# Paramedics sued for not entering house with o2



## ExpatMedic0 (Jul 25, 2014)

I found this interesting, paramedics where dispatched for a fall, upon entering find a pregnant women who also complains of shortness of breath. Patient is brought outside to ambulance and oxygen is applied. Paramedics are being sued for not entering the house with oxygen and delaying oxygen delivery until outside on the gurney (article states around 3-4 minutes)
Thoughts? 

http://www.emsworld.com/news/11590454/lawsuit-accuses-paramedics-of-malpractice-in-phila


----------



## OnceAnEMT (Jul 25, 2014)

Seeing as to how they contacted FD for a comment, I assume this is city of Philly EMS. I'm curious if its stated in their protocols anywhere what is required to be brought into the scene for certain situations (ie, what bags). Should O2 have been brought in? Obviously, yes. Perhaps it was just really poor judgement. 48 off without pay? They're lucky if their license isn't challenged. 

About the "do your part" and "you need to sit up" comments. For one this is yet again another very one-sided article against civil services. Secondly, those comments, without context, are not exactly "rude". If I have a large Pt in the ED who is clearly being immature/uncooperative, my questions/requests turn into calm but firm orders. Personally, I consider that more polite than giving up and getting 3 teammates to assist in moving the Pt. 

The article mentions the use of a stair chair, but then talks about a gurney, and "belting the head". Its things like this that wreck credibility. This whole story is second if not third hand account. Useless.


----------



## vcuemt (Jul 25, 2014)

Anyone can sue anyone for anything.

This will go no where.


----------



## medicsb (Jul 25, 2014)

I remember when the first occurred because it made the news back then.  There's actually some video footage of them placing the patient onto the stretcher and then into the ambulance if I recall.  

PFD has some weird policies about what to bring on to a scene.  When I did my ride time with them, we rarely brought the monitor or oxygen.  But, it was emphasized that we had to bring our drug bag.  

Anyhow, with a severe pulmonary embolism that results in cardiac arrest, it's unlikely that an extra 8 minutes of O2 would have made a difference for the mother or the child.  Right off the bat, mortality is as high as 60% for massive PE.  I imagine it would be higher for a pregnant woman.

Though it doesn't sound like prehospital care was ideal, I don't think it is the proximate cause.  Regardless, the city will most likely lose the case (it is Philadelphia after all).


----------



## DrParasite (Jul 27, 2014)

vcuemt said:


> Anyone can sue anyone for anything.
> 
> This will go no where.


you're right that you can sue for anything, but this suit won't go nowhere; the city will settle out of court with the family, to help minimize any more negative PR.

The problem is, and has been for years, that PFD EMS is incredibly understaffed, the :censored::censored::censored::censored::censored::censored::censored: step child of the FD, and is frequently used as a taxi service by their residents, utilizing 2 ALS provider on every ambulance.

Rest assured, the medics will be used as scapegoats for this broken system, and the underlying issues won't be addressed at all.


----------



## hogwiley (Jul 27, 2014)

I just don't understand the mentality. These Paramedics didn't kill this woman, a pulmonary embolism did.  Where I'm from you're really lucky if an ambulance gets there in under 20 minutes, especially in the winter where you can often tack on another 5 to 10 minutes. Yeah ideally they should have had o2 with them, but does anyone think high flow o2 a few minutes sooner would have made a difference in the outcome? 

As for them telling her to do her part and sit up, how is that unprofessional if they really did need to get her from point a to point b and doing that would have helped speed up the process? We don't have jedi powers, we cant levitate people onto a cot and into an ambulance. Is the issue that they didn't say please and thank you?

Do the family really think getting the patient into the ER a few minutes faster would have made a difference?  What magical life saving procedure were they going to perform for a massive PE? Was she in cardiac arrest at that point?

Obviously they didn't do everything right, but I don't see anything blatantly negligent or malicious. Guess what public, not everything runs super smooth on a call. If people expect absolute perfection on every call then its time to get out of EMS. Unless there is more to this than what I've read this lawsuit seems like total BS to me. Misplaced grief and anger combined with the usual ambulance chasing opportunist lawyers.


----------



## ILemt (Aug 7, 2014)

Agree with HOG.


----------



## MarissaLynn (Aug 11, 2014)

Unfortunate, but not criminal in my opinion.


----------



## atropine (Aug 12, 2014)

From the video all I can say without a doubt is that 1: the standards of this EMS agency seem low, and or 2:  the two individuals who responded or low standard employees. I know not all are fire based ems supporters are on this site, but where I come from a big metro area in Los Angeles this would have not flown. The engine company and Rescue Ambulance crew have a set regiment and it would have been strictly followed, my money is on the family and I believe they will be well compensated on behalf of the city of Philly.


