Dying patient left on apartment floor

EpiEMS

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Anybody found the documents from the KS EMS board? I can’t find a thing.
 

MMiz

I put the M in EMTLife
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Wild story.

With four paramedics on scene in contact with medical control, I wonder what I would have done as a lowly EMT.
 

mgr22

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Wild story.

With four paramedics on scene in contact with medical control, I wonder what I would have done as a lowly EMT.
Maybe if they'd listened to you (the MD too), none of the stupid stuff would have happened. I'm serious. Lack of common sense sounds like the presenting problem.
 

ffemt8978

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Maybe if they'd listened to you (the MD too), none of the stupid stuff would have happened. I'm serious. Lack of common sense sounds like the presenting problem.
Wild story.

With four paramedics on scene in contact with medical control, I wonder what I would have done as a lowly EMT.
I don't have a hard time seeing that if was two basics on the call, it would have been a load and go to the hospital and let the ER deal with it.
 

Bullets

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I too work in such a system. Ketamine is not long acting nor is 500mg a pain dose. I ask again what outcome the doctor was seeking here by responding to the scene. This was not a complex call.
Yeah, but is a GSW, and that always brings a crowd
 

EpiEMS

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Wild story.

With four paramedics on scene in contact with medical control, I wonder what I would have done as a lowly EMT.

Hopefully gotten there before then & transported!

In all seriousness, this is much easier as a BLS call:

Observe patient with life threat (likely a terminal wound, based on description) and present VS. Do the usual rapid assessment. Patient to Reeves, Reeves to ambulance stretcher, run hot to nearest trauma center. No suit, no discipline.

Not to get on a BLS first soapbox, but in populated areas, trauma usually should be BLS...
 

Carlos Danger

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While clearly unconventional, I don't think it's necessarily unreasonable that an EMS physician who determined that a patient's injuries were incompatible with life and presumed that the patient would die very soon might choose to direct the administration of analgesia and anxiolysis in lieu of transport for what would be futile care. It's a different thought process and approach, but it makes perfectly good sense from a certain perspective. When things (inevitably) didn't go as planned because the patient was still alive and moving several later, that's really when things complicated and weird.

Is that not the essence of what happened?
 

silver

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While clearly unconventional, I don't think it's necessarily unreasonable that an EMS physician who determined that a patient's injuries were incompatible with life and presumed that the patient would die very soon might choose to direct the administration of analgesia and anxiolysis in lieu of transport for what would be futile care. It's a different thought process and approach, but it makes perfectly good sense from a certain perspective. When things (inevitably) didn't go as planned because the patient was still alive and moving several later, that's really when things complicated and weird.

Is that not the essence of what happened?

And thus we get to what many ethicists emphasize, don't judge decision making on the outcome. I think based on the information at hand, the EMS physician's determination was a reasonable and ethical one.


In the end though it makes you wonder, should there be more guidance in terms of providing comfort care in the field.
 

Tigger

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While clearly unconventional, I don't think it's necessarily unreasonable that an EMS physician who determined that a patient's injuries were incompatible with life and presumed that the patient would die very soon might choose to direct the administration of analgesia and anxiolysis in lieu of transport for what would be futile care. It's a different thought process and approach, but it makes perfectly good sense from a certain perspective. When things (inevitably) didn't go as planned because the patient was still alive and moving several later, that's really when things complicated and weird.

Is that not the essence of what happened?
It is the essence, but it was not executed as such.
 

Jon

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Here are two paragraphs that stood out to me:

"Charges include falsifying information, disregard for patient well-being and dignity, failing to provide patient care, unprofessional conduct and not following protocol.

"Gallagher (an MD) supervised the call that day along with Sedgwick County paramedic Timothy Popp. Gallagher is not facing disciplinary action."

Among those charges, "falsifying information" and "not following protocol" should be specific and the easiest to sustain or refute. And if Dr. Gallagher was providing medical control online and later on-scene, I think that's where the ultimate responsibility should lie.
I agree 100%.

Apparently Dr. Gallagher is/was a member of the ethics committee that reviewed the case and found his conduct acceptable. Seems like a conflict of interest to me.
 

DrParasite

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Hopefully gotten there before then & transported!

