I know, the title is a little confusing. A paramedic rarely admits that he made a mistake. In this instance, it was late January 2020 when I received a text. Adding a little more background into the fray, I had left my office a little on a very pretty day to help my wife go and pick up a table to put in her office. Now those details have nothing to do with the outcome of the story except to say that I was not wanting to answer a message about work on that day, but I did.
In the message, I was asked if I had heard about this new virus that he was hearing about.
Related: Getting Back to Basics: Measuring Blood Pressure
This individual that asked was a friend and colleague in the Emergency Services community focusing on the law enforcement side, but he had safety and security in his role as well. By now you are already tying two and two together and determining that the virus in question was the novel coronavirus that we have heard extensively about since that time, that’s right it was COVID.1
Now, it wasn’t my first answer that was the problem…it was the second. After a short conversation, he asked me THE question. Do you think that this is going to affect us? My answer, if it does make it to the United States, we probably won’t see anything about it in our area. Following that text conversation, there was a reassessment that occurred, we observed more data coming in about it, and in the weeks, and months after that fateful message I subsequently changed my viewpoint and helped guide our portion of the conversation during a time that had significant impact around the globe.
Now, that whole situation took months to develop, and the data points that were being assessed were based upon days or even weeks’ worth of trend analysis, but after exchanging the time cycle it is very similar to the overall assessment and treatment of a patient. In a patient encounter, the treating practitioner is going to make determinations on the care of the patient based upon the information they receive.
Some of these will include the vital signs that we spoke about just a couple of months ago, while others are going to be based on new interview information with the patient or bystanders. Others may even come after consultation with the receiving hospital or review of the protocol manuals, but one way or another we determine the field impression of the patient and start care.
Related: Getting Back to Basics: Obtaining Your First Set of Vital Signs
Before we get into a conversation about what can go wrong with this patient, we should talk about why we continue down the wrong path. In the field, practitioners do not have a substantial amount of time to make decisions. When facing a life-threatening medical or traumatic patient condition the time diminishes rapidly.
In the classroom, we discuss the need to narrow into the microscopic view of the patient’s condition while maintaining the macro view as well. This can be complex especially if the patient’s condition is deteriorating.
To determine if you are on the wrong patient presentation or treatment plan you must constantly and consistently reassess your patient. I once had a conversation about the Trendelenburg position,2 and the individual on the other end of the conversation fought to the end stating that it worked. When I asked what he did in between reassessments he said that he placed the patient in the Trendelenburg position, started bilateral large-bore IVs, and administered dopamine.3
So, the question is, what brought up the blood pressure? When you provide a modality, reassess and see if you had a positive or negative reaction. That information can provide you with an understanding as to whether you are on the right track.
Patient Harm
Patient harm: Foremost, the gravest concern arising from an erroneous field impression or treatment plan lies in the potential exacerbation of the patient’s condition or the infliction of further harm upon the individual. Prompt identification of an inaccurate field impression or treatment plan is crucial to mitigate such harm. In line with the timeless wisdom of Hippocrates, the Greek physician, adhering to the principle of “first do no harm,”4 necessitates swift correction of any such situation and redirection onto the correct course of action.
Legal and Ethical Consequences
Once patient care is transferred and you resume duty, the sphere of legal and ethical implications comes into play. In my extensive experience, I have observed that meticulous documentation plays a pivotal role in these instances, along with transparent communication about the circumstances that guided your approach to patient care. Revisiting the fundamental principles of EMS Education, establishing negligence requires the plaintiff to demonstrate that they had a duty to act, breached that duty and that breach directly caused the harm. Notably, recent news has highlighted various cases across healthcare disciplines attempting to establish failure in one of these areas as the cause of harm.5 Concealing information will invariably compound the legal considerations and unquestionably constitutes an ethical lapse.
Professional Consequence
Errors in patient care can have professional ramifications for the EMS practitioner. This may include disciplinary action from the EMS agency or regulatory bodies, such as license suspension or revocation, retraining requirements, or a damaged professional reputation.
Personal and Emotional Impact
Making a mistake in patient care can have a significant emotional toll on the paramedic.6 They may experience guilt, stress, anxiety, or a loss of confidence in their abilities. Seeking support from peers, supervisors, or professional counseling services is important in coping with these emotions.
While we don’t always like to admit it, there are times when we get things wrong. To prevent these types of errors from happening, make sure that you keep up with the latest medical journals, practice skills that you don’t accomplish frequently, enhance education, review cases, and have others review to help guide you in ways to build your ability to treat patients. If you are wrong, correct it as quickly as you can. Take all the data points that you can get from your patients including your interview, vital signs, and scene indicators to ensure that you are on the right path.
References
1. JEMS. New Name for Disease Caused by Virus Outbreak. 2020 Feb 12 [cited 2023 Nov 6]. Available from: https://www.jems.com/news/new-name-for-disease-caused-by-virus/
2. JEMS. The Myth of the Trendelenburg Position. 2009 Apr 4 [cited 2023 Nov 6]. Available from: https://www.jems.com/patient-care/myth-trendelenburg-position-0/
3. Spruce, Andrew C. Shifting Paradigms In Prehospital Vasoactive Therapy: A Case For Push Dose Vasopressors in Prehospital Protocols. JEMS. 2020 July 9 [cited 2023 Nov 6]. Available from: https://www.jems.com/operations/a-case-for-push-dose-vasopressors-in-prehospital-protocols/
4. JEMS. The Law of EMS. 2007 Feb 21 [cited 2023 Nov 6]. Available from: https://www.jems.com/patient-care/laws-ems/
5. Murphy, John K. Preventing EMS Legal Issues. JEMS. 2022 March 15 [cited 2023 Nov 6]. Available from: https://www.jems.com/special-topics/jems-at-fdic/jems-con-2022-preview-preventing-ems-legal-issues/
6. Duffee Bram. The Role of the Paramedic in the Battle Over Stress. JEMS. 2023 Sept 6 [cited 2023 Nov 6]. Available from: https://www.jems.com/commentary/the-role-of-the-paramedic-in-the-battle-over-stress/
