WolfmanHarris

Okay... how about: 1) National EMS Medical errors and near misses reporting. Similar to FAA encourage providers to report errors in a non-disciplinary environment centred on risk management and education. 2) Encourage Quality Improvement (QI) over Quality Assurance within a service. Encourage management to move away from disciplinary action as the only outcome to a mistake. Encourage teaching and continuing education from Medical Director and Management down such that providers feel safe in their jobs reporting their own mistake, receiving guidance and if necessary CME to prevent it. This doesn't preclude canning someone or suspending them if they really screw up, but encourages development. 3) Learn from what's been found about Physician malpractice suits and consider dropping some of the CYA. I can't find the research to back this up with a quick google search but I have heard it referenced in a few places. (LINK) Consider admitting responsibility and apologizing, rather than saying nothing and hiding behind the "ungoing investigation" defense. An interview I was listening to on CBC's "White Coat, Black Art" (excellent radio show btw) a few month ago had a malpractice attorney discussing how even in the face of gross negligence, a Physician who was upfront and compassionate with the family has the most reluctant plantiffs, even when significant damage has been done. If we can strike a balance between preventing litigation and being responsible for our action with the family, perhaps we can diffuse some of the anger. 4) Continuing education. Fight complacency in your own practice and you might avoid BS refusals and half-assed assessments which result in things being missed. If you know what's going on you're going to be more able to convince your patient. 5) Compassion and communication. If you care about your patient and can communicate that, they may be less likely to refuse based on them not liking their care. If you treat your patient like garbage from beginning to end and they believe you don't care or take them seriously are they not more likely to refuse and find another way (if any) to access treatment? What do you think of these? Just a few spitballed ideas I've ripped off from lecture, JEM's and other reading.

Once again I wasn't comparing our errors to a printing error in the newspaper, a burger flippers screw up (which can kill), or any other job. I was talking about EMS medical errors vs. other medical errors. And ours have less potential to kill than say a Surgeon when you factor in all the possible mistakes they can make? And like I said above, I might be wrong on reporting as my view is likely more skewed than I realized. But whether we commit more or less than RN's, RT's, MD's or any other Healthcare provider, we do have a responsibility to examine how we handle those errors and whether we are addressing them with a mind to prevent further similar errors, improve quality of the system and treat those affected by our errors with due compassion and accountability such that perhaps our bed press can be diminished. (Maybe, just maybe) And yes, before it comes up, proper education is the biggest and most important point. But other than that what can we do?

I agree entirely, but while reducing medical errors is important, that wasn't what I was driving at. My questions had more to do with the management and on-scene attitudes side of things, AFTER the error. Specifically, what is it about our medical errors in EMS, that draw the media on us over other fields? How can we manage our error reporting and the way we deal with the aftermath better so that the media isn't the the first outlet for satisfaction by the family when we screw up? Edit: Actually HellsBelles makes a point in another thread that makes me reconsider this a bit. Maybe it's not that we're reported on more as much as it is the news sources I read and the stories that stick in my memory. My questions still stands as I think it's valid, but it's given me something to think on. - Matt

Bledsoe's "Essentials of Paramedic Care" is the Canadian Edition. The medico-legal side is Canadian references and throughout titles and scope attempts to stay consistent with NOCP. A good chunk of the pictures also have Canadian providers in them and a couple of section use Cambrian College students are the demonstrators (as per their T-shirts). "Case Studies for Paramedics" by Kevin Branch is also all Canadian scenarios.

Ya my degree in Philosophy counts more than Paramedic. Which I understand and don't at the same time.

Vent, I'm not sure if everyone is placing their full stock in a weekend cert as much as they're arguing that the quality of the cert is declining, making it more and more irrelevant and yet it's still required of them. I'm not saying medics don't rely on their merit badge courses for competence, but that's not the main point I'm drawing from most of the discussion here. You're absolutely right, we need to rely on more for education than a one weekend course. But the one weekend course should still be relevant and worthwhile as an update or refresher on key concepts; otherwise what's the point? Without relevance, ACLS will become like the CPR recert we have to do yearly. You're also absolutely right when it comes to comparing ourselves to other healthcare providers. Who cares? "But so and so is doing it too!" is school yard. Keep your own backyard in order first.

