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You may be being a little sensitive. Arctic is a nice guy, has a lot of experience as a paramedic, and has likely been in similar situations many times in the past. We get a lot of people here who try and deceive us, for whatever reason. It could, and perhaps should be talked about. The problem is that, in the current model, there's just so little time. The training is so short, and basically inadequate, and there's so much material to cover that some things have to suffer. Unfortunately, as you've just seen, the provider is often left to work things out for themselves when they hit the road. I don't want to go on a rant about educational standards, as I think it will end up hijacking your thread. Then I think both you and your friend have just learned a very valuable lesson. Human beings are fallible, and every level of provider makes mistakes. Unfortunately, in health care, the patients are often unaware of the mistakes that have been made, and health care providers often collude to cover up treatment errors, and rarely inform the patient when a mistake has been made. It is very hard to be the person who speaks up in this situation, but, ultimately someone has to. I like to hope that in EMS, we are slowly moving towards an environment where we can identify errors, and report them, without having as much fear of punitive action. Obviously poor providers need to be counselled and coached, but hopefully we can identify why errors were made, and see if there's anything we can do to prevent them from happening again. I like this. [edit: nuked some unnecessary white space].

I'm sensing a bit of hostility from Arctickat. In response, I'd like to note that I can be comfortably certain that it was VFib without being there, based on several factors, which include: 1) My confidence in the ECG rhythm interpretation skills provided by the EMT who was there. 2) The documentation of the call, which says Vfib was on the monitor at time of Tx 3) My own interpretation of the code summary provided, event markers included (a handy feature, I might add) and 4) My own experience studying ECG's, and the perception that V-Fib is an easy rhythm to distinguish from bradycardia and PEA. If you disagree that it's an easy differential to make, then your concerns should lie elsewhere. I trust this isn't the case.... So no. I am not "screwing around" with you. And please, try not to sidetrack my discussion, as the purpose was not to discuss treatment methods or ACLS, but to seek advice for the various ethical and moral questions surrounding disagreements made in a public setting. Thank you for your participation. I regret to inform you that I did not alter the medications given, nor the timing of the call (though I did round the numbers, for the sake of making the math easier). There were many faults made, but unfortunately some medic's do not listen to reason in high-stress situations. To make matters worse, the EMT was still fairly new, and rather shy as well. I'm really glad that the question resonates with you, as it's one that has been on my mind for a while. As you realized, the point of the scenario was simply to paint a black-and-white picture for which to give the question context. Obviously, it's not all that uncommon of a problem, though sometimes the results can differ drastically. I'm lucky in that I don't often work with bad medics, however there's always the occasional casual or burnt-out medic that gives the rest of us a bad name. I think this question is something that could almost benefit from being brought up in EMT school, during discussion about ethics and moral obligations. As a student, I always just assumed paramedics knew everything. An open mind is the most essential element of progress.

Yeah, there are quite a few things wrong with this scenario as presented... Only three shocks in 30 mins for continuing Vfib? Only one round of Epi in the same amount of time? A decision to transport yet discontinue meds? (Though perhaps with a 30 minute transport, after a 30 minute effort where Epi was pushed properly, it's likely that the truck had no more onboard.) It sounds to me Brother like your friend is making up stories, or else everyone on scene, not just the medic, needs to be removed from patient care as incompetent...Or, maybe this is a question that you had but didn't think that we'd take it seriously if you presented the scenario other than factual. Either way, your presentation was intelligent and thorough, you've been participating completely, so I don't really see how these inconsistencies change the context of your question, and I think that it's a really important question. And, I think that you've gotten some really amazing answers...Great job! To my way of thinking, these kinds of threads are the best of what happens in the forums, and yeah, including the discussions as to whether or not this really happened. Let's try not to derail his thread with other things not pertinent to the OP's real question if we can avoid it...

+70 degrees Texans turn on the heat and unpack the thermal underwear. People in Canada go swimming in the Lakes. +60 degrees North Carolinians try to turn on the heat. People in Canada plant gardens. +50 degrees Californians shiver uncontrollably. People in Canada sunbathe. +40 degrees Italian & English cars won't start. People in Canada drive with the windows down. +32 degrees Distilled water freezes. Lake Superior's water gets thicker. +20 degrees Floridians don coats, thermal underwear, gloves, and woolly hats. People in Canada throw on a flannel shirt. +15 degrees Philadelphia landlords finally turn up the heat. People in Canada have the last cookout before it gets cold. 0 degrees People in Miami all die... Canadians lick the flagpole. 20 below Californians fly away to Mexico. People in Canada get out their winter coats. 40 below Hollywood disintegrates. The Girl Scouts in Canada are selling cookies door to door. 60 below Polar bears begin to evacuate the Arctic. Canadian Boy Scouts postpone "Winter Survival" classes until it gets cold enough. 80 below Mt. St. Helens freezes. People in Canada rent some videos. 100 below Santa Claus abandons the North Pole. Canadians get frustrated because they can't thaw the keg. 297 below Microbial life no longer survives on dairy products. Cows in Canada complain about farmers with cold hands. 460 below ALL atomic motion stops (absolute zero in the Kelvin scale). People in Canada start saying, "Eh, Cold 'nuff for ya?" 500 below Hell freezes over. The Leafs win the Stanley Cup

