Nurses Accused Of Negligence In Man's Death

akflightmedic said:
Wow...interesting read.

I have a question for people who have regularly handed off to flight crews...if you give report and they take over care, either on scene, in your ambulance, whatever...do you continue to document what they are doing just like the medic did in this case?

If you do, should you? Is it wise to do so, especially when they are functioning at a level above you and it may lead you to document incorrect findings?

Example: When I was on the ground, once the flight team climbed in the truck and received a verbal report and assumed care, that is where my report ended...something along the lines of "At 0130, flight team received verbal report and assumed all patient care."

Was I wrong in doing that? Should I keep documenting? Obviously a caveat may be if they start doing gross misconduct, but routinely should I even mention what they are doing just because I can still see it?
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This is an excellent question, and one I need to put to my agency. I had always assumed the same as you, "Report given, pt turned over to flight crew, Nurse Smith, for packaging and transport."

When I was a BLS provider and a non-RN ALS provider, I wouldn't have known the names for some of the things they did. And what a nightmare it would be if I documented one dose of a drug, and they actually gave another. Or we both documented vital signs, put the same time on our paperwork, and had significantly different information.

I think that answers my question for me. ONE patient care record. ONE timeline. If I feel the need to document, I can do it in an incident report, which seems like it was more what Paramedic Emch was documenting, not a patient care report.
 
I read the link 3 times to make sure I did not misinterpret (and it is still possible) but what I gathered from the medic's report is she did indeed document in her PCR but she also followed up with an incident report...which is what made me bring up the question.

At what point do you stop documenting?

I never really gave it much thought and in all honesty, when I give report, even if they are still on scene, I have officially handed over care and all interventions and vitals from then on out are their responsibility to document. Even if they ask me to hand them something, there is no need for me to make a notation of that.

Now in the event that they ask me to do a procedure, of course I will make note of it, but I currently do not think I need to document any further.

I do recall a discussion about this many years ago in relation to picking up specialty teams from say an airport or LZ and bringing them to a hospital so they could pick up a patient and then transporting them back to the LZ.

For a while, some people would document because we "had a pt" and others would simply note patients name, DOB, DX and say specialty team XYZ with RN... and Medic...on board and handling all patient care needs.

I think this is a similar situation.
 
akflightmedic said:
I read the link 3 times to make sure I did not misinterpret (and it is still possible) but what I gathered from the medic's report is she did indeed document in her PCR but she also followed up with an incident report...which is what made me bring up the question.

At what point do you stop documenting?

I never really gave it much thought and in all honesty, when I give report, even if they are still on scene, I have officially handed over care and all interventions and vitals from then on out are their responsibility to document. Even if they ask me to hand them something, there is no need for me to make a notation of that.

Now in the event that they ask me to do a procedure, of course I will make note of it, but I currently do not think I need to document any further.

I do recall a discussion about this many years ago in relation to picking up specialty teams from say an airport or LZ and bringing them to a hospital so they could pick up a patient and then transporting them back to the LZ.

For a while, some people would document because we "had a pt" and others would simply note patients name, DOB, DX and say specialty team XYZ with RN... and Medic...on board and handling all patient care needs.

I think this is a similar situation.
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I had forgotten about the team runs...yeah, when there's another team responsible for patient care, they get to document the patient care.

Incident reports are a different deal, though. I have worked with people who wrote incident reports for just about everything, and I've had employers who encouraged that practice. Maybe that's where the dramatic part of her story came from, the incident report.
 
I rarely (read once) hand off to flight crews at my current job. However, occasionally we pick up crews with patients and transport them from the airport to the hospital. I'm still required to write a PCR and have two sets of vitals, so yes I end up double documenting.

To prevent issues when they take vitals, I ask what they were, so we have the same numbers. For my narrative I generally just write who the patient is, where they are coming from, why they are being transferred and then something along the lines of "treatment and assessment done by Acme Air Ambulance crew".
 
After doing what you did a few times....I actually started riding up front with my partner. The team has all equipment needed, a much higher level of education/experience and they have absolutely no need for me to ask or interfere in anything. Therefore, I would simply document pt transported from here to there, no patient care or assessment performed by Medic 5, ALL pt care and assessment performed by ACME R' US.

Yes, it is a good time to learn and ask questions if they are willing to do so, but most times I was just in the way...and quite frankly I had zero interest in neonates which was a lot of the transports I was on.
 
Sorry to digress a bit but am I correct in reading that nothing was found on autopsy to suggest any medical cause behind the accident? Any thoughts on why he would veer off the road in such a manner? Did he really just have a severe headache?
 
When you give report and hand off care at a hospital do you continue to document everything the hospital does? The same applies to turning over care to a Flight crew or anytime you are turning over care to an equal or higher level of care. Once you have given report and they have assumed care you don't need to continue documenting. You can still assist but now it is whoever has assumed care's responsibility to document accurately. I have assisted at hospitals to help them out in certain situations but I always leave the documentation up to them as it is their legal responsibility. I think you are setting yourself up for trouble if you continue to document when it is not your responsibility. Like someone said though an incident report is a whole other ball game.

