Making mistakes in the EMS field

Limes

Forum Crew Member
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I know that even in the EMS field, everyone is prone to mistakes. In my work setting, a girl (11 years old) swallowed water, then she had some trouble breathing and was experiencing chest pain.

I did everything I could think of at the time (vitals, O2, head to toe). Near the end, she said she felt better and asked to leave. However, the mistake I made was not going further and finding where her teacher(s) was, to let them know what's going on. Another lifeguard also told her to see a doctor if she felt worse.

2 days later, she was admitted to the hospital. This situation happened 2 weeks ago, and I've been feeling guilty ever since. I've felt like things could have been different had I passed on the message.

My question is, how do you deal with making mistakes in the EMS field? I constantly make scenarios in my head to "prepare" myself, but I'm starting to think this isn't beneficial at all. Also, is there anything else you guys would have done?
 

Flying

Mostly Ignorant
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You're only realizing that scenarios are just a thin substitute for experience, that's fine.

Assuming this was a camp/school, getting a nurse/parent involved could have been a part of the overall plan.
 

MonkeyArrow

Forum Asst. Chief
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Yeah, so she is 11 and requested treatment in obvious distress and you treated her to the best of your ability. Everything good so far. But why didn't you recommend her going to the hospital? Why didn't you call EMS? (I'm assuming you are in a lifeguarding position here). If she is 11, she cannot consent or refuse treatment. You treating her is fine, since that's more than likely implied consent. However, you letting her go without even telling her legal guardian is a bit reckless. You should of told a parent/guardian and probably called ALS for more a advanced assessment and a proper refusal/AMA by people legally able to consent to such.
 
OP
Limes

Limes

Forum Crew Member
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Yeah, so she is 11 and requested treatment in obvious distress and you treated her to the best of your ability. Everything good so far. But why didn't you recommend her going to the hospital? Why didn't you call EMS? (I'm assuming you are in a lifeguarding position here). If she is 11, she cannot consent or refuse treatment. You treating her is fine, since that's more than likely implied consent. However, you letting her go without even telling her legal guardian is a bit reckless. You should of told a parent/guardian and probably called ALS for more a advanced assessment and a proper refusal/AMA by people legally able to consent to such.

Another lifeguard and I did tell her to go seek medical attention if things worsened. That situation itself was the first of its kind I dealt with. Calling EMS didn't occur to me at the time because she said she felt better. If things got worse, I would have called for my supervisor (Which they would then call EMS for us, since we as lifeguards aren't allowed to). I got her vitals and they were within normal range, so I thought that she was just scared.
 

WolfmanHarris

Forum Asst. Chief
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I'm going to set aside the scenario you mentioned, I think you're probably already dissecting it more than is productive. Instead I'd like to touch on embracing a culture that understands human factors, embraces education and strives for a just culture. These ideas are related but not quite the same.

Traditionally in medicine the approach to medical errors was zero tolerance and "blame and shame." The assumption was that the provider was in error. While on the face of it setting such a high standard might seem laudable it created problems. If the assumption is that the provider is always in error than the consequence is that no one attempts to learn from the error and try to fix it.

There is a fantastic video that I've seen a few times in training that provides an overview on human factors in medicine. It tells the story of a healthy woman that died during a routine surgery due to airway complications despite immense experience and competence of the Doctors involved. The pts husband is an expert in human factors in aviation. Related concept: read up on Crew Resource Management.

Once it's accepted that even in the best designed systems, errors will still occur, the system needs to embrace education rather than discipline as their primary motivation. Unless there has been gross negligence, a provider should feel comfortable self-reporting near-misses and medical errors knowing that they will be able to learn and improve.
 
OP
Limes

Limes

Forum Crew Member
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@WolfmanHarris Thank you for your response. I always do the best of my ability, and learn from my mistakes. I just want to minimize error as much as I can.
 

mgr22

Forum Deputy Chief
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Medical mistakes are pretty common, and something like the third- or fourth-leading cause of death. Reducing them involves habits and procedures that seem anal to some -- e.g., checklists, read-backs -- and that aren't always practical.

Math skills help us catch some of those errors -- the kind when a dose just doesn't seem right. Knowing what to expect when we're discussing options or taking direction helps, too. Both are knowledge and experience issues.
 

Underoath87

Forum Asst. Chief
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As a lifeguard with little medical training and tools, the best thing you can do is err on the side of caution and push for anyone with a seemingly legitimate complaint to seek ALS/hospital evaluation.
 

Bullets

Forum Knucklehead
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As a BLS and ALS provider, whenever i have someone refuse it always preface it with " We always recommend seeking care with a Physician, be it through the ER, your personal one, a walk in, ect, You should consult with a doctor."

Also, when dealing with minors, anything beyond a bandaid or ice pack, you need to talk to an adult who is responsible for that kid (or your supervisor) before you let the kid go
 

Martyn

Forum Asst. Chief
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According to the latest guidelines this should have been classed as a drowning. There is no such thing these days as a 'near' drowning. ALS should have been called etc. Lesson learned I hope.
 
OP
Limes

Limes

Forum Crew Member
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According to the latest guidelines this should have been classed as a drowning. There is no such thing these days as a 'near' drowning. ALS should have been called etc. Lesson learned I hope.

Of course. I'm fairly certain this is not a mistake I will make again, both in terms of finding a parent/guardian and recognizing the severity of the symptoms presented.

Also, @Martyn what latest guidelines are you referring to?
 

SpecialK

Forum Captain
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Here's the best advice I can give you, it's the same for every patient;

1. Diagnose what is wrong with them, and on that basis
2. Determine what their healthcare needs are, and on that basis
3. Recommend to the patient the most effective and efficient option to meet them

In the context of somebody "swallowing water" well, if she inhaled a large volume of water to the point where oxygenation was significantly impaired then yes, that is a problem I would recommend she goes to the ED for it however if she just coughed up a bit of water and that's that then she can go on her merry way home as far as I am concerned.

And just because she got "admitted to hospital 2 days later" doesn't really make any difference to be honest. Doesn't mean what happens out of hospital was wrong.

Use your clinical judgement and follow the basic three steps outlined above and you'll be fine. And when in doubt, seek advice.
 
OP
Limes

Limes

Forum Crew Member
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And just because she got "admitted to hospital 2 days later" doesn't really make any difference to be honest. Doesn't mean what happens out of hospital was wrong.

Yeah, I understand. Thanks for your reply, really appreciate it.
 

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