----------



## Tigger (Aug 12, 2014)

atropine said:


> From the video all I can say without a doubt is that 1: the standards of this EMS agency seem low, and or 2:  the two individuals who responded or low standard employees. I know not all are fire based ems supporters are on this site, but where I come from a big metro area in Los Angeles this would have not flown. The engine company and Rescue Ambulance crew have a set regiment and it would have been strictly followed, my money is on the family and I believe they will be well compensated on behalf of the city of Philly.


How are you able to judge them exactly?


----------



## atropine (Aug 12, 2014)

Tigger said:


> How are you able to judge them exactly?


First impression is how, I know I don't run into every call but I walk with some in intent, and just plan image. When people call 911 they want a triathlete who can handle there problem and I didn't see that in the video, shallow maybe, but again where I come from physical fitness and high standards are the norm if you kill someone but you look good doing it well unfortunately it might just be frowned upon instead of a lawsuit.


----------



## chaz90 (Aug 12, 2014)

atropine said:


> First impression is how, I know I don't run into every call but I walk with some in intent, and just plan image. When people call 911 they want a triathlete who can handle there problem and I didn't see that in the video, shallow maybe, but again where I come from physical fitness and high standards are the norm if you kill someone but you look good doing it well unfortunately it might just be frowned upon instead of a lawsuit.



Uhh, what? Is this poster serious?

1. One shouldn't run into any call. Gradual and deliberate action is the goal, and running is the antithesis of what we should be doing.

2. People call 911 to have a triathlete come help them? News to me! Where I work, dispatchers answer the phone by asking if the caller needs "Police, fire, or ambulance?".

3. I haven't seen the video, so I don't know if you're actually judging these providers on their physical attractiveness, weight, fitness or some combination thereof. In any case though, seriously?!?! Are you trying to somehow justify that a supermodel Olympic athlete with a custom fit uniform would somehow change the facts of this case if they performed the exact same medical interventions? I'm utterly flabbergasted.


Furthermore, your profile says you hail from lovely Southern California. I'm not saying Philadelphia is the pinnacle of quality EMS, but for the love of all things holy please don't try to tell us SoCal EMS is known for it's high standards of care and competency in all things EMS.


----------



## atropine (Aug 12, 2014)

chaz90 said:


> Uhh, what? Is this poster serious?
> 
> 1. One shouldn't run into any call. Gradual and deliberate action is the goal, and running is the antithesis of what we should be doing.
> 
> ...


Agreed about the running, and yeah you should see the video, unfortunately this was just a bad outcome, but if you look like a slob then bad things can happen hell if you looked uniformed and professional the heat can still come your way "Micheal Jackson", but I'am just trying to compare this service to my service thats all, and if a big  LA metro FD can have high standards then Philly should too, thats all. In my opinion its all in the presentation, and the family is going to well compensated because of these two knuckle heads who I can assure you would have not lasted the probation period where I come from.


----------



## SandpitMedic (Aug 12, 2014)

atropine said:


> Agreed about the running, and yeah you should see the video, unfortunately this was just a bad outcome, but if you look like a slob then bad things can happen hell if you looked uniformed and professional the heat can still come your way "Micheal Jackson", but I'am just trying to compare this service to my service thats all, and if a big  LA metro FD can have high standards then Philly should too, thats all. In my opinion its all in the presentation, and the family is going to well compensated because of these two knuckle heads who I can assure you would have not lasted the probation period where I come from.


I have nothing to say but LOL. For reals dude?

You sound like a badass... teach me! Please.


----------



## ffemt8978 (Aug 12, 2014)

Knock it off!


----------



## Handsome Robb (Aug 12, 2014)

One of the posters in this thread is the exact reason we can't have nice things.

These medics didn't kill her. O2 isn't a wonder drug and I highly doubt it would've changed the outcome in this case.

Unless it's very obvious I always ask patients if they can sit up for me and/or walk. I've got one back, just because you call 911 doesn't mean you're getting carried. Especially if you're perfectly capable of ambulating. If they say they don't think they can then we start looking at other options. 

We don't run, ever, unless we're running away from something. Move with a purpose, absolutely, but running is a no-no. One, it looks extremely unprofessional. Two, it adds an element of chaos to the scene that we're supposed to be controlling and finally three, running makes it that much easier to trip, roll an ankle, tweak a knee or something similar. How does that help your patient when you hurt yourself and have to call for another unit to transport your patient? 

