Oops Again, Again

[EMS49393]

Now I'm really glad I don't work here anymore. The company runs a 6 month medic mill that graduates 8 paramedics a year. I use the title paramedic loosely. In the two years I was there they had 4 of these medic mill paramedics make mistakes that were so big they were busted down to EMT or terminated. What's that, roughly 25% of the graduates make fatal errors a year. Seems like pretty bad odds to me.

This year we have two more prize winners:

She's dead, I think. Maybe not. I dunno.

This is becoming a nation-wide EMS epidemic. What in the hell is going on with providers these days?

[EMS49393]

I wanted to update this story after this article was brought to my attention by my husband. While I understand it is not fair to "Monday morning quarterback," both my husband and I know the people involved and are NOT at all surprised that they were involved. There comes a point and time in a person's career that they are a liability, they are crusty, uncaring, jaded, and simply do not care about patients, education, or their job.

My husband and I have a combined total of nearly 40 years experience in EMS, over a dozen of those as ALS providers and we know, absolutely, without a doubt the difference between dead and alive. If there is even a remote possibility that a patient is alive or shortly arrested we work the code, completely, and give that patient every chance for survival.

There is just NO DAMN EXCUSE for this, period. You're right, Mr. Swanson, your paramedics did indeed "drop the ball." It's nice to screw up so badly that you get a months worth of paid vacation.

Mistaken Death

MEMS disciplines 2 for mistaking a death Woman left on ground for hours an `error'

By ANDY DAVIS ARKANSAS DEMOCRAT-GAZETTE

Publication: Arkansas Democrat-Gazette (Little Rock)

Two ambulance workers have been disciplined and one of them will receive extra training as a result of an internal investigation into their failure to detect signs of life in a woman and allowed her to lie in a Little Rock yard for more than three hours.

The ambulance service determined that paramedics Pat Bajorek and Brandy Johnson followed all the appropriate procedures last month when they attended the patient, 52-year-old Pamela Harper, but they made mistakes nonetheless, said Jon Swanson, director of Metropolitan Emergency Medical Services.

"They did everything that they were expected to do in terms of protocol, but it's a question of interpretation," Swanson said Monday. "Obviously there was an error made because we left her on the scene, and we accept that, and we have to stand up to that." Harper, dressed only in undergarments, was found in the backyard of a home near Napa Valley Drive at 6:30 a.m. March 26.

The senior member of the first ambulance crew to arrive determined that Harper showed no signs of life and called in Little Rock police detectives. But while investigating, one of the detectives noticed that Harper appeared to be alive, Pulaski County Coroner Garland Camper has said.

Another ambulance crew arrived but that crew detected no vital signs. That crew then called the on-call emergencyroom doctor who handles death pronouncements for people who show no vital signs after paramedics have performed cardiopulmonary resuscitation. The doctor pronounced Harper dead at 9:29 a.m.

Then Camper, Deputy Coroner Patrick McElroy and Chief Deputy Coroner Gerone Hobbs arrived at 9:55 a.m. to examine what they thought was Harper's dead body.

During his examination, McElroy, a paramedic who previously had worked for the ambulance service, saw "several signs of life," Camper has said.

McElroy, Camper and Hobbs looked after the woman until a third ambulance transported her to Baptist Health Medical Center-Little Rock. She died at the hospital two days later.

In a statement the ambulance service issued Monday, Swanson said the service has concluded its internal investigation of the episode, and members of its staff "now understand the unique circumstances of this call and accept responsibility for our actions." He could not say why the paramedics failed to detect signs of life in Harper because of patient privacy concerns. But the ambulance service would "take the opportunity to apply the lessons learned to our training and protocols going forward as we return the paramedics involved to duty," he said.

"This is an extremely unusual case and is the first time in our 26-year history involving hundreds of thousands of calls that we have ever been called back to a scene after determining a patient was deceased," Swanson said in the statement. "We take this situation very seriously and sincerely apologize to the family." In a phone interview, Swanson said that Bajorek will return to duty this week, and Johnson will return to duty after receiving additional training. Both been disciplined, he said, but he declined to elaborate.

