Investigated Because They Did Not Start The I.V. Enroute To Hospital

[romneyfor2012]

http://www.niagarafallsreview.ca/ArticleDisplay.aspx?e=3408114

[CPhT]

After reading some of the comments, it sure seems like they did everything they could to save that girl. However, one of the things that my preceptor and my instructor always tried to pound into my head was the idea that "if it's not on the PCR, it never happened". Likewise, if it's recorded incorrectly on the PCR, that's the only thing they can go by. I'm not sure about the Canadian lawyers and juries, but I'm pretty sure that a good malpractice lawyer here could tear the defense to shreds on that basis alone.

The jury was told earlier there were some discrepancies in the paramedics' documentation of events. That's not unusual, Dreyer said, as patient care is more important than paperwork when dealing with a critically injured patient. "The last thing you are concerned about is documenting second by second," he said. "I personally didn't see a huge benefit to knowing second by second what a paramedic is doing.

On the other hand, the two ER physicians speaking in defense of the medics really lend credibility. The part that always scares me about if I ever had to go to court would be the "standard of care"; basically, asking other providers what they would do in the same situation. Ideally our answers would coincide, but like this article mentions, there are often events or circumstances which give variance to the "standard of care".

All-in-all, it's really sad that the girl died. Accidents are tragic, but they are just that; accidents. Only the people who stepped up and tried to save the girl can really understand what was done, and why it was done. Good job to the medics for trying so hard.

[romneyfor2012]

I read another report that showed it took almost an hour to get to the hospital after arriving on-scene, it does not say how much time they spent on-scene or how many miles away the hospital was, so that could be a problem.

[BEorP]

Though it is nice to see support from the emergency physicians, the bottom line is that if these paramedics delayed transport to start an IV in a trauma patient, they were wrong. Would it have likely made a difference in outcome? Not likely, but they were still wrong to waste time on scene like this. Of course, we don't know all of the facts here and it is always easy to look back and judge, but it certainly seems like the paramedics are getting off relatively easy.

Don't delay transport to start IVs on trauma patients. If you do, you're not acting in the best interests of the patient.

[CPhT]

I just found another article that stated that the scene-to-hospital distance was 20km.

http://www.thespec.com/news/crime/article/628527--anzovino-inquest-will-resume-dec-5

The hospital that was closest (by 5km) was closed due to restructuring. 20km, in icy conditions, seems like it might have close to 20 minutes of travel time. The first article only mentions that the medics spent 50 minutes trying to revive, so I can't really make an assumption of how much was spend on-scene vs. en route.

I've personally never started an IV (still 8 months out of starting my medic courses) but I can imagine they have SOME justification for starting it on-scene rather than waiting to get in the back of the truck. If it's a big enough deal that they mention it as a deviance from the standard, then (Devil's advocate) they MUST have had a reason.

We'll see what comes of it though. I'm really interested now.

[paramedicmike]

I read another report that showed it took almost an hour to get to the hospital after arriving on-scene, it does not say how much time they spent on-scene or how many miles away the hospital was, so that could be a problem.

The article did state that the accident occurred on an icy stretch or road. If that is, in fact, the case, it would not be unexpected that transport might be a little slower so as not to wreck the ambulance on those same icy roads.

With regards to starting the IV prior to transport, there are too few facts to make any kind of judgement here. Was the patient entrapped and the IV was started on scene for pain meds to facilitate extrication? Or was it started while the extrication was ongoing in recognition of fluid volume loss? We don't know. We weren't there. We can't say.

Ultimately, the doc quoted here is going on the record to say that he is backing the medics in question. If there were a question or concern on behalf of this doc the tone of this article would be very different.

[HERBIE1]

It does not specifically say what the charges are here- negligence, malpractice, etc. It also says that this seems to have started with the coroners request that the ER doc review the case in regards to the fact that the closest ER was not available and whether or not that played a role in the outcome of this case. It seems that the lawyers are using the shotgun approach- dissect every aspect of the case and see if they can assign blame/fault/culpability- which in essence means they are looking for the ones with the deepest pockets.

As the doctors testified, "We believe any small delays would not have made a difference and taking her to a trauma centre would not have made a difference." and "Most trauma centres would have recognized the outcome and would not have continued for that period of time."

In other words, if a trauma team couldn't have saved this woman, what difference does a couple minutes make if they did try to start an IV? Maybe they were trying for IV access to sedate the patient, since apparently she was combative? Not knowing local protocols, the patient's vitals or injuries, nor the legal system there it's hard to know any more but it does not sound like the medics did anything egregious, and certainly nothing negligent.

