Pajama Man is on the scene

Quick question:
Who do you want seeing to you if you have an unknown ailment? – A Doctor of course.
Who do you want assisting in the operating room? – A nurse of course.
And who do you want assisting you when you are in a motorcycle accident with midline C-spine tenderness, tingling fingers and a clearly mangled clavicle? – Why, a nurse of course!

Before you nursing types get your scrubs in a wad (scrubs are just pajamas by the way) I have no business on the floors doing your job. I am not trained to do your job, nor will I ever try to tell you how to do your job, unless of course I see you harming in a way I can help.

With that in mind, the following tale.

The gang is rung out for a motorcycle versus vehicle and a 90 year old man has been ejected from the vehicle. Knowing the rider is likely 19, not 90, we arrive to a sharp turn known for trouble in our area and find the local PD doing their thing and blocking traffic. On the ground, in full leathers and helmet laying nearby, is our middle aged patient, alert and in clear discomfort.
Under his now hyper flexed head is a large messenger type bag and his chin is at his chest. As my EMT and I approach we are intercepted by the Pajama Man (nurse) who begins to explain to us his credentials and that he saw the accident.
When I tried to approach the man who needed help we were told by Pajama Man that he had been the one to remove the helmet and place the bag under the man’s head “for comfort, you guys took forever.”

Our assessment continued and revealed injuries and discomfort that would have led me to leave the helmet on and not even consider moving the bag under his head. Lucky for Pajama Man the patient mentioned these symptoms existed prior to the movement.

Pajama Man asked if we would need any help on the way in and my Officer, sensing my response would not be favorable, thanked him for trying to help and asked for his contact information, which he refused to give of course.

For just the briefest of moments I wanted to make this situation into something bigger, to call Pajama Man on his arrogance and complete disregard for BASIC patient assessment. He had not even asked the patient’s name. My mind flashed forward to me standing in the Chief’s office being reminded to respect other health care professionals who arrive on scene and that he was an RN after all, and I’m just a glorified technician who gets off on sirens and flashing lights. Not what she would have said, but the opinion of Pajama Man, I’m sure.

So, in the interest of keeping my job and continuing quality patient care, I let Pajama Man go about his day, with no real way of informing him what a poor job he did in my field of expertise without causing a whole mess of trouble.

Pajama Man is off doing what he does and would go nuclear if I wandered onto his floor and started changing drip rates, medication doses or imaging times simply because I was trying to help, but will likely stop at another accident scene and intervene.

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22 thoughts on “Pajama Man is on the scene”

  1. Oh, no, HM, you are right on–no worry, my scrubs are nice and pressed. I am an RN who worked as an EMT for several years prior to becoming an RN. Life out “under the lights” is very different then that of in the hospital. RNs need to recognize that. Nurse peeps, if at a scene, keep it simple. Keep you and the patient safe. No unnecessary movements of the patient. Assure the ABCs. Wait for the pros. Good post!

  2. Oh, no, HM, you are right on–no worry, my scrubs are nice and pressed. I am an RN who worked as an EMT for several years prior to becoming an RN. Life out “under the lights” is very different then that of in the hospital. RNs need to recognize that. Nurse peeps, if at a scene, keep it simple. Keep you and the patient safe. No unnecessary movements of the patient. Assure the ABCs. Wait for the pros. Good post!

  3. I can see this from both sides. I was in a mc vs prius in the 415 this year, and I six months after, I have completed an EMT-B course. No more bikes for me. I can tell you that when you are lying on the ground and cannot breathe very well-the last thing you want on your head is your helmet, and you don’t really care who comes to your perceived rescue. I had some great guys from King incidentally.
    My helmet was removed on scene with due caution, and I think it was because they were worried about my airway. Happy to report a full recovery, but now I know the importance of spinal precautions.
    So HM my question is this, you’d correct someone doing bystander CPR on a person with chest pain, why not give some feedback to McNurse?

    1. For the exact reasons I mention. Based on his demeanor and attitude there was no winning and every moment I take to lecture him, my patient is robbed of care. I hope to include basic field care into an RN course, but am told it is already included. I have also encountered exceptional care from RNs in the field, mainly with medical patients and persons in their care. Trauma seems to throw a wrench into the thought process of advanced care specialists, just an observation, not a statement of fact.
      The helmet on/off issue can be debated for decades, but based on midline tenderness (never assessed) and lack of assessment at all, my gut would have been with leaving it on based on presentation.
      A crappy answer, I know, but the best a glorified technician can do.
      Thanks for reading.

  4. I can see this from both sides. I was in a mc vs prius in the 415 this year, and I six months after, I have completed an EMT-B course. No more bikes for me. I can tell you that when you are lying on the ground and cannot breathe very well-the last thing you want on your head is your helmet, and you don’t really care who comes to your perceived rescue. I had some great guys from King incidentally.
    My helmet was removed on scene with due caution, and I think it was because they were worried about my airway. Happy to report a full recovery, but now I know the importance of spinal precautions.
    So HM my question is this, you’d correct someone doing bystander CPR on a person with chest pain, why not give some feedback to McNurse?

    1. For the exact reasons I mention. Based on his demeanor and attitude there was no winning and every moment I take to lecture him, my patient is robbed of care. I hope to include basic field care into an RN course, but am told it is already included. I have also encountered exceptional care from RNs in the field, mainly with medical patients and persons in their care. Trauma seems to throw a wrench into the thought process of advanced care specialists, just an observation, not a statement of fact.
      The helmet on/off issue can be debated for decades, but based on midline tenderness (never assessed) and lack of assessment at all, my gut would have been with leaving it on based on presentation.
      A crappy answer, I know, but the best a glorified technician can do.
      Thanks for reading.

