crotchitymedic1986

I have no high horse, I have asked for suggestions, but most replies have been a denial for the need for action. I am open to any suggestion that fixes the problem, I only offered the one that seems the most logical too me, doesnt make it right or wrong. But for those who believe that EMS mistakes only occur in Washington DC, that is fine. Tell me how you would fix their problem. It should be easy since no one at your service has ever made such a mistake, so just tell us what you do to prevent it.

You are right, if you are argueing that it is not a problem at all, then I can not convince you otherwise.

yes, you are right, I do believe that any "preventable death" in our industry is "1" too many. Although there may not be a magical solution that prevents 100% of needless deaths to our patients, or EMS workers for that matter, that doesnt mean we should stick our heads in the sand and pretend no problem exists. Using your logic, there is no reason to use safety needles to protect our workforce; I mean out of the thousands of EMS calls every day, how many ems workers actually got stuck by a contaminated needle ? Less than 1% I am sure, and there were enough babies born today to replace that worker. And its not just the burned out medics. I am sure we kill too many with medication errors and misdiagnosis of illness/injury too (using my definition of one being too many). How many drugs do you have in your drug box that look very similar to each other ? Dobutamine and Dopamine, Atrovent and Albuterol, Solucortef and solumedrol. At least hospitals are trying to work with drug manufacturers to fix this problem. Is there a national voice for EMS trying to fix this problem ?

But I wonder how you could motivate companies or individual medics to tell on themselves by reporting these numbers, as the general rule is to cover-up and deny it when you can. There is no "reward" for reporting the errors, and some could argue that you could open yourself up to a lawsuit by doing so. We should want to know the true number of EMS mistakes that harm patients, but I doubt many would be willing to share their true numbers. Think about the number of medication errors that happen on an annual basis alone (where no harm was to done to the pt).

Thats fine, I am open to suggestion, how would you reduce this problem ? Even if we are just killing 5000 per year, it is something that needs to be addressed. So suggest something.

Doc, I have to admit, thats pretty damn impressive on short notice.

http://www.trueposition.com/web/guest/emer...y-call-location Indicates 200M 911 calls, not every county has 911, and not all emergency ambulance calls are handled by 911, so 200M is a low number. But that is fine, lets assume all my numbers are bogus. How many is too many ? If the real number is only 100,000 deaths, does that make it better ?

P3, we are not talking about the patients who truly refuse AMA, we are talking about the ones where lazy medics talk someone out of transport, and then have them sign a refusal, leaving the patient at home to die.

Good points doc, but the problem is that our errors do result in death, so you can bet on a lawsuit when they occur. If a medic at your service killed my kid, you can display all the compassion and remorse you want to, and even if i believe it to be sincere, I would probably still sue. And to those who wish to call me names, that is fine, that is what most people do when they can not argue with logic, they attack the messenger. Although I applaud Doc's thoughts about managing the situation better, I think we would be better served to figure out how to stop the mistakes from happening. You have several high profile examples of these types of errors from DC alone. If you dont like my method, how would you stop this from happening ?

I dont know that our errors are any more publicized than any others. You hear about every time someone finds something in their hamburger and sues the restaurant, or when a hospital is sued. So when we are sued, it makes the same headlines. But the problem with us is that our errors result in death -- if the kid forgets to take the onions off your hamburger, you take it back, get a free one, end of case

OK, I can conceed that you have made a very logical arguement. The fact is that we do not know, because: a. The occurences are not reported to an entity. So we have no idea what the number is, it could be 10% of what i am proposing, maybe its 400% of what I am proposing. b. Many that do occur, do not result in lawsuits, because we whip out our Ace in the hole, "the refusal form that was signed by the patient" (although the medic told them they didnt need to go). c. Many times these patients are the least educated and on the lower end of the socio-economic ladder. They dont complain or sue, because they dont even know that they can --- and if they did, who is the white court gonna believe, those professional medics in uniform or me the african american crack addict or homeless person ? But as i stated in my last post, lets assume our numbers are far superior to the hospitals (who by the way, kill 400k with all the lab, xrays, and procedures available to them), and are far less than what i suggested (take it down to as low as 10% of what I think it is). How many deaths are too many ? 100,000, 50,000, 25,000, 1,000 ? How about "1" being too many ?

