Cardiac patient walked down stairs, medics don't document it

[ffemt8978]

http://www.telegram.com/article/20090426/NEWS/904260399/1116/NEWSREWIND

 

[Mountain Res-Q]

Wow. We all have EMSA procedures and policies that we don't agree with, but still follow. But in this case, this wasn't an issue of Medics disregarding a bad policy; they practiced bad medicine with no apparent reason. What's more, they lied about it over and over again. And when one lie was revealed, they came up with another. A stupid disision that had a horrible outcome for them, the agency, and EMS in general. Not to mention the patient and family. Can we really say that their actions killed him. Not w/ 100% certainty, but it didn't help treat the patient. The article doesn't mention several things that I am concerned with; most notably: What other care was/wasn't provided that should have been? When this man was walked down the stairs was he on O2? Had he been given Nitro, ASA, or any other meds? Did they run an ECG or get a set of vitals pre stupidity? The way it sounds: They walked him into the amblance before doing anything! And the excuse about Fire not being their to help? LAME; even if they weren't on scene to help (they were) does that mean that we withhold proper treatment and care? Since when does the presence of 3-4 firefighters dictate how a Paramedic provides care for a MI? if he was overweight and requird more hands to move: fine, wait a few moments for FD to arrive and provide care in the appt. 2 minutes of waiting to transport is the lesser of two evils here.

I feel for the family, even though he might have dies regardless of the paramedic's lack of care, because dealing with a death is bad enough without this mess. There actions are a stain on EMS and they should be shot!!!

 

[JPINFV]

Wow...


1. Every ambulance in Mass is supposed to have a stair chair on it, so it wasn't like they didn't have the equipment.

2.

Purpose
The information below provides EMTs with some common complaint findings that are of concern and in violation of the regulations. Please take note of the following issues while practicing as an EMT.

11. Allowing/ encouraging a patient to walk to cot or ambulance.

http://www.mass.gov/?pageID=eohhs2t..._emergency_services_p_complaints&csid=Eeohhs2


Now, to be fair, just about every EMT is going to violate that one (and item 14) just about every shift because both are stupid blanket rules. Unfortunately when you get doofuses that engage in this sort of stupidity, OEMS's hands are kinda of forced in the manner. They are, for lack of a better term, screwed.

 

[HotelCo]

They were wrong. Plain and simple.

A fresh, newly-minted basic knows that you don't have a pt experiencing chest pains walk more than absolutely necessary. Those Paramedics knew better, probably just didn't want to carry him down the stairs.

HotelCo

 

[boingo]

Ever have a patient refuse to be carried? I have had plenty. If the option is leaving the patient (this patient) home or letting them walk, they walk. I will explain my concern, but at the end of the day, they need to go. I've watched patients panic on a 3 story carry down, I'd be curious what is worse for the patient, a controlled, slow walk, down stairs, or a catecholemine dumping hell ride down in a stair chair....something to think about.

 

[daedalus]

I disagree. I do not think they were in the absolute wrong. What if they did not have the proper equipment to carry a large man down the stairs? Why risk their backs with a backboard down three flights of narrow stairs? WHat if they had dropped him? What if mid way down they couldn't handle it anymore? At least they walked him down carefully. Sometimes there is no other option.

 

[ffemt8978]

But, if you do let your patient walk for whatever reason, you need to document it and NOT lie about it when questioned.

 

[Sasha]

I disagree. I do not think they were in the absolute wrong. What if they did not have the proper equipment to carry a large man down the stairs? Why risk their backs with a backboard down three flights of narrow stairs? WHat if they had dropped him? What if mid way down they couldn't handle it anymore? At least they walked him down carefully. Sometimes there is no other option.

What if the patient, wanting to keep his dignity, insisted on walking down the stairs? Pride gets in the way of a lot of things.

But, if you do let your patient walk for whatever reason, you need to document it and NOT lie about it when questioned.

That, I totally agree with!

 

[daedalus]

What if the patient, wanting to keep his dignity, insisted on walking down the stairs? Pride gets in the way of a lot of things.



That, I totally agree with!

I have had many patients like this also! There are way to many factors and this is such a one sided news story like all the rest. You can already see the lawsuit brewing on the horizon. Lets not judge these medics, but take this as a lesson in proper documentation. Its paramount.

 

[boingo]

I certainly wouldn't lie about it, but I'm not in the habit of documenting how I extricate a medical patient from their home. Maybe it is something to think about. I suppose if he looked like they say, and he refused to be carried (big assumption) documenting that would probably be a good idea in retrospect, however having walked too many patient to remember (their choice) I honestly can't remember documenting a single one.

 

[Aidey]

It's impossible to judge from the article if they made the man walk, or if the man refused to be carried.

That being said, they absolutely should not have lied about it, and that is what is going to screw them royally.

