# Good ways to kill patients



## 281mustang (Dec 7, 2013)

I've been out of school for a about 2 years and will be out in the field in a few weeks. I have no EMS experience beyond clinicals and am obviously a bit apprehensive about taking on the responsibility. 

Use this thread to list common pitfalls that can result in death/harm to patients. Things along the lines of giving an inferior MI w/ right side involvement nitro, overhydrating shock patients, decreasing preload as a result of overventilating during codes, etc.

I may not be a 'good' Medic right out of the gate but if I can acquire the necessary experience without killing anyone in the process I'll be content with that. 

Thanks!


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## NYEMTCorrie (Dec 7, 2013)

When in a cardiovert situation, forget to sync your monitor. 

-Forgetting to secure your oxygen bottle to your stretcher. 

-Forget to flush your IV line before you run it into your Patient. 

-fart in your Patients face and make him die of muster gas poisoning. 

-Don't verify your intubation with ETCO2 and lung sounds. 

-Didn't read the signs and fed the Paramedic.


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## Carlos Danger (Dec 7, 2013)

Failing to maintain a high level of skill with a BVM - as well as an eagerness to use it - will put every one of your airway patients at serious risk.


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## Rialaigh (Dec 7, 2013)

When going to synchronize cardiovert a patient, make sure the monitor is set to sync AND the monitor is picking up the QRS portion of the beat, some people with large T waves will fool the monitor into synchronize shocking them at the wrong time....


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## NomadicMedic (Dec 7, 2013)

An unrecognized tube in the goose. Kills 'em every time.


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## Anjel (Dec 7, 2013)

Becoming complacent


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## teedubbyaw (Dec 7, 2013)

Not listening to your patient.


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## TheLocalMedic (Dec 7, 2013)

Anjel said:


> Becoming complacent



This


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## ffemt8978 (Dec 8, 2013)

Driving like an idiot.


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## Brandon O (Dec 8, 2013)

-- Letting anything except bleeding control delay transport of your hemorrhaging patient to the trauma center

-- Letting anything except defibrillation interrupt or compromise high-quality chest compressions in your cardiac arrest

-- Taking away a patient's airway when you're not sure you can give it back

Funny thing is, you'll probably only ever get criticized for the last one... the others will be good clean kills.


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## mycrofft (Dec 8, 2013)

Getting so wrapped in the fancies that you lose sight of your role and the basics.

Not learning how to do a rapid survey starting as you first see the pt, and keep them alive until you have time to do a secondary…strike that. You are constantly assessing the pt. Just learn what normal, abnormal, and really abnormal present and don't stay took long on scene.


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## CentralCalEMT (Dec 8, 2013)

Being indecisive and sitting around over thinking situations. If your patient needs meds, procedures, etc, they need it. Being indecisive an getting decision paralysis leading you to do nothing can kill a patient just as quickly as anything.


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## NomadicMedic (Dec 8, 2013)

teedubbyaw said:


> Not listening to your patient.



I frequently tune my patients out. It hasn't resulted in a death.


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## 46Young (Dec 8, 2013)

Medication errors(confirm the 6 rights), moving a cardiac arrest patient early, instead of working them for at least 20 mins. before transferring to the ambulance (maybe not an issue if a Lucas or Autopulse is in operation), bagging too fast during a cardiac arrest/low flow state (which impedes venous return), or bagging too quickly when there are signs of increased ICP (eliminates CO2 > increased cerebral vasoconstriction > reduces or cuts off cerebral blood flow), taking critical patients outside to the bus after just vitals/ECG/O2, to treat them in the ambulance when they need timely interventions, walking unstable patients, treating the ACS pt with meds before getting a 12-lead, which may erase any evidence of a STEMI, being lazy in not using the shoulder harness to properly secure the patient to the cot


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## Chris07 (Dec 8, 2013)

46Young said:


> not using the shoulder harness to properly secure the patient to the cot



++
This is the one that bugs the everliving snot out of me. So many people I work with don't do this regularly on their own and I'm usually the one that initiates it. In a crash situation, it really is the only thing keeping them from shooting forward. If they are on a backboard it is imperative that you feed those shoulder straps through the top hand holes and not just over the board. 

Not using shoulder straps on gurney during transport = major pet peeve of mine.


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## Brandon O (Dec 8, 2013)

Chris07 said:


> Not using shoulder straps on gurney during transport = major pet peeve of mine.



Also mad illegal.