And in the case of a patient that died after truly refusing, wouldnt it be great to be able to tell the jury: Hey, not only did we beg him to go, but we had a supervisor come to the scene or called the patient on a recorded line, and we still couldnt get him to go. Please admit this taped conversation as defendant's exhibit- A, and play the tape for the court (or note our refusal form that was also witnessed by the supervisor).

Fair questions: Define Alot: It was my experience that when my medics called a supervisor to the scene to help them talk a patient into going (who needed to go, but was really refusing) the supervisor was able to talk the vast majority into transport. And that wasnt always because the supervisor knew something to say that the medics didnt, but i think that the pt realized "if these guys are so concerned about me that they called a supervisor, and the supervisor agrees with them, then I should probably go". With that being said, some small percentage would still refuse, so I dont think you can save them all. But what if the number is only 10% of what I think it is ? If we only save 200,000 patients, would it not be worth it ? And I appreciate the desire to defend the medic and say that we cant be blamed if the patient refuses, but we know that the vast majority of refusals are not "true refusals" but rather the result of some conversation where the medic said "you will be ok to go by car or go to your doctor tomorrow, as indicated in the DC cases.

Are you saying that in all of 2008, your service has not had a single patient death from someone who "refused" EMS transport ? And all I can do is use logic and reasoning as EMS is not required to report these incidents like hospitals are, so there are no "real statistics to use", but if you google phrases like EMTs blamed for death Paramedics blamed for death EMS sued over patient death You will see this is not an isolated problem, but in your heart you already know that, as everyone in this room has heard a story about a similar call in their region (if not their service).

OK, the math was questioned, lets address that: 1. A 1-2% failure rate is universal to almost every business. No business is perfect. 2. We know for a fact that 400,000 US citizens die each year from hospital medical mistakes. I think the last number I heard was that there was about 5,000 hospitals in the US, and there are far MORE EMS providers than there are hospitals. So it is reasonable to assume that our numbers would be proportionally higher. Next, can you guarantee that the supervisor is smarter -- NO, but most supervisors have some seniority and have shown that they were better than others in the company at one time. You can dislike this all you want, but it is an ugly EMS secret that needs to be dealt with if you are a true patient advocate. What has happened in DC is not unique, nor limited to that geographic area.

Thread Moved to "If you could save 1-2 million patients. But to answer these two questions: 1. Supervisor could make phone contact, doesnt have to come to scene 2. Employer doesnt trust you, if they did you would not have to do a morning checklist, you wouldnt have to have someone witness your waste of narcotics, or drug test you after an accident.

Ok, I will go ahead and spill the beans, and then you can attempt to argue my hypothesis: The last number I saw on how many 911 calls occur in the US each year, was around 250 million calls per year. I am going to give us credit for running 99% of those calls perfectly, and only having 1% with a patient death as a result of a poor paramedic care (unless you live in DC, where it seems it is a much higher number). That would mean 2,500,000 deaths, total, for the whole US. If we were to change one rule, we could save alot of these patients. If you no longer allowed ambulance crews to get a patient refusal unless it was witnessed by a supervisor (the supervisor could call the patients home or cell and talk to the patient to confirm that he is actually refusing transport), many of these deaths would be prevented. Now before you get on your high horse, realize that you do alot of things in the name of SAFETY to protect alot fewer patients. You clean your laryngoscope blades or use disposable to prevent the spread of disease. You use stretcher straps to protect your patient in the event of an accident. You employee all kinds of policy and procedures to protect the patient from HIPPAA violations. You test/check your equipment every shift to protect the patient against equipment failure. You may use the "5R's" to make sure the patient doesnt suffer a medication error. So, why not make this easy, but necessary, change to ensure that the lazy or inexperienced providers do not get refusals on patients who need transport ?

If I promised you that by changing one thing, one drug, or one piece of equipment on all ambulances in the US that we could save between 1,000,000 - 2,000,000 patients in 2009, would you be for it ?

At what point does the Chief just need to say, no more patient refusals unless witnessed by a supervisor ? Which might be good for all EMS services, think about how many lives would be saved, as almost every service has had one of these calls at some point in the last 5 years (most just dont get media attention), and if you multiply that out, that is alot of needless patient deaths.

