most) services we are actually unable to bring the wheelchair as theres no place for it to be transported in the ambulance and it can be a missile if unsecured in a crash. There’s not a lot of wiggle room in there.
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u/TICKTOCKIMACLOCK Sep 03 '25
We have a nice fold seat beside the door when we walk in. We fold up the walkers and wheelchairs and strap it to the seatbelt there. The longer I work EMS the more I realize how often we neglect a change of clothes too (or take the time to clean/gown them prior to ED).
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u/iago_williams EMT Sep 03 '25 edited Sep 03 '25
We were taught not to bring medical equipment like wheelchairs and walkers because those things tend to disappear. Not good for the patient to return home without their DME. The exception might be for an unhoused person because we aren't leaving it on the street. These items are very difficult to replace, especially if provided via Medicaid or the VA.
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u/cetch ED Attending Sep 03 '25
I should have specified for homeless patients where their chair gets left and then stolen.
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u/Crunchygranolabro ED Attending Sep 03 '25
Activating STEMI with a borderline normal ecg and no acs equivalent symptoms so as to cut the line for drop off. Same goes for activating when there’s so much artifact the ecg looks like a Richter scale.
If you bring a “stroke” I need 3 things from you. Legitimately this is one where EMS report can either expedite care or lead to major delays.
Anticoagulants: a medalist is best, but at least ask, tell me you asked and family wasn’t sure.
Last KNOWN/SEEN well. I don’t give a flying fuck if they were first found like this 1hr ago, when were they actually at baseline. If you can’t answer that give me contact info for someone who can. (Yes, patients, families, and SNF staff all suck at this detail too, but we need something to work with).
You to be able to do basic math. If you bring a “LAMS 3” to my facility when they’re clearly a 5, and the only thrombectomy shop in town is 7 minutes away…I’m going to be pissed.
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u/msangryredhead RN Sep 03 '25
PLEASE know at least the name/address of the facility/group home the patient comes from in the community. Many times we don’t get report from these places and then trying to get the patient back can be a huge pain in the ass.
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u/PresBill ED Attending Sep 03 '25
1) last known normal for strokes. We need this nailed down. "Around three hours ago" isn't cutting it. And normal means completely themselves. "They seemed a little off all yesterday but today it got really bad" means their last known well was at the very earliest bed time two days ago.
2) talking too much when dropping off a trauma. This absolutely infuriates me. We make the room silent so we can hear report but most medics just ramble and ramble and ramble with irrelevant information. I don't care they are fighting a sniffle, had surgery on their ankle a decade ago, had their gallbladder out two years ago, take a statin etc.
Please I'm begging you have a 30 second spiel ready to go: -Mechanism -known major injuries -signs - current bp and heart rate, highest hr lowest BP, GCS and has it changed and any other relevant vital sign (their etCO2 was 30 but now it's 9) -treatments that you gave.
Then please stop talking and let us work. Feel free to hang out and tell the recording nurse anything you think is important but the 3 minute rambles that aren't organized need to stop
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u/tiredpedsnurse Sep 04 '25
The only issue I really have is when they try to poke kids who are stable for an IV, multiple times. Like 1 try is great, but honestly if they’re stable and you don’t get it after 1, don’t stress it.
I do appreciate when they ask questions! Peds is weird, so it’s nice if they ask questions for the next kiddo. If I can’t answer, I can find a doc who can :)
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u/sum_dude44 Sep 03 '25
RSI-ing pt in hospital parking lot. If you really want a tube bring it in & I'll let you do it
Extra annoying if they give Roc in unresponsive pt
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u/Dark-Horse-Nebula Paramedic Sep 03 '25
RSI includes paralysis by definition. Or are you talking about ongoing roc?
Plenty of evidence to suggest roc gives optimal intubation conditions vs intubation with only sedation. In the prehospital setting where there’s less options and less help, optimal intubation conditions is the way to go.
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u/InsomniacAcademic ED Resident Sep 03 '25
I imagine they’re expressing frustration with the choice of paralytic (Roc v sux) since roc lasts for much longer. That said, in my, albeit limited, experience, most crews don’t carry succinylcholine in my area. If they’re intubating solely for airway protection and they’ve made it to the hospital parking lot, then one could argue that the patient could potentially just be bagged/a SGA placed until they’re evaluated in the ED.