  5. This is an interesting story, although one I am a little too familiar with personally. To be fair though, I have also had nurses who have done similar things without a proper assessment and have had the opportunity to explain to them that although their intentions are pure and good their actions are not in the best interest of the patient and they have acknowledged this and hopefully never repeated it.

    Of course, the attitude description of Pajama Man leads me to believe that whatever would have been said would have gone in one ear and out the other and possible incite an argument, and I commend you for your restraint… because that is something I probably would not have been able to do.

  6. This is an interesting story, although one I am a little too familiar with personally. To be fair though, I have also had nurses who have done similar things without a proper assessment and have had the opportunity to explain to them that although their intentions are pure and good their actions are not in the best interest of the patient and they have acknowledged this and hopefully never repeated it.

    Of course, the attitude description of Pajama Man leads me to believe that whatever would have been said would have gone in one ear and out the other and possible incite an argument, and I commend you for your restraint… because that is something I probably would not have been able to do.

  7. I’ve had to tell a doctor to get out of my ambulance when he interfered with my care of a patient with chest pain, telling me I was taking to long and hurry up.

    I have no qualms with telling people they are wrong when they are, regardless of their credentials, and regardless of the perceived ass-whooping I’ll receive from my supervisor later (to which I got none) My job is patient care, and if someone gets in my way of doing the best I can, they’ll get an ear-full.

  8. I’ve had to tell a doctor to get out of my ambulance when he interfered with my care of a patient with chest pain, telling me I was taking to long and hurry up.

    I have no qualms with telling people they are wrong when they are, regardless of their credentials, and regardless of the perceived ass-whooping I’ll receive from my supervisor later (to which I got none) My job is patient care, and if someone gets in my way of doing the best I can, they’ll get an ear-full.

  9. Yeah I understand your frustration… they might think they are a class above us and all but instead cause more problems for the patient…

  10. Yeah I understand your frustration… they might think they are a class above us and all but instead cause more problems for the patient…

  11. Here in Maine, as an EMT-basic, I seem to have quite an advantage: if someone — RN, DO, MD, off-duty medic — tries to take over, I simply point out that HE is assuming ALL responsibility for patient care (and the attending liability) and that by law, HE must accompany the patient to the hospital. It’s that whole “you can’t relinquish care to someone licensed at a lower level than you” thing, coupled with the fact that the medical types made it clear that RNs legally outrank medics.

    Amazing how many folks suddenly decide the best thing they can do is stand back and observe.

    1. Interesting, because while my protocols outline a procedure for an MD to assume patient care if one presents themselves at a scene, there are no such provisions for an RN taking over care. Ergo, as far as I’m concerned, they can’t.

  12. Here in Maine, as an EMT-basic, I seem to have quite an advantage: if someone — RN, DO, MD, off-duty medic — tries to take over, I simply point out that HE is assuming ALL responsibility for patient care (and the attending liability) and that by law, HE must accompany the patient to the hospital. It’s that whole “you can’t relinquish care to someone licensed at a lower level than you” thing, coupled with the fact that the medical types made it clear that RNs legally outrank medics.

    Amazing how many folks suddenly decide the best thing they can do is stand back and observe.

    1. Interesting, because while my protocols outline a procedure for an MD to assume patient care if one presents themselves at a scene, there are no such provisions for an RN taking over care. Ergo, as far as I’m concerned, they can’t.

  13. Hi happy medic. I am a Pajama Man. RN. Oh, Five years in a busy ER. EMT since 1980. Community volunteer fireman. Was a flight nurse, a paramedic program instructor, and enough certification cards to play poker with. And a paid EMT part time for many years. Come hang out with me at my job. Sorry he was a chump, but we are not all like him. Keep smilin’. And have a safe shift. Big Dave in NY.

  14. Hi happy medic. I am a Pajama Man. RN. Oh, Five years in a busy ER. EMT since 1980. Community volunteer fireman. Was a flight nurse, a paramedic program instructor, and enough certification cards to play poker with. And a paid EMT part time for many years. Come hang out with me at my job. Sorry he was a chump, but we are not all like him. Keep smilin’. And have a safe shift. Big Dave in NY.

  15. I had read some words of wisdom a few weeks ago: Should you find a doctor on scene, assume they are a gynecologist until proven otherwise. I suppose the same could be said of nurses. Unless they typically work in the trauma field, they may have no idea what to do. But even if they do work in the ER, they only get the aftermath. They don’t treat the pt until after we have packaged them up. Be safe.

  16. I had read some words of wisdom a few weeks ago: Should you find a doctor on scene, assume they are a gynecologist until proven otherwise. I suppose the same could be said of nurses. Unless they typically work in the trauma field, they may have no idea what to do. But even if they do work in the ER, they only get the aftermath. They don’t treat the pt until after we have packaged them up. Be safe.

  17. Unless I know them Doc’s and Nurses make great I.V. stands! Though in this day and age we should be extatic that someone even stopped at all. The title “Pajama Man” reminds me of a call in the middle of the night. We showed up in the typical 0300 medical call fire uniform, bunker pants and t-shirt. As we’re moving the patient to the wheels his wife said “I can’t believe you guys wear those to bed!” pointing at our pants and boots “I’ll make you boys some pajamas.” Still haven’t seen my new PJ’s…oh well.

  18. Unless I know them Doc’s and Nurses make great I.V. stands! Though in this day and age we should be extatic that someone even stopped at all. The title “Pajama Man” reminds me of a call in the middle of the night. We showed up in the typical 0300 medical call fire uniform, bunker pants and t-shirt. As we’re moving the patient to the wheels his wife said “I can’t believe you guys wear those to bed!” pointing at our pants and boots “I’ll make you boys some pajamas.” Still haven’t seen my new PJ’s…oh well.

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