Stroke patient dies...at shift turnover

[downunderwunda]

Do your hospitals really make them wait 30 minutes for a CT?

Depends on what else is in t the same time.

Priority is what comes to the fore. Our transports can be up to & in excess of 1 hour, we call ahead & in most cases, the ER will have made arrangments for radiology, however, I have arrived having done that to see the patient delayed because of a major multi system trauma, who takes precedence when there is only 1 CT available? A 65 YOM with little chance of recovery as he was coning, or a 24 YOM with excellent chances of complete rehabilitation?

As a side note, we did not know he was coning at the time, it was purly on CT it was found, we called it as a CVA based on families reports to us as he was GCS 3 while he was in our care.

 

[djmedic913]

I understand that there are different levels down under, but I am curious, to what US level would you most closes compare in reference to training and protocols?

Do you do all of your pre hospital medical assessments based on marketing principals?

I have to ask, Who is marketing the golden hour? Was the golden hour invented by the trauma surgeons to help increase their business and income. A marketing principle? And I always thought is for increase in trauma patient survival rates...guess I was wrong.

Where does the 4 minutes fit now?

what happens at the hospital is not our responsibility or concern for the most part. Especially since last time I checked, Doctors are supposed a higher level of care and training than EMS. So what decisions they make for their patients we can not control. Ultimately, our job is to get the patient to the hospital/Dr and hopefully better than we found them (not always possible, I know). The patient does not need to be in the back of our ambulance, but in the hospital with a doctor. Even with all we are now able to do in the back of an ambulance we treat symptoms and never cure anyone. Our jobs are still transportation. As much as we all want to think are jobs are more involved, alas they truly are not. It is our job to transport a patient as safe and fast as possible (this does not always mean driving hot to hospital since driving lights is extremely dangerous).

Back to the original thread for a quick minute. with the new information from the last link, what that medic did was appalling. the articles make no mention of whether the attendant also left to do crew change or not. If he did NOT, I don't understand why he is in trouble as well.

Whether those 4 minutes contributed to the patient's death is unimportant. What the driver did was unethical, immoral, negligent, abandonment, etc. There is NO excuse or reason for him to do what he did. The idea of family emergency was brought up, and if that was the case or something as horrible, you call your dispatch and get something up. you don't just leave a patient no matter how critical or stable the patient is.

 

[ffemt8978]

Play nice, everyone.

 

[Bloom-IUEMT]

downundawunda:
...further investigation of the events demonstrates you were wrong and all this hairspliting is going to accomplish is that it's going to make you look self-righteous in the eyes of your peers.
I know a lot about CVAs, more than most. And do not think by quoting misplaced statistics that you have proven your point. The men had no excuse for what they did I don't care what the survival rate for hemorrhagic strokes are, I don't care how long the CT wait is. They messed up. THey messed up because they wanted to go home.

90% survival rate huh? What about the 10%? Do they not deserve to rushed to hospital or would your frank honesty tell them "We arent going to rush it mate! THere is a 90% chance your gonna die anyway."
You are wrong and no matter what you say you will continue to be wrong.
Are you trying to give US an ethics lesson? Are you trying to simply tell us that we shouldn't judge until all the facts are in? Thanks dad, I learned that a looooong time ago. But as I have alluded to, in this case there could possibly be maybe one reason to clock out and leave a critical patient in the back of the ambulance even that reason is morally dubious.
That is way we made comments about the medic making the wrong choice. THe argument isn't about whether they were at fault for his death; the argument was whether he should have clocked out and regardless of the outcome he was wrong.
Am I to understand that because you have extended transport times that an extra 4 minutes to stop and have a coke is negligible? Some reasoning skills.

Don't misunderstand, everyone here understands to need to give medics and FF the benefit of the doubt when a sensationalized medic-done-bad article comes out but I believe I have a consensus here when I say this is one of those times there is not much doubt to be raised for this English medic. Furthermore, am I to understand that because a patient will have wait several minutes for a CT that an extra 4 minutes is meaningless? Shouldn't that be even more reason to rush the cardiac/cva victim to the hospital? At some point sir someone has to take accountibility and responsibility of getting the patient to treatment expeditiously.
My condolences to his family, and my condolences to your future patients. You can tell your next cardiac patient your 4 minutes is negligible theory.

