Kicking Yourself About Tough Calls

[funkytomtom]

I had the most critical call I've ever been on the other night. It seems that I missed something that would have given us a slight chance to save a life (very slight). There were multiple critical pt's so I was trying to do a million things at once, and I missed something huge. My boss, my partner, and my one friend I have told about it all stand behind me, but I can't get over the fact that I took away that .01 percent chance at life. I did. ME. "Everyone makes mistakes," or "you did your best and that's all you can do," or "most people would have missed that too," just doesn't seem to be cutting it. I'm sorry if this is repetitive, but I've read the other stress reduction polls and I'd kind of like something that addresses my situation a little more. How do you move on let alone work again after something like this? How big of a mistake is too big to make? Also, I don't really want to talk about the call specifics thanks (I know that's kind of a dick move, but please respect it).

[scubanurse]

I can't imagine how you are feeling. And I know saying "you did your best" etc, brings little comfort right now.

The only advice I can give is we do all mess up at some point...I'm sure even dust, ak, the best among us have messed up at some point in their career. A bigger mess up would be to let this ruin you. The best thing you can do is to show up next shift, and do the best you can. It just takes time to move on from crappy situations. Sounds like it was a rough call, and talking to others on the call might help you work it out.

Best of luck, and feel free to PM me if you just want to talk.

Keep your head up and keep on going

[funkytomtom]

I can't imagine how you are feeling. And I know saying "you did your best" etc, brings little comfort right now.

The only advice I can give is we do all mess up at some point...I'm sure even dust, ak, the best among us have messed up at some point in their career. A bigger mess up would be to let this ruin you. The best thing you can do is to show up next shift, and do the best you can. It just takes time to move on from crappy situations. Sounds like it was a rough call, and talking to others on the call might help you work it out.

Best of luck, and feel free to PM me if you just want to talk.

Keep your head up and keep on going

Thank you. It has been amazing seeing my co-workers and now you really being there. EMS truly is a family, and I would be lost without it.

[scubanurse]

It really is a great family to have. Reach out when you need it and help others when they need it

Best of luck to you!

[Kaisu]

My first critical call and I missed something too. It tore me up. I got a great deal of support from my EMS family but it took time for me to feel better about it. One of the things that helped me was that I knew I would NOT make the same mistake twice. The protocol for that type of call is forever seared into my soul. I knew that I will use what I learned on that call to save someone else. I later found out that the mistake was meaningless as the patient was doomed. Perhaps if you follow up on the patient, you may find information that will put your .01 into perspective.

The other thing is a psychological point. It is hard to accept that sometimes you cannot do everything right and people die. Your overall responsibility in the situation is very small. You did not create the illness/crisis and I am certain that you did the best you could at that time. By raking yourself over the coals, in a way you are trying to control what is essentially uncontrollable. It will happen. Take this as an opportunity to be a better provider and learn from it. Forgive yourself and move on.

[DwayneEMTP]

I think it's important to decide why you messed up, and why it's effecting you so severely?

I mess up something on every call. I know, as I find something else I wish I would have done, or asked, or discovered while reviewing them later. That doesn't destroy me for two reasons. One, I'm never likely to be perfect, so I review each call to help guarantee that I'll be the best that I know how to be next time. Second, in my opinion, EMS is a learning environment. On the most critical calls I rarely have as much time as I'd like, nor access to the amount of competent help that would allow me to perform at the level that I would like. But you know what? It's the gig I signed on for, I don't really deserve the luxury of having people pat me on the back for my mistakes...I learn from them, make sure others have the benefit of learning from them, and then move on.

Did you miss something because you don't have a good plan for running calls? Were you tunnel visioned by one thing, causing you to ignore something else? Did you trust part of care to someone else that didn't follow through? All of these are correctable, none of them should cause the kind of angst you're showing here. Why did you miss what you missed? Answer that question, and then follow Kaisu's advice and make sure you don't do it again. That's kind of how this game works brother.

I'm not sure what level you're working at, medic/intermediate/basic but I'm guessing that you may be overstating things just a bit as well, and that's certainly easy to do if you don't have a lot of experience. It's a rare thing when we make a massive difference in the mortality of our patients in pre hospital environment, and even more rare when a 'slight error' (.01 % I think you said?) would have made any difference at all. Is it possible that what you're agonizing over is the difference between your treatment and following the protocols to the letter? If so, then you should stop that. It's simply making you miserable and not producing anything positive.

I'm sorry I don't have more sympathetic things to say, but not discussing the call really only leaves room for general advice and shotgun sympathy. The first I gave my best shot, the second won't really do anything but make you a weaker person and less potent provider, so I'll let it alone.

I hope you find whatever it is you're looking for.