It seems the biggest mistake made in EMS management is equating good medic with good leadership. While they need to be competent, they need more than that to lead and manage.

If you have that many supervisors you're going to end up promoting someone who has no business leading and is just as likely to make the mistake you're trying to prevent just to fill a hole. Reminds me of a quote from a children's book my fiance has "Ozma of Oz" (Wizard of Oz series) "I have in my army eight general," said the Tin Woodman "six colonel, seven majors and five captain besides one private for them to command. I'd like to promote the private, for I believe no private should ever be in public life." If every second person is a supervisor it really just removes all accountability from those that aren't. "Not my problem, I called the supervisor and they decided." Here's my question though. With all the medical errors that occur daily around North America, what is it about the way we f-up that it makes the news over the others? What could we do differently so that our medical errors can be dealt with in such a way that our patients and their families don't feel like they have to go to the media just to get accountability and improvement?

Rookie mistakes or no, if these are exact quotes than this medic is not providing constructive criticism or helping a new medic develop. They're putting one down as unqualified and using criteria they can't possibly change to justify it.

We don't often get the chance for a good reply from the person in question, but half-way down is a comment from the commissioner that says: Whole thing still makes me shake my head.

Sorry when I was referring to declining standards in education I was talking beyond EMS and healthcare, though I do believe as grade inflation worsens and we rely more and more on curriculum and systems of evaluation that concerns themselves with a combination of self-esteem and standardized tests the effects will be felt even more within higher education. (though they are already) Our education system (Canada and the United States) does not prepare students for higher education or the real world, forcing higher education to fill in more and more holes in the first year. This of course is a losing proposition as it supports the decreased standards and even less onus is placed on high schools to prepare students properly. Not to mention that University and College is so lucrative that if the undergrads who were not prepared for their first year were just flunked the revenue would drop rapidly. I don't teach in a classroom, though for many years I was pressured to become a teacher. Many of closest friends and family are teachers. I do continue to teach outdoor education, swimming, lifeguarding, first aid, etc. and as a result I have a continued interest in education. It remains the most depressing moment in any of my teaching when I receive comments from participants or parents along the lines of "Wow, you work them really hard!" or "I like that you actually tell me what I have to work on and make me do better next time." etc. I don't think I do anything other than teach to the standard; but they're all so used to games and play and having smoke blown up their ass that being taught and having to work are surprises. My friends that are new teachers are already frustrated by how little they can do if a student does not do their work, or isn't capable or progressing. But I suppose that's neither here nor there. Since I've lost online access to my University library I don't have access to some of the journal articles I previously bookmarked. I do however have a list of a few other links that illustrate the underlying problem in education that affects us all, EMS or not. Decline in Education (as seen in University Physics) Hoover Institution: Decline and Fall of American Education Decline and Fall of American Higher Education University of Lethbridge: Grade Inflation Grade Inflation: Admittedly NOT well sourced "Why Johnny Can't Fail" Ontario Secondary School Teacher's Federation Social Promotion Policies Fail Students "Why Johnny Can't Fail" A similar article by a teacher And just for filler context info No Child Left Behind (Wiki) There is a lot more information out there and if you have access to a good University library and can read their journals online there's some excellent studies on this. These are just the bookmarks I have that aren't dead links or I can still access. EMS education is worse of than others, but it's hardly alone in subpar education. I'm not saying that there aren't still programs, school and individual educators who keep the bar high and don't fail their students, but I worry that they'll become the minority. So ya ummm... all ranting aside I agree that ACLS should be a worthwhile course that keeps one current in a specific skill set as part of CME. So should all the other merit badge courses. Cheers, - Matt

Sounds like ACLS is mirroring education throughout the western world. Can't fail anyone, lots of positive feedback and no constructive criticism, a million and once chances to do anything and the primacy of self-esteem have damaged education. ACLS is just a symptom of it in EMS. The cult of "that's okay. You tried." Not every educator buy this load of BS though. And when they get together and start influencing each other couldn't it start being done right in an area? I know as it stands with the amount of resistance coming from services, associations and the like and the lucrativeness of medic mills that's a lot of inertia to overcome, but there's always small victories.

