St John apologises for care failings

[enjoynz]

I guess this is one thing always in the back of your mind when going to a call out, where the patient's are showing flu S & S.
Not so good not to pick up the warning signs of meningococcal disease and have the pt die!

If a family had asked if the pt could be taken to hospital anyway, to be checked, I probably would have done so.
(Being a medical call, the family would have paid for the ride, so the ambulance service would not have been out of pocket).
Just the ambo's would look a little silly with the ER staff, if it was just a case of the flu.
Mind you, a pt complaining of a stiff neck, would have got my alarm bells ringing...tough call...what would you have done???

Story as attached:
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10749467

 

[MrBrown]

Brown is no fan of St John, just so we are clear.

In Brown's time in Metro Auckland Brown has had the pleasure of working with some excellent, wonderfully competent and skilled crews and had the distain of working with some absolutely horrendous Ambulance Officers who are lazy, probably barely passed the National Certificate and couldn't differentiate a broken leg and asthma if they tried.

First we should not apologise that West crews were busy. West has West 1/2, 21 and an Oscar or Tango unit out that way. Sick person (code twenty six) is not life threatning, it's a green two job and can wait.

Meningococcial disease is a bugger of a thing, kind of like sepsis, it's easily missed in subtle presentation.

If this lady was so bloody sore she cannot walk then Brown is transporting her, regardless of the fact she is not status 1 and dying she needs to be evaluated further if she is in that much discomfort, it's not really acceptable to leave her at home the crew should have recommened she go to the medical centre or taken her.

Not doing an ECG or SPO2 is just wrong, bloody lazy ambos, Brown knows their type, quick to get back to the station and watch telly or take their break.

 

[Shishkabob]

On one hand, "stiff neck" would have gotten me thinking, too.



But let's be honest here... nothing prevented the family from driving her themselves in the first place, as the did MUCH later to an urgent care clinic type thing.

Seriously, why call 911 (111, 000) for a "sore neck", as they did in the first place?


Plus, the story says that another patient was misdiagnosed by 2 doctors, as well. It's a disease that is fairly often missed. Sad situation, but it happens.

 

[MrBrown]

Seriously, why call 911 (111, 000) for a "sore neck", as they did in the first place?.

Do you really need to ask that? ... how long have you been an ambo again

/taking the piss

We don't have the same rate of ambo-abuse you blokes do but we get our fair share of crap that just doesn't need the ambos here. Good thing is that here people are a bit keener to nick around the corner to the GP/A&E clinic or hospital.

 

[Melclin]

Meh, I barely read the article because I don't trust how the press report these things anyway.

If the chief complaint was being generally unwell like a million other idiots who call us, then I can understand it. I run the meningitis questions on them all anyway, partly in the hopes that I might get to give some ceftriaxone one day, but I can understand people who don't.

If her chief complaint was actually that she had a stiff neck, then one would have to wonder why it wasn't explored a bit more.

The thing that bothers me in these stories is that hindsight is 20/20 and that the end result doesn't make the original decision wrong.

Take a patient I went to a few months ago. 22YOM, tummy ache, all his numbers are good. A few hours of diffuse cramping and mild diarrhoea. Nil signs of peritonitis, absolutely nothing untoward going on. I tell him and his parents, that I can't see any reason I need to take him, I don't suspect anything immediately life threatening, if he gets worse in the next 24 hours, take him to the GP/ED yourselves. They followed my advice and I see them in hospital 2 days later; appendicitis, and everyone is happy. At the time, I had no reason to suspect appendicitis and any other ambo/doctor, would have made the same choice/recommendations. The pt and the family see it that way as well. But you take that same pt, a less reasonable family and wait a little longer (they don't follow your advice to seek a follow up), have his appendix burst and have him end up in ICU for 2 weeks... watch how fast it ends up on the front page of *INSERT S**T NEWSPAPER HERE*, with the headline "Paramedic kills local hero".

It s**ts me because we're not afforded the same grace when it comes to mistakes as doctors. How many doctors have sent people with stiff necks home to die? They did in this case as well. But a paramedic does it and all of a sudden, you have an "ambulance service in crisis". Its pure BS.

 

[MrBrown]

You are correct mate, in the last two years St John treated and/or transported over half a million patients.

There have been maybe 6 to 10 cases of non transport that have been raised either internally via the Clinical Management Group or externally via the media since 2009 where people died and Ambulance was either "maybe" at partial fault in the "well if we took him he might not have died um but we are not sure nobody can say" category.

Did this bloke die because Ambulance did not take him? probably not but Brown faults the crew for not doing even basic things like an ECG or SPO2 or recommending that he go down to the medical centre.

 

[Ramathorn90]

This pt deserved a full assessment and not a lazy one. Not placing this pt on an ecg or spo2 is pure laziness! Obviously it is not easy to say what did or did not occur or what the media simply chose to report; however, hopefully, the family received some sort of instructions on what to do had the situation worsened and not some answer like "she's just got the flu."

 

[the_negro_puppy]

Always do a full assessment and never dissuade or refuse anyone transport to hospital. We call it the C.A.R.E acronym

Cover
Arse
Retain
Employment

Whilst i certainly agree that not everyone who calls for an ambulance needs to go to hospital its a fine line of responsibility and accountability to tread. Ambos don't want to make overcrowded hospital situation worse but we only spend a small amount of time with our patients and use a brief hx and some numbers to formulate a Dx. I always tell patients my findings and always offer a ride to hospital. If they are worried enough to call 000 then hospital should always be an option.

As bad as it sounds. If you transport everyone who calls to hospital you will never find yourself in this situation. Society as a whole is based on shifting responsibility and liability. GPs/Family doctors who call us to transport patients unnecessarily pass on the liability/responsibility to us, who then pass it to the hospital. / end rant