Man dies after misdiagnosis from EMTs

[effd3918 34]

Man dies after wrong diagnosis

Authorities investigate emergency workers who misdiagnosed a man's heart attack for acid reflux. WJLA reports.

http

://www.cnn.com/video/#/video/us/2008/1...th.wjla

[50-65 205]

If this is the one I saw on the news last night, it was in D.C. They seem to be in the news alot for negative news with their EMS.

Anyway, since when does a paramedic make a diagnosis? Someone calls 911 for chest pain and they tell him he has acid reflux?

They deserve what ever punishment they get and probably more.

[E58RET 24]

OK! Was it emt'S OR MEDICS??? Ifit was the latter ,then then they have a problem,without definitive EKG changes orsupporting physical results ,this should have ben treated,conservativly as a possible AMI.Standard of care being ,Monitor, IV acess,ASA,O2,pallaitave pain relief,etc

[effd3918 34]

I agree that paramedics were probably on scene but the title says EMTs. The woman also said that the ambulance refused to take him. I highly doubt that but they might have suggested he not go

[NWFDMedic 58]

This is why even with 10 years as a paramedic that RMA's scare me. We are all sitting here hundreds of miles away and commenting on a news story. This might be the same information that eventually a court may hear. In EMT and paramedic classes, we spend very little time on documentation in general, much less documentation of refusals despite the fact that they are one of our highest risks for lawsuits. This crew may very well have done everything right, but when the family wakes up in the morning and dad, son, and coach is dead on the ground, the family will have to look for an outlet of their grief.

I know this is the time of year where a lot of us get students on our ambulances both perspective EMT's and paramedics. Take a few minutes with your students to discuss your documentation, even if the call might seem to be one that is relatively benign in nature. Remind them that even the best documentation, the best assessment, and the best witnesses may not eliminate problems but they will have protection behind them.

For RMA's in particular, go overboard with your assessment, performing every last procedure in your scope that may be of benefit. If you think you've explained to the patient enough times what the problem might be (worst case) and you're sure that they understand, tell them one more time about that worst case problem and tell them that we don't have the resources in the field to rule it out completely. When the patient and family look at you with the look of "ok, I heard you already, now let me sign and get the heck out of here", then you've told them enough. In this case, if the patient is convinced he has reflux, don't disagree with him and become confrontational, instead tell him "Well that may very well be the case, but your symptoms may also be consistent with serious heart problems or a heart attack." For the most part, if the family hears that, they will convince the patient to go and the job is done. For the BLS providers, don't be afraid to keep the ALS provider coming if the patient has/had an ALS complaint and is now looking at refusing. I'm sure some paramedics will grumble about it, but feel free to tell them to do their job and get over it; a little extra paperwork won't hurt (too much) but an abnormal EKG finding, for example, may save a life.

Remember to get reliable witnesses. The 85 year old wife of the 85 year old man who is refusing may not be so reliable. The other family may be in a better state to remember what you are saying and if you have doubts about their state, get a member of another service (police) to witness. If you've said the right things, a reliable witness signature will be your a good backup.

Finally, remember to document everything you did. Pertinent negatives are important. Patient statements are important. If the patient tells you why they are refusing, that may also be important. Document your explanation of the patient's potential problems, the patient's apparent understanding of your explanation. Document the fact that you have told them that they can still ask for help at any time despite refusing now. We all know that if we don't write it, it didn't happen but a lot of people forget that even if we write it, it may be our responsibility to give information to show it happened. That's where documenting patients' responses come in handy.

Even if you do everything right, your patient may not make out so well. I had a case a couple years ago where the patient wanted nothing to do with the hospital. He was c/a/o x 3, had completely normal vitals, a normal EKG and 12 lead, a normal finger stick, he passed the Cincinnati stroke assessment without defecit, and had no complaints. I told him, his wife, his family, etc. that even though he seemed fine, he may have suffered a serious medical condition (general in this thread for the purpose of HIPAA); he was still set on refusing. When he died a week later of a serious medical condition, my call was investigated by the medical examiner's office and it was my documentation, the extra assessment on scene, and the confirmation of my assessment by a family member who was a nurse on scene, that prevented it from becoming possible litigation.

[RescueKujo 130]

I want to echo NWFDMedic's post and state document, document, document. I have been on the witness stand, and even though most of my documentation sucked (my admission, I had been an EMT for 8 months when I ran this response), I documented in 5 seperate places that the pt refused transport. It saved my bacon.

