Mistakes

EMS Reruns addresses dilemmas in EMS. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     You work in a quiet little town with an interstate and some train tracks. Other than a few MVAs and occasional farm accidents, not much ever seems to happen there. It's Saturday night, and you're called to a parking lot behind a bar for a person down with shots fired. PD declares the scene safe and calls you in for two shooting victims.

     You arrive to find the place crawling with cops. They're moving quickly, and they're all business—yellow perimeter tape, floodlights, the staccato blinding glare of red, blue and amber flashers, photo strobes and a crescendo of radio traffic all around you. Most of the activity surrounds a black Camaro with its trunk and doors open. In the cool night air, you can see from 20 feet away that the car's engine is still running. As you approach, you see a still dark form on the ground next to the driver's door and another one behind the rear bumper. The one by the door is a 30-year-old male, and he appears to have been executed; he has two precordial wounds in his chest and a third in the middle of his forehead. The inside of the driver's door looks like it's been sprayed with blood, and the patient is lying in a big, round pool of it. He has occasional agonal respirations, he's pulseless, and his pale skin is covered with crude-looking black tats that vary in age. You have one ambulance, an engine company and no choppers, and you're about an hour from the closest trauma center. You suspect he's a write-off, but you ask someone to patch him while you move to patient No. 2.

     This one's also a male, about 20. His body is covered with bruises, but you don't see any penetrating wounds and there is no external bleeding. He's breathing noisily, about 20 times a minute, mostly with his right chest, and he has a thready brachial pulse of 130. A strip from the first patient reveals asystole, so you decide to pronounce him and focus on this guy.

     You package and load the younger patient, and you're halfway to the trauma center before you realize you forgot to pronounce the first guy. You call your medical control doc and tell him what happened, and he seems cool enough. But by morning, it's a big deal. Your estimated pronouncement time disagrees with the time on the strip and your time of departure from the scene, and the coroner and police want a meet. They're not very nice, and your boss sells you right down the river. He openly reveals that you've been counseled before about the completeness of your charting, and says you will receive discipline as a result of this incident.

     Q. We did the best we could, but we're small-town paramedics and we don't get a lot of practice with these kinds of calls. Why the big fuss over a time of death?
     A. When you deal with a crime scene, you can expect things to be fussier than usual—especially if the call involves a felony. But it does sound like people are over-reacting, possibly because they don't handle these kinds of calls any more often than you do. None of us is accountable for perfection.

     Q. I took my boss' actions personally in this situation. Should he have discussed my disciplinary history with the police and coroner?
     A. I don't blame you. Unless your disciplinary history involves a crime or has been subpoenaed, it's nobody's business but yours and your agency's. Your boss definitely set you up for some hard times by casting unnecessary doubt on your credibility. He also had no business promising anybody that you would be disciplined, especially before he even discussed the call with you. He owes you a prompt, spontaneous apology. If that doesn't occur to him, he has an ethical problem, and this is probably not the first time it has surfaced.

     Q. Right now, I need to get out of this jam with the cops and the coroner's office. How do I do that?
     A. The best thing to do is admit you made a mistake and concede there's nothing you can do to take it back. Then ask them what would make things better. You could attach an addendum to your chart, written as soon as possible after the time of service. In the addendum, explain what happened. Especially explain that being the only paramedic made you responsible for another badly injured patient.

     Q. I am actually a very conscientious paramedic, but I'm not a good writer. Any suggestions for writing that addendum?
     A. Lots of honest paramedics would say the same thing. I suggest writing a rough draft and asking one of your peers who writes well to help you polish it. Tell him the whole story and ask him to make sure the finished product tells that story. In fact, he may be able to help with your charting in general. While he's at it, maybe he can help you with your resume as well. You could use a new boss.

Thom Dick has been involved in EMS for 38 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.