Re: Firing as a bad policy

[Guest guest]

One other thing I find confusing about the stuff NOW being published in the

paper. Other EMT's at the station are saying that vital signs and a proper

assessment WERE performed. If this is so, the EMT involved is may be guilty

of failing to write a run report (if he didn't), and IS guilty of poor

judgement. But I don't think any of us can claim to never have made a bad

judgement.

Again, my main point is that firing should almost always be a last resort.

OTHER diciplinary (sp) measures should be used first. Keep in mind, you can

ALWAYS fire them later. But if you fire them then rehire them, you look

double the fool. And if you fire them and they turn out to be in the right,

you might be facing a lawsuit.

Webb

PS: Oh great, a lawyer agrees with me, my reputation is TOTALLY shot now.

(JOKING) Hiya Melody, how are you? Of course, the first statement assumes

my reputation wasn't already totally shot. =)

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[Guest guest]

I am tending to agree with more on this situation. After reading

the report I am even more perplexed. It says:

" Twelve year old reportedly arrived at Ben Taub Hospital by

private automobile at approximately 4:51 p.m. on June 17, 2000 and died at

approximately 9:21p.m. of an Aortic Aneurysm. This investigation confirmed

that between the hours of 3:30 p.m. and 4:30 p.m. on the same day,

was taken three times to Fire Station 18 by relatives seeking medical

assistance. "

It seem there were some internal administrative regulations violated by not

notifying the supervisor on duty, no vital signs, ect. but I think the

Plaintiff's attorney will have a hard time showing this 'failure' is what we

call a " proximate cause " of the death of the child. He was at the hospital

almost FIVE hours before he died!! . . . and the delay of transport by

private car may be minimal considering all the facts of the case.

Needless to say, it is tragic for all involved.

Melody

[Guest guest]

The official report does not say that.

Melody

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

<<One other thing I find confusing about the stuff NOW being published in

the

paper. Other EMT's at the station are saying that vital signs and a proper

assessment WERE performed.>>

[Guest guest]

What happened to the " DUTY TO ACT " that has been said to us all throughout

our EMS classes and our carrers. The medics in Houston had a DUTY TO ACT and

did not!!!!!!!!!!!!! that is the bottom line.

Gene Sullinger EMT-P

[Guest guest]

Again, where is the paper work.

--- m & m's wrote:

>

> The official report does not say that.

>

> Melody

>

> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

>

> <<One other thing I find confusing about the stuff

> NOW being published in

> the

> paper. Other EMT's at the station are saying that

> vital signs and a proper

> assessment WERE performed.>>

>

>

> [Non-text portions of this message have been

> removed]

>

>

__________________________________________________

[Guest guest]

I think what's important for us, is to learn from this incident (right or

wrong).

We need to realize that this is a common event, if it hasn't happened to you

it will eventually. The result does not have to be a death, for it to come

back and haunt you.

1. If Pt. contact is made, report it. Make a run sheet, tell you shift

supervisor and or EMS Officer. Bottom line, CYA.

2. I don't recall if the article stated a language barrier existed, but if

it does, find an interpreter. Spanish, Asian, or even Signing. Especially if

a no transport is done.

3. I was once told ( at a service in the Dallas area ) " don't worry about

it, you know we won't get paid for this. " This event also involved a 6yo

child. BULL BUTTER, never forget Money is not everything!

-

[Guest guest]

.. . . AND the LESS said about money is probably better !!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

<< I was once told ( at a service in the Dallas area ) " don't worry about

it, you know we won't get paid for this. " This event also involved a 6yo

child. BULL BUTTER, never forget Money is not everything!>>

[Guest guest]

The action taken by HFD against firefighter may look unfair to someone

looking at it from his point of view. Most of us would tend to look at it

that way. However, if you look at it from the chief's point of view, then it

may make more sense. First, let's assume that this episode is NOT evidence

of a more serious problem at HFD or an effort to use as a scapegoat.

Let's consider it at face value.

Here is a man with 20 years experience who should be familiar with his

patient's culture. He should also be familiar with department rules and

policies. He is medically trained enough to have a high index of suspicion

in certain cases. Alarm bells should always light up if the patient is a

pedi, even a 12-year old. They should light even brighter if that same

patient presents to him three times in an 1.5 hour timespan. He should have

the judgement and experience to recognize that something out of the ordinary

is going on and that Mrs Mendez's reluctance to authorize calling the

ambulance is not appropriate. These facts should have prompted him to get

his station officer involved even if there hadn't been a policy directing

him to do so. It should have prompted him to find out for sure about the

availability of the nearest medic unit, instead of just assuming it was

15-30 minutes away (an ALS unit was available and less than 2.5 miles away

during most of the time all this was going on).

