Killing Your Patients

[Lifeguards For Life]

I remember when I was in school, how the instructors would tell us how our patient's life lies in our hands, and if we mess up we could easily kill someone.

I heard this in EMT school, but the message was a lot more common in Paramedic school.

I haven't thought too hard on this, but what honest, understandable mistakes can you imagine an EMT or PM making, that could kill a patient.

To be considered an understandable mistake, ask yourself "If I heard about this mistake being made, would I sympathize with the offending EMT/PM, or would I be horrified and think they were horribly incompetent ?"

For example, when I have asked this question before, the Medic instructor told me about a guy in his department who accidentally gave an elderly patient epi instead of morphine. He seemed to think this was an understandable mistake as these were the only two medications they caried that came in ampules. As all departments I am familiar with keep their narcs in a separate locked "narc box", and medications should be verified before being given, I have a hard time viewing this as an understandable mistake.

So, let's hear it. what mistakes can you imagine an EMS provider making in good faith, that could prove fatal to a patient.

 

[SeanEddy]

I'm starting off with an easy one.....

Intubating the esophagus (without recognition). Although with Sp02, Capnography, and listening to the freaking lung sounds, it would be pretty hard NOT to recognize that.

 

[HotelCo]

I remember when I was in school, how the instructors would tell us how our patient's life lies in our hands, and if we mess up we could easily kill someone.

I heard this in EMT school, but the message was a lot more common in Paramedic school.

I haven't thought too hard on this, but what honest, understandable mistakes can you imagine an EMT or PM making, that could kill a patient.

To be considered an understandable mistake, ask yourself "If I heard about this mistake being made, would I sympathize with the offending EMT/PM, or would I be horrified and think they were horribly incompetent ?"

For example, when I have asked this question before, the Medic instructor told me about a guy in his department who accidentally gave an elderly patient epi instead of morphine. He seemed to think this was an understandable mistake as these were the only two medications they caried that came in ampules. As all departments I am familiar with keep their narcs in a separate locked "narc box", and medications should be verified before being given, I have a hard time viewing this as an understandable mistake.

So, let's hear it. what mistakes can you imagine an EMS provider making in good faith, that could prove fatal to a patient.

Southeastern Michigan has only one drug box, with all meds inside of it. There is no separate narc box.

 

[SeanEddy]

Forgetting to put the defibrillator in "sync" mode.

 

[Lifeguards For Life]

I'm starting off with an easy one.....

Intubating the esophagus (without recognition). Although with Sp02, Capnography, and listening to the freaking lung sounds, it would be pretty hard NOT to recognize that.

I have seen this done twice, both times, it was obvious from across the room. Like you said there are so many simplistic tools to avoid this, that I think this is more neglect than a mistake.

 

[LucidResq]

Driving recklessly.

 

[Shishkabob]

Every time I give a medication.



Every. Single. Time.

 

[usalsfyre]

In good faith? Giving the wrong med due to poor labeling and extended shifts. Choosing the wrong sequence when controlling an airway (the sedative, succs, CPR sequence). Failure to recognize tension pneumothorax. Forgetting to hit synch. Failure to recognize shock.

I've seen or done/come close to or know people who have seen or done all of these, some more "in good faith" than others.

 

[abckidsmom]

Overall laziness that reduces your unit hour utilization to the point that you're not available for calls.

A system I know has extreme staffing issues, to the point that medics that are barely competent are cleared for duty and on a 1-paramedic unit. In that system, it's seen as acceptable to spend an hour at the hospital. If they could take hold of those lost hours, they would need a third fewer medic units all the time.

The dispatchers don't watch the system, and very commonly "cross trucks" who are responding to calls...having responding ambulances basically cross paths, when the calls should have been switched out.

Poor unit hour utilization leads to wasted money, and though this system seems to have a bottomless pit of money, it won't last forever.

(Can you tell I worked for AMR at one point, lol? I really do believe that higher efficiency can be had if you ask for it and reward the crews for it.)

