Administration and Leadership, Patient Care, Training, Trauma

Caught on Tape

Issue 9 and Volume 33.

I was sitting in a hotel this morning watching a special report about an American who was participating in the running of the bulls in„Pamplona,„Spain. He was gored and stepped on by a bull, but thanks to surgery, lived to tell his tale on TV. I was quickly reminded that folks like this provide„EMS job security.

A video of the incident played, while reporters discussed how this guy was going to recover from his injuries. In the end, the intrepid bovine adventurer insisted he was ˙really stokedÓ until the ˙gnarlyÓ injury happened and that he_ll return again next year to participate.„

From„Pamplona to your ambulance, video is being shot everywhere. How might it affect„EMS? Consider this scenario.

You_re working as an„EMS provider for a large teaching hospital network. The network provides a multitude of prehospital services, including medevac, paramedic fly car, BLS ambulance transport and transportation of patients between hospitals and nursing homes or patients_ homes.„

On this day, you_re working on the transport vehicle and have a scheduled pickup at a skilled nursing facility for transport to another hospital that isn_t in the health network you work for. Your patient is an 80-year-old female with chronic dementia. You package her up, placing her on the high-tech stretcher, and begin the transport.

Your partner drives the truck slowly and carefully, and you arrive at the network hospital without incident 40 minutes later. As your partner parks the ambulance, you jump out of the back and take out the stretcher, extending the wheels to the cement at the ambulance entrance.„

You begin pushing the patient toward the door of the hospital solo, even though you know the stretcher manufacturer advisesƒand your agency insistsƒthat two people hold the extended stretcher. Your partner calls for you to wait for him. As you turn to answer him, it happens.

The left front wheel of the stretcher gets hung up in a crack in the cement and the stretcher tips over. The patient_s head and left side absorb all of the impact. You and your partner pick up the patient and observe that she now has a large laceration on the side of her head. You both take the patient in to the emergency department for treatment and then leave to report to your supervisor_s office to fill out the required incident reports.

During the ride to your headquarters, you and your partner are concerned not only about the dropped patient, but also the disciplinary actions that may be coming your way. You and your previously innocent partner decide to get creative with your incident report, essentially stating the stretcher was being operated as your organization stipulated, with both crewmembers holding on to it, with the crack in the concrete emerging as the primary villain.„

After filling out the incident report, you and your partner each explain your version of the event to the supervisor, who tells you he called the hospital and found out the patient has fractures to her skull, left shoulder and ribs. He gives you the details for your remedial training on patient moving and stretcher techniques.

Fast forward four days. Your supervisor calls you in for a meeting about the incident. When you arrive, you find your corporation_s directors of human resources and risk management as well as a company attorney. Your boss gives you the horrible news: The patient who was on the fallen stretcher has died from a subdural bleed. This news is stunning. You knew she had some injuries but presumed she would be OK.

In addition, you_re informed the hospital you brought the patient to has a surveillance camera focused on the parking lot. Your boss, risk management director, the deceased patient_s family and their attorney, plus the state agency that credentials you, will become very interested in that video.„

You and your partner now have to explain not only why the patient was injured, but also why you misrepresented the facts. Perhaps now would be a good time to look for a new job (and an attorney).

As our parents told us, honesty is the best policy. Video doesn_t lie and neither should you. Very few people get dismissed over an actual incident; they get dismissed for lying and misrepresenting the facts.„

What happened to this patient is a tragedy. It could_ve been prevented, but you can never discount human error; just ask the aviation industry. We must train our students to be honest and ethical providers, and we must also recognize that in this post-9/11 world, more likely than not, we_re being filmed on the job. JEMS

Paul Werfel, NREMT-P, is the paramedic program director for the„University„Medical„Center at State University of New York, Stony Brook. Contact him at[email protected]