His actions suggest several possible things. He may have seriously flawed

judgement and problem-solving skills despite years of training and

experience. If this is so, these deficiencies are probably ingrained enough

to be dangerous in the future to other patients or to his fellow

firefighters and it is lucky they haven't manifested before now. He may have

good judgement but may have an unacceptable level of indifference or a lack

of caring for the people whose taxes pay his salary. At some point, he

probably took an oath to protect these very people. If this is the problem,

discipline is probably not going to reinstill in him concern for the

citizens he is pledged to serve. His mindset is established. In either of

these cases, the HFD adminstration owes greater loyalty to the citizens that

pay for the organization and two the main body of firefighters than they do

to one seriously flawed crew member. Removing him, given what his actions

suggest, isn't necessarily a bad policy. It also isn't necessarily the only

appropriate action. Lets look at the possible actions Matt suggested.

>

> IF the personnel involved have otherwise CLEAN records, they should:

> A> Suffer loss in pay-grade/rank by one full level, yet remain eligible

for

> promotion at the next scheduled interval. (In other words, dropped from

Cpt.

> to Lt. but able to return to Cpt. at the time s/he would have gone to Bat.

> Chief)

Given this person's length of service it is unlikely this would change his

spots, as it were. If he is already dysfunctional as I suggest he might be,

the Chief may feel he would never again be a good risk for promotion. I

would certainly feel so. It might be different if the guy had only three

years or so in and was still learning. I would assume that demotion of an

already dysfunctional employee would just make him bitter and more of a

potential liability.

> B> Be sent through a LOT of remedial education (retake EMT class if

> necessary) and be retested by the State to guarentee understanding.

If we could be sure this was a problem purely to do with medical accumen,

this would make sense. I don't think they see it this way. I think they are

focusing on judgement flaws and indifference as key issues. I'm sorry, but

you can't train judgement and a sense of caring into a 20-year employee that

hasn't already developed them on his own. In this specific case, retraining

would probably be a waste of time. The expected outcome would be unlikely to

correct the underlying problem.

> C> NOT be in charge for at LEAST 6 months. If this means being third out

> for that time, then so be it. The cost will eventually save you money.

The firefighter in question wasn't in charge at the time this happened. He

failed to refer the matter to the officer who was. This action would be

meaningless and would not protect against a possible reoccurrance.

> D> Be forced to hang a picture of the victim over their bed for a full

year

> to REMIND them of why this is happening to them. They should also have to

> attend the funeral to see the results of their in/actions.

For personal reasons, this is an appealing idea, but if this guy is the way

I suggest they think he is, it couldn't be relied on to have any effect. It

might be appropriate for a relatively-inexperienced crew member who still

has a lot to learn (but probably not even then), but not in this case.

> E> Do about 100 push-ups a day for a year. With every push-up they should

> have to recite their crime and that they " won't do it again " . Trust me, it

> works better than writing on the board.

I assume Matt put this one in to lighten the mood. In real-world terms, this

is silly. Not only that, if the guy pulled another stunt a year later that

indicated he should be fired, he would be much better equipped in a physical

sense to rip the chief's arm off and beat him to death with it after all

those pushups...

> F> The entire department should have to go through some sort of CE to

> assure this doesn't happen again somewhere else.

If this incident is a symptom of a wider problem in the department, then

this action would definitely be part of the solution. However, if that is

indeed the case, then it is even more imperative that firefighter be

fired. The shock value of seeing someone with a similar attitude take a long

fall and lose it all would be a wakeup call to other potential

problem-children and would make them more receptive to retraining. In this

case, he isn't being made a scapegoat, he is being made an example of. I

would be suspicious that it was a case of scapegoating if, given the

existence of a widespread problem, general retraining of personnel didn't

follow his termination. We'll have to wait and see about this.

>

> These EMT's are less likely to make the same mistake again. They are MORE

> likely to pay better attention in the future (at least until they get

> complacent again). They will (hopefully) grow as individuals and

> professionals as a result of this.

>

> I am sorry folks, this almost sounds like saying, " If a doctor loses a

> patient for ANY reason, they should lose their license. " I know it isn't

> that extreme, but that is almost what I am hearing advocated here by some

of

> you.

The cases aren't parallel. A doctor, or a paramedic for that matter, can

lose a patient through no failure of his or her own. You can do everything

right and still have a bad outcome. The only time punitive actions should be

taken is when the bad outcome is the result of bad action on the part of the

caregiver who demonstratably should have known better.

>

> As always, these are my OPINIONS. Feel free to flame.

> Webb, LP

> FLW EMS, MO

BTW. Matt, don't take this as a flame-blast. I'm not saying your view of

this thing is wrong. I'm just trying to look at it from a different angle.

ly, we may never know what the real situation was. Given his obvious

transgressions of policy, I just can't see Mr. as a victim in this,

though, no matter which point of view I look at it from.