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## JPINFV (Dec 8, 2013)

Chris07 said:


> ++
> This is the one that bugs the everliving snot out of me. So many people I work with don't do this regularly on their own and I'm usually the one that initiates it. In a crash situation, it really is the only thing keeping them from shooting forward. If they are on a backboard it is imperative that you feed those shoulder straps through the top hand holes and not just over the board.
> 
> Not using shoulder straps on gurney during transport = major pet peeve of mine.



There are ambulance companies in Southern California that use shoulder straps?


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## fma08 (Dec 8, 2013)

Blood letting (unless they have hemochromatosis), leeches, and of course bicarb.


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## DrParasite (Dec 8, 2013)

JPINFV said:


> There are ambulance companies in Southern California that use shoulder straps?


I'm pretty sure there aren't companies in NJ that have them.

In fact, my former employer's supervisor actually removed them from the new cot when it was delivered.  And I don't miss that supervisor one bit.


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## Brandon O (Dec 8, 2013)

DrParasite said:


> I'm pretty sure there aren't companies in NJ that have them.
> 
> In fact, my former employer's supervisor actually removed them from the new cot when it was delivered.  And I don't miss that supervisor one bit.



M-a-d illegal.


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## Jim37F (Dec 8, 2013)

JPINFV said:


> There are ambulance companies in Southern California that use shoulder straps?



At my old company a small handful had the shoulder straps, but most didn't. None of the gurneys at my current company have more than two seatbelts on them. :-/


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## TransportJockey (Dec 8, 2013)

Jim37F said:


> At my old company a small handful had the shoulder straps, but most didn't. None of the gurneys at my current company have more than two seatbelts on them. :-/



Really? I write up my crews if they don't use shoulder harnesses and I catch them


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## JPINFV (Dec 8, 2013)

TransportJockey said:


> Really? I write up my crews if they don't use shoulder harnesses and I catch them




It's really hard to use something that's not there.


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## JPINFV (Dec 8, 2013)

Brandon O said:


> M-a-d illegal.



Penal/vehicle code source?


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## TransportJockey (Dec 8, 2013)

JPINFV said:


> It's really hard to use something that's not there.



Just meant that as a wtf especially when It comes to risk management advisors for the evil empire. We are told they are a company wide mandate


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## Brandon O (Dec 8, 2013)

JPINFV said:


> Penal/vehicle code source?



DoT by my understanding. I admit I've never run my eye over it.


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## NomadicMedic (Dec 8, 2013)

I don't know if it's illegal... However, it's certainly negligent to not use the manufacturer supplied safety equipment. And I've not seen one fire company use them here, even though most stretchers have those straps tucked behind the mattress.


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## JPINFV (Dec 8, 2013)

DEmedic said:


> I don't know if it's illegal... However, it's certainly negligent to not use the manufacturer supplied safety equipment. And I've not seen one fire company use them here, even though most stretchers have those straps tucked behind the mattress.




From a provider level, I think that's worse. It's one thing to say, "Shoulder straps? What shoulder straps?" and a completely different thing to be able to say, "Oh, -those- shoulder straps."


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## NomadicMedic (Dec 8, 2013)

JPINFV said:


> From a provider level, I think that's worse. It's one thing to say, "Shoulder straps? What shoulder straps?" and a completely different thing to be able to say, "Oh, -those- shoulder straps."



I fully agree. And when see them on a stretcher and they're not used, I mention it. If they don't put them on (which they never do) I document it. 

It's scant protection, but it's not my ambulance,  as we're frequently reminded.

However, we're drifting off topic here.


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## CFal (Dec 8, 2013)

In RI if you get caught by state not using them than it is a warning, 2 warnings and you get your ALS license suspended.  If it keeps happening you get your transport license revoked.


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## exodus (Dec 8, 2013)

TransportJockey said:


> Really? I write up my crews if they don't use shoulder harnesses and I catch them



Same thing here, the only time they are "acceptable" (not allowed, but will be glanced over) is when transferring the patient to the unit on the gurney.  And the only time we do that is if we will be getting a 12 lead once we're in the back, otherwise, they all go on.  If we have a backboard, they get fed through the top holes in the board as well.  All of our gurneys have them, and if they aren't working, it is an acceptable reason to place yourself OOS to get them swapped.


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## CANMAN (Dec 11, 2013)

Halothane said:


> Failing to maintain a high level of skill with a BVM - as well as an eagerness to use it - will put every one of your airway patients at serious risk.



This and if you intubate not catching a esophageal tube, which with the addition of ETCO2 is inexcusable.

Also if you practice RSI or interfacility transfers, intubating a patient who is profoundly acidotic and placing them on vent without matching minute volumes, such as a metabolic/DKA patient.


