Dallas Fire Department EMS Care - Quality

[Fish]

If a patient has been walking around an MVA seen for 10 minutes, and claim spinal injury they can't attribute that damage to you not performing a standing takedown.

I've had patients walk to the stretcher and lay down as well as walking into the ambulance.

My agency can knock me for doing it improperly, but in a court of law you can't prove negligence on that basis.

An Attorney will find a way to prove anything, just because you have been walking around with no deficits does not mean there is no damage to the vertabre, the chord? Different story. Have loose or jagged ends of the broken vertabre cause damage after asking the patient to do some type of extensive bending manuver like lying down and I would say yes you are at fault.

 

[Christopher]

An Attorney will find a way to prove anything, just because you have been walking around with no deficits does not mean there is no damage to the vertabre, the chord? Different story. Have loose or jagged ends of the broken vertabre cause damage after asking the patient to do some type of extensive bending manuver like lying down and I would say yes you are at fault.

Except it doesn't happen like that in reality...external motion does not correlate well to internal motion against the cord. Besides, if what you're saying is true then you're negligent by placing them on a spine board as forces will be directed into the cord by virtue of lying on a rigid board.

I do agree that you'll be gigged in the courts, as they are probably 20 years behind reality (you should see what we deal with in software engineering). You'll be faulted for not forcibly manipulating the person onto a rigid spinal non-immobilization device with a cervical-doesn't-actually-provide-immobilization device.

We need to find an enterprising lawyer who will work to sue EMS and Fire departments when their protocols are awful; e.g. placing people on backboards or using lasix for CHF or for stopping at 3 sprays of NTG with pulmonary edema...

 

[NYMedic828]

An Attorney will find a way to prove anything, just because you have been walking around with no deficits does not mean there is no damage to the vertabre, the chord? Different story. Have loose or jagged ends of the broken vertabre cause damage after asking the patient to do some type of extensive bending manuver like lying down and I would say yes you are at fault.

Find me a case where its happened and find me a way to prove that it was the sole fault of EMS that permanent damage was caused.

Its very difficult to win a negligence lawsuit against EMS. It isn't worth going after most EMS agencies to begin with because we don't have malpractice insurance and furthermore that whole "If he moves he could be paralyzed for life" never happens. You also have no ones word but yours, your partner and the patient most times. Its not a very good weight on either side and it just gets dismissed more often than not.

The fact is when you go to court, the lawsuit is ruled based on findings of not providing the standard of care. Backboards aren't the standard of care in actual medicine. Its nearly impossible to prove you did harm on the sole basis of not doing some ridiculous maneuver to lay a patient down who got out of his vehicle prior to arrival on his own free-will and has been roaming
around on scene for 10 minutes.

While I respect following procedure, I also respect doing what is ACTUALLY right for my patient. If the protocol could potentially hurt them, it isn't happening. As far as im concerned a backboard at a minimum causes discomfort. Thats a minor form of harming my patient. If I actually backboard someone, its rare and its basically because everything listed in the protocol is met.

 

[Fish]

Find me a case where its happened and find me a way to prove that it was the sole fault of EMS that permanent damage was caused.

Its very difficult to win a negligence lawsuit against EMS. It isn't worth going after most EMS agencies to begin with because we don't have malpractice insurance and furthermore that whole "If he moves he could be paralyzed for life" never happens. You also have no ones word but yours, your partner and the patient most times. Its not a very good weight on either side and it just gets dismissed more often than not.

The fact is when you go to court, the lawsuit is ruled based on findings of not providing the standard of care. Backboards aren't the standard of care in actual medicine. Its nearly impossible to prove you did harm on the sole basis of not doing some ridiculous maneuver to lay a patient down who got out of his vehicle prior to arrival on his own free-will and has been roaming
around on scene for 10 minutes.

While I respect following procedure, I also respect doing what is ACTUALLY right for my patient. If the protocol could potentially hurt them, it isn't happening. As far as im concerned a backboard at a minimum causes discomfort. Thats a minor form of harming my patient. If I actually backboard someone, its rare and its basically because everything listed in the protocol is met.

San Diego Rural Metro had this happen, did not ever end up in court because it was not the MES crews fault, it happened while the guy was walking up the beach towards them and bent over to grab his things. I know it is a rare occurance, very rare. And I hope I don't come off as the uber back boarder, cause I am very much the opposite

 

[NYMedic828]

San Diego Rural Metro had this happen, did not ever end up in court because it was not the MES crews fault, it happened while the guy was walking up the beach towards them and bent over to grab his things. I know it is a rare occurance, very rare. And I hope I don't come off as the uber back boarder, cause I am very much the opposite

I'm not saying it never happened.