I agree with the doc's statement that load and go is the preferred treatment on a critical ill trauma patient, but patient and crew safety comes first, meaning she needed to be restrained before they took off.

I cannot imagine they will find fault in the prehospital treatment of this patient.

[BEorP]

I've personally never started an IV (still 8 months out of starting my medic courses) but I can imagine they have SOME justification for starting it on-scene rather than waiting to get in the back of the truck. If it's a big enough deal that they mention it as a deviance from the standard, then (Devil's advocate) they MUST have had a reason.

If they delayed transport to start an IV on a trauma patient, they were wrong. I don't mean to seem like I'm not open to a discussion, but I really don't see how there is much more to say on this. Prehospital IVs in trauma patients don't save lives. This type of patient is why the OPALS study showed that severe trauma patients treated by ACPs (likely getting IVs) had worse outcomes than patients treated by providers not certified in IV therapy.

If the patient was trapped and they popped a line in then, it would not have been mentioned as a deviation from accepted practice since it would not have delayed them on scene.

Despite her chances of survival being incredibly low, this girl needed a doctor, not an IV.

It does not specifically say what the charges are here- negligence, malpractice, etc. It also says that this seems to have started with the coroners request that the ER doc review the case in regards to the fact that the closest ER was not available and whether or not that played a role in the outcome of this case. It seems that the lawyers are using the shotgun approach- dissect every aspect of the case and see if they can assign blame/fault/culpability- which in essence means they are looking for the ones with the deepest pockets.

This is not a lawsuit, it is a coroner's inquest. The jury is mainly trying to answer basic questions about the death and is also likely to make non-binding recommendations to prevent future deaths. More information here.

[HERBIE1]

If they delayed transport to start an IV on a trauma patient, they were wrong. I don't mean to seem like I'm not open to a discussion, but I really don't see how there is much more to say on this. Prehospital IVs in trauma patients don't save lives. This type of patient is why the OPALS study showed that severe trauma patients treated by ACPs (likely getting IVs) had worse outcomes than patients treated by providers not certified in IV therapy.

If the patient was trapped and they popped a line in then, it would not have been mentioned as a deviation from accepted practice since it would not have delayed them on scene.

Despite her chances of survival being incredibly low, this girl needed a doctor, not an IV.

This is not a lawsuit, it is a coroner's inquest. The jury is mainly trying to answer basic questions about the death and is also likely to make non-binding recommendations to prevent future deaths. More information here.

Thanks for the info- very informative. Sorry, but here in the states, we are a litigious society, which means everything is about assigning blame and looking for someone to pay up. (That's why so many folks here have been campaigning for tort reforms in recent years.) That was simply my knee jerk response because of my perspective.

Agreed about delaying transport for an IV being flat out wrong- unless there were extenuating circumstances as I mentioned above, but I find it impossible to believe that this in any way contributed to the death of this patient. The docs even agreed this patient's outcome was not affected by their actions.

[DwayneEMTP]

If they delayed transport to start an IV on a trauma patient, they were wrong. I don't mean to seem like I'm not open to a discussion, but I really don't see how there is much more to say on this. Prehospital IVs in trauma patients don't save lives...

So are you suggesting then that fighting with and sitting on this combative patient until the ambulance was rolling, instead of sedating, (Theoretical case of course, and assuming worst case, no IN drugs.) is a more realistic approach? As she soon died from her injuries I have a hard time believing that this could be considered 'doing no harm', right?

Actually I think we need to define 'delaying transport' as I don't believe that transport would be delayed if it was not realistic to actually get the patient into the ambulance. An extremely combative trauma patient is not so different from one that's entrapped as I doubt that you will do much less damage by continuing fight with them then you would by simply ripping many traumas out of their entrapments.

It's not your general argument that I have an issue with but the absolute statement. I've heard of that study, but haven't read it on my own, which I would need to do as most every study of it's type that I have ever been exposed to has been heavily flawed.

But even so I'm willing to bet, and you can help me out as it seems that you have read it, that their conclusion wasn't 'There is never a need to begin an IV prior to transport as no trauma patient has ever been helped via that intervention."

We need to put the 'never start an IV before rolling' with the Golden Hour and the Platinum 10 as absolutes that have no real place in intelligent patient care. In my opinion of course.

Dwayne