The two junior members of the ambulance crews, who are emergency medical technicians, were not suspended because it was the paramedics who were responsible for determining whether Harper was alive.

Swanson stressed that while the ambulance service takes responsibility for its employees' actions, it would be inappropriate for it to take responsibility for Harper's death because her cause of death has not been determined.

The results of the ambulance service's investigation will be turned over to the state Health Department, which licenses ambulance services in the state, Swanson said.

Camper is continuing his investigation to determine the cause and manner of Harper's death, Camper said, as well as why it took so long for emergency personnel at the scene to determine she was still alive. He is waiting for autopsy results from the state Crime Laboratory.

Three hours is "a long time for someone to just [lie] there exposed to the elements," Camper said. "It's clear that the ball was dropped."

This article was published 04/20/2010

Edited May 3, 2010 by EMS49393

[WolfmanHarris]

I had a bit of a "pucker factor" moment a few months ago after pronouncing an obvious death. (Rigor, fixed dependent lividity, opacification and pulseless/apneic for good measure) I'd informed the family who essentially already knew and had grabbed the coroner's package from the truck when my partner passed me a six second strip. It wasn't flat. Both my partner and I were fairly new and it took us a few seconds to not only recognize a pacemaker, but convince ourselves that it couldn't be anything else. I think that was the day I was sure I'd mastered my ability to mask those "oh crap" moments. (Like when your partner passes you a STEMI 12 lead, or a positive SAS test for a CVA.)

[spenac]

I had a bit of a "pucker factor" moment a few months ago after pronouncing an obvious death. (Rigor, fixed dependent lividity, opacification and pulseless/apneic for good measure) I'd informed the family who essentially already knew and had grabbed the coroner's package from the truck when my partner passed me a six second strip. It wasn't flat. Both my partner and I were fairly new and it took us a few seconds to not only recognize a pacemaker, but convince ourselves that it couldn't be anything else. I think that was the day I was sure I'd mastered my ability to mask those "oh crap" moments. (Like when your partner passes you a STEMI 12 lead, or a positive SAS test for a CVA.)

I pronounced a death of a lady in her RV. I went outside and was explaining to the husband that she was dead and that there was nothing we could do except call the funeral home and deputy. About that time I heard a loud thump come from the back inside of the RV. I'm sure I turned pale white. I excused myself saying I needed to get my equipment and went back into the RV. That was the longest 20 feet I ever walked. Got back to the lady and by her side was her dog and the lady was still dead. What a relief!!!!! Don't know where that dog came from but there was almost another body at that scene as I about died when I heard it make that noise in the RV.

I do multiple checks to confirm death. I have my partner confirm death. I do not just glance and say yup dead. I check pulse, lividity, pupils, rigor, etc, etc, etc.

[WolfmanHarris]

I pronounced a death of a lady in her RV. I went outside and was explaining to the husband that she was dead and that there was nothing we could do except call the funeral home and deputy. About that time I heard a loud thump come from the back inside of the RV. I'm sure I turned pale white. I excused myself saying I needed to get my equipment and went back into the RV. That was the longest 20 feet I ever walked. Got back to the lady and by her side was her dog and the lady was still dead. What a relief!!!!! Don't know where that dog came from but there was almost another body at that scene as I about died when I heard it make that noise in the RV.

I do multiple checks to confirm death. I have my partner confirm death. I do not just glance and say yup dead. I check pulse, lividity, pupils, rigor, etc, etc, etc.

we have to do a thorough exam in order to report anyways. We have to document how we determined death.

[Just Plain Ruff]

we have to do a thorough exam in order to report anyways. We have to document how we determined death.

Hold the phone a minute

The patient had all the signs of being dead.

If the patient had those signs and you call the doctor and the doctor concurs then why are we slamming these providers????