But if it did it can't be proven to be the sole fault of the EMS crew.

 

[Fish]

I'm not saying it never happened.

But if it did it can't be proven to be the sole fault of the EMS crew.

On the same page now, agreed


And the chances are most likely cervical than any, not to mention it is more of an old schoool thought that has been going away with time. Which is good, if we want to get to the point of not backboarding everyone who says they have neck and back pain, or a mechanism that can potentially cause it

 

[sir.shocksalot]

I think you can be sued for anything in this day and age, even walking someone to a back board. That being said I still do it too.

I can't say I have any first hand experience with DFD but I have heard horrid things too, I still remember Vene siting their paramedic program as one of the great big problems with EMS. I think every agency has problem people there, and I think every state has numerous examples of horrid EMS systems with inadequate analgesia, out dated treatment plans (like lasix for CHF), or other problems. If I had a dollar for every time I saw a paramedic put high flow oxygen on patients with an indication of "patient looks sick", or heck just putting oxygen on everyone because they got into an ambulance (on that note do I need oxygen too then?) I'd be stinking rich. There are highly respected EMS agencies that still do somethings backwards or "old school", I think it's actually a profession wide problem of which DFD might just be an extreme example. Until we do something to standardize care and expectations across the country and have real CEs not "refreshers" (where old material is rehashed), there will always be others (or more) like DFD.

 

[Fish]

I respectfully disagree. While I think you are spot on about the ridiculousness of the procedure, and how much more likely it is to cause harm with a LSB than to actually prevent harm as was intended, I think you can still get sued by walking a patient to a board.

You are correct, the standard of care in medicine is to remove LSB as soon as possible and generally the patient is left in a collar (at least around these parts). The problem is that doing standing take downs and whatever to back board people is the standard of "care" for EMS, it's how we were trained, and that is the expectation. All a lawyer needs to do is find an educator or clinical director or whatever backwards thinking dumdum we have rampart in our profession to say "It is expected that paramedics back-board patients in this manner", and then find a neurologist to say "I suppose it's possible that the patient walking/climbing to the back-board exasperated his spinal injury". No matter how false or exaggerated any of this stuff is, that alone would likely be enough to sue you. Not to mention if you don't have "selective" spinal immobilization protocols you could really be screwed. Plus there are cases of paramedics getting sued for not back-boarding someone, or not administering oxygen fast enough. All it takes is a smart lawyer and a dumb jury.

With that being said, I do exactly the same things you do NYMedic. I almost regularly walk people to the backboard (not far though), I have had a patient on rare occasions and under certain circumstances climb into the ambulance to be boarded. I personally think both are totally safe. While it would be better if I didn't have to board these people at all the reality is that anyone complaining of neck pain/back pain/drunk and fell/old and fell the expectation for us is to board, so I board in the most back-saving way possible to CMA (cover my a$$).

Basically, I think you're right in what you do, heck I'm the same way, but I'm fully aware that if one of my supervisors saw me or a lawyer wanted to get me I'd be hung out to dry. I cannot defend walking a patient to the board because if they have to be boarded I have to follow my protocols on how it's done... and they definitely don't say "walk patient and have them sit on the board". It sucks but it's the reality of being a certified technician...

As a small side note, as a paramedic you are extremely unlikely to be sued. I make $40,000/yr, no one is going to get rich slamming me with a law suit. I actually can't think of a single time I have read of a paramedic getting sued. Your employer however is very likely to get sued if someone is looking to go after you.

What it comes down to for me is "not allowed to" we do not do half cspines, or walk people to the board, if we do cspine we do it the way taught in school and we do it 100%. Walking a patient to the stretcher to be boarded would raise eyebrows for us, and might get you a trip to explain yourself at Clinical.

 

[TomP]

People who c-spine just to CYA is one of my biggest pet pives, we are supposed to be pt advocates and do whats best for our pt's and strapping someone on an uncomfortable board when they don't need it is horrible practice.

 

[jgmedic]

People who c-spine just to CYA is one of my biggest pet pives, we are supposed to be pt advocates and do whats best for our pt's and strapping someone on an uncomfortable board when they don't need it is horrible practice.

Quoted for truth!

 

[Sublime]

I heard that back in the day DFD used to have their medications catagorized in boxes by colors.

If you had a cardiac pt. with chest pain you opened the red box and gave those drugs.

Respiratory patients got the blue box with those meds.

They didn't actually know what they were giving just gave the colors that corresponded with the complaint.

