http://www.wkyt.com/home/headlines/...njuries-despite-parents-wishes-224175611.html
Let's talk about assessment and consent here. I don't want to criticize Mr. Cain too harshly, but let's be completely honest- this was a financially-abusive, inappropriate and ignorance-driven request in the first place. The reason this was even started hinges on the trauma assessment- Mr. Cain clearly failed to identify basic anatomical landmarks and was unable to even locate a secondary injury. Yes, I understand that scalp wounds bleed more profusely than others- but there is no excuse for not being able to complete a focused assessment. Due to the extremely short stays in the emergency room, I feel it would be appropriate to point out that neither patient experienced any sort of traumatic brain injury or was ever even close to "life-threatening danger". We can start this Monday film session with a comfortable chair, a bottle of cold water and a recognition that this paramedic's bread-and-butter, fundamental assessment sucks great big rocks from the sea floor. "Four stitches" is not a life-threatening emergency. We have a knowledge deficit here. I'm sure that Mr. Cain has already identified that deficiency and is working hard to correct it.
Mr. Cain and his crew were sucked into a fantasy world of their own creation, which they then panicked in and called for a helicopter. This farce of a health-care experience then apparently spun completely out of control when the second patient was flown, on a second helicopter, for 'mechanism'. People who actually study know that mechanism is a poor indicator of injuries. (
http://www.east.org/resources/treatment-guidelines/triage-of-the-trauma-patient).
This gets even more farcical when the mother's understandable concern is factored in for the cost and need for service here. Something that literally could have been handled by a community paramedic and a suture kit or a local community urgent care was upgraded by ignorance and tunnel vision to a dual-level-one trauma with two c-spined little girls strapped to backboards for at least the better part of two hours, with bilateral IV's established in immobilized limbs, by hyperexcited and serious-faced "paramedics", firefighters (and a flight nurse, let's not leave anyone out here) hovering around over them, shouting questions and generally seriously overreacting. Add in a mother whose concern is building as her daughters are strapped down, cannulated and start complaining about headaches, neck pain, back pain and IV-site pain, all while words like "possible head bleeds" and quiet prayers are whispered. Perhaps there was even some sort of dramatic time-to-arrival resource when the almighty, all-knowing flight crew gravely announced that both girls were in serious, life-threatening danger.
I'm not surprised they didn't hear Mom withdrawing consent, over the sound of how awesome they were being. MCI scene, idling vehicles everywhere, busy-looking officers and all sorts of people wondering if those poor little girls are dead or something....yep, must have been something to see. Completely ignoring the resources wasted, calls potentially unanswered, safety issues with sending the girls out by helicopter as opposed to an appropriate nonemergent ambulance transport...it must have been something to see. Meanwhile Mom is seeing something that she remembers her own mother fixing with a short ride in a Buick and a few stitches that she lacks only the kit for turning into a disaster scene worthy of a Hollywood movie- on her dime.
This is not patient advocacy. This is not providing community service or health care. This is throwing resources at problems that do not need those resources thrown at them, and then shrugging when our patients are billed for those services and falling back on ignorance and stupidity as our justification. This is why we, as a profession, are not trusted with important decisions and have permission to perform dangerous interventions stripped from us. This is why those doctors whose voices actually matter are sitting down when a paramedics asks for orders- they don't want to fall too far laughing when we ask them for a surgical crike or a nonstandard drug administration or permission to deviate from lowest-common-denominator protocols. How can they trust you to make doctor-level decisions when a paramedic cannot even appropriately triage Level-4, 'meh' patients, and when your overreaction is so severe as to bring in AirEvac?
Yes, this is Monday-morning quarterbacking. I wasn't there, I didn't see these horrific scalp wounds resolved by a few stitches. I don't know the precise MoI, and I don't know Mr. Cain or his fire department's usual performance. I really hope that this is an outlier, and I hope that the department uses this as a positive training tool for the improvement and prevention of future mistakes. I don't wish any disciplinary action on good people that can learn from their mistakes- but I do want it made clear that there were mistakes made that we can all learn from. At the end of the day, this is not a Lincoln County, Kentucky issue. This is not a fire-paramedic or flight issue. This is an issue that concerns all of us, ranging from my big-city private company to the most rural volunteer EMT/FF. Would your community trust you if your sole function in their eyes was to send boo-boos to the big city trauma center by helicopter? They reckon you break out the transporter beam when you have a real mess!
Monday morning is when coaching staffs go over films and decide who plays, who sits and who walks, and professional teams are better for it. Let's see who we can retrain before our communities decide who walks.