Another EMS horror story…

Posted by Patrick Lickiss on Jun 28, 2010 in Assessment, Current Events, Legal, Treatment | 1 comment

UK Paramedic Told Dying Man to Walk to Emergency Vehicle

So to summarize, a paramedic working on a Rapid Response Vehicle, is dispatched to a chest pain call, performs an initial exam, determines that the patient is having an asthma attack, and tells that patient that he must walk to the vehicle so that he can be transported to the hospital.  While walking out to the vehicle, the patient collapses in cardiac arrest.

The article goes on to detail the disciplinary hearings and the subsequent findings against the paramedic, but I’d like to discuss the alleged call itself first.  The first paragraph of the article reads:

“A patient suffered a heart attack and died on his doorstep after a paramedic wrongly diagnosed asthma – then told him to walk to an emergency vehicle.”

My first issue with the call, or perhaps the article, is the fact that a patient diagnosed with an asthma attack, rather than an active MI, is walked from his residence to a vehicle in the first place.  All too often, responders walk patients with significant medical complaints like SOB, seemingly not understanding that even a small amount of exertion can exacerbate the patient’s condition significantly.

The root cause of the issue appears to be a lack of organized assessment on the part of the responding paramedic.  After arriving on scene, he did not bring a cardiac monitor into the residence and did not perform a secondary examination, apparently not checking vital signs either.  The paramedic fully intended to transport the patient to the hospital in the Rapid Response Vehicle, leaving no way for the patient to be monitored en route to the hospital and likely not receiving any treatment.

This case underscores the necessity to treat every patient as though they are “big sick” until proven otherwise.  Had the responding paramedic performed a full ALS assessment on a patient with an ALS complaints, he would have undoubtedly called for a transport ambulance and initiated proper care for the patient.  While it is still possible that the patient may have died, at least he would have been provided with proper care and subsequently a fighting chance.  This case is a stark reminder of the complacency and downright laziness which exists in EMS.  It is a sobering reminder that we have a responsibility to hold our coworkers accountable.

On the subject of accountability, the disciplinary action taken against the responding paramedic seems somewhat inappropriate.  The reporter seems surprised that the paramedic was “allowed to keep his job by the regulatory board” .  I am a firm believer that most CES-related issues in EMS can, and should, be corrected by educational action.  We are all humans and we all make mistakes.  I fully advocate providing the opportunity to learn from those mistakes.  That being said, while educational deficiencies can generally be corrected, personality deficiencies sometime can not.  There are simply people who are not suited to work in EMS.  The kind of paramedic who would knowingly walk an asthma patient (regardless of an acute MI) to a non-transport vehicle may simply not have the requisite personality to continue a career in EMS.

So what was the disciplinary action taken against the paramedic you may ask? A five-year caution order.  The most frustrating part of the article is a statement made by the panel spokesman:

“…saying that problems with Mr Galligan’s patient care meant they had to take some action, but observing that placing conditions on him would be impractical as he worked alone.”

As I stated before, I’m all for correcting educational deficiencies, but allowing a paramedic who made a mistake such as this to continue to work alone seems ludicrous.  Working solo on a Rapid Response Vehicle seems to be a shift that should be reserved for highly trained, clinically sound paramedics.  Using the argument that further oversight would be impractical simply means that the paramedic should be placed on a shift where such oversight is practical.

It seems to me that the Health Professions Council dropped the ball.  I will add the caveat that I have no immediate knowledge of the call in question, nor the subsequent investigation, and I am sure that there are other aspects to the situation than what are stated in this single article.  I still believe, however, that we are standing at a crossroads in the future of EMS and that if we allow apathy and laziness to overwhelm clinical judgement and a desire for excellence, we are going to wind up being relegated to the position of “ambulance drivers” before we know it.

Okay, enough of me on my soapbox, now it’s your turn.  Do you feel the right decision was made from a disciplinary standpoint?  What is your opinion on education vs. punishment in these kinds of cases?  What can we do to weed out/inspire to excellence these types of coworkers?  I’m looking forward to hearing your thoughts.