Can Medics be wrong?

[Jon]

The topic came up in another thread that perhaps ALS isn't always right, and sometimes they do things that are wrong in front of us.

What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".

What do you do?

 

[Hastings]

The topic came up in another thread that perhaps ALS isn't always right, and sometimes they do things that are wrong in front of us.

What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".

What do you do?

Purposely doing something to harm the patient? Keep quiet until you can tell a supervisor ASAP.

Doing something you believe is incorrect? Well, as a Paramedic myself...

As long as it's not placing the patient in danger, don't question me in front of the patient or bystanders. In a respectful way, ask me WHY I did things as I did them AFTER the call is over and we're in private. Phrase it in a "desire to learn" manner. Be respectful. Don't tell me I did something wrong. Accept that there may be alternative ways of doing things.

If it is causing risk to the patient however, find a VERY diplomatic (and more so, subtle) way of asking me about it. Do not confront me in front of the patient or bystanders. I am wrong sometimes. Tread lightly, be respectful, be subtle. As long as you act in that manner, I am very open to hearing your opinion on how something may be done in a better way.

 

[Ridryder911]

Me do something worng?... You'r kidding?..

Seriously, I make mistakes everyday. I hope & pray that they will not cause harm or injure anyone, with saying that remember it is a team effort. If your leader goes down, so do you. There is not a "my patient' rather it is "our patient". There maybe times I may have missed something in the history, or did not see witness something, or even just blindly got tunnel vision and started heading down the wrong path. As well, as alike some of the others posted, maybe I was just being a rear end (hey! It happens, were all human).

Hopefully, my EMT has learned to discreetly inform me, let me know or give me hint. I much rather have my pride or ego bruised than to allow harm or do wrong. We all screw up .. and anyone that says differently is either a liar or is very, very dangerous.

My new saying is : " They say you learn from the stupid mistakes you have made, in that case I must be very bright!"

Again, hopefully the mistakes we make are minor and are few. With time we have learned off ours and observing others. Unlike other professions are mistakes can be costly so we have to be extra cautious. No one is exempt...

R/r 911

 

[MJordan2121]

Well put RidRyder

 

[Sasha]

What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".

What do you do?

That is malpractice. Properly report it ASAP.

 

[emt19723]

The topic came up in another thread that perhaps ALS isn't always right, and sometimes they do things that are wrong in front of us.

What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".

What do you do?

how am I as a BLS provider going to KNOW that what my Medic is doing is wrong, unless it is so blatant that it would spit on you, or you been running BLS so long that you totally know every ALS protocol and you just dont want to be a Medic?

ok, yeah, ive definitely had quite a few pts that were ignorant and whatnot, but i would also like to think that my medics around here would be more professional than that. I would have to go along and say that if a medic did something and i didnt understand, i would approach him in a respectful way and say something to the extent of......why did you do this this way? or....could we have done it this way....?
and depending on the response i got would dictate if any action would be required. if i got an intelligent, sensible answer.....it ends there. if i would get something like..."oh, just because..." or "the pt was being an a--hole..." yeah, then Medical Command would definitely be getting involved.

 

[Sasha]

My B. Not malpractice, malfeasance.

And one does not have to be a medic to know that IVs in the hands hurt. One also does not have to be a medic to know that large bore IVs hurt, and if an EMT is working with a medic long enough, they would start to learn when a large bore IV is appropriate.

It is never OK to intentionally cause the patient more discomfort because you don't like them. I hate when I hear medics make the joke "Oh he ticked me off so he got a 16 instead of an 18". Not funny. Do your job, do it right.

 

[Ridryder911]

That is malpractice. Properly report it ASAP.

Actually, this is NOT malpractice or negligence. I have started large bore IV's in the dorsum of the hand for trauma patients, so the event itself is not wrong just the intent.

There is a practice of deterrence medicine that is practiced and is a fine line of ethical behavior. Such as placing an NG tube, catheter, IV's (which is all considered treatment) especially on first time OD's, youth, that are rather exhibiting attention seeking behavior and not suicidal ideologies. After treating, I have had many youth exclaim and tell others to never attempt such... I will only perform such from recommendation or orders of a physician.