Dave

> ________________________________________________________________________

> Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

>

>

>

>

>

>

>

[Guest guest]

I am not sure who you were replying to but my comments were based upon the

civil lawsuit that has been filed not the administrative violations that

have been asserted.

Remember negligence is a 4-headed animal and without any one of the elements

a verdict is not valid.

1. Duty (to act or not act)

2. Breech of Duty (did it or didn't do " it " )

3. Proximate Cause ( 1 & 2 above were a cause of the " bad result " ).

4. Damages (of some sort that can be testified to).

Remember " justice " is not a science of black and white issues . . . . and

my opinions are my own.

Melody

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

What happened to the " DUTY TO ACT " that has been said to us all throughout

our EMS classes and our careers. The medics in Houston had a DUTY TO ACT and

did not!!!!!!!!!!!!! that is the bottom line.

Gene Sullinger EMT-P

[Guest guest]

Why take action before outside agencies finish their investigation?

- [texasems-L] Firing as a bad policy

Let's all think on this for a moment. By firing the EMT, what GOOD actually

comes of this tragedy? Seriously. Nothing. The EMT loses his job and

pension. Other people come forward and file complaints and those EMT's get

fired (sorry, put on indefinate suspension). Who wins? The family who gets a

poop pot full of money? This victim? The city? HFD? The 'guilty' party?

Now, I am NOT saying these people should get off without discipline. I am a

FIRM believer in remediation, loss of pay, loss of grade/rank, and physical

punishment (push-ups good...make you not want to have to do push-ups =). But

the termination will do NOTHING but create a VERY hostile work environment.

I would be looking for another department to work for if I was at HFD. Why?

Because I would be worried that if I fouled up I would get fired, no matter

the reasons for the foul-up.

To me, HFD needs to ask itself:

1> Are the perpitrators salvagable as employee's?

2> Will re-education allow them to return to duty without endangering the

public?

3> Is termination the BEST choice for ALL concerned?

IF the personnel involved have otherwise CLEAN records, they should:

A> Suffer loss in pay-grade/rank by one full level, yet remain eligible for

promotion at the next scheduled interval. (In other words, dropped from Cpt.

to Lt. but able to return to Cpt. at the time s/he would have gone to Bat.

Chief)

B> Be sent through a LOT of remedial education (retake EMT class if

necessary) and be retested by the State to guarentee understanding.

C> NOT be in charge for at LEAST 6 months. If this means being third out

for that time, then so be it. The cost will eventually save you money.

D> Be forced to hang a picture of the victim over their bed for a full year

to REMIND them of why this is happening to them. They should also have to

attend the funeral to see the results of their in/actions.

E> Do about 100 push-ups a day for a year. With every push-up they should

have to recite their crime and that they " won't do it again " . Trust me, it

works better than writing on the board.

F> The entire department should have to go through some sort of CE to

assure this doesn't happen again somewhere else.

These EMT's are less likely to make the same mistake again. They are MORE

likely to pay better attention in the future (at least until they get

complacent again). They will (hopefully) grow as individuals and

professionals as a result of this.

I am sorry folks, this almost sounds like saying, " If a doctor loses a

patient for ANY reason, they should lose their license. " I know it isn't

that extreme, but that is almost what I am hearing advocated here by some of

you.

As always, these are my OPINIONS. Feel free to flame.

Webb, LP

FLW EMS, MO

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[Guest guest]

Just to throw another curve into this matter....What would have changed for

this pt if he had been transported to Ben Taub 30-90 mins earlier? He did

not pass away until 2100 hrs. Why are we hanging the entire incident on a

FF? For the legal aspect, was this FF's inaction really the proximate cause

of death?

Lic-P

[Guest guest]

Newspaper article. Ah nuts, trash can emptied automatically and I don't have

it now. It was in a Houston Newspaper 'clipping' Mr. Haussecker (sp) sent

me.

Interview was with one of the other EMT's at the station who says that the

child was offered transport and he was given a proper assessment and vital

signs.

Webb

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[Guest guest]

DUTY TO ACT?

Had they acted, and I'm not saying that their not

doing so is right, how would it be exactly that they

were supposed to:

a) transport without given consent in a situation

which does not present as an immediate threat to life?

He's a minor and there was no one present who wanted

to be the one to stand up and take responsibility for

this child. Responsibility which was not taken because

of " the cost. " but which should have been done

regardless of the cost. As we have been tragically

shown, personal health should always be a priority

even though todays system doesn't make it exactly

easy. That is another topic altogether.

diagnose an aortic anneurism (sp?) He was (from

what has been publicized so far) in no apparent life

threatening situation. While CP radiating to the areas

specified coupled with vomiting - which was witnessed

by the medic in question - does suggest a cardiac

issue, without given consent they would have been

" wrong " to take the boy to the hospital by our own

state mandates as well as local protocols. And when

the boy finally did make it to BEN TAUB one of the

biggest trauma centers IN Houston (where I happen to

live), it took them FIVE hours to determine what was

wrong with him....