We have massive issues in my service with carrying patients and stairs. We have stair chairs, but I doubt anyone could remember the last time they used one. The general consensus among my co-workers is that lifting is too dangerous, and that having to lift anything beyond the gurney straight up to the load position is a violation of the EMTs/Medics safety. The FD also does not provide lift assist services. If they are already on scene, they will help, sometimes. But they will not respond to a scene in order to help lift.

Therefor the vast majority of patients end up walking some distance if they are able to, since it's against company policy, I'm pretty sure it's not getting documented either.

 

[JPINFV]

I have had many patients like this also! There are way to many factors and this is such a one sided news story like all the rest. You can already see the lawsuit brewing on the horizon. Lets not judge these medics, but take this as a lesson in proper documentation. Its paramount.

Oh, ok. We shouldn't lie about people who lie on their documentation? I have this one regular patient who is able to, with assistance, slide from his wheel chair to the gurney but gets lifted via draw sheet into and from the dialysis chair. Guess what, it get's documented that he is assisted to the gurney and moved via draw sheet from the gurney.

If it had been documented properly, then I would agree with giving them the benefit of the doubt. Now lying on both whether fire was on scene AND on using the stair chair? Can someone get me my pitchfork and torch please?

 

[Mountain Res-Q]

So, based on most replies, I take it that most "professionals" here would have walked this man down? You have the stair chair, man power, and a man having a heart attack on the third floor... and you walk them down? I disagree, (even if the man refused to go don this way, because our communications skills should have been employed as advocates for our patients health), but fine, if that is your companies commonly accepted malpractice... eh... practice. But, if that is in your medical opinion the right call to make, your defense when called to the mat is what... to lie? The obviously knew that what they did was wrong because their paperwork (completed enroute to the hospital - not months later) was a lie and a crime. Yes I agree that walking a patient is often easier and a better course of action with some patients (especially the obstinate ones) but NOT IN THIS CASE. Stabbing chest pain and dying heart muscle and you allow the patient to walk down 3 flights? You make the argument "what if we had dropped him?" What if he had coded as he took his first step of the third floor? Yes, lifting is dangerous for us and the patient, but if we are competent in our lifting techniques and strive to have additional hands (the FF's) the risk to the patient and ourselves is reduced and is preferable to LETTING A MAN HAVING A MI (stressed heart, shortness of breath, imminent death) WALK DOWN THREE FLIGHTS. Just because these folks were fellow EMSers doesn’t mean we should automatically defend them... they practiced piss poor medicine. If this was your father having an MI would you walk them to the ambulance?

 

[boingo]

I'm not sure how wide your staircases are, but in Worcester, as in a lot of NE cities you have the "triple decker", wooden, 3 story apartment buildings with narrow, poorly lit, and often poorly maintained steps. It doesn't matter how many FF's you have, only two people can fit on the staircase, the person at the top of the chair and the one at the bottom. We purchased new stairchairs about a year ago, I'm not sure who makes them but they are heavy duty, with treads like a tank track and a handle that extends vertically from the top of the chair. Its like moving a refridgerator on a dolley, the chair is heavy, but once you hump it up, it makes the trip down sooo much easier. I don't know it they have them in Worcester. I do believe that as a whole, we (EMS) carry way too many people. I'm not condoning walking this patient or others like them, but how many systems require you to carry everyone?

 

[Sasha]

So, based on most replies, I take it that most "professionals" here would have walked this man down? You have the stair chair, man power, and a man having a heart attack on the third floor... and you walk them down? I disagree, (even if the man refused to go don this way, because our communications skills should have been employed as advocates for our patients health), but fine, if that is your companies commonly accepted malpractice... eh... practice. But, if that is in your medical opinion the right call to make, your defense when called to the mat is what... to lie? The obviously knew that what they did was wrong because their paperwork (completed enroute to the hospital - not months later) was a lie and a crime. Yes I agree that walking a patient is often easier and a better course of action with some patients (especially the obstinate ones) but NOT IN THIS CASE. Stabbing chest pain and dying heart muscle and you allow the patient to walk down 3 flights? You make the argument "what if we had dropped him?" What if he had coded as he took his first step of the third floor? Yes, lifting is dangerous for us and the patient, but if we are competent in our lifting techniques and strive to have additional hands (the FF's) the risk to the patient and ourselves is reduced and is preferable to LETTING A MAN HAVING A MI (stressed heart, shortness of breath, imminent death) WALK DOWN THREE FLIGHTS. Just because these folks were fellow EMSers doesn’t mean we should automatically defend them... they practiced piss poor medicine. If this was your father having an MI would you walk them to the ambulance?

No one is defending them but we're looking at other possiblities. It's easy to jump to conclusions, but you've got to remember, unless the patient is a child or unresponsive the PATIENT has final say on what his or her treatment will be, including on how he or she will get to the stretcher.