I know this is a huge mistake but.... if the signs of life are not there ergo no pulse, no respirations, no auscultatable heart beat, Asystole on the monitor then I'd call this lady dead.

I'd look for other signs, like Lividity or rigor but dammit to hell

If the signs are there, why are we chastising these medics.

now the article says more about their being other circumstances but what the hell do you guys want them to do? Talk to God and say "Hey God, can you send me a sign that this person is really dead??" What if no sign comes down?

Are you going to make them wait on scene for 3 hours just to make sure that no signs of life are there during that 3 hours.

Let me know when you guys stop making mistakes in your daily life, then you can cast stones. Until then.....

I know this will not make many on here happy with me but dangit, this forum continues to amaze me at how much judgement there is here and it makes me very sad.

Now when the rest of this story comes out then we can cast stones and chastise these medics but until then we need to learn from this rather than crucify.

Edited May 4, 2010 by Ruffems

[spenac]

Hold the phone a minuteNow when the rest of this story comes out then we can cast stones and chastise these medics but until then we need to learn from this rather than crucify.

Ruff I have seen medics just look at the person and say they are dead w/o ever checking. But me as the partner I still got down by the person and did a full check. Yes most times somebody looks dead they are but perhaps in this case the medics did the look but no touch. Perhaps they have bad patient assessment skills and could not find a pulse on a person if you drew an X on it. Perhaps they failed to do a true exam and just wrote it up. Second medic arrives and decides hey no way my fellow medic was wrong and quick glance and they then to document complete check when in fact they performed no check.

Is that what happened? Only they and God know. But sadly we have some lazy uneducated people in this field. Should we judge? No but discussing possible reasons or even scares we had is in no way condemning them. They obviously misdiagnosed something somehow. Would it have changed outcome? Probably not but now we will never know. Perhaps it was cold so patients color was bad. Being old and cold maybe she seem stiff so they thought hey rigor. Maybe like so many old people she was very bradycardiac and they only felt for a second for the pulse and missed it. Tons of what ifs.

[Just Plain Ruff]

Ruff I have seen medics just look at the person and say they are dead w/o ever checking. But me as the partner I still got down by the person and did a full check. Yes most times somebody looks dead they are but perhaps in this case the medics did the look but no touch. Perhaps they have bad patient assessment skills and could not find a pulse on a person if you drew an X on it. Perhaps they failed to do a true exam and just wrote it up. Second medic arrives and decides hey no way my fellow medic was wrong and quick glance and they then to document complete check when in fact they performed no check.

Is that what happened? Only they and God know. But sadly we have some lazy uneducated people in this field. Should we judge? No but discussing possible reasons or even scares we had is in no way condemning them. They obviously misdiagnosed something somehow. Would it have changed outcome? Probably not but now we will never know. Perhaps it was cold so patients color was bad. Being old and cold maybe she seem stiff so they thought hey rigor. Maybe like so many old people she was very bradycardiac and they only felt for a second for the pulse and missed it. Tons of what ifs.

I agree Spenac

If the OP has inside information maybe they will share it, it seems that they do at least about these providers.

but since we do NOT know what happened, how can we be sure that what was reported really happened?

What I'm getting at is this. Newspapers make money selling papers and news organizations make money with higher ratings and this is a great story to sensationalize and possibly NOT GET RIGHT!!!!!!!!!!!

Plus the ambulance service If the original poster infers, is a shoddy service, or at least it's medic mill medics are, why wouldn't they try to blame the crews in order to deflect bad publicity away from themselves. I haven't heard of any ambulance service throwing their employee's under the bus to keep out of hot water (SARCASM)

So until we get more info, maybe we can be a little less judgemental and more thoughtful and reflective and use this to serve our educational interests and learn from it. Not knee jerkedly hang the providers out to dry. Maybe these guys did all they were supposed to but there were extenuating circumstances - which to kind of quote the manager of the service - it was a very unique call. (not sure what that means.)