The main problem with this call is that the medic became angered at the patient. In which I really do understand. If no one understands that or attempts that they themselves have never have not been calloused or maybe rougher than usual to certain patients, then they are either lying or never responded to many calls. It is when one goes over the line as in this case.

The partner (no matter what level) should discuss the action that occurred with the medic. If one feels that it will not be corrected or feels that further action should occur contact the Supervisor. That is what the Supervisor is there for.

R/r 911

 

[Sasha]

You are correct if starting large bore IVs on that patient was a reasonable and appropriate action, and if the medic would have done the same to a similar patient who had not ticked him off, then it was not negligence.

I know quite a few medics who have been in the business longer than I have been alive, great medics, and have never once observed them or heard about them being unnecessairly rough with any patient, no matter if the patient has threatened them, yanked out IVs, been an AIDS/HIV patient who tried to intentionally bite them/expose them to the infected fluids and called them everything but a child of god.

Causing harm to your patient because they have pissed you off is not appropriate and if you feel the need to do so then maybe you should take a look at why you're in the field and reconsider your career choice.

 

[MedicPrincess]

I know quite a few medics who have been in the business longer than I have been alive, great medics, and have never once observed them or heard about them being unnecessairly rough with any patient, no matter if the patient has threatened them, yanked out IVs, been an AIDS/HIV patient who tried to intentionally bite them/expose them to the infected fluids and called them everything but a child of god.

It happens. To everyone. If you haven't seen it, you haven't been around very long. If you haven't heard them talk about it, it because its not everyday open conversation. Make a point to ask them if they have ever put a 14g in someone because they were drunk/beligerant/violent/ect. Or have they ever inserted an NPA in a pt that they knew was faking unconscious, just because they can. Or some other form of creative "painful" stimulus.

I am known for my "Eating Butterflies, pooping Rainbows" theres a bright side to everything alwasy smiling attitude. And when someone does push the right buttons, the people I work with are often surprised when I am not as pleasent as my norm.

As for what to do if I am.... w.. wr...wr...wro... Yea.. I can't even say it

My partner knows, and has seen it from me when dealing with other Paramedics, that unless what is happening is going to actually cause the patient additional harm... or in one recent case.... the actions are going to actually kill the patient.... there is a time and place to ask questions and correct.

If my partner is going to attempt to correct my or question what I am doing in front of other providers or a physician, they had better make sure their correction is 110% correct. I once had an EMT interrupt my report to the trauma team on an intubated trauma patient. She started with "thats not what happened....." and continued. She wasn't even close to the events. When she took a breath, I sent her out of the room, apologized for her, and continued on with the accurate report. When I finished and met her back at the truck, we came to an understanding that will never happen again.

It is possible for me to be wrong. Sure..... After all, there is a town call Hell, and it does snow there... J/K.

The point is, we all need to understand there is a time and place for everything. And 99% of the time, embarassing your partner (either EMT to Medic.... or Medic to EMT) is never the right time. Thats what the back of the truck, with the doors shut, and its just the two of you is for.


No Witness to the bloodshed!.... hahahahahha!!!

 

[Sasha]

It happens. To everyone. If you haven't seen it, you haven't been around very long. If you haven't heard them talk about it, it because its not everyday open conversation. Make a point to ask them if they have ever put a 14g in someone because they were drunk/beligerant/violent/ect. Or have they ever inserted an NPA in a pt that they knew was faking unconscious, just because they can. Or some other form of creative "painful" stimulus.

I am known for my "Eating Butterflies, pooping Rainbows" theres a bright side to everything alwasy smiling attitude. And when someone does push the right buttons, the people I work with are often surprised when I am not as pleasent as my norm.

We have, it's come up in class, especially during the legal chapters. I still believe it's wrong and don't find it funny at all.

 

[VentMedic]

Make a point to ask them if they have ever put a 14g in someone because they were drunk/beligerant/violent/ect. Or have they ever inserted an NPA in a pt that they knew was faking unconscious, just because they can. Or some other form of creative "painful" stimulus.

Anytime you do an invasive procedure, which even an NPA is considered to be, you may have to justify your actions. Yes, I do document anytime a patient comes to the ED with a bloody nose for further investigation especially if no airway was warranted. There had better be good documentation on the Paramedic's part to justify the bloody nose. Hospitals are now documenting everything carefully since any acquired infections may not be covered by insurances such as Medicare.

