Nurses Accused Of Negligence In Man's Death

MMiz

MMiz

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Nurses Accused Of Negligence In Man's Death

WOODLAND, Calif. -- State medical reviewers are accusing two local flight nurses of incompetence and gross negligence in the death of a Yolo County bus driver.

On Feb. 25, 2008, Quintin Jones crashed on Highway 16, and within minutes, emergency crews were at the scene.

According to the report, two CALSTAR flight nurses -- who thought Jones was struggling to breathe -- made the decision to perform an emergency cricothyrotomy.

Read more
 
Going back a little this got included in Airwaygoddess' adventure.

http://www.emtlife.com/showthread.php?t=7704


It is a sad situation and I want to convey my sympathy to the family and friends of this man.

The final judgement is not in and until we hear the nurses' side of what happened, it will be difficult to criticize.

However, it does make one think about the procedures available in their own protocols and how well prepared they are to perform them. Often, advanced procedures such as a cricothyrotomy are not very well covered in Paramedic school and will rarely be mentioned during employment except for referring to the protocols.

Decisions sometimes must be made in just a few seconds. While what may have seemed to be appropriate at the moment, if it goes bad someone will always be there to hold you responsible for your actions. If it goes well, few will take note except for the patient and his loved ones. But, when being concerned about patient care, that is all who matters.
 
Cric used to be in basic first aid training decades ago.

It was covered in the old "EMT-A" training of the first and second editions of the Orange Book. Never had to do one, never knew anyone who personally had to do one except our anatomic exam professor ("Crikey! Thyrotomy!") who advised it was tricky and not frequently of use.

Yes, suspemnd judgement until all sides are herd, but remember that what we do, without that certificate and employment, is assault, battery and worse.
 
re

This is up in my neck of the woods. Will be interesting to talk to the other flight crews around here and found out what they have heard from these other nurses.
 
mycrofft said:
Yes, suspemnd judgement until all sides are herd, but remember that what we do, without that certificate and employment, is assault, battery and worse.
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Assault and battery? Without a certificate? Where did you get this out of that article? These were licensed RNs on a Flight team.
 
A cric is the last thing a medic or Rn want to do. If they did it, then there was probably a good reason. We are not getting the whole story here!
 
Two minds think alike

There were 2 flight nurses and they must have decided that this intervention was the most appropriate. hindsight is 20/20. To be the coroner and say that their actions are what caused this gentleman to die, should be saved for an autopsy. We are given interventions that if not done properly can cause harm or even death, however without them, death could also be the outcome. I am sure these 2 nurses had this mans best interest at mind. I cannot wait for the outcome of this case.
 
To paraphrase my statement

If an uncertified someone were to walk up to you in the street and do what we do to people professionally, it would be a felony. Parse, please.

There's no way to "judge" this event.
 
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I might have skimmed over the article too fast, but I don't remember any part of that write up that said the patient had an ET Tube. Now am I correct in assuming that rather than attempting to intubate the patient, that these 2 flight nurses went right for the difficult airway bag and performed a cric?

I don't think it is fair to pass judgement until we hear the RN's side of the story.
 
Aussieaid said:
The full BON report is here: http://rn.ca.gov/public/rn528232.pdf

Interesting reading courtesy of a Flightweb thread on the same.
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Fascinating. Sounds like it was a nightmare of a call.

I was disappointed to read the judgment on the behavior of the medic that came on the ground ambulance (Emch?). Her testimony sounded rather hystrionic, and cast her in a negative light to the board. I felt a little embarassed for all of us to have her play the role of paramedic in this case. Who stabs from 17 inches away when doing a surgical cric?

I don't know about flight web. What are they saying over there?
 
The BON report was interesting. The short version is,

1 An unknown cause led to the driver running off of the road (c/o head pain), and he was ejected from the vehicle
2 During the ejection, he sustained some sort of wound to his neck (possible tracheal transection), either a cut from glass or a tear from hyperextension (This wound was not found during the initial examination by EMS, very strange)
3 He was able to answer the questions of the original responding EMS unit and was ventilated adequately with a BVM
4 During transfer to the flight unit, the medics and nurses turned their back on the patient, at which point he seized the opportunity and went into respiratory failure
5 Multiple attempts at intubation were made by the flight unit, but were unsuccessful (despite placement appearing to be correct, they could not get chest rise)
6 The decision was made to attempt a surgical airway, and by the examiner's report, the incision appeared to be correct, however when a tube was placed air would only travel out the mouth

It appears to me that he had massive bleeding into his lungs from the tracheal transection, which led to his eventual crash when they transferred to the flight nurses, as well as the increasing difficulty they faced in keeping his O2 sat up after each intubation attempt. Because for whatever reason they didn't see the existing laceration, they didn't know he was bleeding into his lungs (although the nurse did notice excess bleeding when they did the cricothyrotomy). The evidence in that report sure makes it look like the surgical airway was justified, but that with his injury it wouldn't have mattered. Also, never turn your back on your patient. This is what 10 seconds of abandonment gets you.
 