Looking more at the quotes from the paper - this sounds like (I'm assuming) a cold body.

News quote starts here

The ambulance service determined that paramedics Pat Bajorek and Brandy Johnson followed all the appropriate procedures last month when they attended the patient, 52-year-old Pamela Harper, but they made mistakes nonetheless, said Jon Swanson, director of Metropolitan Emergency Medical Services.

"They did everything that they were expected to do in terms of protocol, but it's a question of interpretation," Swanson said Monday. "Obviously there was an error made because we left her on the scene, and we accept that, and we have to stand up to that." Harper, dressed only in undergarments, was found in the backyard of a home near Napa Valley Drive at 6:30 a.m. March 26.

Ends here

This says to me that they failed to (I'm assuming again) determine that her body temperature was very cold and thus you cannot determine someone dead until they are warm and dead.

I did some research and found via Weatherunderground.com the low temp in Little Rock on March 23 was 37 degrees. The high temp later that day was 60 degrees. At 6am I don't know what the temp was but I can postulate it was around 40 degrees or so. It had also rained that night or morning. Put those two together and this could have been a cold weather arrest. So if they did not interpret that the woman was cold and they didn't run a long enough strip on the monitor then I can see how they missed it.

3 hours later the temperature would have warmed up a bit to mid 50's or so maybe. So she could have "thawed out" by then.

I'm not sure If I am on the right track here but this is just some additional information that I looked at.

Ruff

Edited May 4, 2010 by Ruffems

[emtannie]

I am curious as to what their protocol of "no signs of life" is.

If they ran a 1 minute strip and it was confirmed asystole, the patient was not breathing, and there was no pulse, and lividty was present, then the patient is dead.

Maybe although those medics performed all actions required by their service, it wasn't enough - who knows.

One thing caught my eye in the original article: "Swanson stressed that while the ambulance service takes responsibility for its employees' actions, it would be inappropriate for it to take responsibility for Harper's death because her cause of death has not been determined."

If I understand correctly, 2 crews went to the scene, and 2 crews pronounced this patient dead. I am curious what the factors were - I agree with Ruff that it may have been cold weather related, and that was part of the error in pronouncing. I think they have to take some responsibility in the woman's death; yes she may have died of her medical condition anyways, but the "do no more harm" comes into effect here.

These medics and EMT's have to live with the consequences of this - I hope that it is a learning experience for all.

[ambodriver]

Hold the phone a minute

The patient had all the signs of being dead.

If the patient had those signs and you call the doctor and the doctor concurs then why are we slamming these providers????

I know this is a huge mistake but.... if the signs of life are not there ergo no pulse, no respirations, no auscultatable heart beat, Asystole on the monitor then I'd call this lady dead.

I'd look for other signs, like Lividity or rigor but dammit to hell

If the signs are there, why are we chastising these medics.

now the article says more about their being other circumstances but what the hell do you guys want them to do? Talk to God and say "Hey God, can you send me a sign that this person is really dead??" What if no sign comes down?

Are you going to make them wait on scene for 3 hours just to make sure that no signs of life are there during that 3 hours.

Let me know when you guys stop making mistakes in your daily life, then you can cast stones. Until then.....

I know this will not make many on here happy with me but dangit, this forum continues to amaze me at how much judgement there is here and it makes me very sad.

Now when the rest of this story comes out then we can cast stones and chastise these medics but until then we need to learn from this rather than crucify.

Hey Ruff I agree 100% everyone here LOVES to hate on people. Let's face it EMS is a cruel place where we eat our young and always try to one up each other. I didn't earn my -30 rep. points for sugar coating and not saying how I think it is.

No one really knows what happened.....I wouldn't be so quick to judge w/o having the whole story here.

That being said.....determining death should include a full assessment...including a strip....and cold dead patients..need to be worked in some cases

Stay safe out there guys/gals

Edited May 5, 2010 by ambodriver