Duty to act? Maybe so if you want to keep it black and

white. But everyone in medicine (of any sort) knows

that black and white is not how things always are. As

medics, we specialize in sifting through the ambiguity

and bs that we get on scene trying to find out what's

really going on to provide quality, efficient, and

effective patient care. Maybe there was a duty to act

there on the part of the medic...but there was also

DEFINITELY a " duty to act " on the part of the family

as well. If there is to be a hangin', let's be sure

there's enough rope for everyone. Medics aren't the

only ones who make mistakes.

As always, these are just my opinions!

A Polk EMT-I

--- trauma2002@... wrote:

> What happened to the " DUTY TO ACT " that has been

> said to us all throughout

> our EMS classes and our carrers. The medics in

> Houston had a DUTY TO ACT and

> did not!!!!!!!!!!!!! that is the bottom line.

>

>

> Gene Sullinger EMT-P

>

__________________________________________________

[Guest guest]

My statements are based on what I have read both on this list and in the

paper.

A CHILD DIED! That child presented himself for care at a place where care

was supposed to be available. Not once, not twice, but three times. He

eventually ended up at an ED where his condition was again undiagnosed.

(Understood, its rare. Understood, lots of people missed it. He's still

dead.)

I am floored by how so many of you think that these people should continue

providing care. They dropped the ball. They saw a belly ache in an

otherwise healthy kid and ignored his repeated attempts to get help. I have

yet to read a post the acknowledges the fact that the patient who arrives on

a cot gets seen quicker that the one who shows up at the desk.

We all could have missed this one. But, these guys DID miss it. They

deserve to get fired.

The firemen lost their jobs. Who got the better end of the deal: them or

the child?

Steve Pike

[texasems-L] Firing as a bad policy

Let's all think on this for a moment. By firing the EMT, what GOOD actually

comes of this tragedy? Seriously. Nothing. The EMT loses his job and

pension. Other people come forward and file complaints and those EMT's get

fired (sorry, put on indefinate suspension). Who wins? The family who gets a

poop pot full of money? This victim? The city? HFD? The 'guilty' party?

Now, I am NOT saying these people should get off without discipline. I am a

FIRM believer in remediation, loss of pay, loss of grade/rank, and physical

punishment (push-ups good...make you not want to have to do push-ups =). But

the termination will do NOTHING but create a VERY hostile work environment.

I would be looking for another department to work for if I was at HFD. Why?

Because I would be worried that if I fouled up I would get fired, no matter

the reasons for the foul-up.

To me, HFD needs to ask itself:

1> Are the perpitrators salvagable as employee's?

2> Will re-education allow them to return to duty without endangering the

public?

3> Is termination the BEST choice for ALL concerned?

IF the personnel involved have otherwise CLEAN records, they should:

A> Suffer loss in pay-grade/rank by one full level, yet remain eligible for

promotion at the next scheduled interval. (In other words, dropped from Cpt.

to Lt. but able to return to Cpt. at the time s/he would have gone to Bat.

Chief)

B> Be sent through a LOT of remedial education (retake EMT class if

necessary) and be retested by the State to guarentee understanding.

C> NOT be in charge for at LEAST 6 months. If this means being third out

for that time, then so be it. The cost will eventually save you money.

D> Be forced to hang a picture of the victim over their bed for a full year

to REMIND them of why this is happening to them. They should also have to

attend the funeral to see the results of their in/actions.

E> Do about 100 push-ups a day for a year. With every push-up they should

have to recite their crime and that they " won't do it again " . Trust me, it

works better than writing on the board.

F> The entire department should have to go through some sort of CE to

assure this doesn't happen again somewhere else.

These EMT's are less likely to make the same mistake again. They are MORE

likely to pay better attention in the future (at least until they get

complacent again). They will (hopefully) grow as individuals and

professionals as a result of this.

I am sorry folks, this almost sounds like saying, " If a doctor loses a

patient for ANY reason, they should lose their license. " I know it isn't

that extreme, but that is almost what I am hearing advocated here by some of

you.

As always, these are my OPINIONS. Feel free to flame.

Webb, LP

FLW EMS, MO

________________________________________________________________________

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[Guest guest]

I have to agree. A MINOR walks in with a complaint (or complaint pattern)

that does not suggest an immediate threat to life and health. This minor

CANNOT consent to treatment (assuming the boy is not pregnant), and the

firefighters CANNOT treat him without consent. Which leads to the first

question, where is/was the responsible adult? Why exactly was this child

being walked back and forth to the fire station? While there are certainly

patient care and documentation issues to be argued, I can't feel comfortable

doing so a) here in this forum and without direct firsthand accounts

(which I wouldn't expect to be forthcoming here). Remember, even the media

reports you read are EDITED and taliored to a specific point-of-view.

