Killing Your Patients

Tigger said:
I guess from the basic prospective, there's not a whole lot I can do to even hasten a patient's death, much less kill the patient.
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There is however, a lot you can do to help a patient
 
Mistake versus Accident, again.

Mistake: try to make the ambulance litter straddle the hole in the sidewalk, but it goes in anyway; you did what you meant to do, but it was wrong. Intent was present.
Accident: you didn't see that hole in the pavement and fell into it. Lack of intent.
Neglect, malpractice, or being unprofessional: didn't look for the hole in the pavement, accident or not.

Medicine tries to be a zero-mistake field. It has become populated with people unwilling to grant the fact of human error because to deny it gives them the whip hand. It has also become the hunting preserve of non-medical administrators and lawyers using the same unassailable strategy. So, instead of sharing mistakes, owning up, learning from others as well as ourselves, we find ways to hide mistakes, distribute blame, or cover ourselves at the expense of others (and sometimes the expense of reason) to avoid this sort of weeding-out or punishment. Do the right thing in good faith each and every time.
 
Hit the nail on the head!

mycrofft said:
Medicine...a zero-mistake field...populated with people unwilling to grant the fact of human error... instead of sharing mistakes, owning up, learning from others as well as ourselves, we find ways to hide mistakes...distribute blame...cover ourselves at the expense of others...of reason... to avoid... punishment [/QUOTE]

In both subtle and not so subtle ways, punishment often appears to be for being a human in an extremely demanding field. Even speaking honestly amongst ourselves is covertly discouraged.

...and, one of the things that is happening on-line, and right here, is people are looking. People are talking. People really are looking at the human experience. Maybe we're mad as hell and not going to take it anymore!

It may seem kinda weird, but one of the ways we can make this a real profession is by really being aware of the important roles we play and the burdens we carry. If we honor each other first, perhaps others will as well.

(Steps off soapbox.)
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Besides the many instances of med errors and esophageal intubations...

1) Blowing off ALOC as ETOH and not realizing the patient had in fact received a head injury from an assault.

2) "It's just acid reflux. Call us back if you feel worse."

3) Epi 1:1,000 IVP (not 1:10,000) for anaphylaxis.

4) Missing trauma patients, like little old lady found by the wrecking yard operator under the passenger side dash. (LA County)

These ones are well know to people on this site. Advice to the OP would be to read the EMS news posts and learn from other people's mistakes.

Other mistakes that I have witnessed or that I have heard of locally:

1) The medic who believed the cop when he said the guy involved in the minor T/C was drunk. He AMA'ed a surgeon who'd crashed his car after suffering from a hemorrhagic stroke.

2) Firefighter (though it could have been anyone) yelling at the hyperventilating patient, telling her to call down, and not recognizing the she was having a massive PE.

3) Medics who transported the "homeless guy" w/o providing treatment and not recognizing he was hypoglycemic.

There's lots more...just can't remember the other classic FAILS right now.
 
I mean someone using undiluted epi IV push....

Another classic FAIL that was previously discussed on this site (or EMT City?) was the medic who didn't recognize agitation/combativeness as due to hypoxia and did nothing but administer Benadryl.

Or the medic who, or at least it was claimed, fell asleep in the back of the ambulance on an transfer, and woke up upon arrival at the hospital with the patient deceased.:unsure:
 
zzyzx said:
I mean someone using undiluted epi IV push....
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Good God do we gave to beat this horse again....

Assuming the same DOSE, there is no difference between 1:1000 and 1:10000 when given IV push.
 
Yeah, I remember that thread as well. Sorry, I was referring to the incident where the crew slammed 1/2 mg undiluted IVP.
 
zzyzx said:
Yeah, I remember that thread as well. Sorry, I was referring to the incident where the crew slammed 1/2 mg undiluted IVP.
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Yeah, when you overdose the patient because your not paying attention to concentration....that's what management calls "an issue" :D.
 
