Stressed guys messdd up on some calls.

chickj0434

Forum Lieutenant
107
4
18
Firefighter/emt and working on ambulance.

Ems director just talked to me and my partner about some complaints they had.

First call showed up guy had his bag packed and met us inside the ambulance. Said he had abdominal pain x3 days. Transport was 3 min. Didn't get a BP. Guess his BP was super high and the hospital said he later had stroke .

Second was a covid pneumonia call. Had to wear those suits. Speaking in complete sentences with cough. Said he feels a little bit out of breath. Sat monitor wasn't working so we put him on 4 lpm nasal said he feels better now. Again tried to get a BP best I could but with those suits can't put the scope in my ear.

Hospital called and said his BP was tanking and complained to our director.

So just feeling really discouraged right now. I like to think I do good work in the field but definitely messed up on these two.

Just needed to share
 

Jn1232th

Forum Captain
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28
My suggestion, always get at least one full set of vitals ( my area requires two). Even if means waiting a second to unload patient at ER. And if you can’t hear ( which for me is an issue with the manual cuffs) you can always get a palpated BP.
if unable to at all, document document document and make sure to tell ER you were unable to for x,y,z.
 

NomadicMedic

Pot or Kettle? Unsure.
11,368
5,922
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One set of vital is interesting. Two send of vitals are a comparison. Three sets give you trends.

Not getting vitals is inexcusable. If you’re looking for someone to absolve your guilt, keep looking. Do better.
 

SandpitMedic

Crowd pleaser
2,258
1,208
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Always document at least two accurate sets of VS. It's okay to take a few seconds to get them... think of what taking a few extra minutes to get them could have meant for you or perhaps your patients.
 

MMiz

I put the M in EMTLife
Community Leader
5,297
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Of all of the ways to mess up in EMS, it could have been far worse!

Make sure you get a couple sets of vitals, that was a non-negotiable when I actively worked in EMS. As @Jn1232th suggested, you can always palpate a blood pressure if you need to.

I found sometimes I messed up on the most mundane parts of working in EMS. Making sure I had all of my equipment before leaving calls, disconnecting patients from O2 before taking them out of the rig, etc. On of my ALS colleagues told me to slow down and be more methodical about my processes.

You're going to make mistakes, that's part of working in any career. Learn, grow, and move on.
 
OP
C

chickj0434

Forum Lieutenant
107
4
18
Of all of the ways to mess up in EMS, it could have been far worse!

Make sure you get a couple sets of vitals, that was a non-negotiable when I actively worked in EMS. As @Jn1232th suggested, you can always palpate a blood pressure if you need to.

I found sometimes I messed up on the most mundane parts of working in EMS. Making sure I had all of my equipment before leaving calls, disconnecting patients from O2 before taking them out of the rig, etc. On of my ALS colleagues told me to slow down and be more methodical about my processes.

You're going to make mistakes, that's part of working in any career. Learn, grow, and move on.
Thank you. Definitely going to make sure it doesn't happen again. Going to slow down and bit and grab a set from now on.
 

Peak

ED/Prehospital Registered Nurse
968
559
93
Not getting a BP isn’t the end of the world. There are many ways to document perfusion status beyond a BP. Heads up, if you ever get an LVAD patient there is a really good chance you won’t be able to get a BP in the field.

I don’t reduce my ED triage based on the lack of an EMS vital sign. Almost all of my ambulance patients arrive without a temp. I don’t hold a fever against our medics. Likewise we get a lot of patients who have a one or two minute transport time and don’t get a full set of vitals, I’d rather have that crew available for calls than delay transport for a BP when they are otherwise well perfused.

It is important to document limitations in your report. I’ve given a lot of meds and interventions without a BP, pulse ox, or other vitals when the clinical benefit far outweighs the most risk. We do not have unlimited resources in the field or in the back of the bus. It often takes us 10 or 15 minutes (if not longer) to get an accurate temp or BP in the ED.

I did get a complaint once from the transporting agency (way up in the sticks) for not getting a BP before giving fluids or zofran to a patient who had a negative history, weak threads pulses, nausea, and delayed cap refill. The patient had clinical improvement during my care while we awaited transport, and our manual cuff had been left on a code patient (we didn’t realize this and were dispatched before we got back to the station, and our monitor malfunctioned and wouldn’t take a BP). I documented my clinical reasoning in my note, but sure enough the transporting agency complained. Our medical director couldn’t have cared less, and dismissed the complaint.
 

Achilles

Forum Moron
1,394
11
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One set of vital is interesting. Two send of vitals are a comparison. Three sets give you trends.

Not getting vitals is inexcusable. If you’re looking for someone to absolve your guilt, keep looking. Do better.
there are instances when you’re unable to get vitals, so to say it’s inexcusable to a bit far fetched.
 

akflightmedic

Forum Deputy Chief
3,611
2,165
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One thing you said which caught my eye and you attempted to justify one of your failures is "the hospital is 3 minutes away".