DFIB, I am a true beleiver in the post mortem what did we do right and what did we do wrong reviews on most calls. Transfers usually didn't get them but most other calls did. They are always informative and sometimes cause negative feelings but they always are learning sessions and ALWAYS Never accusatory in nature. Good that you incorporate that type of thing into your practice of EMS. I just wish more people did that. One of the last services I worked for had monthly M&M sessions that were mandatory for medics and STRONGLY suggested for EMTS. They were never a disciplinary session as that had already occurred prior to the M&M session if there was discipline.

Hey DFIB, Thank you. That’s exactly why I wrote it, to make my readers look like strange crazy people laughing. So you, Sir, obviously have a keen and exceptionally well-developed sense of humor! I really appreciate you saying that it was touching on a deeper level and that you can relate. I obviously take massive comedic license with my memories and the other stories that I include that were told to me by partners and others, but there is an underlying comprehension, I guess, that not everyone who hasn’t been there, or been there long enough, gets. So, I appreciate your insight. How is your Niece and her baby? That makes you the Great Uncle doesn’t it? Ouch! Isn’t the Great Uncle supposed to pay for the first two years of diapers and then half of the kid’s college education…up front! Like, NOW! Yea, I’m pretty sure that’s right. If you could just tell 100,000 of your close personal friends how funny the book was, you would make my wife one very happy woman! Thanks DFIB, Mike

And you defended yourself respectfully and admirably. Although your presentation left a few inconsistencies, you've addressed them to my satisfaction. Well done. That would be me, but you're not thinking in the same context as I am. We're supposed to be masters at manipulation, and what I'm getting at is to manipulate this medic into putting his brain into gear and think about what he did. Kinda like one time during flight training, I was supposed to land on 13 but was heading for the pattern to enter downwind 31. A simple brain fart, and my instructor had to ask me about which runway I wanted 3 times before my brain finally kicked in and I corrected my mistake. This medic screwed up, I mean really...we don't even give Atropine for asystole anymore, but was it a one off that he would recognise, or was it pure incompetence that requires remedial training. Using a heavy handed confrontational approach after the fact solves nothing, but makes a poor work environment. Give the guy a chance to realise what he had done and correct his mistake first before screwing with his career. If he doesn't, then go up the food chain.

I usually just look at the thermometer.

I know this thread has been sort of stagnant for a while.....but as a current medic student, here's my 2 cents: 1) Don't go into medic school blind....get some experience. You'll have a much higher chance of being successful if yo get some EMT-B experience first. 2) As far as courses to take, I would definitely suggest taking a Pharmacology course & a Cardiology course. You will be much more prepared for the more potentially challenging parts of a Paramedic program this way. Other than those two....I can only second the courses listed in posts above. Again, I know that the post has been stale, but there's no substitute for education, experience, & thorough preparation.

Just a quick interjection here, someone stated, "to stroke his ego.." meaning the medic's. F**K his ego! Ego's kill people. The patient comes first. As Dwayne noted, I've heard Trauma Surgeons say the same thing many, many times, "Can anyone think of anything we missed..." Visualize the Space Shuttle exploding.

Dwayne, you are absolutely correct, and I 100% agree that respect should be given to those who've earned it, and I never intended to take away any of that respect from Arctickat. I do still, however, feel that my comments were intended to defend my own credibility when it was brought into question, and while I don't feel that I crossed any lines in my statements, I do apologize for any disrespect that may very easily have been interpreted from my writing. My mood in my written communication can very easily be misconstrued, and that's my own fault. I hope I simply misconstrued the tone of his comment, as well. And I hope that Arctickat understands. The point that I intended to make was that I have no intention of "screwing anybody around", but I also have not given any reason to question my credibility aside from being a stranger in a forum of strangers. Perhaps I was overly sensitive, though in my (probably biased) opinion, I feel I deserve the benefit of the doubt. I hope that this can be a forgiveable trait of mine, as I am working on improving it. EMS education would definitely be a whole new topic; and one that I would very much enjoy participating in! There's a lot of things I look forward to seeing as this industry grows and matures. And I very much like the thoughts you've shared so far. Thanks note: and thank you to everybody so far who's contributed. I've enjoyed this topic very much.

I just read your book while waiting for a niece to have a baby. People at the hospital thought I was a crazy guy laughing alone. It is really funny but is touching on a deeper level because I can relate to so many of the scenarios. Great read.