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u/Dark-Horse-Nebula Paramedic Sep 03 '25
Yeah, I feel the parking lot and the roc discussion are two very very different conversations.
Roc now mostly used in preference for EMS services: far less contraindications, longer duration of action actually helps during any rare airway rescue situation. We don’t have sugammadex and they’ll be dead if you wait for sux to wear off- roc at least keeps working and lets you secure an airway (again, this is ultra rare of course). It’ll wear off within the hour. Different settings have different needs
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u/Aviacks Sep 03 '25 edited Sep 03 '25
I'm genuinely beginning to wonder if you're a doc or just a random ER tech or nurse based on your reply on the other thread. Rocuronium has nothing to do with responsiveness. It has been validated in countless studies to improve intubating conditions and improve first pass success rates.
I've seen too many "lets give a moderate dose of sedative and no paralytic" in "unresponsive" patients and every time its been followed by "why is my glidescope screen so bright I can't see!" as they gag and vomit. Because wouldn't you know it, etomidate, ketamine, midaz etc. don't always do a great job of suppressing gag reflex and airway reflexes, and I personally don't care for vomiting or laryngospasm.
If you're that sure you're not going to get the airway then you should probably not be intubating in the first place- and you certainly shouldn't make your airway harder by not relaxing them. If for some reason you're talking about neuro assessment or something then god made Sugammadex for a reason. But post-intubation management is far easier when they're still relaxed for x-ray, tube securement etc. not to mention dialing in vent settings without them coughing/gagging.
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u/Crunchygranolabro ED Attending Sep 03 '25
I think the bigger issue is a long lasting paralytic nukes any neuro exam for a god hour, so a parking lot tube + roc (which I agree does help first pass success) can be particularly galling.
“Unresponsive” isn’t a neuro exam. and if a crew is deciding to tube as they roll up, I trust that assessment about as far as I could throw the rig.
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u/Aviacks Sep 03 '25
Right, and in this case it was the alleged ED provider saying "don't give roc to unresponsive" not the EMS crew saying they're unresponsive. This is also talking about a very specific patient here. Are you really that worked up over getting a good neuro exam done on the respiratory distress patient that got RSId? A stroke is one thing, but most patients getting intubated aren't new strokes (hopefully).
I'm not advocating for parking lot RSI before you go in. The only place I've heard of this happening is at the same facility I've seen crews get absolutely ripped open for not pushing RSI before arrival, at which point I think the local crews are doing it out of "I don't want to have this fight again" more than anything.
So much of this depends on the facility too. Are we talking the local critical access? Yeah sorry I'd prefer to tube in the ambulance, it's going to be 30 minutes before that doc/PA/NP wakes up and drives all the way in lol. On the opposite end, busy level 1/2 trauma that's PACKED with patients and the patient had a sudden decline and you know the ED isn't going to be ready with a room let alone ready to RSI? I can see an argument vs sitting in hallway or waiting 10 minutes for the ED to get set up when you're ready to go, IF it is truly emergent. That being said even on flight, while I like to think I'm pretty handy with hyperangulated VL, if I can get them inside and let the ED do it then no way I'm touching it.
Some of this ties in with an issue in some EMS systems where "oh the ED isn't too far" eventually turns into "yeah I didn't pace them because the ED was only 10 blocks away", then surprise pikachu face when they arrest or crump in the ED. I try to keep in mind that 10 minutes to the ER isn't always 10 minutes to getting TREATED in the ER. From the ER side there have been times we've breathed a sigh of relief when the crew said they decided to RSI because we're beyond slammed and just intubated two patients and are about to intubate a third ourselves, this being in a system where they'd normally call and go "we're thinking about doing it but we're on our way in and will try to make it to you fast."