If the patient REFUSES to get stair chair'd down the stairs, then you have no right and legally cannot FORCE them down on one. You can talk their ear off all day why (wasting cardiac muscle while you do.) they should get on the stair chair and be carried down, but some people are too proud to be carried down the stairs.

Men have had it ingrained in their minds since child hood that they should be strong at all times. How weak is it to be carried down the stairs? And of course, how many patients have you run into who insist "I'm alright, my wife/husband/son/daughter/sister/neighbor is just overreacting!"

If they didn't give him an option and forced him to walk down the stairs, by all means shame on them. Shame on them anyway for falsifying paperwork and not going over it before you turn it in.

Instead of outrage, take away the importance of proper documentation from this article.

 

[Aidey]

I wouldn't have walked him down no, I'm young, healthy and know proper lifting techniques, granted, it takes more than one person willing to carry a patient to get them down the stairs though. As for my co-workers, I'm not really sure what they would have done.

If it was my father, yes, I may have had to. The man weighs 400lbs, and I know he will not fit in a stair chair.

 

[Mountain Res-Q]

For me in my area:
I live in the mountains. Houses are built to fit the terrain, which often means redwood stairs that extend 1-3 stories up to the front door. The stairs are usually old and rotting after 20 years of little care and the scorcing summer sun and hevy snow. They are usually covered in et slippery pine needles, ice, rain, or snow. They are no more than 3 feet wide. I could never, ever, see myself walking a heart attack patient down them. That's why god invented FF's. Just kiddin'. But really, yea I agree that their are circumstances where not carrying you patient down those stairs is the right call for safety sake. BUT NOT IN THIS CASE. If anyone here would walk a MI patient down 3 flights when other options existed for moving him, then falsify reports, and then lie over and over again... get the hell out of EMS now before I hunt you down and beet you with your dust covered stair chair...

 

[Sasha]

For me in my area:
I live in the mountains. Houses are built to fit the terrain, which often means redwood stairs that extend 1-3 stories up to the front door. The stairs are usually old and rotting after 20 years of little care and the scorcing summer sun and hevy snow. They are usually covered in et slippery pine needles, ice, rain, or snow. They are no more than 3 feet wide. I could never, ever, see myself walking a heart attack patient down them. That's why god invented FF's. Just kiddin'. But really, yea I agree that their are circumstances where not carrying you patient down those stairs is the right call for safety sake. BUT NOT IN THIS CASE. If anyone here would walk a MI patient down 3 flights when other options existed for moving him, then falsify reports, and then lie over and over again... get the hell out of EMS now before I hunt you down and beet you with your dust covered stair chair...

So, since you've got all the answers, what would you do if your patient refused to be carried down the stairs and insisted on walking down them?

 

[Mountain Res-Q]

So, since you've got all the answers, what would you do if your patient refused to be carried down the stairs and insisted on walking down them?

I am very convincing.
They called me because they felt that they needed help and if I don't do the best I can to provide the BEST CARE then I might as well have become a LEO. I am going to pull a VentMedic line of thought here and scream out the importance of COMMUNICATION. It is one of those things that seperates a good EMSers from a great one and you obviously think I am great "since you've got all the answer". (Ya know, if I could find a woman that said that to my face without the sarcasm, I might consider getting married one day.) I can communicate and convince my pateint that I am here to help and would do nothing to endanger him... including walking him. I am an advocate for my patient and their health.

However, your argument here is based on a belief that this man refused to be carried. No information exists in this article to support this. I doubt that a patient in that much pain and suffering would protest a quick, safe carry to the hospital, or couldn;t be convinced by a quality EMT with a basic grasp of the Ameriglish Language.. But, let's take it one step further... what if your patient was deathly affraid of vehicles and refused transport my ambulance or other vehicle, but wanted to go to the hospital... you gonna walk the MI patient to the hospital? However, all ridiculous hypotheticles aside, would you have walked this patient... not some hypothetic patients? And then would you lie about it, a sure sign that you feel guilty for providing a lower standard of care than you ought?

 

[daedalus]

Oh, ok. We shouldn't lie about people who lie on their documentation? I have this one regular patient who is able to, with assistance, slide from his wheel chair to the gurney but gets lifted via draw sheet into and from the dialysis chair. Guess what, it get's documented that he is assisted to the gurney and moved via draw sheet from the gurney.

If it had been documented properly, then I would agree with giving them the benefit of the doubt. Now lying on both whether fire was on scene AND on using the stair chair? Can someone get me my pitchfork and torch please?

I do not understand the hostility, did you misunderstand my post? I said that documentation is important to protect oneself from legal trouble. I meant nothing more than that.

I have on more than one occasion document that a patient was "assisted to gurney by EMTs" and if asked about it, I will state that I had them stand up, with help, pivot, and sit back down on the gurney.