In all seriousness, this is much easier as a BLS call:

Observe patient with life threat (likely a terminal wound, based on description) and present VS. Do the usual rapid assessment. Patient to Reeves, Reeves to ambulance stretcher, run hot to nearest trauma center. No suit, no discipline.

Not to get on a BLS first soapbox, but in populated areas, trauma usually should be BLS...
let's be realistic: no areas of this country are going to treat a GSW to the head as a BLS call. I don't care how populated the area is, it's never going to be just two EMTs being dispatched. Almost always ALS, sometimes a supervisor, maybe even a first responder from another agency.

That being said, if it's you and me on the truck, and we decide to scoop and run, that is an option, but that doesn't mean it's the most appropriate. if that GSW results in brain matter showing, should we even be transporting? if we transport hot with a soon-to-be dead body and T-bone a bus full of kids, how bad will it look in the papers? on the witness stand when the lawsuit is filed? And if our medical director buffs the call (because he was around the corner) and tells us not to transport because he is going to pronounce the patient as DOA, and we transport anyway, how does that muddy up the situation?

Just because we do transport, doesn't mean that was the appropriate action based on the patient's clinical presentation.
 

GMCmedic

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While clearly unconventional, I don't think it's necessarily unreasonable that an EMS physician who determined that a patient's injuries were incompatible with life and presumed that the patient would die very soon might choose to direct the administration of analgesia and anxiolysis in lieu of transport for what would be futile care. It's a different thought process and approach, but it makes perfectly good sense from a certain perspective. When things (inevitably) didn't go as planned because the patient was still alive and moving several later, that's really when things complicated and weird.

Is that not the essence of what happened?

I think where the issue lies, is they committed themselves to the initial decision and were unable/unwilling to accept an alternative when things didn't go as planned.

Even an hour in, if they had transported him, this PR nightmare could have been avoided.
 

Carlos Danger

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I think where the issue lies, is they committed themselves to the initial decision and were unable/unwilling to accept an alternative when things didn't go as planned.

Even an hour in, if they had transported him, this PR nightmare could have been avoided.
Exactly
 

FiremanMike

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I can’t imagine sitting on a scene with a man we resuscitated with sustained rosc and apparently purposeful movement and thinking “hell I need to call the doc and ask what to do!”

I’m all about termination of resuscitation, but I’m fairly certain ROSC and spontaneous respiration’s put you well outside of the appropriate criteria for TOR..

What a monumentally pathetic display of “EMS” and empathy for human suffering
 

EpiEMS

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I agree 100%.

Apparently Dr. Gallagher is/was a member of the ethics committee that reviewed the case and found his conduct acceptable. Seems like a conflict of interest to me.

There's a lot of interesting research on why physicians don't discipline their own, I enjoyed this summary piece. This survey has some interesting stats as well. Also of interest -- Kansas has a very low rate of physician discipline (along with NY and CT, which I was a bit surprised by).

I think the broad point is that physicians (indeed, most professions) don't discipline their own because it makes them look bad collectively.

let's be realistic: no areas of this country are going to treat a GSW to the head as a BLS call. I don't care how populated the area is, it's never going to be just two EMTs being dispatched. Almost always ALS, sometimes a supervisor, maybe even a first responder from another agency.

That being said, if it's you and me on the truck, and we decide to scoop and run, that is an option, but that doesn't mean it's the most appropriate. if that GSW results in brain matter showing, should we even be transporting? if we transport hot with a soon-to-be dead body and T-bone a bus full of kids, how bad will it look in the papers? on the witness stand when the lawsuit is filed? And if our medical director buffs the call (because he was around the corner) and tells us not to transport because he is going to pronounce the patient as DOA, and we transport anyway, how does that muddy up the situation?

Just because we do transport, doesn't mean that was the appropriate action based on the patient's clinical presentation.

I'd agree with that first point -- almost always ALS, but probably not always rightly. OPALS showed no significant improvement in survival to discharge for AIS 4 & 5 injuries to the head & neck. With brain matter showing, for example, we may be right or wrong to transport -- my guess is wrong, but with respirations and a pulse, I'd be hard pressed to not give it consideration under the protocols I have read (NY, CT, MA, NH). The medical director aspect is much more complicated, for sure. It doesn't absolve the EMS providers, but it may mitigate culpability.
 

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