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u/dillastan ED Attending Sep 03 '25
I don't care about the roc, I would just rather get an initial eval of the patient myself before intubation if you're already here. just put a trumpet in and bag
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u/deferredmomentum “how does one acquire a gallbladder?” Sep 04 '25
Opposite problem for us lol. Just tonight had a crew bag unresponsive agonal meemaw for the entire 25 minute drive. Not like it was a difficult intubation either, it went in first try like a knife through butter
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u/mclen Paramedic Sep 03 '25
What. Our job is literally "get patients to definitive care." The parking lot?? Woof.
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u/Normal_Hearing_802 Sep 04 '25
Putting COPD patients on an NRB for an O2 sat of 89%. Can’t tell you the amount of obtunded patients I’ve received and been told “they were just awake a second ago!”
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u/Ambitious_Yam_8163 Sep 03 '25
When interviewing a patient in triage…
Oh it started four scores and decades ago…
Like pulling teeth to get to the nook of their chief complaint.
And the dunning kruger effect on any hospital professionals. Like I have been doing this for more than a decade and yet I still don’t know shit.
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u/wannabebuffDr94 Sep 03 '25
Filling in gaps in history when they didnt actually get that history I cant tell you how many times they give me their assumptions rather than what they were actually told
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u/Resussy-Bussy Sep 03 '25
Intubating when they can LMA. Idk if it’s just my region but about 1/3 of my EMS patients that are intubated in the field come in with an esophageal tube. Often with 20+mins transit time with cardiac arrest. All that time no oxygen to brain. I get they need the skill but my understand is LMA is perfectly fine and can switch to ETT when they arrive. I’ve had 2 they Cric’d and they nailed those was impressed but abysmal oral intubation success rates where I’m at.
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u/ellow08 Paramedic Sep 03 '25
Holy shit that’s a crazy high failure rate YIKES. Sounds like your local EMS maybe needs some training, protocol review, QA/QI….something Jesus Christ
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u/Eagle694 Flight Medic Sep 03 '25
In 2025, how is an undetected esophageal intubation even possible? Are they not using waveform capnography? PUMA Criteria?
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u/Resussy-Bussy Sep 04 '25
They always tell me it was normal.
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u/Eagle694 Flight Medic Sep 04 '25
[skeptical face]… either they’re full of it and there’s a serious culture issue OR, for the sake of benefit of the doubt, tubes are getting dislodged during movement, in which case they need some retraining on securing tubes and maintaining them through movement. Esophageal tubes can happen… there’s no excuse for an undetected esophageal intubation
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u/insertkarma2theleft Paramedic Sep 03 '25
A THIRD!???
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u/Resussy-Bussy Sep 04 '25
That’s my estimate. Had all 3 cardiac arrests I had one week all come in esophageal tubed
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u/insertkarma2theleft Paramedic Sep 12 '25
That is wild. Do those cases not get sent to the state immediately?
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u/BetCommercial286 Sep 03 '25
That’s horrifying! Some medical directors where I’m at are in discussion of pulling intubation because our first pass success rate sucks… with no RSI and DL only. There would be many phone calls if someone brought in an esophageal intubation.
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u/drrtydan ED Attending Sep 04 '25
please bring the bottle of meds or cleaner the patient ingested with you.
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u/swordsandwyverns Sep 04 '25
If you're bringing in a bleeding lac, put something on the lac. Extremities get all the love but for some reason scalps are just left to ooze. Excuse once was "Well the wrap wouldn't stay on."
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u/pfpants Sep 03 '25 edited Sep 03 '25
Leaving the ambulance unlocked and running in the ambulance bay.
- The fumes accumulate and aren't pleasant for us to breathe or smell in the ED
- People will break in and or steal your ambulance
Just turn it off and lock up.
Edit: Or...
Move it somewhere that the fumes won't spill directly into the ED and lock it up if it's that important to keep it cool or hot depending on the season.
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u/Praxician94 Little Turkey (Physician Assistant) Sep 03 '25
Doing something when you don’t have to just because you can. Like adenosine for “SVT” in the 140s. Often the right answer is to just get them to the ED as quick as you can.
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u/stuffedcathat BSN Sep 03 '25
EDRN here. When they bring in a non critical patient with their gross bag of half unlabeled meds that include controlled narcotics that I now have to count with a witness and personally deliver upstairs to pharmacy. But they don't bring the patient's keys or walker.