 

[downunderwunda]

I understand that there are different levels down under, but I am curious, to what US level would you most closes compare in reference to training and protocols?QUOTE]

Our base level of training is between your EMT-I & EMT-P.

I have to ask, Who is marketing the golden hour? Was the golden hour invented by the trauma surgeons to help increase their business and income. A marketing principle? And I always thought is for increase in trauma patient survival rates...guess I was wrong.

http://www.bryanbledsoe.com/data/pdf/mags/Golden Hour.pdf

That should answer that question

what happens at the hospital is not our responsibility or concern for the most part. Especially since last time I checked, Doctors are supposed a higher level of care and training than EMS. So what decisions they make for their patients we can not control. Ultimately, our job is to get the patient to the hospital/Dr and hopefully better than we found them (not always possible, I know). The patient does not need to be in the back of our ambulance, but in the hospital with a doctor. Even with all we are now able to do in the back of an ambulance we treat symptoms and never cure anyone. Our jobs are still transportation. As much as we all want to think are jobs are more involved, alas they truly are not. It is our job to transport a patient as safe and fast as possible (this does not always mean driving hot to hospital since driving lights is extremely dangerous).

Where have i suggested that we compromise patient care? I note the reference to my arrogance has been removed. My patients get the best care available. They get timely transport to hospital, the necesarry drugs, how is that 1. arrogant & 2 compromising patient care? At no point have i suggested otherwise.

Whether those 4 minutes contributed to the patient's death is unimportant. What the driver did was unethical, immoral, negligent, abandonment, etc. There is NO excuse or reason for him to do what he did. The idea of family emergency was brought up, and if that was the case or something as horrible, you call your dispatch and get something up. you don't just leave a patient no matter how critical or stable the patient is.[/

Well said.

 

[Bloom-IUEMT]

downunda:
the article you posted was interesting but I believe its referring to trauma pts not medical patients. Also, he is doubting the exact time the "Golden" should apply to (2 hours? 30 minutes?). As we are aware, when dealing with CVAs and AMI there definitely is a Golden Something.

 

[downunderwunda]

downunda:
the article you posted was interesting but I believe its referring to trauma pts not medical patients. Also, he is doubting the exact time the "Golden" should apply to (2 hours? 30 minutes?). As we are aware, when dealing with CVAs and AMI there definitely is a Golden Something.

I made a veiled reference to the fact you probably believed in it, I did not say that it was relative to medical emergencies.

 

[OzAmbo]

For a stroke patient you should always run code 3 or emergent. Doesn't your jurisdiction do that? Every minute counts when your dealing with infarctions.

No, my jursdiction doesn't do that. In fact id argue that a "jursdiction" that has a system where speed of transport = time saved is negligent and unduly endangerign the public.

I certainly wont bring a CVA in Sig1, there is not point to gain a minute or two that wont change the outcome.

Bloom IUEMT, you had some great info into this, but your starting to come off a bit angry and a tad arrogant. This isn't a lecture in ethics, its a description of downunda's reality, and the reality is that in his situation, mine and many others, 4 minutes is not going to change a thing in the case of a CVA, especially given the amount of variables outside of our control. It doesn't mean we are not time conscious during the length of a case, or condone wasting time by changing drivers or having a coke (i could go a coke now actually) but in downundas reality and in mine, 240 seconds is not going to really alter the outcome. Frequently i pick up patients who started exhibiting AMI or CVA signs hours before hand - I dont condone changing drivers in the middle of a case but i certainly wont run emergent for the sake of making up time, i feel that is an unjustifiable risk to the public for the sake of gaining a couple of minutes.

 

[OzAmbo]

Do your hospitals really make them wait 30 minutes for a CT?

Naw, not intentionally. But when there is only 1 CT for several hundred kilometers its quite possible to not be the priority for scanning

 

[Bloom-IUEMT]

Well in our jurisdiction, system,county, district, whatever you want to call it we run stroke pts in Code 3 unless the pt began exhibiting sx > 2 hours prior.
I dont know code 3 means for other folks but for us it doesn't mean running 60mph through a 30 mph zone and running red lights. When a pt is having AMI or CVA we run code 3 and drive with due regard.
Again, once again, and again: 4 minutes probably doesn't make a big difference but its still a difference and I simply want the best possible outcome for the patient. That outcome does not come about by taking the stance "a few minutes doesn't matter."