I agree that first impressions are important but saying the general population expects a triathlete to respond to their call for help is absolutely asinine.


----------



## atropine (Aug 12, 2014)

chaz90 said:


> Uhh, what? Is this poster serious?
> 
> 1. One shouldn't run into any call. Gradual and deliberate action is the goal, and running is the antithesis of what we should be doing.
> 
> ...


I'm not sure I get the your sourthern Cali thing, 25k people just applied to work where I work and we have a very high standard a tough probation.


----------



## Handsome Robb (Aug 13, 2014)

Southern California is generally at the bottom of the barrel, clinically, is what he means.


----------



## STXmedic (Aug 13, 2014)

25k people know that LAFD pays really well. Don't feel too special, though. From what I hear, all of the major cities in California get that kind of large number of applicants. I know I sure as hell wouldn't want to be in EMS in SoCal.


----------



## atropine (Aug 13, 2014)

STXmedic said:


> 25k people know that LAFD pays really well. Don't feel too special, though. From what I hear, all of the major cities in California get that kind of large number of applicants. I know I sure as hell wouldn't want to be in EMS in SoCal.


Its not so bad the $$ is good the pension is well funded and the weather is great, all in all not a bad place to work.


----------



## chaz90 (Aug 13, 2014)

atropine said:


> Its not so bad the $$ is good the pension is well funded and the weather is great, all in all not a bad place to work.


I'm not arguing any of those points. Inefficiency, high costs, archaic protocols, fire based EMS (yes, I know this point is debatable) and ALS oversaturation would start my short list of problems with LA EMS. More people applying to a job doesn't help convince me of its quality.

I get that it can be a good place to work as a FF, but don't drink the Kool-Aid and fool yourself into thinking it's a well implemented EMS system.


----------



## Tigger (Aug 13, 2014)

atropine said:


> I'm not sure I get the your sourthern Cali thing, 25k people just applied to work where I work and we have a very high standard a tough probation.


I am sure you have lots of places to compare this to.

As the saying goes, when you've seen one system, you've seen one system. What works for yours might not somewhere else.

For what it's worth I don't bring O2 in on every call either.


----------



## TransportJockey (Aug 13, 2014)

My O2 is on my gurney. It gets brought in on some dispatches, but not all. But then again we are far from a cookbook system out here.


----------



## atropine (Aug 13, 2014)

chaz90 said:


> I'm not arguing any of those points. Inefficiency, high costs, archaic protocols, fire based EMS (yes, I know this point is debatable) and ALS oversaturation would start my short list of problems with LA EMS. More people applying to a job doesn't help convince me of its quality.
> 
> I get that it can be a good place to work as a FF, but don't drink the Kool-Aid and fool yourself into thinking it's a well implemented EMS system.


Well if I could pull 130k somewhere else, I might think about it, but my whole point was that these two knuckle heads looked sloppy and presented their selves in a poor light, that reflects very badly on Philly FD. I take some pride were I work and iam glad I have a company officer to take some heat, which might have been helpful in this situation, from a clinical point I think as well as everyone else does the PE was going to do her in, but look like your working with some intent. The city pays me well to do my job and if they say I have to bring my drug box on every call then guess what on my 14th call at 0300 hrs I'm going to bring in my box for that toothache call. I guess I just think in a public view this thing could have gone way different that is all.


----------



## STXmedic (Aug 13, 2014)

atropine said:


> Well if I could pull 130k somewhere else, I might think about it


Oh, it's doable. I manage to just fine, and without the high cost and archaic protocols. They must put extra sugar in the Kool-aid for you, bud.


----------



## atropine (Aug 13, 2014)

STXmedic said:


> Oh, it's doable. I manage to just fine, and without the high cost and archaic protocols. They must put extra sugar in the Kool-aid for you, bud.


Where?, only thing is I have too many years vested in, and I do want 90% of my base salary for doing nothing.


----------



## STXmedic (Aug 13, 2014)

atropine said:


> Where?, only thing is I have too many years vested in, and I do want 90% of my base salary for doing nothing.


A large city in Texas.

To keep it in topic (and stay on Chimpie's good side), I rarely bring our O2 in for a fall. If the stretcher is with us, we do have O2 on the stretcher, but it's not a full oxygen bag (no cpap, no neb stuff, just the cylinder, a NC, and a NRB).


----------



## Tigger (Aug 13, 2014)

No where does it say what PFD requires it's ambulance crews to bring into the house. At two of my jobs there is no written standard for what comes in the house and what does not. Does PFD send an engine to medical calls as well? If I arrive on scene and the fire department is there, I am not bringing my oxygen inside if fire has already done so.