Sometimes when I'm done laughing at something like this, I worry it might be serious or not too far from the truth. [web:71cb839e49]http://www.eoeamb.org/nosey_bystander.htm[/web:71cb839e49]

I was poking around on Google looking for a picture of the lifts on the ambulance and found this picture of one with a ramp. What I found interesting and potentially more practical about it was it doesn't look like it stick out as far as some I've seen making parking in a tighter area easier. Also, notice how much lower to the ground it looks. Can any of the UK providers out there speak to how well this concept works? I look promising, though perhaps cramped like the old Type II's. - Matt

Still provided it wasn't in any town I was visiting or living in, I'd be curious to see the last best word in saving municipal money; enter Constable-Firefighter Sanitation Engineer Groundskeeper Utilityperson Jones, EMT-P, MSW. Response times will suck, but think of how the whacker's will cream themselves over that apparatus? Seriously, though I don't quite get the combined LEO/Medic thing. In Ontario, where there are tactical medics (which is only the large services and the OPP) they are FT medics who are unarmed and train with the Police to operate in the warm zone if necessary. In my experience, (limited as it may be) none of my friends who are cops are very good at turning it off. I don't see how they'd be able to effectively focus on pt care, when that pt might be a suspect or someone who'd just been shooting at them.

I know these alphabet soup courses are considered merit badges and shouldn't be treated as a huge intensive education and definitely shouldn't be listed after your name like a PhD. (Ala Joe Shmo NREMTB, ITLS, NRP, ACLS, Switfwater 1, fingerpainting 3...) What I'm wondering is if they're still worthwhile as CME. Or if there are some that are more worthwhile than others? I've got the chance to take ACLS and NRP at school next semester and am wondering if it's worth the cost at this point in my education?

Maybe I misread the article, but when was it said they were given no notice on the test? Also, we're talking about a standard entry level test here right? Not a test from hell. I agree in the situation you described that would be unfair. But I don't think that's the issue at hand.

Mobey, you're right. That's a distinction that I should have considered. There are predatory sex offenders out there who might be consciously drawn to EMS but there are also a great deal of ill people whose compulsions may one day get the better of them. It was a mistake for me to lump these people in with the worst of the worst. While I empathize with those that are likely good people unable to fight their own compulsions, they do not have a place in EMS anymore than the predators. There are treatments available for offenders but from what I understand their difficult to access outside of the criminal justice system, not to mention the stigma that would go along with it. I hope that those who have to fight these compulsions and have done nothing wrong succeed and never harm a soul; but until and unless there is a way we can guarantee this, I don't believe they should be in EMS.

Once again, I ended up convinced (after a fashion) and agreed with the procedure. So while I agree with you, I have questioned your methods. Browbeating refers to a behaviour not a person or their character. For example, one can act like a jerk from time to time, but not themselves be a jerk. Remember, when fully informed of the facts in question and clear on the pros and cons, people can still disagree. Creating scenarios where someone is left no choice but to agree doesn't actually bring someone onto your side in the original question, only a concept which no bears little to no resemblence. It's a hell of a leap to go from "you're right. In a plane crash in the middle of nowhere if a loved one was injured I'd do anything possible to save them; in my scope or not." to "because in that extreme situation I would go outside my comfort zone, then it must of course be the right way to go in any situation." And that's the problem I have with the scenarios you've brought up. Claiming that C-sections are done daily by those with no training around the world, while not elaborating or backing it up is equally problematic. Allow me to demonstrate, "Paramedics lose their license and livelihood daily for improper practice resulting in their families living on the street and the destruction of live." Anyways, this whole discussion is pretty much a shambles and I doubt much more productive is going to come from this. I did however learn alot in the debate in the first few pages. For that, thanks. - Matt