But idk, I'm a newbie and maybe I'll think differently in the future. Maybe I'm just a idealist.

 

[downunderwunda]

downundawunda:
...further investigation of the events demonstrates you were wrong and all this hairspliting is going to accomplish is that it's going to make you look self-righteous in the eyes of your peers.

On the contrary, it has shown the lack of understanding that too many in EMS have

I know a lot about CVAs, more than most. And do not think by quoting misplaced statistics that you have proven your point. The men had no excuse for what they did I don't care what the survival rate for hemorrhagic strokes are, I don't care how long the CT wait is. They messed up. THey messed up because they wanted to go home.

Um, read my last post, further evidence has come to light.

90% survival rate huh? What about the 10%? Do they not deserve to rushed to hospital or would your frank honesty tell them "We arent going to rush it mate! THere is a 90% chance your gonna die anyway."

I have continually said in my posts that patients deserve the best care, & please quote properly, i said greater than 90% I also believe at one point that I did state that many have severe impairments (i believe i used different terminology) even if this happens in a hospital environment with rehab.

You are wrong and no matter what you say you will continue to be wrong

.

In your opinion

Are you trying to give US an ethics lesson? Are you trying to simply tell us that we shouldn't judge until all the facts are in? Thanks dad, I learned that a looooong time ago.

No you didnt, you judged them guilty from the outset.

But as I have alluded to, in this case there could possibly be maybe one reason to clock out and leave a critical patient in the back of the ambulance even that reason is morally dubious.

If that was the case, why not have a crew meet them en route?

That is way we made comments about the medic making the wrong choice. THe argument isn't about whether they were at fault for his death; the argument was whether he should have clocked out and regardless of the outcome he was wrong.

Am I to understand you have NEVER made a bad decision? Yes this was a really really bad decision. However djmedic913 made 4 minutes an issue originally. I simply responded to those comments. You decided to run with it.

Am I to understand that because you have extended transport times that an extra 4 minutes to stop and have a coke is negligible? Some reasoning skills.

Please reread what OzAmbo said, now look at your question again I dont need to respond to this.

It doesn't mean we are not time conscious during the length of a case, or condone wasting time by changing drivers or having a coke (i could go a coke now actually) but in downundas reality and in mine, 240 seconds is not going to really alter the outcome.

Don't misunderstand, everyone here understands to need to give medics and FF the benefit of the doubt when a sensationalized medic-done-bad article comes out but I believe I have a consensus here when I say this is one of those times there is not much doubt to be raised for this English medic.

Then why did you not give them the benefit of the doubt in the first instance?

Furthermore, am I to understand that because a patient will have wait several minutes for a CT that an extra 4 minutes is meaningless?

Umm, who said that? Both OzAmbo & myself have both said that we do not condone wasting time on scene, I know I have never said it, in fact I know I said we should do the opposite & aviod wasting time on scene.

Shouldn't that be even more reason to rush the cardiac/cva victim to the hospital?

Pre hospital medicine is moving forward, Evidence Based Practice has proven that early reperfusion of the myocardium is vital to ensure an positive outcome for the patient. While I do not waste time on scene, I will usually be there 10-15 minutes allowing for some drug administration, that is proven to assist with said reperfusion, gaining IV access, allowing my partner time to organise egress, & administration of IV morphine.

Answer me this, what is better for the patient, to have 2 EMT's who have the knowledge of what is happening, what to do that remain calm, drive appropriatly to the hospital without further causing tension to the patient, or one who will rush rush rush causing further panic & increasing myocardial excitment?

At some point sir someone has to take accountibility and responsibility of getting the patient to treatment expeditiously.

I am accountable to my patients, who are also members of the community in which I live. I am responsible for my action to my employer & regulatory body. We have targets which, with the odd excedption due to access or patient size issues, that are met.

My condolences to his family, and my condolences to your future patients.

You are basing this judgment on what? Have you ever seen me treat a patient? Have you seen me control a scene? You claim to have more knowledge than most on CVA's yet you are ignorant to other opinions & reasoning that differs from yours in any way.

You can tell your next cardiac patient your 4 minutes is negligible theory

My next cardiac patient will receive the best treatment I can offer, as all have done in the past. I look forward to the completion of thrombolysis trials & the roll out of thrombolytics to allow us greater lattitude & transport options.