While a 14 guage might be required in a hand on rare occasions, that is a large catheter for small vessels that could blow easy if one is not careful. Thus, serious damage can occur depending on what fluid or med was being pushed. Again you may have to justify your reasons for insertion if not for the hospital at least for reviews from your medical director.

You should not be in pre-hospital medicine to correct established behavior, to judge others or to be the one who provides the punishment. If this is what makes you feel good about your job or you get your superiority kicks by intentionally causing pain when not justified, maybe medicine (which comes with enough pain) should not be your career choice. Play by the accepted practices of establishing consciousness in the short time you are with the patient. If you do this, you will make your company's attorney much happier by not having to defend your actions.

 

[MedicPrincess]

Let me say this..... I, personally, have not done the 14g or NPA or whatever to a pt. I have also stopped another provider from doing the same on a patient I would be transporting. I have also asked more than one person why they would feel the need to further injure someone they were supposed to be helping. Usually I am just reminded I am still "new" and I would do it too sometime.

Mine is generally an attitude thing. I am not as cheerful with someone as normal. I may not catch the legs as quickly as the stretcher gets pulled out. We will probably be "out" of pillows. The extra nice to haves just won't be there.

 

[Blacke00]

Usually I am just reminded I am still "new" and I would do it too sometime.

This would be alot like telling somebody that just started at Burger King with you, that it's ok if I spit on this guy's whopper because someday you'll do it too.

I know I'm nowhere near even being that new guy yet, but if the person who I'm supposed to be learning from did something like this (regardless of job or circumstance), they'd forfeit all earned respect and credibility from me.

It's low and petty, period. (IMHO of course)

 

[mikie]

I would probably wait till the patient is transferred to the ER or wherever before questioning what the medic did. Now if (s)he is about to do something horrible and obviously wrong, I might quietly say to him/her. but nothign to frighten the patient or question their authority.

 

[VentMedic]

Mine is generally an attitude thing. I am not as cheerful with someone as normal. I may not catch the legs as quickly as the stretcher gets pulled out. We will probably be "out" of pillows. The extra nice to haves just won't be there.

Again you are judging your patients. Your judgement may someday cloud your assessments and the ability to make medically sound decisions.

Alcohol, drugs and nicotine (cigarettes) are addictions whether we like it or not. If a person is being an absolute jerk, are you absolutely sure that there is not some chemical/electrolyte imbalance, injury or some cerebral event that might be the cause? Does making a patient uncomfortable really give you that much satisfaction? Maintaining a professional attitude even in the worst of situations is a skill that must be obtained to make it in the healthcare profession.

I've also found patients respond better to a kind but professional attitude more than a bad arse b!%*& in the back of the truck or at the bedside in the hospital.

 

[Hastings]

I also feel VERY uncomfortable with the very casual attitude some medics have about treating patients poorly or unprofessionally. Everyone does it? No, everyone doesn't do it. And no, I don't believe for one second that it's part of being a paramedic. I believe when you start doing things like that, it's time to take a break. I just find this attitude extremely depressing.

Call me naive if you will, but I will never believe that it is normal or acceptable to hurt a patient, whether you think they deserve it or not.

 

[Jochempeiper]

I can pretty much read any EKG rythmn, it doesn't mean that I will call out "PVC, TOMBSTONE T-WAVE!" etc. If I see something that I MAY think is wrong with a monitor, I will ask him/her to check out the monitor for himself/herself. I have confidence in my Medics, but if something may seem odd about what they're doing, I'll ask them in private, as they would do with me, it doesn't matter that they're a medic, it is all about respect.

 

[Hastings]

I can pretty much read any EKG rythmn, it doesn't mean that I will call out "PVC, TOMBSTONE T-WAVE!" etc. If I see something that I MAY think is wrong with a monitor, I will ask him/her to check out the monitor for himself/herself. I have confidence in my Medics, but if something may seem odd about what they're doing, I'll ask them in private, as they would do with me, it doesn't matter that they're a medic, it is all about respect.

I like you. You can be my partner.

 

[Jochempeiper]

you're making me blush