Wasted time and money in the system kills people, eventually. It certainly has in the system I'm currently working in.

 

[Lifeguards For Life]

Forgetting to put the defibrillator in "sync" mode.

Point.

 

[Lifeguards For Life]

Driving recklessly.

While this is not to be accepted, as you have labeled this behavior as reckless, and as such, is not a mistake.

 

[Lifeguards For Life]

Every time I give a medication.



Every. Single. Time.

I don't buy into this one. "Every. Single. Time"?

Most of our meds have reversal agents, or are fairly benign in nature. And for the meds that do not fall under the afore mentioned categories, there is usually measures that can be taken to sustain life in the event of an overdose.

I fail to see how your patient is placed at any appreciable risk Every. Single. Time. you administer a med.

 

[silver]

Point.

Hey! I told you this a couple of days ago.

I think anything is possible really. People often have lapses of attention or get distracted and could easily incorrectly give a med (wrong dose/med/route etc.) or not notice indications/contraindications for a procedure.

 

[abckidsmom]

While this is not to be accepted, as you have labeled this behavior as reckless, and as such, is not a mistake.

Tell that to the guy who "accidentally" plowed into a family when he ran a red light. Biggest mistake of his life.

 

[EMSrush]

How about palpating a carotid BP using a manual cuff?

 

[Lifeguards For Life]

Hey! I told you this a couple of days ago.

I think anything is possible really. People often have lapses of attention or get distracted and could easily incorrectly give a med (wrong dose/med/route etc.) or not notice indications/contraindications for a procedure.

Lol, i remember that chat room conversation.

I had started to reply about unsynchronized cardioversion in hemodynamicaly unstable patients with VT, but this is worth a point.

(I thought about it for a while, trying to argue, as I think that no matter what you do to your patients, most of them are going to live, but to argue this one would be stupid)

 

[Lifeguards For Life]

Tell that to the guy who "accidentally" plowed into a family when he ran a red light. Biggest mistake of his life.

don't run red lights?

EMS should not be driving recklessly plain and simple.

I think there have been many threads here regarding the efficacy of running code 3, and most people would agree that in the majority of cases, L&S make a negligible contribution to patient care.

There is no reason for EMS to be running red lights.

 

[abckidsmom]

don't run red lights?

EMS should not be driving recklessly plain and simple.

I think there have been many threads here regarding the efficacy of running code 3, and most people would agree that in the majority of cases, L&S make a negligible contribution to patient care.

There is no reason for EMS to be running red lights.

Well, yeah. I totally agree with you. But people do stupid stuff all the time, and you have to chalk it up to something.

I think that being lazy in the performance of your job can be equivalent to being reckless. Is the monitor totally checked out? Do we have the right masks to all of the ambu bags? Etc. Skipping that stuff can be the same level of recklessness that blowing a red light can be.

And sometimes you really just don't see the light. That's when it is a mistake, be it one of distractedness, not looking, whatever, but I will give people credit for it being a mistake.

That doesn't exempt them from the consequences of the mistake.

 

[sir.shocksalot]

There is no reason for EMS to be running red lights.

As much as I agree that time is hardly a factor in most disease processes that we encounter, I don't think the public would stand for 20 to 30 minute response times.

However, of the response time studies I have read they made no mention of the environment that is being responded in. When I worked in some rural and suburban parts of CO going L/S made zero to negligible time difference. In a large, dense, urban area L/S can turn a 20 minute response down to 8 minutes.

But I will maintain that safety and caution should always be the #1 priority regardless of distance that you are responding from or what you are responding to. Don't end up on the 6 am news.

 

[MrBrown]

The only thing that could be fatal as Brown sees it is bad driving, but there are lots of things that are not always good for your patients .... like high flow oxygen, glucose in stroke, frusemide for CHF, suxamethonium in hyperkalemia, IV fluids in people with CHF etc etc etc

Oh, there is one really bad, almost certainly always fatal thing ... letting Brown work on you