Certainly this should point out a need, especially in departments where

ambulances are not at every station, to have a walk-in policy that mirrors

your treatment and refusal policies. Generally, if they have a complaint or

could reasonably be assumed to " need " to have a complaint, they should be

treated as patients. This includes documentation as such. Even if they

walk up, tell you they're having 10 of 10 crushing chest pain with shortness

of breath then hail a cab and drive off before you can say " wow, " is not

documenting that really worth losing everything you've worked for?

Unfortunately, if you wear a uniform, patch or have a department

affiliation, you're pretty much required to err on the safe side, even if it

seems silly at the time.

Let me ask you this - say you're wearing your department t-shirt and walking

through the grocery store (let's even say it's in your district, right after

you've come off shift and are about to head home). Someone walks up and

tells you they felt dizzy and almost passed out, and ask you if you think

they should see a doctor. What do you say? What do you do? How do you

report this, especially if the person adamantly refuses to let you call an

ambulance for them to " check them out " (which really means " do the

paperwork " )? If you walk off and this patient codes in the frozen foods

section, you'd better hope that nobody saw or heard your conversation...

because it could be you on the hot seat next. All of your asserting that

you did nothing wrong and that your department doesn't have a policy for

off-duty " patient contacts " won't matter a bit, because you'll just be torn

apart on this listserv, in the media, and in court.

Mike :/

Re: [texasems-L] Firing as a bad policy

> DUTY TO ACT?

>

> Had they acted, and I'm not saying that their not

> doing so is right, how would it be exactly that they

> were supposed to:

> a) transport without given consent in a situation

> which does not present as an immediate threat to life?

> He's a minor and there was no one present who wanted

> to be the one to stand up and take responsibility for

> this child. Responsibility which was not taken because

> of " the cost. " but which should have been done

> regardless of the cost. As we have been tragically

> shown, personal health should always be a priority

> even though todays system doesn't make it exactly

> easy. That is another topic altogether.

> diagnose an aortic anneurism (sp?) He was (from

> what has been publicized so far) in no apparent life

> threatening situation. While CP radiating to the areas

> specified coupled with vomiting - which was witnessed

> by the medic in question - does suggest a cardiac

> issue, without given consent they would have been

> " wrong " to take the boy to the hospital by our own

> state mandates as well as local protocols. And when

> the boy finally did make it to BEN TAUB one of the

> biggest trauma centers IN Houston (where I happen to

> live), it took them FIVE hours to determine what was

> wrong with him....

> Duty to act? Maybe so if you want to keep it black and

> white. But everyone in medicine (of any sort) knows

> that black and white is not how things always are. As

> medics, we specialize in sifting through the ambiguity

> and bs that we get on scene trying to find out what's

> really going on to provide quality, efficient, and

> effective patient care. Maybe there was a duty to act

> there on the part of the medic...but there was also

> DEFINITELY a " duty to act " on the part of the family

> as well. If there is to be a hangin', let's be sure

> there's enough rope for everyone. Medics aren't the

> only ones who make mistakes.

>

> As always, these are just my opinions!

>

> A Polk EMT-I

>

> --- trauma2002@... wrote:

> > What happened to the " DUTY TO ACT " that has been

> > said to us all throughout

> > our EMS classes and our carrers. The medics in

> > Houston had a DUTY TO ACT and

> > did not!!!!!!!!!!!!! that is the bottom line.

> >

> >

> > Gene Sullinger EMT-P

> >

>

>

> __________________________________________________

>

[Guest guest]

Although it should not be this way, I have found that many triage nurses

seem to take a patient brought in by 911 ambulance as being a little more

serious than those that come in on their own steam. The circumstances seem

to raise their index of suspicion for cases that might otherwise slip

through the cracks due to the constant assault they are under at the busy

facilities. They build up mental calluses against the more innocuous

complaints and it takes a patient being on an ambulance stretcher to

penetrate the thickened mindset. This also happens to EMS personnel and may

have been part of the explanation for 's actions. Unfortunately, this

case was of that type. If this boy had been brought in by HFD ambulance

after his initial contact with Firefighter , it is likely, although

admittedly not certain, his case would have been handled differently. He

probably would have been evaluated thoroughly at an earlier point. It is

still possible they might have missed his true problem or, even if they had

found it, that surgical repair would have failed. We can't know for sure. We

can say with some degree of certainty that if anything had caused him to

find his way onto an operating table before he crumped, his chances would

have improved. The sooner it happened, the better his chances. The point is

that, by not following through with what should have been done at the EMS

level, the possibility that this boy would have survived diminished.