Dwayne

[HERBIE1]

I noticed you said there were multiple critical patients. Well, this is basic triage, then. The "best" solution is a very grey area in these situations.

It is crucial to QI/QA your actions- especially on critical calls, but you cannot beat yourself up over it. You do the best you can given your resources,, the surroundings, and available personnel.

Shoulda, coulda, and woulda's are OK to help you for the next situation, but unless you did something like a missed esophageal intubation, I'm sure it's not as bad as you think.

Sometimes we are forced to make judgment calls that may not sit well with us later. You simply do the best you can.

The most difficult thing in the world is to leave a critically injured person who if they were your only victim, you may be able to help. With multiple victims, you look for people who have the best chance at survival and hope for the best.

There's always second guessing- even with single victims- maybe I could have driven faster, maybe I could have pushed more fluids, if only we didn't hit that traffic on the way to the call, if I had gotten the IV quicker we could have pushed the meds faster... generally it's not as bad as you think. As we all know, when someone's number is up, there's usually not a damn thing we can do about it.

The fact that it's bothering you means it's a learning experience- either you can do something better next time, or you may simply realize that sometimes "feces occurs" despite our best efforts.

[Richard B the EMT]

Everyone has had one of "Those" calls somewhere along their career. You review the textbooks, talk it over with others on the call, talk with supervisors as you feel necessary, speak with the Clergy person(s) of your choice.

Believe me, you'll survive. It might take more time with one individual than with another to "get over it", but sooner or later, you will.

Good luck, PM me if you feel it will help, or any of us on the city, as I feel sure we all care.

[HERBIE1]

Everyone has had one of "Those" calls somewhere along their career. You review the textbooks, talk it over with others on the call, talk with supervisors as you feel necessary, speak with the Clergy person(s) of your choice.

Believe me, you'll survive. It might take more time with one individual than with another to "get over it", but sooner or later, you will.

Good luck, PM me if you feel it will help, or any of us on the city, as I feel sure we all care.

"Those" calls SHOULD bother any provider worth their salt. I'd hate to work with anyone who didn't get upset when something bad happens.

"Those" calls could be anything from a question about the care you provided or simply a bad situation. My (and most provider's) Achilles Heel is kids. Had a stretch years ago when every shift I had a pediatric arrest- 4 in a row. SIDS, trauma, abuse, medical issues- it was bad. I was a new dad at the time, so they hit me hard, and after the 2nd one, I dreaded going into work. I talked with coworkers and even the department chaplain. Sometimes there are no "answers" and simply talking it out gets you through it.

Like you said, anyone who's been doing this awhile has been in the same boat- more than once and the key is to NOT keep it bottled up inside. We are human, we get upset, and we wonder how we can do it better the next time.

That's what it's all about.

[Riverpiratemedic]

Rookie

Ease up on yourself. You'll thank yourself for it in time.

EMS practitioners are by far, the worst offenders of being one's own worst enemy when it comes to looking back and wondering what could have been.

After 21 yrs in EMS (17 + as an ALS practitioner and 18 as an EMS educator) this I know; trauma patients die. A lot. And mostly in spite of what we do.

Five years ago on Memorial day weekend, my brother in law suffered a cardiac arrest in the driveway. He was 43.

I was with him the day before when he was complaining of palpitations and like all of us would, strongly advised him to go to to the ER. Not strongly enough.

I, like you, beat myself up over it, over and over until the weeks turned into months and the months to years. In the process I began to lose my faith in my abilities as an ALS practitioner, insomnia set in, then came a couple of med errors, (strangely things continued to get worse despite my avoidance of the real issue), my long term relationship failed (not related to this incident), and my desire to care took flight. I was the poster child for EMS related stress and Accumulative Stress Disorder.

I existed as a shell of myself for a little over two years, until I became seriously ill. The illness was the last straw and I ended up on stress leave. Four months later I walked away from my twenty year career without blinking an eye.

After a year and a half of unemployment, some menial jobs for minumum wage, and five months on welfare, I returned to prehospital health care. I kicked my arse for a long while for not getting the help I needed when I needed it.

Don't make the same mistakes many of us have made, Rookie; everyone makes a mistake or two, and most of them are not life critical. Some mistakes are, but I doubt yours was.

Given the chance to do the call again, knowing what you know now, the outcome would be the same. Trauma patients die. A lot.

If you need to speak with someone professionally have your service provider make the arrangements. Speak with someone outside of your service / agency.

And stop beating yourself up over something that would have happened regardless of what you, I, or anyone else would have done.

Also keep in mind; you weren't the only one on scene; if whatever it was had been obvious, someone else would have caught it.

I don't have all the answers, just a lot of experiences of things not to do again.

I wish you only the best, and then some.

Take care of yourself,

Paul