Defective People

     EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. 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. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right experts and share their advice with you. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     You're switching into a reserve ambulance-definitely not your favorite part of being an EMT -and, of course, it's filthy. You and your paramedic partner, Louise, get the thing washed and rinsed and are just about to wipe it dry. Of course, you realize that's like begging for somebody to call 9-1-1.

     Sure enough, somebody does, and you're invited. You and Louise head out of the driveway and north on Fourth for a few blocks, then turn east onto Oxford and pull up in front of Mary McGlocklin's place. Mary is a frequent-flyer with diabetes whose treatment regimen is a persistent source of bewilderment to her. Today, you find her pale, diaphoretic, incontinent of urine and arousable, but when not stimulated, she dozes off. She has a pulse of 130, and her respiratory rate is about 30. She tolerates a nasal airway. You get her on mask oxygen and set up an IV.

     Louise isn't your regular partner; in fact, you prefer not working with her almost the way you'd rather not be assigned to that reserve ambulance. She's kind to her patients, and she seems to know her medicine. But she's not very attractive, and she has a goofy, irritating laugh that she interposes in just about every conversation-even when nothing seems funny. You get the IV and draw the bloods, and Louise records a blood sugar of 42. She gets ready to give Mrs. McGlocklin some D50 while you label the blood tubes and tape them to the IV bag. But as you glance down, you notice an open bicarb package on the floor. Louise has administered about a third of the preload into the IV when you interrupt her.

     Q. Now what? How do you proceed at this point?
     A. Note the time and the dose administered, make sure the patient gets the right drug and finish the call. Bicarb is not likely to hurt this lady; in fact, it may help her. Chances are, your system has a written protocol for situations like this one, and it should specify procedures for both of you after the patient is in the hospital. Generally, the idea is to make sure the error gets reported verbally to the ED physician and to a supervisor, and documented in writing.

     Q. How can anybody confuse those two drugs under these circumstances? Louise is obviously unsafe. Just wait till the other crews hear about this.
     A. Whoa, baby. You can really hurt this paramedic-and prove you're an amateur-by overreacting to this honest mistake. Instead, keep your mouth shut and see what she does next. Even the best of us screw up once in a while. If she's worth her salt, she will report her mistake to everybody under the sun, and she will probably be a ton harder on herself than you could ever be.

     Q. How often does a good paramedic actually give the wrong drug?
     A. I don't know if that information has ever been published. It seems to be pretty rare. But it does happen, especially when people are really tired or distracted. A good supervisor would want to know early in the investigation if Louise is all right. Actually, that wouldn't be a bad thing for her partner to ask her. We're not machines, and sometimes stuff happens in our personal lives that can make it hard to concentrate on our work.

     Q. But there's always a reason why people don't want to work with somebody. Maybe this is just part of Louise's unpopularity. I wouldn't want it to happen again.
     A. I have never understood why, but for people who are supposed to care about others, we can be cruel to one another. Where does it say that a good caregiver has to be good-looking, popular or perfect? Great EMTs understand that some of the most beautiful souls on earth come packaged in the plainest wrappers. On the other hand, lots of wonderful people become unpopular for reasons that are tragically unfair.

     I once read that someone named Samson killed 1,000 Philistines with the jawbone of an ass. It turns out that people's careers, marriages and lives can be destroyed with the same implement.

Thom Dick has been involved in EMS for 37 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.

Thom Dick is a featured speaker at EMS EXPO, October 11-13, in Orlando, FL. For more information, visit www.emsexpo2007.com.