Firefighter did not kill him. I think the case against the hospital in

that regard is far more damning. However, if the sequence of events are as

the investigation indicates, he caused a critical portion of the chain of

care to break that might have positively affected the outcome. Everything

about this case is might-haves and could-haves but, coupled with definite

violations of SOP, that is all it takes to hang someone.

Dave

Re: [texasems-L] Firing as a bad policy

> Just to throw another curve into this matter....What would have changed

for

> this pt if he had been transported to Ben Taub 30-90 mins earlier? He did

> not pass away until 2100 hrs. Why are we hanging the entire incident on a

> FF? For the legal aspect, was this FF's inaction really the proximate

cause

> of death?

>

> Lic-P

>

>

>

>

>

>

[Guest guest]

One question I have, is what motivation did have for allegedly

no-loading this child? He wasn't assigned to an ambulance, so the odds

of him having to transport were pretty slim. I could see this a little

different if he was on a bls truck that day, (assuming that he wasn't)

and had a walk-in after working non-stop. In my mind the ambulance crew

would have the motivation to no-load, and not the guy that only had to

call for the truck & take vitals.

Sheri, LP

[Guest guest]

That's only if he wasn't turfed to triage immediately. I don't have enough

fingers and toes to count the folks I've brought in on a stretcher and

either walked into triage, or stretchered into triage upon arrival per phone

instructions from the triage nurse.

Mike

Re: [texasems-L] Firing as a bad policy

Although it should not be this way, I have found that many triage nurses

seem to take a patient brought in by 911 ambulance as being a little

more

serious than those that come in on their own steam. The circumstances

seem

to raise their index of suspicion for cases that might otherwise slip

through the cracks due to the constant assault they are under at the

busy

facilities. They build up mental calluses against the more innocuous

complaints and it takes a patient being on an ambulance stretcher to

penetrate the thickened mindset. This also happens to EMS personnel and

may

have been part of the explanation for 's actions. Unfortunately,

this

case was of that type. If this boy had been brought in by HFD ambulance

after his initial contact with Firefighter , it is likely, although

admittedly not certain, his case would have been handled differently. He

probably would have been evaluated thoroughly at an earlier point. It is

still possible they might have missed his true problem or, even if they

had

found it, that surgical repair would have failed. We can't know for

sure. We

can say with some degree of certainty that if anything had caused him to

find his way onto an operating table before he crumped, his chances

would

have improved. The sooner it happened, the better his chances. The point

is

that, by not following through with what should have been done at the

EMS

level, the possibility that this boy would have survived diminished.

Firefighter did not kill him. I think the case against the

hospital in

that regard is far more damning. However, if the sequence of events are

as

the investigation indicates, he caused a critical portion of the chain

of

care to break that might have positively affected the outcome.

Everything

about this case is might-haves and could-haves but, coupled with

definite

violations of SOP, that is all it takes to hang someone.

Dave

Re: [texasems-L] Firing as a bad policy

> Just to throw another curve into this matter....What would have

changed

for

> this pt if he had been transported to Ben Taub 30-90 mins earlier? He

did

> not pass away until 2100 hrs. Why are we hanging the entire incident

on a

> FF? For the legal aspect, was this FF's inaction really the proximate

cause

> of death?

>

> Lic-P

>

>

>

>

>

>

[Guest guest]

Mr. Pike,

Agreed. The child died. If the child had arrived on a cot he would have,

most likely, been triaged by an RN (perhaps the same one that triaged him as

it was) then probably waited the same amount of time and DIED anyway.

So, if the EMT's are getting canned then perhaps the only COLLEGE EDUCATED,

DEGREED, LICENSED person involved in this before the MD/DO(the RN) should

also be canned? Wanna bet s/he doesn't get canned?

I am sorry beyond words the child died. If it was my child I would want

blood (and lots of it) before I was satisfied. I imagine that is how the

family feels. I don't think anyone here is belittling the families grief or

trying to say, " Well, stuff happens, drive on. " If that is how it has come

across, that is not how it was meant.

I have been trying to say that until every commission/agency/lawyer has

finished their investigation and the decisions are all in, termination is a

BAD choice (again, with the assumption that the EMT is salvagable. As

pointed out, s/he probably isn't). I am sorry, I don't think the child going

in by ambulance would have made much of a difference. I don't know if you

have ever worked in the ED, but when you are stacked, packed, and have a 2

hour wait due to the 3 cardiac patients (12 bed ED), 4 belly-aches, 2

muliple traumas, and one stubbed toe already in the bed, the truck comes in

and you do a quick triage to decide who gets the bed first. The guy/girl on

the cot might get sent to triage (happens a LOT at RE on in El Paso

and here at GLWACH) so someone in the ED waiting area who is 'more critical'

comes in first. I am just about willing to bet that would have happened if

the kid came in by truck (this is based on an absolute lack of knowledge

about Ben Taub by-the-way, so I am sorry if I am WAY off base).