My advice to you is read, reread & learn from what people are saying. You may one day make a good EMT. Face reality, stop being abusive to those who may have a greater knowledge than you do.

 

[Bloom-IUEMT]

I have continually said in my posts that patients deserve the best care, & please quote properly, i said greater than 90% I also believe at one point that I did state that many have severe impairments (i believe i used different terminology) even if this happens in a hospital environment with rehab.

Excuse me, greater than 90%! The only percent that would make a difference is 100%. Then we can say transport time doesn't matter.

In your opinion

No, follow up on the story please. The medic clocked out because he wanted to go home...its in black and white. You wanted to defend his actions and you were wrong. Its ok, it doesn't make you bad person, it doesn't make me a good EMT. Its noble of you to want to stand up for colleagues but I think you're aware that just because we have the same job doesn't mean I hold to a lower ethical standard. Defending someone based on the fact you wear the same uniform is what we call the "good ole boy system" here in America. Its abhorrent.

No you didnt, you judged them guilty from the outset.

What could possibly be this man's reason for clocking out during a transport? Maybe if just found out his wife/son/daughter was dying and that moment and he needed to be with them would warrant leaving the pt , but even then its unethical.

Yeah it really sounds like I am nailing them to a cross doesn't it

If that was the case, why not have a crew meet them en route?

Would have made more sense.

Am I to understand you have NEVER made a bad decision? Yes this was a really really bad decision. However djmedic913 made 4 minutes an issue originally. I simply responded to those comments. You decided to run with it.

There is a difference between making a bad decision during a tense moment that turns out to wrong than doing something unethical because you feel you are entitled.

Then why did you not give them the benefit of the doubt in the first instance?

See above

Umm, who said that? Both OzAmbo & myself have both said that we do not condone wasting time on scene, I know I have never said it, in fact I know I said we should do the opposite & aviod wasting time on scene.

Them why make excuses for the English Medic if you don't condone it?

Pre hospital medicine is moving forward, Evidence Based Practice has proven that early reperfusion of the myocardium is vital to ensure an positive outcome for the patient. While I do not waste time on scene, I will usually be there 10-15 minutes allowing for some drug administration, that is proven to assist with said reperfusion, gaining IV access, allowing my partner time to organise egress, & administration of IV morphine.

Amen. I don't consider giving IV cardiac drugs wasting time so I'm not sure why you are even bringing this up.

Answer me this, what is better for the patient, to have 2 EMT's who have the knowledge of what is happening, what to do that remain calm, drive appropriatly to the hospital without further causing tension to the patient, or one who will rush rush rush causing further panic & increasing myocardial excitment?

Just because you're driving code 3 doesn't mean your being reckless, I can drive appropriately to the hospital and get there fast on code 3. believe me when I say at our EMS safe driving is beaten into our heads and engraved in our skin.

You are basing this judgment on what? Have you ever seen me treat a patient? Have you seen me control a scene? You claim to have more knowledge than most on CVA's yet you are ignorant to other opinions & reasoning that differs from yours in any way.

I'm ignorant because why? I don't agree with you? I beg to differ. I'm pretty sure you said if the patient was having a hemorrhagic CVA as oppose to ischemic CVA then the 4 minute hold over wouldn't be as bad. Regardless if it was ICVA or HCVA the medic did not know and had a duty to transport immediately.

My next cardiac patient will receive the best treatment I can offer, as all have done in the past. I look forward to the completion of thrombolysis trials & the roll out of thrombolytics to allow us greater lattitude & transport options.

My advice to you is read, reread & learn from what people are saying. You may one day make a good EMT. Face reality, stop being abusive to those who may have a greater knowledge than you do.

I see, because I am new and you have many years experience I can't argue patient care ethics or about CVA patients. Although i am new to EMS a big problem I can see a few paramedics think they can do no wrong, not a good way to grow as a person or a professional.
I am agreeing that a few minutes doesn't make a big difference---it still makes A difference and that difference will have to experienced by the patient, not you. We both agree that we want the best possible outcome for our patients so why do you disagree that a few minutes of infarction matters to the patient. It makes a measurable difference and if I can save some tissue by running emergent, then will....of course with regard to the safety of me, my pt. and the general public.
I have no doubt you are an excellent medic and your patients get the best care you can give them...and....well.....thats it...thought I'd end with a compliment.

 

[ffemt8978]

Okay, I don't see anything good coming from this little

so the thread is now