Re: [ems-l] Re: whats wrong here

[Guest guest]

I also get lots of calls to review cases which involve missed intubations

and other airway management disasters, particularly asthma patients gone bad.

I have had several cases involving that in the last few years, and I advise

and testify for both the plaintiff and the defense.

One of the most fundamental problems that I encounter is the failure of

management to realize that each and every aspect of the system can and will

be scrutinized and questioned as it applies to the ultimate care given or not

given to the patient, and that lawyers now understand perhaps better than

they do how an EMS system ought to work. Many of them don't really know what

the Standard of Care is.

When I consult with lawyers for either side, I attempt to educate them about

the whole system and how it relates to patient care and how responsibility

for patient care begins with the CEO and ends at the person who restocks the

truck and the mechanic who performs routine maintenance, not to mention the

EMT. Some of them are getting the message better than EMS management is.

The specific problems that I routinely find are:

1. Inadequate training of medics to begin with

2. No continuing education of any quality which can be documented and no

" buy-in " by the medics to CE because it's punitive in their view

3. No CI program which is consistently applied and which works, but a

corporate " front " that touts how good they are when appearing before city

councils and county boards

4. No actual Medical Direction, meaning no day-to-day involvement of the MD

or even, in some cases no direct involvement in field care EVER. Medical

Directors who never, ever, go into the field with their troops and observe,

mentor, or critique their medics, and who demand that the

certifying/licensing agency be responsible for insuring the quality of the

medics who work under them, thus relieving them (in their minds) of any

responsibility for quality

5. Management which is totally immersed in the business aspects of the

service and pays scant attention to quality, abuses the employees, and denies

that it does so, and which refuses to purchase items such as CO2 detectors

which would tip the medics off to missed intubations

6. Medic burnout from low pay, SSM overwork, ridiculous unit deployments,

favoritism by controllers and Ops Mgrs, inconsistent and discriminatory

policies, general dumbness of HR people who NEVER have EMS backgrounds and

have no clue about the stresses the medics go through, all of which result

in poor performance which in turn results in medical disasters

7. Little scenario practice so that when the " shit hits the fan " the medic

is unprepared for it

8. Poor to awful documentation which is never addressed until too late, no

peer review, no CI review, no MD review, no remedial actions taken

9. " Sham " CI which monitors the minutia of call documentation (boxes

checked) but misses the point entirely while touting its effectiveness to the

public and to the politicians who hold the pursestrings

10. Disgraceful lying to everybody about what really happens

11. No recognition of a problem until the process server arrives

12. Denial, denial, denial of any problems when confronted

13. Failure to use the concept of " best practices " and implementation of

policies to insure that they are employed

14. Shock and surprise that they can be asked about the foregoing items by

attorneys and made to answer under oath, and to have every aspect of the

system looked at in detail.

Of all the aforelisted problems, I would say that the most troublesome is the

lack of physician involvement in day to day operations of so many services.

Lawyers are just beginning to understand that physician medical directors are

ultimately responsible for the practices of those who work pursuant to their

" delegated practice. " We will see many more Medical Directors sued in the

future. Those without a " firewall " of demonstrable good practices will find

themselves vulnerable for damages. Those who do develop a system which

favors and encourages " best practices " and which makes an honest attempt to

eliminate errors will find jurors to be sympathetic. The others will not.

Gene

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX