Wierd call. Can you create a scenario that justifies it?

[DwayneEMTP]

Hey, I ran across this article on Link'd in, used as an example of the deterioration of EMS. What bothered me about the article is that it was just accepted that this call made the authors point.

I don't care, in this thread, what you think of the call, or the providers. I only want to hear your scenario as it might have happened to justify the providers reported actions.

This is an exercise in imagination, not morals or ethics, see?

I've been running this through my head for a few hours, and I truly have a hard time creating a scenario where everything makes sense, though it's not too difficult to make one where most things do.

I thought that this might be fun. Please, lets keep it serious for at least a half dozen posts, then it might be even more fun to get more creative...

Hmmm....perhaps then we should move it to the members forum... :-)

http://www.emsworld....by-side-of-road

Dwayne

[paramedicmike]

The only thing I can think of is that she went bat sh*t crazy and was a danger to the crew and patient.

Speculation only.

[Eydawn]

Nope... I can piece together bits and pieces... but there's not enough info here.

Sounds like they were a BLS crew... sounds like he was very sick... but beyond that? I got nothing. There's weird phrasing in this article. There's just not enough info.

I can't even make up a BS scenario that justifies the "abandon woman halfway" and "return to podunk clinic"- those two really get me. The rest of it? Whether or not they provided good care? That's totally impossible to project...

Wendy

CO EMT-B

[ERDoc]

This article had me saying WTF? A little more digging brought me to this blog by an experienced FF and lawyers (that's two strikes against him).

http://firelawblog.com/tag/sugarloaf-ski-area/

Apparently, it Maine there is a new protocol that says that a pt does not need to be taken to the hospital if they code in the field and are without vitals/shockable rhythm for more than 20 minutes. The body can be taken to a morgue, returned to the scene or another place where the body can be properly secured. I think this would clear up the return to the mountain. As for the delays reported by the wife, the records will determine the validity of that but we know how families interpet time when they have an injured loved one. It's also not clear if this crew was ALS or BLS. The few sources I've read have referred to them as both EMTs and paramedics. She criticizes the crew for not treating him for internal bleeding. What exactly did she expect them to do? Prehospital laparotomy or thoracotomy? IV fluids were not going to change the outcome. Some people just get injuries that are not survivable and I would say that is the case here. I'm guessing this NP had medical ICU experience and not surgical or trauma ICU experience. They are totally different experiences and the surgical side gives you a different view on trauma care and expectations. The only thing I cannot make sense of is the claim of the crew leaving her on the side of the road.

[Kiwiology]

What exactly did she expect them to do? Prehospital laparotomy or thoracotomy?

Sure, that's why you need a Kiwiologist on the Ambulance, I've got a big kitchen knife that I use to cut up things and I can have a nose around the insides of somebodies gizzard as long as I have my anatomy book in tablet form; not sure how easy it is to use the touch screen with bloody gloves?

Now if this bloke met the criteria for termination of out of hospital resuscitation then that's fine, but transporting him back to the scene of the accident is pretty weird. So is leaving his wife behind, but maybe he didn't like her? Heck who knows ....

[DwayneEMTP]

Thanks Doc, exactly in the spirit I was hoping for...

...The only thing I cannot make sense of is the claim of the crew leaving her on the side of the road.

My guess is that she was mean, panicked bitch. But again, 'the side of the road' is pretty vague. If she jumped in the back despite being told not to and they pushed her out, then the side of the road could actually be the side of the parking lot. Or the side of the road with the ski lodge on it.

Maybe this place is really remote, so the protocol allowes for securing the body so that you don't have to either shut down the resort or leave it under manned for emergencies? That was the hardest thing for me to figure...I can pretty easily see needing to kick Ms "I'm a nurse and you need to fucking listen to me!!" out (Not a general shot at nurses, but at the type of provider at any level that most of us have seen behave in such a manner.), but I couldn't for the life of me figure out why the hell they would have driven the body back to the scene.

I do think that it's interesting that everyone involved had to be notified that there were problems, and complaints being filed, from a reporter. She was so crushed by her husbands death and mis-care that her first thought was to begin shoring up the jury pool for her lawsuit....grrrrrrrrr...

Dwayne

[systemet]

It's a little confusing.

* In the different posts it's suggested she's left at scene, and elsewhere that they started transport with her up front, she asked (demanded?) to be let into the back, and they let her out the passenger door and then drove off.

I can see refusing to transport her if he's critical. I believe this would be a mistake unless she's interfering with medical care. The only circumstances I can see leaving her on the side of the road after initiated transport under would be if the driver is concerned she is going to do something crazy like grabbing the steering wheel. This would have to be a really well-founded fear, otherwise it would be kind of a dick move.

* I don't understand how them move him to the ambulance with pulse, he codes, and they d/c BLS and return him to the scene.

Maybe there's a specific rule for BLS crews with a prolonged transport. One source suggests it's an hour to the ER with no medevac available. Even there, I'd expect any crew to start CPR, and run the code for a while in the absence of a DNR.

My suspicion is that the available (often contradictory) information doesn't fully describe what happened in an accurate manner.

[Chief1C]

Being in a rural/wilderness area with varing degrees of ourdoor recreation, this area attracts a lot of folks who want some adventure, but not too much. I've had interfaces, I guess would be the best way to put it, with varied professionals, nurses (which is a broad term, since they never say WHAT KIND of nurse they are), which also applies to doctors. I know a few people very well that are doctors, well, that have doctorates, and application of Band-Aids is probably the most invasive skill they have. I don't have time now, but I care share a scenario. In fact, several, but we'll go with one.

*can share. I'm tired, I have paperwork to do. A LOT OF FRICKEN PAPERWORK. And I'm on call, so I'm gonna nap. I'd have edited this, but their computer sucks and "Windows - Virtual Memory Minimum is Too Low". wtfbatman.

....and I'm hungry, which is a combination that will make my bgl low, which in turn will make me pissy.

[ERDoc]

Sugarloaf is pretty rural. According to what I read, the closest hospital, which is where the ambulance came from and was going to to was 1 hr away under normal conditions. Comments from the EMS service say that the weather and roads that day were bad and they couldn't go much over 35mph. Looking at it on Google maps, it seem like a 43 mile ride on mountainous, rural roads.

Sysmet, the protocols that are posted in the blog I referenced above say that BLS can call a code after 20 minutes without a pulse.

I think it's interesting that this man dies on Jan 12 and his wife has already started the complaints within the next few days. WTF?

[Kiwiology]

....and I'm hungry, which is a combination that will make my bgl low, which in turn will make me pissy.

... but that defies the laws of basic science, you should only get pissy if your BGL is high and you've got polyuria due to osmotic diuresis

/taking the piss

Oops too much talk of piss, quick, lay still while I foley catheter you ...

I think it's interesting that this man dies on Jan 12 and his wife has already started the complaints within the next few days. WTF?

Well if your significant other died and you felt those responsible had been in the wrong wouldn't you be complaining?

No, you wouldn't, you don't love me that much, infact knowing you, you'd drop me at like nine mile road and make me walk through Harper Woods or some shit, bastard!