Interesting read. I think a surgical airway was completely justified in this individual and that there was not much anyone short of a trauma doc in an OR could have done for the pt. Several pathologists found that the pt had sustained an internal tracheal and esophageal laceration when he was ejected that had no outward signs, there was no corresponding skin laceration or anterior tracheal laceration; the internal lacerations were only found on the inside of the trachea and the esophagus, which would have been impossible to see in what sounded to be a disaster of a call.

And the paramedic that testified simply made herself, and the rest of us, sound like an idiot. She claimed that the flight nurses stabbed the pt in the neck and fished around with the scalpel. She also initially stated that she thought the pt's "jugular" had been lacerated during incision, which shows an obvious complete lack of understanding of anatomy and physiology. Furthermore she wasn't trained or authorized to perform a cric anyway.

Good to see that the nurses were found not be be negligent.
 
Paramedic Emch has some strange testimony. I find it tough to believe a flight nurse would stab the membrane from 16-17 inches away. That makes no since at all.
 
It was an interesting read. I think it was just very traumatizing and also had a bad brush off with the flight crew for Emch that she started making up things in her mind. I think everyone does that a little here and there. Like they were saying, her story changed, and I don't think she was purposely lying.
 
Wow...interesting read.

I have a question for people who have regularly handed off to flight crews...if you give report and they take over care, either on scene, in your ambulance, whatever...do you continue to document what they are doing just like the medic did in this case?

If you do, should you? Is it wise to do so, especially when they are functioning at a level above you and it may lead you to document incorrect findings?

Example: When I was on the ground, once the flight team climbed in the truck and received a verbal report and assumed care, that is where my report ended...something along the lines of "At 0130, flight team received verbal report and assumed all patient care."

Was I wrong in doing that? Should I keep documenting? Obviously a caveat may be if they start doing gross misconduct, but routinely should I even mention what they are doing just because I can still see it?
 
akflightmedic said:
Wow...interesting read.

I have a question for people who have regularly handed off to flight crews...if you give report and they take over care, either on scene, in your ambulance, whatever...do you continue to document what they are doing just like the medic did in this case?

If you do, should you? Is it wise to do so, especially when they are functioning at a level above you and it may lead you to document incorrect findings?

Example: When I was on the ground, once the flight team climbed in the truck and received a verbal report and assumed care, that is where my report ended...something along the lines of "At 0130, flight team received verbal report and assumed all patient care."

Was I wrong in doing that? Should I keep documenting? Obviously a caveat may be if they start doing gross misconduct, but routinely should I even mention what they are doing just because I can still see it?
Click to expand...
I have no experience in that, but I personally would continue to document. Aren't you still considered assisting? Even if you aren't directly participating with patient care, you are still somewhat involved, and until you are done with anything with the patient period, I'd continue document what I see, but of course if they are doing something beyond your level, I'd be careful of what I say such as "stabbing patient in the neck", haha, like in this case, and if I don't know what's going on, use simple English as usual. That's personally what I would do. Who knows? Maybe that flight crew could turn on you, say you refuse to do anything after you handed the patient off, and that you were being detrimental to patient care. I wouldn't have thought they would do that until reading this article when the paramedic turned on the flight crew. I also heard of it once before, but with an EMT student. I kind of blew him off, but he was talking about how everyone didn't know what they were doing during his ride along like a fire crew didn't hold c-spine on somebody who doesn't need it, they also didn't remove the flaps off non rebreathers, and didn't give everyone non rebreather, and those EMTs and Paramedics should lose their license (our program taught everyone to do it on everyone, taught students to remove the flap incase it malfunctions, but didn't teach everyone to throw a NRB on everyone - that was just him "more doesn't hurt + it's better" :s / obviously I blew him off cause he thought he knew it all and yelled at me saying that you had to remove the flaps off a non rebreather, which I told him you didn't.... Grr... I can't believe he passed the class) At least if you document it, you got something.
 
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