They stopped when one medication was labeled the wrong color (I believe it was lidocaine) and was given improperly and killed someone.


This is just what I heard from multiple people, not sure if it's actually true lol.

 

[medic417]

I heard that back in the day DFD used to have their medications catagorized in boxes by colors.

If you had a cardiac pt. with chest pain you opened the red box and gave those drugs.

Respiratory patients got the blue box with those meds.

They didn't actually know what they were giving just gave the colors that corresponded with the complaint.

They stopped when one medication was labeled the wrong color (I believe it was lidocaine) and was given improperly and killed someone.


This is just what I heard from multiple people, not sure if it's actually true lol.

Actually the colored boxes you mentioned were used in many places across the nation.

 

[medicsb]

Actually the colored boxes you mentioned were used in many places across the nation.

Was gonna say the same.

 

[TomP]

It is true and it is stupid. In medic school we were taught to learn the colors of boxes of meds, but just like you said what happens if the colors change or a different manufacture uses a different color, then what? Lawsuit!

 

[Medic Tim]

It is true and it is stupid. In medic school we were taught to learn the colors of boxes of meds, but just like you said what happens if the colors change or a different manufacture uses a different color, then what? Lawsuit!

they teach you to give the colour? Or teach you about the drug but know it is usually in this coloured box so you can find it easier?

 

[Shishkabob]

Pretty standard for DFD, actually.


Actually a bit surprised to hear you say they have Fent, last I heard they had no narcotic analgesics (granted this was a while ago). But they also don't intubate but rely on supraglotic airways.


It's well known in this area (DFW) that Dallas will all but tell you that you don't need an ambulance most of the time. Now, I'd argue they are right most of the time, the people they do it to and the tact they use are... not.



Go through my previous posts on here, I'm sure I've posted several times that if I'm involved in an MVC on the east side of DFW (especially Dallas) I'm crawling my butt to Baylor or Parkland as I stand a better chance.

 

[medicsb]

But they also don't intubate but rely on supraglotic airways.
.

That would actually be progressive, really, but Biotel has ETI in their protocols.

 

[Fish]

That would actually be progressive, really, but Biotel has ETI in their protocols.

They do it due to incompetence, not progressive-ness

 

[foreverbound]

Successful intubation with DFD? :rofl:

DFD will use, from what I've heard, a King (no Combitubes carried) for nearly all airways. Although arguments could be made that this is "progressive"...I think it's clear and evident that ETI is still the way to go for most cases...including arrests. We routinely place ET tubes while compressions are going. I won't get on a soapbox here...but...our EMS system is considering passive ventilation (OPA and NPA with NC and NRB at 15lpm). Yes, a nasal cannula with 15 LPM.

As for the colors, I think they use the "standard" color boxes just like nearly every EMS system although it does sound like nit he past they were taught to give "the red box" to "X patient" not because it was easier, but because they saw no need to teach the real function/effect of the medications.

I was told that DFD rarely ever gives narcotics. I believe the "biggest" drug they use is midazolam and it's almost exclusively for seizures.

I absolutely agree with the education crisis in EMS. Education has, is, and will continue to be the foundation for better, more aggressive, and more professional EMS care. Until we increase EMS education requirements to better standards. Like I read in another post, and sadly agree with...everything's bigger in Texas

...except EMS education.

Thank you for everyone's comments.

 

[Fish]

Successful intubation with DFD? :rofl:

DFD will use, from what I've heard, a King (no Combitubes carried) for nearly all airways. Although arguments could be made that this is "progressive"...I think it's clear and evident that ETI is still the way to go for most cases...including arrests. We routinely place ET tubes while compressions are going. I won't get on a soapbox here...but...our EMS system is considering passive ventilation (OPA and NPA with NC and NRB at 15lpm). Yes, a nasal cannula with 15 LPM.

As for the colors, I think they use the "standard" color boxes just like nearly every EMS system although it does sound like nit he past they were taught to give "the red box" to "X patient" not because it was easier, but because they saw no need to teach the real function/effect of the medications.

I was told that DFD rarely ever gives narcotics. I believe the "biggest" drug they use is midazolam and it's almost exclusively for seizures.

I absolutely agree with the education crisis in EMS. Education has, is, and will continue to be the foundation for better, more aggressive, and more professional EMS care. Until we increase EMS education requirements to better standards. Like I read in another post, and sadly agree with...everything's bigger in Texas

...except EMS education.

Thank you for everyone's comments.

First 6 minutes are an OPA and NRB during Cardiac Arrest for us

During RSI, we place a NC at 15lpm, this is discontinued after tube has been secured.