Loud Music

You’re transferring Emma Hawken, an elderly woman, from one of the EDs in your service area to a rehab facility about 45 minutes away.

Emma has just endured a surgical repair of her right hip. She’s suffering some coccygeal tenderness from a pressure sore that began to form after she lay undiscovered for awhile following her injury. She’s readily arousable, but when undisturbed she stoically closes her eyes and doesn’t speak.

Your partner is Cliff, and Emma is his attend. You’re easing into traffic and heading for the interstate when you receive a familiar request from the compartment. Cliff’s a bright young medic, but he doesn’t hide his disdain for transfer calls—especially those involving elderly patients. In fact, he conceals it least of all from the patients. When he attends on geriatric transfers, he typically wears sun glasses and listens to loud music. He’s already inserted a Rush CD in the ambulance’s audio system. He wants you to play it for him and direct plenty of sound to the rear speakers.

Q. This seems odd to me, but I’m just a new EMT and Cliff is my assigned training officer. I’ve asked him about it, and he says I should trust him to decide what’s appropriate. He says the old folks never complain, and that most of them can’t hear anyway. (He calls them droids or gummers.) I don’t know, does this sound right to you? I think about my grandmother in Ms. Hawken’s place, and I would never want her treated this way.

A. Sounds pretty strange all right, and your “granny test” is a reasonable standard—one that many seasoned medics trust daily. It sounds like your partner is using the sun glasses and the music as barriers to insulate himself from his patients, and from you.

Q. I don’t disagree with you, but what do you mean by insulating himself from me?

A. One of the protections a patient and a crew have during transport is that there’s always a witness to anything that transpires between any two people in the ambulance. The sun glasses prevent you and the patient from seeing Cliff’s eyes, and the music prevents you from hearing any conversation that might transpire between him and the patient.

Q. OK, so where do I go from here? Is this just a minor idiosyncracy of Cliff’s or is it something I should discuss with a superior? I don’t want to blow things out of proportion, but it doesn’t sound like this is standard practice at my agency. In fact, I’m pretty sure some of the crews offer to play whatever kind of music their transfer patients want to hear. (Or none at all, if that’s their wish.)

A. It’s certainly not minor, but I think Cliff deserves to hear your perspective before you involve a supervisor. In fact, I think talking directly to people is a good first step in any disagreement. Tell Cliff, yes, he’s the FTO, and you appreciate what you’re learning from him. But advocate for the patients. Tell him you believe they deserve some say about the selection of music in their environment, and the amplitude at which they hear it. (Actually, so do you.)

If Cliff’s as bright as he’s supposed to be, he’s probably thought this out already, and he knows what he’s doing is not right. It’s the worst kind of insult to a patient like Ms. Hawken, who may be quiet but appears to be normally perceptive.

Q. While we’re on this subject, I have a more general concern about a teacher referring to patients in the negative terms I mentioned earlier. I used to work in another field, and they used slang terms for their customers as well, so I understand that. But it doesn’t sound good coming from a training officer, does it?

A. You’re right, of course. Many of us subscribe to a whole dialect of cynical terminology in regard to the elderly, and that’s a shame. But it shouldn’t be perpetuated by those we choose to teach our newest members. Sadly, people like Cliff are often assigned as trainers on the basis of their experience instead of their qualifications or their wishes. We need to improve in so many ways.

I would still recommend you tell Cliff what you think. You may be the first person who has ever been that fair with him. I think he may need to switch professions; we usually say what we think and believe. But someday, when you find yourself in his position, remember how this felt to you. Make sure no student of yours ever hears or sees the things you’ve described here.

Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.