Ok, so the guy met you outside with a positive Samosonite sign (I get it, this happens). However, them ambulating to your truck and the hospital being minutes away is no excuse to not assess. Yes, it is frustrating cause the call is BS, yes he could have walked there faster than it took for you to get there, yes this is a waste of your time and generated another report....we all understand that.

In the same breath, you are new and need a lot of experience and the only way to get that is to practice. So the guy climbs in your truck...depending on your department policy you can have anywhere from 10 minutes to as long as you need to sit right there and not spin a wheel. Take that time and do an assessment. What if you found a condition which the hospital 3 minutes away was not best destination for? Instead the patient now needs the hospital 10 minutes away, or greater. Set a 10 minute clock for yourself, do systems assessment, take vitals, listen to lung sounds. Do whatever you can in a reasonable time and then transport the patient.

Keep in mind, and I have said this before....just because YOUR clock stops in 3 minutes, that is NOT the end of the clock for the patient. Depending on how busy that facility is, once you unload the pt and give a quick verbal report, that patient could very easily have 15 minute, one hour, or even longer wait times before seeing a provider. Yeh that sounds crazy, but it can and does happen. So when you transport a patient and think to yourself the facility is only 3 minutes away, factor in your unloading/handover time, then also throw in an extra 15-30 minutes before the patient sees a provider, and then ask yourself...should I have done an on scene assessment or did I do the right thing by driving three minutes and dumping?
 

mgr22

Forum Deputy Chief
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470
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To the OP, in addition to the advice you've already gotten, maybe begin your assessment by noting the pulse "character" -- i.e., fast or slow, weak or strong, regular or irregular. It's not a replacement for documenting full sets of vitals, but it'll help you form an early impression without equipment. You can use a similar approach for respirations and mental status, and usually evaluate all three simultaneously during the first 30 seconds of patient contact.
 

Jim37F

Forum Deputy Chief
3,714
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If you are on an ambulance you typically have two trained providers. When you make patient contact (whether that's after traipsing through an apt building or SNF, or they met you on the curb with their luggage) is that while one person (usually the attendant) starts talking to the patient, you know A&O level, Chief Complaint, basic SAMPLE/OPQRST, the other guy/gal is getting the first set of vitals at that time.

So now you have your first set of vitals all before you ever turn a wheel (even if the patient met you outside). If by the time you finished you're initial assessment on scene, loaded the patient up on the gurney, wheeled them to the ambulance, go ahead and get that second set of vitals inside before driving off.

We've all heard "Critical patients reasses vitals ever 5 min, Stable every 15". Thats the max recommended intervals, if the hospital is 10 min drive, there's absolutely nothing wrong with taking another set of vitals on your nice stable patient at the 5 minute mark.

If your "Met you at the curb and climbed into the back of the ambulance as soon as you pull up patient" is only a couple minutes away from thr hospital (wouldn't be the first time I've picked someone up while we're within sight of the ER entrance....) you do that "Assessment and Vitals before leaving the scene", then 2 or 3 minutes later parking at the ER, take a second set before you actually pull the gurney out/walk the patient out.

And voila, 2 sets of vitals on a 2 min transport
 

medichopeful

Flight nurse, ground paramedic
1,845
232
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First call showed up guy had his bag packed and met us inside the ambulance. Said he had abdominal pain x3 days. Transport was 3 min. Didn't get a BP. Guess his BP was super high and the hospital said he later had stroke .

Generally speaking, distance to the hospital is not a good way to decide what treatments or assessments to do or not do. There are, of course, exceptions. However, take a few minutes on scene to actually assess your patient. You'll be surprised by what you might catch.

Second was a covid pneumonia call. Had to wear those suits. Speaking in complete sentences with cough. Said he feels a little bit out of breath. Sat monitor wasn't working so we put him on 4 lpm nasal said he feels better now. Again tried to get a BP best I could but with those suits can't put the scope in my ear.

Hospital called and said his BP was tanking and complained to our director.
Sometimes patients get sicker after we drop them off. Sometimes they just crash out of the blue. I would learn to take a palpated BP for when you run into this again in the future.

So just feeling really discouraged right now. I like to think I do good work in the field but definitely messed up on these two.
We all make mistakes, it's called the practice of medicine for a reason. Learn from these and move on.
 

johnrsemt

Forum Deputy Chief
1,400
192
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Always wait a minute (or 5) at the scene: either in the ambulance or in the room and get a set of vital signs before you start transporting.

I was working with an experienced EMT-B, but he was in a hurry and "it is my patient so we will do what I say" so we left a hospital floor, and started transporting and he did the 1st set of VS. Then he asked me if he could put the patient on the monitor because the HR wasn't making sense to him. I told him yes, and pulled off of the freeway at the exit and stopped, and got into the back of the ambulance as my partner handed me the strip. 60 year male on the way to Rehab from a week in the hospital after a stroke was in SVT with a HR of 266. Nurse on the floor didn't believe the VS machine so told us made up vital signs. 16 years later that EMT-B still gets a good set of vitals before he starts transporting.
 

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