Webb, LP

FLW EMS, MO

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[Guest guest]

Ah poop. I misread the article. The statement was that they 'thought' he had

taken vitals. My bed. Melonie right (egads, that was painful to say =).

Excerpt from HFD Investigation:

This investigation confirmed that Mr. told them might have a

virus and should be taken to the hospital. Firefighter , who is not an

EMT and assumed Mr. was handling the situation, came outside to see

what was going on and overheard part of the conversation. Mr.

testified that he heard one of the ladies ask where the ambulance was and

heard Mr. explain that it was out on another call. He said he heard

Mr. offer to call another ambulance but that it may take some time to

respond because the ambulances were busy. Mr. also testified that he

did not witness Mr. take the child's vital signs but assumed he had

taken them upon initial patient contact.

Well, having read the whole investigation thing that was published I can now

say that Mr. appears to have had intercourse with the canine (for

those of you needing a translation, email me privately). I am still not sure

termination was the right choice, but that appears to be the HFD's policy on

these issues.

Webb

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[Guest guest]

Not off base at all. County facility, indigent care provider, trauma

center. Stacked, packed and a line out the door.

Mike

PS - If I'm ever hurt and can't tell you where to take me for any reason,

I'd better wake up at Ben Taub. You'll know I'm okay when I want to

transfer to Methodist.

RE: [texasems-L] Firing as a bad policy

> Mr. Pike,

>

> Agreed. The child died. If the child had arrived on a cot he would have,

> most likely, been triaged by an RN (perhaps the same one that triaged him

as

> it was) then probably waited the same amount of time and DIED anyway.

>

> So, if the EMT's are getting canned then perhaps the only COLLEGE

EDUCATED,

> DEGREED, LICENSED person involved in this before the MD/DO(the RN) should

> also be canned? Wanna bet s/he doesn't get canned?

>

> I am sorry beyond words the child died. If it was my child I would want

> blood (and lots of it) before I was satisfied. I imagine that is how the

> family feels. I don't think anyone here is belittling the families grief

or

> trying to say, " Well, stuff happens, drive on. " If that is how it has come

> across, that is not how it was meant.

>

> I have been trying to say that until every commission/agency/lawyer has

> finished their investigation and the decisions are all in, termination is

a

> BAD choice (again, with the assumption that the EMT is salvagable. As

> pointed out, s/he probably isn't). I am sorry, I don't think the child

going

> in by ambulance would have made much of a difference. I don't know if you

> have ever worked in the ED, but when you are stacked, packed, and have a 2

> hour wait due to the 3 cardiac patients (12 bed ED), 4 belly-aches, 2

> muliple traumas, and one stubbed toe already in the bed, the truck comes

in

> and you do a quick triage to decide who gets the bed first. The guy/girl

on

> the cot might get sent to triage (happens a LOT at RE on in El Paso

> and here at GLWACH) so someone in the ED waiting area who is 'more

critical'

> comes in first. I am just about willing to bet that would have happened if

> the kid came in by truck (this is based on an absolute lack of knowledge

> about Ben Taub by-the-way, so I am sorry if I am WAY off base).

>

> Webb, LP

> FLW EMS, MO

> ________________________________________________________________________

> Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

>

>

>

>

>

[Guest guest]

The key to this situation is informed refusal. I would evaluation the

patient to the extent that he allows, and in consideration of the limits of

my abilities given the lack of equipent I usually carry into the grocery

store. I would inform the patient of my concenrs based of what i found on

assessment and leave the decision to the patient.

The t-shirt factoid i think was added in to add the possibility of duty to

act. I don't think in the case as described, a duty to act exists.

Steve Pike

Re: [texasems-L] Firing as a bad policy

I have to agree. A MINOR walks in with a complaint (or complaint pattern)

that does not suggest an immediate threat to life and health. This minor

CANNOT consent to treatment (assuming the boy is not pregnant), and the

firefighters CANNOT treat him without consent. Which leads to the first

question, where is/was the responsible adult? Why exactly was this child

being walked back and forth to the fire station? While there are certainly

patient care and documentation issues to be argued, I can't feel comfortable

doing so a) here in this forum and without direct firsthand accounts

(which I wouldn't expect to be forthcoming here). Remember, even the media

reports you read are EDITED and taliored to a specific point-of-view.

Certainly this should point out a need, especially in departments where

ambulances are not at every station, to have a walk-in policy that mirrors

your treatment and refusal policies. Generally, if they have a complaint or

could reasonably be assumed to " need " to have a complaint, they should be

treated as patients. This includes documentation as such. Even if they

walk up, tell you they're having 10 of 10 crushing chest pain with shortness

of breath then hail a cab and drive off before you can say " wow, " is not

documenting that really worth losing everything you've worked for?

