In Your Words - Administration and Leadership - @

In Your Words


From the May 2010 Issue | Thursday, April 29, 2010

Standing Trial
This month, a subscriber shares his experience at the center of a lawsuit for his treatment of a patient with, what was at the time, a relatively unknown condition, which JEMS covered in depth in February. Also, a provider who took a patient to the appropriate facility rather than the family’s preference—and may now have to answer in court for secondary injuries the patient sustained there—writes about finding solace in W. Ann Maggiore’s “Destination Decisions.”

You did a great service to the EMS community by providing the article (“Red Hot Herring,” February JEMS). I’m a paramedic who was charged, stood trial and was acquitted in connection with the death of a patient in my care. I successfully proved in court that the patient in question died of excited delirium syndrome (ExDS). This case took place in 2004, when ExDS wasn’t widely known and wasn’t yet recognized by any medical board as a unique syndrome. I was aware of it because of training I received. Good thing, or I wouldn’t have known about it either. I’m now lecturing about my experience and ExDS in an attempt to educate other health-care providers, should they ever encounter it. Again, great job, I was truly excited to see ExDS brought to the pages of JEMS.
Marty Johnson, NREMT-P
Ashland, Kentucky

Thank you for your timely article (“Destination Decisions,” I run a tiered paramedic service in conjunction with several BLS fire departments. We recently had a call in which we used the state trauma triage criteria to transport to a Level 1 trauma facility. The family preferred another hospital and because there were no obvious broken bones or interruptions in the continuity of the skin, they didn’t understand why he needed to go to the trauma center.

Unfortunately, the patient received secondary wounds during treatment in the trauma hospital and has a cric and is scheduled for surgery to repair the secondary wounds. Because the patient wasn’t transported to their favorite hospital, the family is now claiming the BLS fire chief is responsible for their loved one sustaining a “hole in his neck.”

We met with the family this week, and the conversation went well. I’m reasonably sure the hospital will be sued and we may be named in the suit. But I feel confident that we did the appropriate thing for the patient. The wife and daughter stated several times that the field care was excellent, but continued to contend a wife should determine which hospital is chosen for her husband. As a token of faith between the two groups, she has agreed to review the handouts of the trauma triage laws with the chart of hospital capabilities. I’ve agreed to hold training with all of our staff, ALS and BLS, reviewing the importance of a thorough assessment, knowledge of capabilities and respect for and communication with the family on the scene. I will now distribute “Destination Decisions” during that training.
 Nadine J. Swift, NREMT-P
Via e-mail

Words of Encouragement
JEMS, you’re great at getting some “heated” disagreements going, which I like and think is great for the prehospital field. JEMS is a valuable educational tool to use for everyone. Keep up the great work. I’ve missed working as a paramedic and will recertify my credentials in the fall.
 David Stratton
Via Facebook

A  World of ‘No’
“Critical Decisions” (March JEMS) missed the mark. I’ve quit reading EMS journals because every time I pick one up, Bryan Bledsoe writes another article about something else we shouldn’t do. Helicopters again? Try working somewhere where emergency departments routinely have less than 10 beds, services with no continuing education for those who might intubate just a few times a year, poor or non-functioning communications, demographically destitute tax bases and rural medicine years behind the curve. Be the one in charge of 10 or 12 patients critically injured in a motor vehicle collision where you have only a couple of ambulances and mutual aid is 45 minutes away (if they respond at all). Work where there is no more money, no more people, and sometimes no other—and no better—way than a helicopter. EMS in much of the country lives and practices in this reality every day. Write an article about ambulance and fire truck crashes for a change.
Robin House, NREMT-P/FP-C
Kennesaw, Georgia

Editor-in-Chief A.J. Heightman responds: I understand your concern over Dr. Bledsoe’s article, but having lost one of my best friends to a poor-weather, poor-decision, helicopter crash and having to present at the National EMS Memorial service this year with 75% of the EMS deaths attributed to aeromedical crashes, I also understand the need for more vigilance in the request, screening and use of helicopter resources. Dr. Bledsoe isn’t opposed to helicopter use. He’s opposed to inappropriate use of helicopters, particularly when they place flight crews and patients at risk or kill them because of poor weather or poor dispatch decisions.

Locally, I witness crews sending conscious head “bumps” 40 miles to the “city” because the ambulance services involved don’t want to fight traffic and lose an ambulance out of service for two hours because the specialty centers are so far from their district. Call it laziness, poor decision-making or negligence, it involves the “requesting” ambulance service and the “accepting” helicopter service. I believe both are wrong in many instances. So, until there are better guidelines and standards nationwide for use of helicopters and/or medical audits of inappropriate use, I will continue to periodically allow articles to keep the heat on them.

Please keep in mind that we try to have balance in what we present. We cannot ignore the fact that helicopters are crashing at an unacceptably high rate and some operators refuse to upgrade their acceptance protocols, or add important navigation and flight-following equipment—contributing to the problem; they need a reminder (conscience) to force them to pay attention to, and address, these important issues. JEMS

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Related Topics: Administration and Leadership, Leadership and Professionalism, Jems Letters

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