On this person there was nothing found on autopsy in his head but that doesn't mean that there was nothing wrong with him. He could have had severe migraines, meningitis, cerebral vasoconstriction or spasms which can cause TIA's without findings on autopsy (since I doubt this coroner even did any labs. Seems like he thought he found a cause of death, made assumptions and didn't look any further. :wacko: )
 
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When I picked up flight teams, I'd essentially document some very basic stuff about the patient: How transported, how the patient was packaged, any vents/lines/other equipment in place, two sets of vitals (whatever the transport team has) and usually concluded with something along the line of "all patient care provided by and under direction of the (insert transport team)." If I have to go hands-on or perform some delegated task within my scope, (such as providing CPR) that would be documented as "(task) performed by (me) under direction of..." and all that would be before the "all care provided or under direction of..." line.

In any event, from what I read from the final report, it seemed obvious to me that the flight crew did what they thought was best for that patient. The internal injuries could not plausibly come from making a small incision at the midline of the body right at the cricothyroid membrane. I think that this patient had non-survivable injuries.
 
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Aussieaid said:
On this person there was nothing found on autopsy in his head but that doesn't mean that there was nothing wrong with him. He could have had severe migraines, meningitis, cerebral vasoconstriction or spasms which can cause TIA's without findings on autopsy (since I doubt this coroner even did any labs. Seems like he thought he found a cause of death, made assumptions and didn't look any further. :wacko: )
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That's what I'm getting. Maybe there was something else.... I'm not sure if something else was discovered and they didn't find it relevant to this investigation and therefore didn't include it, or if they truly didn't find any underlying cause.

Kinda sad... I mean what if it's something potentially heritable? If I were this man's family member I would want to know what would cause him to do such a thing in the first place... even if the injury was what actually killed him.
 
akflightmedic said:
After doing what you did a few times....I actually started riding up front with my partner. The team has all equipment needed, a much higher level of education/experience and they have absolutely no need for me to ask or interfere in anything. Therefore, I would simply document pt transported from here to there, no patient care or assessment performed by Medic 5, ALL pt care and assessment performed by ACME R' US.

Yes, it is a good time to learn and ask questions if they are willing to do so, but most times I was just in the way...and quite frankly I had zero interest in neonates which was a lot of the transports I was on.
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Company policy is that if there is a patient in the back, one of us has to be in the back. On flight crew transports the EMT can be in the back instead of the Paramedic.
 
Aidey said:
Company policy is that if there is a patient in the back, one of us has to be in the back. On flight crew transports the EMT can be in the back instead of the Paramedic.
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I don't think I've ever worked for a company or agency that didn't have a similar policy. The ambulance crew knows where everything is... the transport team doesn't... it's not their ambulance! I got familiar with several different flight teams from several different agencies and companies. They also got familiar with our equipment, but that didn't mean that I didn't have to be in the back with them. When you know where all the ports, plugs, switches, and other supplies are, things go much more smoothly than if you have to find them without help.
 
First, an ambulance is an ambulance...the majority are very similar in design and I could jump in any unit and be quite comfortable in less than a minute.

However, most specialty teams operate out of THEIR equipment bags. It is their patient, they know their equipment and that is what they use. Realistically, the only two items they ever used of ours was oxygen and suction...occasionally they would dim a light or turn another one on.

If they can not manage that on their own, then there are serious issues.

Also, most teams have everything needed for the transport taken care of, hooked up, etc prior to them leaving the room the patient is in. They typically need nothing else.

In addition to that, if any emergency occurred, we would stop as they are quite capable of handling it, especially the NICU teams. There would be no turning around, no rushing to get this or that done, they are the experts and they are prepared.

Just sayin...
 
Very interesting read indeed.... it was nice to see such a thorough investigation done.

One thing I was kinda surprised to see not mentioned was the ruling out of a tension pneumothorax. With the MOI, assessment findings, inability to ventilate and absent breath sounds, a needle decompression wouldn't have hurt. That was just a thought while reading.

Sounds like they were very skilled in their performance and had tons of experience. The AMR Paramedic was disgraceful in her testimony.
 
18G said:
One thing I was kinda surprised to see not mentioned was the ruling out of a tension pneumothorax. With the MOI, assessment findings, inability to ventilate and absent breath sounds, a needle decompression wouldn't have hurt. That was just a thought while reading.
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Although its always possible, there was no thoracic injury they could see that would have caused a pneumothorax and the patient wasn't of the correct bodytype to suspect spontaneous pneumothorax (6ft4in, 280lbs). Honestly, nightmare case all around, I imagine they were all freaking out a little as he slowly went into respiratory failure and they didn't know why. A needle decompression might not have hurt the patient, but remember they are getting chewed out for doing what looks to be a completely justified surgical airway. Of course, I don't advocate for treating based on possible legal liability so long as you are following protocol and sound medical judgement.
 
True, true.... I was just thinking with the very poor compliance, the inability to achieve chest rise, and no audible lung sounds combined with the MOI, a bilateral tension pneumo may have been considered as a possible cause. I think the flight crew knew what was going on and it was just one of those cases that the patient died despite everyone's best efforts.
 
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