Lifeguards For Life said:
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.
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Wow, that's a dangerous way to think. No doubt you will kill more than your fair share of patients. In fact, you should take to putting a cross on the fender of your ambulance for each confirmed kill, just like they did in WWII. That's if you even recognize what that you killed the patient. Yes. Every. Single. Time. There are some drugs that don't scare me much, but there are some drugs I give where I am terrified, Every. Single. Time. That's not because I don't know what they can do, but because I know exactly what they can do. Every. Single. Time.

DrParasite said:
Amazing. Brown is not only an expert on EMS and medicine, but he is an expert on the mentality of American EMS, as well as what is written in the the American EMS textbooks. this is amazing because he has never attended an EMS course in the US, and I'm betting he has never stepped foot on a US ambulance nor worked in an Urban or rural American EMS system.

but Brown is an expert in how we do everything wrong. Amazing how that works out.
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I wish I was half the medic that Brown fancies himself to be. Then I'd be a Hero Medic for the 21st century. If you don't know who hero medic was, then you missed out on a very rich part of pre Internet EMS forums.

Akulahawk said:
While a Physician and a PA will undoubtedly have more education than a Paramedic will... Trauma victims need a surgeon, an OR and enough hands to make sure that everything is ready to support the patient. Last time I checked, an ambulance makes for a poor OR and generally lack enough trained hands to do the job well (let alone have sufficient supplies of, well, everything because you'd have to be ready for any surgical need...)
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Not to mention that an EMT or paramedic's knowledge is really only skin deep. Most doctors are smarter than most paramedics. Not all, but most of them.

Truly sick people do need an ER. Why? All the support/resources available. An ambulance doesn't (yet) have the ability to do portable X-ray and doesn't have a CT scanner. While there is bedside lab equipment out and about in the world, a much better lab capability is available to the ER. There are Pharmacy services available there too. An ambulance can stock only so much.
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Yes.

"Stay and play" vs "load and go" is a very old argument that does need to be rehashed every so often to make sure that those patients that should be stabilized on scene, are while the patients that need transport urgently should get it... regardless of who is staffing the ambulance.

Delete the Paramedic vs MD/PA stuff and a good argument was made by DrParasite about the limitations of ambulances.
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Since we only temporize and only rarely do we make a patient completely "better" than it's axiomatic that transport is part of the treatment.

As to having doctors on ambulances because they can "do more", how did that work out for Princess Diana? She had a slow bleeding tear in (I believe) the IVC that could have been surgically repaired fairly easily. If the MD staffed French ambulance hadn't stayed on scene trying to stabilize her, then she might have survived.
 
Lifeguards For Life said:
I maintain that no matter what you do to them, most of your patients will live.
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While that might be true, I maintain that if that is your approach to EMS then we'd all be better off if you went into something more suited to your abilities. The fast food industry comes to mind.
 
Let's keep it civil

Each of us comes to certain conclusions about who we are in relationship to the work we do.

Every one of us has the right to learn and better understand what we are in the midst of.

The purpose of this forum, to me, in part, is to allow our peers to come in, state their opinions of the moment, learn from the responses given them and then evolve their positions.

TOTW, you're judging an EMS provider on his ability to serve based on one statement that absolutely does NOT reflect who the provider is.

I happen to agree with him...sometimes. And sometimes as well there are runs where nothing you do can save a patient. EMS experience is fluid, not fixed, and I'd much prefer you help your peers see more aspects than their own rather than belting them for the only one they can see today.
 
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firetender said:
TOTW, you're judging an EMS provider on his ability to serve based on one statement that absolutely does NOT reflect who the provider is.

I happen to agree with him...sometimes. And sometimes as well there are runs where nothing you do can save a patient. EMS experience is fluid, not fixed, and I'd much prefer you help your peers see more aspects than their own rather than belting them for the only one they can see today.
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Actually, I'm basing it on several posts of his. This just happens to be one of the less well reasoned ones. You may agree with him, I don't. What we do is fraught with risk, more for the patient than for us. We have a drug box full of medications that can cause great good, or cause great harm. The medic that treats that responsibility cavalierly does harm to the patient and to what many people hope will some day be a profession.
 
Too Old To Work said:
Actually, I'm basing it on several posts of his. QUOTE]


In that case, please keep your comments limited to the actual post you are referring to. From this point on, further comments of this kind will be considered violation of our "Be Polite" rule.
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