----------



## DrParasite (Aug 13, 2014)

atropine said:


> I'm not sure I get the your sourthern Cali thing, 25k people just applied to work where I work and we have a very high standard a tough probation.


So does FDNY EMS.... so I guess maybe your agency is about as good as FDNY EMS?


----------



## Jon (Aug 19, 2014)

DrParasite said:


> So does FDNY EMS.... so I guess maybe your agency is about as good as FDNY EMS?


Hey... I want to bash SoCal too... But that's not the topic of this post.

So I'll use my admin privileges to get the last word, and that's simply this... Pay alone does not make a good EMS system. In fact, if the only reason you're in this industry is the paycheck, please retire. Or at least stay the hell off my ambulance and away from my family. People deserve competent providers.


Back on topic... This call was a ****show. The ambulance doors getting stuck is, I believe, why Philly will likely pay money and settle this. As for the providers actions... It's what happens in many fire-based EMS agencies where there's little clinical oversight and being a mediocre provider is an acceptable standard.


----------



## samiam (Aug 19, 2014)

Lol this went way far off topic. I agree with Jon. The doors will ultimately get them. As far as not bringing in O2 that is not even a judgment call really, its like saying they should bring everything just in case but that makes no sense. As long as a medic competently determined someone needed O2 then went and got O2/put the patient on O2 in the truck then it really should not be a issue, we never know what we are getting into and there is only so much you can bring in with you.


----------



## vcuemt (Aug 19, 2014)

Jon said:


> As for the providers actions... It's what happens in many fire-based EMS agencies where there's little clinical oversight and being a mediocre provider is an acceptable standard.


Is your position that not entering the house with O2 makes one a mediocre provider?

(Apparently someone decided to use _their _admin privileges to let others have a say, too.)


----------



## samiam (Aug 19, 2014)

vcuemt said:


> Is your position that not entering the house with O2 makes one a mediocre provider?
> 
> (Apparently someone decided to use _their _admin privileges to let others have a say, too.)



It does seem that they ultimately were not appropriately treating the patient as she died.. I don't think Jon was saying that because they did not enter the house with O2 they were mediocre but actions after the fact that seemed less then desirable (As I am not him I cannot be sure but that is what is seems). If you read the whole article it shows that the paramedics were suspended for not following their established protocol. Also Jon did not lock the thread so others could not have their say, he just steered it back to the topic. If you read above it was going far from it.


----------



## Jon (Aug 19, 2014)

vcuemt said:


> Is your position that not entering the house with O2 makes one a mediocre provider?
> 
> (Apparently someone decided to use _their _admin privileges to let others have a say, too.)


No. I've responded to plenty of calls and not brought in the whole kit. I've also been burned a couple of times by not being as prepared as I should have been.

My comment regarding "mediocre providers" is that these providers apparently failed to realize just how sick this person was... Comments like "you've got to help us" are BS.

My "back on topic" was to stop bashing SoCal . And PS- what's the point of being an admin if I don't get to throw my weight around once in a while?


----------



## usalsfyre (Aug 19, 2014)

Basic resus equipment (monitor, O2, airway stuff) should go bedside or at least close to on every 911 call. Even was the last time you saw an ED room without O2 and a BVM?


----------



## DesertMedic66 (Aug 19, 2014)

usalsfyre said:


> Basic resus equipment (monitor, O2, airway stuff) should go bedside or at least close to on every 911 call. Even was the last time you saw an ED room without O2 and a BVM?


I see that fairly often actually. 

I've gotten burned by some medics who think since fire is already on scene we don't need to bring in any gear. The only gear that doesn't go in with us usually to calls is LSB, cardboard splints, and CPAP.


----------



## Kevinf (Aug 20, 2014)

My take from the article is that it sounds like the providers felt they couldn't wait for a lift assist to arrive and the patient was too overweight for them to manage without her own assistance. So they told the patient to sit up and get into the stair chair and then they took her to the stretcher. And when it takes three people to load a stretcher the patient is definitely an overly large one. Two vehicles out of seventy-five sounds like a reasonable failure rate for equipment at any given time... however if the doors being stuck was a known issue the rig shouldn't have been in service.


----------



## vcuemt (Aug 20, 2014)

samiam said:


> It does seem that they ultimately were not appropriately treating the patient as she died..


I would venture to say that the tiniest of minorities of people that ever ride on an ambulance die because of what happens during those 15-30 minutes.

It doesn't effect my care, but I do understand that everything I do is delaying the inevitable - be it on a 16-year-old with a broken leg or a 98-year-old with an MI.


----------