Unfortunately, if you wear a uniform, patch or have a department

affiliation, you're pretty much required to err on the safe side, even if it

seems silly at the time.

Let me ask you this - say you're wearing your department t-shirt and walking

through the grocery store (let's even say it's in your district, right after

you've come off shift and are about to head home). Someone walks up and

tells you they felt dizzy and almost passed out, and ask you if you think

they should see a doctor. What do you say? What do you do? How do you

report this, especially if the person adamantly refuses to let you call an

ambulance for them to " check them out " (which really means " do the

paperwork " )? If you walk off and this patient codes in the frozen foods

section, you'd better hope that nobody saw or heard your conversation...

because it could be you on the hot seat next. All of your asserting that

you did nothing wrong and that your department doesn't have a policy for

off-duty " patient contacts " won't matter a bit, because you'll just be torn

apart on this listserv, in the media, and in court.

Mike :/

Re: [texasems-L] Firing as a bad policy

> DUTY TO ACT?

>

> Had they acted, and I'm not saying that their not

> doing so is right, how would it be exactly that they

> were supposed to:

> a) transport without given consent in a situation

> which does not present as an immediate threat to life?

> He's a minor and there was no one present who wanted

> to be the one to stand up and take responsibility for

> this child. Responsibility which was not taken because

> of " the cost. " but which should have been done

> regardless of the cost. As we have been tragically

> shown, personal health should always be a priority

> even though todays system doesn't make it exactly

> easy. That is another topic altogether.

> diagnose an aortic anneurism (sp?) He was (from

> what has been publicized so far) in no apparent life

> threatening situation. While CP radiating to the areas

> specified coupled with vomiting - which was witnessed

> by the medic in question - does suggest a cardiac

> issue, without given consent they would have been

> " wrong " to take the boy to the hospital by our own

> state mandates as well as local protocols. And when

> the boy finally did make it to BEN TAUB one of the

> biggest trauma centers IN Houston (where I happen to

> live), it took them FIVE hours to determine what was

> wrong with him....

> Duty to act? Maybe so if you want to keep it black and

> white. But everyone in medicine (of any sort) knows

> that black and white is not how things always are. As

> medics, we specialize in sifting through the ambiguity

> and bs that we get on scene trying to find out what's

> really going on to provide quality, efficient, and

> effective patient care. Maybe there was a duty to act

> there on the part of the medic...but there was also

> DEFINITELY a " duty to act " on the part of the family

> as well. If there is to be a hangin', let's be sure

> there's enough rope for everyone. Medics aren't the

> only ones who make mistakes.

>

> As always, these are just my opinions!

>

> A Polk EMT-I

>

> --- trauma2002@... wrote:

> > What happened to the " DUTY TO ACT " that has been

> > said to us all throughout

> > our EMS classes and our carrers. The medics in

> > Houston had a DUTY TO ACT and

> > did not!!!!!!!!!!!!! that is the bottom line.

> >

> >

> > Gene Sullinger EMT-P

> >

>

>

> __________________________________________________

>

[Guest guest]

I think the firings should start at the firehouse and end as high up as the

negligence trail leads.

Steve Pike

RE: [texasems-L] Firing as a bad policy

Mr. Pike,

Agreed. The child died. If the child had arrived on a cot he would have,

most likely, been triaged by an RN (perhaps the same one that triaged him as

it was) then probably waited the same amount of time and DIED anyway.

So, if the EMT's are getting canned then perhaps the only COLLEGE EDUCATED,

DEGREED, LICENSED person involved in this before the MD/DO(the RN) should

also be canned? Wanna bet s/he doesn't get canned?

I am sorry beyond words the child died. If it was my child I would want

blood (and lots of it) before I was satisfied. I imagine that is how the

family feels. I don't think anyone here is belittling the families grief or

trying to say, " Well, stuff happens, drive on. " If that is how it has come

across, that is not how it was meant.

I have been trying to say that until every commission/agency/lawyer has

finished their investigation and the decisions are all in, termination is a

BAD choice (again, with the assumption that the EMT is salvagable. As

pointed out, s/he probably isn't). I am sorry, I don't think the child going

in by ambulance would have made much of a difference. I don't know if you

have ever worked in the ED, but when you are stacked, packed, and have a 2

hour wait due to the 3 cardiac patients (12 bed ED), 4 belly-aches, 2

muliple traumas, and one stubbed toe already in the bed, the truck comes in

and you do a quick triage to decide who gets the bed first. The guy/girl on

the cot might get sent to triage (happens a LOT at RE on in El Paso

and here at GLWACH) so someone in the ED waiting area who is 'more critical'

comes in first. I am just about willing to bet that would have happened if

the kid came in by truck (this is based on an absolute lack of knowledge

about Ben Taub by-the-way, so I am sorry if I am WAY off base).

Webb, LP

FLW EMS, MO

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