Dwayne, I appreciate the back-up and I'm glad I hadn't missed the point I was trying to communicate so poorly that someone got it, but I honestly didn't mind taking a minute to clear it up. My apology was to anyone who despite my disclaimer still took it as an attack, because that was the last thing I wanted. From everything that's said about Basic education on the City, EMS could use way more Basics like those on here. But they are a credit to Basics despite their training class, not because of it. Online it can sometimes be difficult to communicate clearly in a potentially emotionally charged discussion without leaving room for misinterpretation. I don't mind getting smacked down a bit from time to time when I'm out of line, even unintentionally. I'm so green I look like the Hulk. Anyways, sorry for stirring up the pot too badly. With regards to the reports referencing medics more than EMT's I'll expand my original question. Do medic mills, in combination with piss poor standards EMT education and a job market where there's limited competition nationally for job and a great deal of mobility allowing a provider to move from place to place to work, provider not only an attractive work environment for a potential predator, but make it incredibly easy for them to get in? Aside from a proper education (degree, 2yrs+, etc) which we've done to death, what can be done at the schooling level to decrease this. As was asked above, how does EMS compare to other occupations with exposure to vulnerable sectors for prevalence of sex offenders/charges of sexual impropriety? What can be done to screen out potential predators? What is currently being done? Convicted sex offenders aside, does the fact that most of us work alone and in private contribute more to complaint numbers than actual impropriety? Now before it comes up; I'm not one to ever jump to the "they must be making it up" reaction to a sexual offense complaint, but we do know that they do occur. While cameras are being discussed in Crotchity's thread (sorta), what else can be done to safeguard providers and patients in the back against assault or complaints? - Matt

Remember the bad news usually comes from the family straight to the media. How often do we see in and out of EMS a complaint end up in the paper but not at the office of the people responsible. There was a protest on my University campus 3 years ago about how during winter wheelchair accessible parking space were not well marked and covered by snow. There were signs and a demo where people could use a wheelchair to see what it was like to get around campus. What not a single person had done was call physical resources and let them know. Once the local and campus papers ran it there quote was "No one had let us know until just now. We've ordered news signs which will arrive next week and in the interim temporary signs went up today and Security has been asked to make an extra effort to police those spaces." The protesters called it a victory. The odd call might get a thank-you card, but not all services are going to feel comfortable sending that to the local news and the news likely won't run it since they won't be able to get all the details they want without a HIPPA violation. I know Toronto EMS runs a section of good news from the professional standards department in their internal newsletter, but they don't put it in the paper. Also the same privacy laws make it near impossible for the service in question to defend themselves, no matter how stupid the claims are, until they get to court. The other good news stuff we do, may or may not make the news, as it's all been done before. So EMS did a Toy Drive? Great so did FD and PD. We'll put them in as an also ran. Paramedics did an outstanding job treating a family pulled from a house fire? That's good, but did you catch the picture of the FF holding the puppy that was in the backyard? Let's run that. EMS is doing a fundraiser for blank cause. Put it in the community calender with all the other fundraisers. Good news just doesn't sell and is usually forgetablle by the people who read it anyways. It gets a "that's nice and we move on."

The TTC (Toronto Transit Commission) has been putting more and more camera in public transit as a result of an increase in assault against drivers.

Crotichity, I've already said under what circumstances I'd feel comfortable doing this. I'm not going to play the slippery slope of anecdotes as they represent the worst sort of reasoning and are always designed to create a situation where someone has no choice to agree with you, because the situation has been designed as such. So with reference to plane crash, I decline to participate. Now, before you prode people into taking part in your scenarios, could you please actually answer the questions asked of you and support some of the claims you have made? If not, say so. Otherwise, Ak and Eyedawn are right that this has become less of a discussion and more browbeating.

Merry Christmas to all and to all a slow night (shift).

Sorry, I don't know if I made my point clear. I wasn't drawing a correlation between being a basic and any wrong doing. I was saying that limited education requirements that can be completed in a very short time frame, for a job that has aspects that would appeal to a predator looking for an outlet is the problem. By saying I didn't want to denigrate Basics, I meant that despite this incredibly limited education, there are competent providers dedicated to their education and that the fact that the Basic education is incredibly limited does not in itself speak to them as providers. In other words I was saying with such a short course, are we making it easy for a predator to enter the field. I hope that has redeemed my F-up a bit.