The Best Way To Phrase This? *Injured Child*

[TexasRanger]

I just finished my last ride out for my EMT-B class. It was in a different town/county then the one we normally use.  I have done 60+ hours of  ride alongs.

We where dispatched to a house where a 13yr old boy had broken his arm while goofing around (jumped off banister). When we get there it is obvious that his arm is broken. From appearances it looks like a greenstick fracture (some mild deformity) and, this is importent, some blood on his hand.

When we get to the hospital the nurses and doctor take over his care. Nurse unwraps the splint we put on and that is when we (medics and me) and the hospital staff notice that the bone has broken the skin, so the break is now classified as a open fracture..

What bothers me is that this wasn't noticed during the assessement of the patient (they never really looked at the arm, all they had to do was ask the kid to move the ice pack and they would of seen it). It just bothers me and I want to tell my superviser about it. IT wasn't the only thing that bothered me. Other things were:

1.Their truck looked like a war zone, trash and blood everywhere. Handles broken off cupboards and stuff held together with duct tape. Equipment left wherever they dropped it. They only had three calls that day.
2. At times they were rather abrupt with me and the patient. Yelling at an injured and frightened boy to lift up his head so they could tighten the sling. It was said in the tone of an officer arresting someone.
3. One medic had me help him with the IV, half the bag was in the kid in less then 3 minutes. Also over a span of half an hour they gave the kid two doses, 50cc, each of a powerful narcotic. It was concerning to me because the kid weighed less then 100lbs.
4. They also managed to collapse a vein in the kids arm. He had good veins and the truck was not moving. I have watched dozens of IV's being put in and have never seen that happen in a healthy person.

Any medics want to chime in on what I should ommit and what I should tell her? The whole experience was disturbing.

[pierrotlunaire0]

I don't see this as an etiquette question.  What's going on here is far beyond the scope of manners.

[WillyNilly]

I don't see this as an etiquette question.  What's going on here is far beyond the scope of manners.

This ^

As to your question tell your supervisor everything you wrote here, leaving out the personal commentary (for example omit "I have watched dozens of IV's being put in and have never seen that happen in a healthy person," and just mention the vein was collapsed, the truck wasn't moving.)

[TexasRanger]

I don't see this as an etiquette question.  What's going on here is far beyond the scope of manners.

I'm just asking for a way to tell her (good wording) that won't start a war between the stations.  I'm not asking if the meds pushed or IV starting was done right.

[WillyNilly]

I don't see this as an etiquette question.  What's going on here is far beyond the scope of manners.

I'm just asking for a way to tell her (good wording) that won't start a war between the stations.  I'm not asking if the meds pushed or IV starting was done right.

The answer is factually.  Just lay out the facts.  You are riding along to learn and observe right?  Well this is what you observed and what can you learn from this?  (Probably what you can learn is some ambulance corps need better training, funding and oversight, and the first step towards that is reporting your observations).

[TootsNYC]

One thing supervisors are *supposed* to do is field this sort of question from their subordinates.

"Boss, I had some troubling observations on this trip, and I don't know whether I should do anything with them. Will you help me sort this out? Here's what bothered me. . . ."

I'm a supervisor, and I can even sort my way through a little bit of ranting and some snarky personal observations.

[pierrotlunaire0]

In a situation like this, I would recommend approaching it as seeking info from your supervisor.  "I am not certain if I am overreacting since I am new, but these things concerned me."  Then itemize your concerns.

A good supervisor will be able to sort out what is trivial, and what is vital.

[MrTango]

I was an EMT-B while I was in college, and some of the things you describe are pretty obvious issues that need to be corrected before someone (patient or medic) gets hurt.

I'd speak up.

[Elessarion]

Slightly off-topic question but aren't drugs now measured in units of mls instead of ccs?

In regards to this question yes I'd speak to your supervisor.

[fountainsoflettuce]

I have some questions about your experience...

Are you positive the open fracture wasn't noticed? 

If you weren't certified, why are you helping with an IV?  I'd be concerned about getting into trouble because you rendered medical treatment without the appropriate licensing.  If that much of an IV was used in such a short time, are you sure the IV was inserted correctly? or that all of the related tubing wasn't leaking somewhere? 

Are you positive they gave the child that much of a powerful narcotic?  Are you sure it measured in cc's?  I know you've had problems with math in the past but that is a significant amount of a drug.

Also, don't you have a medical condition that affects your ability to lift heavy things?  How do you compensation for this condition while training to be an EMT?  I'm truly impressed with your fortitude to overcome these disabilities and become an EMT.  I would love to know your secret so I can tell others who get discouraged by their limitations.

And the vein thing isn't a big deal.  Recently, I've had many IV's in the same arm.  Sometimes it's a miss.

As stated, just stick with the facts but be prepared to answer a lot of questions.  Some of the things you observed will likely raise a lot of questions and concerns internally.

[newbiePA]

How to present this?? VERY factually.  Many of the things you name either make no sense or ate no big deal.  100 mL of a heav narcotic seems exceedingly unlikely.  Not everyone has the dulcet tones of a newscaster, and often, sharp matter of fact speaking gets through easier when someone was upset.  And even the worlds best IV starter can blow a vein.  It happens.  For sure, share your concerns, but be very factual.

[guihong]

Slightly off-topic question but aren't drugs now measured in units of mls instead of ccs?

In regards to this question yes I'd speak to your supervisor.

Milliliters are equivalent to cubic centimeters.