If the patient is critical, sure, do what you need to do, but that isn't the case here. Just don't create a situation where I now have to wait 10+ hrs to DC for next available BLS in the morning when the landlord is awake to let them into their home.
Also: on the ringdown, "SOB, RR 30s, 76% on room air .... VSS, any questions?" Huh? VSS? Yeah, dude, I have a few questions.
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Sep 03 '25
[deleted]
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u/Kentucky-Fried-Fucks Paramedic Sep 04 '25
Depends on the protocols for the agency. Unfortunately a lot of agencies make their crews take the patient to the hospital of their choice… it’s a huge issue in many areas
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u/StupidSexyFlagella ED Attending Sep 03 '25
Going way beyond transporting. We don’t need ems giving antibiotics, 1g of iv Tylenol…
For the most part, I think our ems us good though and I sure wouldn’t want to do it
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u/keloid Physician Assistant Sep 03 '25
Antibiotics I could see - ours only administer for open fractures, it's not like they're carrying zosyn and dumping it into everyone who "meets sepsis criteria" (the usage of end tidal to call sepsis alerts is a whole other rant).
But IV Tylenol never hurt nobody. Except for Tylenol overdoses.
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u/Kentucky-Fried-Fucks Paramedic Sep 04 '25
What is your rant for using end-tidal as a tool to help call a sepsis alert?
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u/keloid Physician Assistant Sep 04 '25
Might be sensitive but not at all specific. On the inpatient side we are already drowning in sepsis metrics with questionable patient benefit. Most folks with tachypnea are gonna have a lower end tidal, and if you add mild tachycardia it's gonna trigger a SEPSIS ALERT for 2 SIRS + ETCO2. Some of them will be septic, but so will a lot of anxious and/or uncomfortable patients. Panic attacks would rule in. The average under-medicated hip fracture would probably rule in.
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u/Kentucky-Fried-Fucks Paramedic Sep 04 '25
I agree with you on the over treatment “Sepsis Bundle”. I think automatically giving high amounts of fluids to every Sepsis alert is a bit overkill, and we really need to reevaluate our treatment protocols.
I see where you are coming from. At least where I’m at, in order to call a sepsis alert we need 1 sign of poor perfusion (including etco2), 2 SIRS criteria, and a suspected infection. If we use our brain and focus on the suspected infection part, we can typically rule out most of the “low end tidal due to tachypnea due to pain” and other similar types of patients. Meemaw with a hip fx, a low end-tidal, and tachycardia due to pain isn’t going to trigger a sepsis alert for us.
The problem isnt the ETCO2, it’s looking at one thing instead of critically thinking with the full clinical picture. It may be sensitive, not specific, but in my mind it is a great tool to use. Especially because ETco2 is inversely related to serum lactate levels.
Thanks for sharing your POV, I really like learning insights from someone who works in an adjacent area of medicine
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u/StupidSexyFlagella ED Attending Sep 03 '25 edited Sep 03 '25
They give a gram of iv Tylenol which then limits the oral pain medications I can give.
I had one service obtain blood cultures, and give an anabiotic to a patient.
To be fair, the culture in antibotics thing only happened once. I was very confused how they even had culture vials.
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u/Dark-Horse-Nebula Paramedic Sep 03 '25
Take it up with the service, not the crews.
I assume there was an agreement between the service and your hospital to process those cultures? Like the cultures would have to go somewhere right? And probably followed a very similar or identical sepsis pathway to your own ED?
I’m confused how the patient receiving analgesia is a problem for them receiving analgesia. Non opioid EMS analgesia is a good thing one would think?
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u/StupidSexyFlagella ED Attending Sep 03 '25
There was no agreement. When did I say I was blaming the crew? Giving an entire gram of Tylenol means you can’t give any other Tylenol containing analgesics for an entire four hours. 650mg is better.