I just put the numbers in my phone, hit convert and it magically gives me the answer

This question is just stuck in my head. I can't begin to tell you how much I love it, as it represents the very best of the EMS spirit in my opinion. It sticks not only because I love it, but because despite thinking about it almost constantly for the last 24hrs, I have no idea how to answer it. Since my first paid day as an EMS provider I've been a paramedic, so I don't really have much context. I once disobeyed several orders given to me by a doctor that I know, beyond any doubt were dangerous and possibly terminal to my patient, but I just did it. I was alone in the back of the ambulance, I had no question whatsoever that I was given really bad orders, I knew beyond any doubt that calling to get them changed wouldn't get it done as he'd continue to insist that I follow his instructions, so I just didn't call. I changed to my treatment path, things worked out as I'd hoped, I reported the instructions given to me and my reasons for disobeying them to the recieving doc, and they, I assume, took over from there. The perfect way to resolve your question involves perfect timing, a great approach to the correction, aggressive enough to be heard but not so aggressive as to be ignored, a strong justification for your recommendation, and a medic that's open and willing to hear it all. Yeah man, depending on the medic you're working with, you're likely screwed... :-) This statement resonates with me, once again from systemet, "If I worked a shift and was allowed to make an error this big, when someone there could have spoken up, I'd be pissed...." Yeah, me too...As he mentioned in that same post, one of the things that I'm most afraid of is making a preventable error because I'd forgotten something, or was distracted. I will never, ever thank you for watching that happen while you stand quietly by.

You're not the real Santa! You are that old guy that sits on the corner with a bottle all day! Bad Santa!

Okay, I think we're getting screwed around with here. Either you were there or you weren't. You can't be sure it was VFib unless you saw it, but you claim you weren't there to see it.

I, unfortunately, am sure that it was V-fib on the monitor. For the sake of the scenario, I called it "coarse" just to remove any element of doubt. My best guess as to why atropine was given instead of amio would have to be that they both start with the letter 'A'... As for multitude of other errors made, I completely agree. They are surprising actions for a registered paramedic to make. But I'd like to provide some reassurance by letting you know that the Medic involved is being held accountable for their actions. It wasn't their first time making terrible treatment errors. I'm not sure what my reaction will be if I ever see THAT headline on EMS1.com...Possibly a mix of amusement and sadness. I couldn't agree more. Unfortunately though, I know a few people who think that if it's not their PCR, it's not their problem. But I'm glad to see that you're one of the medic's who encourages a team approach to treatment and patient advocacy. Thank you for your response! And merry Christmas! I can safely say that I learn more from my mistakes than I do otherwise. That being said, it took me a few too many times flapping my gums when I shouldn't be before I learned to shut my mouth when I should. Unfortunately, I've also made the mistake of being quiet when I should have spoken, and regret it. And thus my quest for the perfect balance began!

EDIT: This story is not very exciting but was unique enough to where I remember it. At the time I thought it was hilarious It is probably one of those "You would have to be there" stories. One time we were transporting a term pregnant woman with pre-eclampsia on a transfer. She had a mag sulfate drip and after a 45 transport her BP was down about 20 mmHg and the hospitals did not want to take her because she was an out of state transfer (the joy of socialized healthcare systems). Each hospital would check her, declare she was stable for transport and have us take her away. We are on approach to the last hospital, which is a nightmare, almost entirely run by med students, and always backed up. The advantage is that they will take anyone. I tell the patient that when Dooguie Houser comes out to see her and ask if she has a headache, ringing in her ears, swelling in her extremities or sees spots in her field of vision she should answer yes. We wait in the hall for about 40 minutes and I finally grab a guy in a lab coat that looks like he is 12 and ask him to check out our patient so we can go back into service. The Med student walks up to the lady an says, "Pre-eclampsia eh, do you have a headache" The patient answers "What, my ears are ringing and I almost cant see my swollen hands from the spots in my vision" My patient learned too well. Your homework is to look up the pre-eclampsia, its causes, symptoms and treatment. Investigate the difference between pre-eclampsia and eclampsia. If you come back with the answers we might be able to provide another story.

Mike: I suspect the reason you don't buy this story is because you have no experience in the healthcare scene. It is really a really poor attitude for fresh EMT-B to come into a thread like this where a practitioner is clearly reaching out for advice from fellow healthcare professionals, and get brushed off by an arrogant No0b, presenting yourself as "suspicious". What could the poster possibly gain from this thread other than a little compassion?? They are not asking for legal advise or money! Anyway; on to the OP. I suspect you also may be new(er) to EMS. This is a crappy lesson to learn, but it is a very real one. Sometimes horrible things happen to good people and children. Sometimes the healthcare system fails royally. You need to decide for yourself how far you are willing to go for this one patient. IF you decide to persue this, it could very well cost you your job... or possibly your cert, but most definatly, your reputation will change. If you decide to do nothing, you may not be able to live with yourself. I have no idea! What I do know is that you WILL run into very similar scenario's frequently and if you do not decide right now, how you are going to deal with these unfair instances, you WILL burn out rapidly. You must make peace with yourself.