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## unleashedfury (Dec 24, 2013)

Forgetting the basics, which makes you complacent

I met alot of Paramedics who forget they were EMTs and still are EMTs 

I'm sure by now you have airway management, Medications indications and appropriate dosages. ACLS algorithms beaten into your head. 

1. Remember the basics, who cares if can start every IV successfully, get all your tubes and can identify any rhythm if you cant assess your patient and get a general impression your skills are useless. 

2. Use aseptic technique, when initiating IV therapy, using medications IM or Sub Q, I seen medics do this all the time. We use IV start kits that have chloroform in them never seems to get used. 

3. back to assessments, every time you do an intervention, check to see if your making improvement, You apply oxygen reassess, Use a medication reassess, Tube a patient verify placement. reassess. 

4. Safety in driving, more EMS employees are probably killed driving to a call, than patients are killed every year. 

5. When in doubt,, Call medical Command. the doc on the other end can be helpful when your stuck or have a hunch


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## TransportJockey (Dec 24, 2013)

unleashedfury said:


> 2. Use aseptic technique, when initiating IV therapy, using medications IM or Sub Q, I seen medics do this all the time. We use IV start kits that have chloroform in them never seems to get used.



I'll take all the unused chloroform y'all have! Now, if they were, however, chloropreps instead, I'm not as interested


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## unleashedfury (Dec 24, 2013)

TransportJockey said:


> I'll take all the unused chloroform y'all have! Now, if they were, however, chloropreps instead, I'm not as interested



LOL.. yeah I just caught that, its been a long day, I need to learn to proof read before posting <_<

OTOH if you really want chloroform, you can make it with household cleaning items.


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## Anonymous (Dec 24, 2013)

I know this is off topic but +1 for never seeing shoulder harnesses in my life. Sure as heck would make the backboard sliding all over the place much easier to deal with.


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## NomadicMedic (Dec 24, 2013)

I'm surprised. I've only seen "ALS before BLS" once in this thread.


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## DesertMedic66 (Dec 24, 2013)

TransportJockey said:


> I'll take all the unused chloroform y'all have! Now, if they were, however, chloropreps instead, I'm not as interested



What are you planning on doing with the unused chloroform? "Does this rag smell like chloroform to you?" is not a very popular pick up line with the ladies...


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## NomadicMedic (Dec 24, 2013)

DesertEMT66 said:


> What are you planning on doing with the unused chloroform? "Does this rag smell like chloroform to you?" is not a very popular pick up line with the ladies...




Giggity.


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## TransportJockey (Dec 24, 2013)

DesertEMT66 said:


> What are you planning on doing with the unused chloroform? "Does this rag smell like chloroform to you?" is not a very popular pick up line with the ladies...



Absolutely nothing... *innocent look*


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## unleashedfury (Dec 24, 2013)

DEmedic said:


> I'm surprised. I've only seen "ALS before BLS" once in this thread.



True Story, get all those bad azz skills and forget that you still need to manage your patient. 

OTOH I really need to start proofreading, I'm watching the aftermath of my "chloroform" vs, chloroprep post. Though entertaining.


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## Tigger (Dec 24, 2013)

DesertEMT66 said:


> What are you planning on doing with the unused chloroform? "Does this rag smell like chloroform to you?" is not a very popular pick up line with the ladies...



Says you.


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## Handsome Robb (Dec 25, 2013)

I think how you present the rag...and the question...is going to depend on success rate.







Too soon?


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## Medic348 (Jan 20, 2014)

Driving crazy! This is our biggest liability!~


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## mycrofft (Jan 20, 2014)

Best way to kill a pt: send her home from the ER with Battle signs forming, nausea, vertigo, and incipient syncope after a traffic accident that caused loss of consciousness for two hrs probably due to the pt being thrown from her wheelchair in the family van, with instructions to RTC (return ot clinic) PRN.


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## Av8or007 (Jan 20, 2014)

Being "too good" to ask for help or look something up. Better to check a protocol book or medscape then kill a patient with a med error.

If you're looking for the stealth assassination, then high concentration o2 for all copd and post cardiac arrest pts without regard to spo2 (or blood gases if you have an iStat).


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## Emtsgv (Jan 21, 2014)

dont respond to the call lol


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## UnkiEMT (Jan 26, 2014)

DesertEMT66 said:


> What are you planning on doing with the unused chloroform? "Does this rag smell like chloroform to you?" is not a very popular pick up line with the ladies...



It may not be popular, but it sure is effective.


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