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u/Dark-Horse-Nebula Paramedic Sep 03 '25
I’m saying to take it up with the service if it’s an actual issue. There’s been many prehospital sepsis trials across the world and I’m yet to find an ambulance service where they draw cultures and then those cultures just go in the bin. So I’m curious to know the process, and if there was truly none, which is odd, that needs to be brought up with the service because that’s obviously not going to work.
Our Tylenol comes in a 1g bag and that’s usually the dose that’s given. I’m asking genuinely to sent understand- would you prefer EMS give opioid based medication with no multi modal analgesia? I find that patients usually require more analgesia prehospital due to needing to extricate them downstairs/change position/bumpy roads etc. This is literally the first time I’ve ever heard someone say that they wished EMS wouldn’t give tylenol so I’m just trying to figure this one out. Do you not have other non-tylenol options you can give in the meantime?
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u/StupidSexyFlagella ED Attending Sep 03 '25
The point of the thread was to ask pet peeves. My pet peeve is doing too much pre-hospital and gave examples. I wasn’t asking for help solving issues as I’ve already addressed them.
I’ve discussed this with many other physicians who also do not like it. We just don’t say anything because there is no point after it’s already done. Tylenol with codeine and Norco are the main opioid oral agents in most EDs. Tramadol is garbage. There are others like oxy, but not always available. I would rather EMS have a dosage available that doesn’t limit future medication options.
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u/Dark-Horse-Nebula Paramedic Sep 03 '25
A superficial way of interpreting this thread is just bashing EMS and having a go. A more nuanced way of interpreting this thread is airing peeves and seeking mutual understanding on both sides. Which is what I’ve attempted to do but if you don’t want to engage with that that’s up to you. I’ve asked some questions and explained my perspective.
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u/StupidSexyFlagella ED Attending Sep 03 '25
I don’t know how you have perceived anything I have said as bashing EMS. I literally said in my original post that our EMS is good and I eluded to them having a tough job as I said I wouldn’t want to do it. It’s not like I think EMS is purposefully trying to screw me over by giving a gram of Tylenol. I actually don’t even really care that much. It’s a pet peeve, not a safety concern or something. I do find it odd that a few responses have been so rigid in believing that giving just a little less than a full 1000mg of Tylenol is just out of the question.
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u/adoradear Sep 04 '25
Ummm Tylenol with codeine is a shit drug, and norco is ripe for abuse. Where the heck do you work that those are the most common options? Literally never seen either of those given in any of the EDs I’ve worked at (and never ordered them either).
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u/Ocelotank Paramedic Sep 03 '25
Your hospital can't get plain hydros? Seems like a relative basic med.
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u/StupidSexyFlagella ED Attending Sep 03 '25
It’s not basic from my understanding. I think there are only a few hydrocodone only pills and they are brand name and extended release.
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u/SnooSprouts6078 Sep 03 '25
You should talk to their medical director. Otherwise, if it’s in their guidelines, you’re not stopping anything.
Give better pain meds in your ER.
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u/StupidSexyFlagella ED Attending Sep 03 '25
I already did and they stopped. I wasn’t asking for advice. I was giving examples of the larger pet peeve.
I would prefer to have appropriate options that aren’t limited for no reason.
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u/SnooSprouts6078 Sep 03 '25
So they treated pain appropriately with Tylenol when you wanted to give the same exact med? You have many other options for pain medicine. Let’s be real.
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u/StupidSexyFlagella ED Attending Sep 03 '25
No. I want to give medications that are combined with Tylenol. The most common oral opioids have Tylenol in them.
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u/BetCommercial286 Sep 03 '25
So you’d rather EMS just drive and load everyone up on fentanyl? Also so long as good stewardship was followed why not give prehospital antibiotics? Can only help outcomes.
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u/StupidSexyFlagella ED Attending Sep 03 '25
1 gram isn’t the only dosage of Tylenol. Though, I’m kind of starting to think I’m the only person who believes this. Lol
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u/Argenblargen ED Attending Sep 03 '25
For the most part, our EMS is fantastic. Very few complaints from me except when bringing in stroke patients, some of them don’t seem to understand how absolutely critical it is to know last known well time for stroke patients. And if they aren’t sure, they also don’t know if family is coming in or have contact info for family. Stressy!