A.J.'s Take: Know Your Limits and Your Role
Note: A. J. Heightman comments on "Former Va. EMT pleads no contest in prank death of colleague" that appeared on Jems.com January 25, 2006.
This is a tragic case that has affected the lives of family members on both sides of the case. But there are several important lessons that can be learned from this case. First of all, it never should have happened. An EMT, unless trained and certified to use a manual defibrillator, should not touch or charge the paddles period!
While family members can cry out that Joshua Philip Martin was a "good kid," the fact is that he performed an action that he should have known could have detrimental effects. During EMT training, EMT instructors should clearly delineate the roles and responsibilities of EMTs. That includes what an EMT is allowed to do and what an EMT is NOT allowed to do. We talk about scope of practice, but usually in the context of paramedics. EMTs have to be taught what their scope of practice is as well, with emphasis on their role while interfacing with, or assisting, paramedics.
This is not the first case, and won't be the last, where an EMT uses equipment inappropriately. During my 18 years as a regional EMS director, I was called on to investigate instances where an EMT used a manual defibrillator or advanced airway (in the absence of a paramedic) in an effort to save the life of a patient that deteriorates before their eyes. The EMTs defense was often that he or she felt compelled to do whatever they could to save the patient's life. The fact is, however, that, if they did not have access to the ALS device they weren't supposed to use, they wouldn't have been tempted to do so.
In addition to training institutes, the EMS agency also has an obligation, through employee orientations, training sessions and standard operating procedures, to clearly identify to their personnel what they are allowed to do, and what they are not allowed do in the performance of their duties.
The agency also has a moral and legal obligation to keep ALS equipment out of the hands of non-trained personnel, whether that be an EMT on an ambulance or fire rig not staffed by paramedics on a particular shift, or a teenager that enters the ambulance during a local school presentation and shocks a classmate while, as Martin's aunt proclaimed, he or she is "just playing around."
Many EMS agencies secure their ALS gear in locked compartments when the unit isn't staffed by paramedics. This keeps crews from being tempted to act beyond their level of training. It also keeps morphine and other drugs secure from theft while their vehicle is unattended. Remember, drug abusers know what's carried in your drug kits.
Joshua's mother said that "Everyone plays on the job." While I don't disagree that emergency personnel often play practical jokes on each other while on the job, in this case, Joshua Martin crossed the line and will pay dearly for his actions the rest of his life. There's a big difference between short-sheeting a bed while a crew is on a 2 a.m. run and sending 200 to 360 jolts of energy across the chest of a healthy co-worker.
This case should be printed out and posted on every EMS and fire station bulletin board to emphasize the often unexplained consequences of inappropriate actions by EMTs and paramedics.