Cardiac & Resuscitation, Patient Care

Are Foxes Guarding Your Henhouse?

What does the word„accountability„ mean to you? Does it mean that you answer to a medical director or QA committee? Does it mean you_re being held to a state law, standard or set of rigid protocols?„

Or does it mean that you operate in a system that holds court internally, brushes under the carpet issues regarding poor care and reports only the most egregious cases to a county, regional or state„EMS agency?„

Several recent cases make me wonder whether we have the fox guarding the proverbial henhouse in some„EMS systems, because the errors that occurred are so obvious that it seems the officials involved either were asleep at the quality review switch, were clueless about what constituted acceptable care or simply whitewashed the citizen complaints.„

In one case, a woman who was trapped and unconscious in her car awoke covered with an oily film. She remembers her eyes and face burning, ˙like bacon sizzling,Ó and telling the firefighters who were working to rescue her. But, she says, they didn_t flush her eyes. She also told the transporting private ambulance crew that her eyes were burning, but they didn_t flush her eyes either, reportedly telling her that it would get their floor wet.„

By the time she got to the emergency department and her eyes were irrigated, battery acid and other chemicals from her vehicle had burned her corneas. Despite five eye surgeries, the 47-year-old woman sees nothing but blurred images and has been unable to return to her job. She sued the ambulance company and received a $400,000 settlement.„

When an investigative reporter checked with the„county„EMS authority that regulates the involved rescuers, the agency had heard nothing of the incident or the crews_ failures to flush the woman_s eyes. Although county policy requires fire and ambulance service officials to report medical errors or potentially serious lapses by„EMS providers, neither agency felt their crews rendered inappropriate care.„

In another case, a woman claimed a fire department crew conducted a ˙perfunctoryÓ exam on her husband after he collapsed in a store and that they concluded he was just having an anxiety attack. The woman says the paramedics ˙grudginglyÓ performed an ECG, deemed it inconclusive and discouraged her from having him transported to the hospital, saying they wouldn_t give him medications or keep him hooked to their monitor. ˙It_s going to be an expensive taxi ride,Ó one responder reportedly said.„

She told fire department officials in a formal, written complaint that the crew joked around while caring for her husband and told her to take him home, get him a beer and let him rest. Upset by their callous attitude, she took him to the hospital in her own car, where he was admitted and had cardiac surgery.„

After the woman wrote the complaint, she received a letter that stated an internal review found her husband_s medical care was ˙within the scope of standardized treatment.Ó The responding chief apologized for the crew_s ˙insensitive or abusive comments.Ó However, when a reporter questioned the care rendered, an assistant city attorney declined comment, citing confidential medical and personnel issues.„

In May, Hall of Fame jockey Laffit Pincay Jr. was awarded a judgment of $2.7 million by a jury following a lawsuit against a private ambulance service. The jury found that a responding crew that attended to him after a fall did not follow proper„EMS procedure.„

When Pincay was thrown from his horse during a race four years earlier, he wasn_t collared or backboarded. Instead, the crew reportedly had him walk into their ambulance and transferred him to the track_s first aid station, which treated and released him. He was scheduled to race again less than a week later, but his neck pain persisted and he went to a hospital to be examined. The exam revealed two cervical fractures, and the injury forced his retirement.„

Pincay_s attorney successfully argued that if proper immobilization procedures had been followed, Pincay would have been able to return to racing in six to eight weeks. When commenting on the jury_s decision, one of the ambulance service owners told a newspaper, ˙As far as I_m concerned, nobody at the company did anything negligent. We didn_t cause [the jockey_s] accident or his retirement, but the jury saw it differently.Ó„

Pincay also received an out-of-court settlement from the racetrack and the physician_s assistant who treated him immediately after the accident.„

If an EMT was thrown from a horse, do you think they would receive full immobilization? And if a firefighter got hydraulic fluid or an ˙oily substanceÓ in their eyes during a rescue, do you think they_d get their eyes flushed? You bet they would.„

So why does a patient have to practically beg to have her eyes flushed? One likely reason is a lack of detailed care and quality review procedures, such as flushing of a complaining victim_s eyes.„

Much of what we do in„EMS requires us to use our judgment. But basic proceduresƒ such as backboarding patients who meet the mechanism of trauma criteria and flushing the eyes of a patient in obvious pain and distressƒ should not be among them. Take a close look at your agency_s policies and procedures, and don_t let foxes guard your henhouse.„