Oh, i agree. Even if the veteran is right about barefoots medic skills, he is totally unprofessional and should not be riding with new employees. But just because he is a jerk, doesnt mean that is wrong about barefoot's skills. He may have no patience for ANY rookie, or he may just not have patience for THIS rookie. If he is yelling at the rookie because he connects the white lead wire to the patient before he connects the red lead wire, that is one thing; but if he is yelling because the rookie is attaching the wires to the patient's forehead (repeatedly, after being told not to the first time in a nice tone), its different. Just because someone has graduated EMT or Paramedic School and passed the NR in their first 3 attempts does not guarantee that they are competent to do the job.

I would be very cautious about directly contacting the media, as it can backfire on you depending upon what is stated, or how the reporters slant the story. If you embarass your political leaders and they know it was the EMS folks behind the story, they may choose to punish you in a variety of ways. On the other hand, if you know of a call with a bad outcome due to budget cuts, and the media finds out about it anonymously, then so be it. Just realize that when you air your dirty laundry to the media, they may not stop where you want them to, and may also point out some unflattering statistics or facts about your service (maybe your EMS cost 30% more than the neighboring county, maybe you run "x" less calls than your neighbor but have a higher budget, maybe you had a medic accused of sexually molesting someone two years ago, and a new "news" story might breath some life into that old embarassing story).

I am not saying that it should be the only class. I would hope that all services have a very rigorous training program that ensures quality patient care, but we all know that is not the case. Many services have no training (pencil whipped, or classes where nothing is taught), little training, or easy training that does not challenge the personnel. It was sad, that the only mechanism you had to ensure some training was a mandatory ACLS class, but it is even worse now that you dont even have that safety net. If you work at one of those services that has such a good training program, that ACLS is an easy cert to pass, then that is great. But how many services can truly say that ? If I walked into your service with a hard ECG test that had WPW and some 30 second strips of mixed 2nd and 3rd degree blocks, would your medics be able to make an easy 100, or would your service be the kind where most of the medics correctly identified 60-70% of the strips on the first test (all of your medics, not just you) ?

Barefoot said : I keep running into this ... age problem. The medic I ran with today did nothing but put me down, discourage me, yell at me, repeat over and over and over and over and over ... and did I mention that he repeated it over and over and OVER again that, "[i'm] to young to be in this business, [i'm] wasting my time, and people are going to die because they are letting [me] become a paramedic" and then he would top it with the nice cherry of, "you have NO experience and I don't believe you should even be allowed to be in medic class" ... his theory ... "Everyone should have ten years of experience before they even think about starting paramedic class" ... Is there any possibility that you are making alot of rookie mistakes, and he is just calling you out on them and showing you where you need to improve (maybe not in a loving tone). Its like the Ron White joke where he was talking about being at a military base and referenced that there was 35,000 soldiers at that base, when a drunk woman in the audience shouted out, "And none of them know how to f**k. To which Ron responded, "you know, after you did about 34,000 of them, you might say "maybe its me", maybe I need to take a class. Maybe this guy is jealous or has a bias against young folks, but if I had someone do nothing but yell at me and tell me how stupid I was all day, I might have to ask myself if maybe he has a point. I am not saying the guy isnt a jerk, but usually if I had to repeatedly tell a rookie something over and over again, there was an issue with the rookie. Give us an example of what you did that he yelled at you for, or what happened immediately before he said you shouldnt be in paramedic class ?

No, I was not saying that there hasnt been ANY competent care since ACLS became a "no fail" class, as there will always be the medics who wont settle for the status quo, and will take other classes to improve their skills. My point was that when ACLS was so tough that you could fail (and most physicians did, so thats why it was changed to a no fail), you atleast had a minimum standard in EMS for a period of time. You had to know the drugs backwards and forwards and atleast be able to read 80% of EKGs shown to pass. It was a course that you had to study for to pass, even if you were a good medic. The last 3 or 4 times I took it, I didnt even open the book; I didnt study at all. If you think departmental training is bad now, it was almost non-existent then, so ACLS was the only way to insure that medics had any training whatsoever.

There is a lyric in the song American Pie (Don McClean) that talks about the day the music died. I can definitively pinpoint the day Competent EMS Care Died, and it was the day that ACLS became a "cant fail" class. I can remember people puking in anticipation of having to pass ACLS, because it was so difficult. Now, ACLS is so easy that you can bring a citizen with no medical training whatsoever into the class, and they could become certified 16 hours later. So sad ! Forget the 4 year degree, if you want to improve EMS, make the 16 hours of ACLS count again.