As he stated, learn to document and do it well. Take the extra time to do it thoroughly, because you never know what call is going end up with you being deposed or on a witness stand. We have crews here testifying in cases all the time, and their paperwork is used for that purpose. Do you want someone else to read your patient care record and think "Jesus, what a dumba$$"? Write your documentation so that anyone not on scene with you will know exactly what you saw, your findings and your treatment. It should all be spelled out.

This should be a lesson that if true proves that it's always easier to transport the patient.

[ckroll 101]

Lots to talk about here. None of us know what happened on scene. The EMT did not kill the patient, the heart attack did. EMTs of any flavor do not diagnose, we have 'impressions'. To take the role of devil's advocate....[ and I bet no one knows where the phrase comes from ] Documentation is not the solution; it's transporting the patient.

I think whether we are aware of it or not, when we take on the 'keep it covered' attitude that it spills over into the quality of the work we do and the patient and family sense this. Our patients... and by extension the crew.... are best served when we are teaching and practicing patient/assessment skills that focus on getting the patient to definitive care. I am fortunate to work in systems that are not so busy that I can't take time with patients that need it. Any patient with a life threat knows they are in trouble. Chances are they are either angry or in denial. Standing over that person and giving them the "Listen, buddy if don't go you'll die." lecture may be coverage, but you're going to need it because it will only make the patient more intransigent.

Consider getting at or below eye level, taking off the gloves for skin to skin contact when holding their hand and letting them know how serious it is and that EMS is not leaving without them. If you believe it, they will. Pull up a chair, put your elbows on the table, let the patient know with what you say and how you present yourself that you will wait them out. Sit on the floor with them. It takes about 10 minutes to wear them down with patience...... in the end, less time than it takes to document, document, document.

[antiquefirelt 994]

Some of you either work and live in the perfect system or you're full of sh*t if you think there aren't bad medics/EMT's out there.

Hell yes this could have happened just as described, it happens more often than is reported. I've known medics that were all too happy to blow off chest pain as non-cardiac. Dinner time, Super Bowls, just burned out, etc. In the emergency medical profession it's one of the most common misdiagnoses, also the one with the worst consequences. Sorry to those EMS only folks, but it seems like the EMS only crews have a much higher burnout rate and a far shorter career ladder, leading to unhappy employees who may cut corners, lose their compassion or otherwise not really do the right thing when it's inconvenient.

Hopefully there is more to the story and maybe this wasn't as reported, but all medics know the right way, but some choose the easy way. No different than firefighters, cops or any vocation.

ckroll: "The EMT did not kill the patient, the heart attack did." Seriously, consider another career if you think this argument is at all valid. If these guys failed to do a proper assessment and blew off the chest pain as non-cardiac, it can be liken to giving the gun to a suicidal teen. If it was as reported, then they had a duty to act and failed in a negligent manner.

[NWFDMedic 58]

I don't think anyone said there aren't bad EMT's or Medics out there but I think we all know that the story we get from the press or the family quite often does not match what happens. Heck, I'm sure we all hear stories about "what happened on this call" and find out later that it was far from the truth.

I also agree that the best thing to do is transport the patient but no matter how much effort you put into it, you aren't going to win 100% of the time. I've sat on scene with patients for an hour, called families on the phone, called medical control, had the police come into assist, called local friends and had them come to the scene, sometimes it just doesn't work. If I believe a person is having a medical emergency, I will do everything in my power to convince them to go short of kidnapping them. I've even had a medical control physician instruct the PD to take a patient into protective custody because the MI he was having was making him hypoxic and therefore not of sound mental status. I'm not sure how well that floats legally, but that was the doctor's decision.

Documentation is the key in any refusal situation or for that matter any transport situation. I have been called to court for a case where I did transport the patient and the patient had a bad outcome in the hospital. I documented everything I did for the patient well and why I had a high index of suspicion for the patient's eventual lethal diagnosis (it turned out my paramedic impression was right on the money). That patient's family eventually sued everyone involved in the patient's care (hospital, doctor's group, individual nurses and doctors) and I received a subpoena as well. Fortunately, my documentation saved me from being listed as a defendant and I was instead a non-party witness. The plaintiff's attorney actually said that I was the only one during the course of the patient's care who did what was right to look out for the patient. (I'm not saying that was true, but it was definitely nice not to be a party in a lawsuit.)

[ckroll 101]

Some of you either work and live in the perfect system or you're full of sh*t if you think there aren't bad medics/EMT's out there.

Hell yes this could have happened just as described, it happens more often than is reported. I've known medics that were all too happy to blow off chest pain as non-cardiac. Dinner time, Super Bowls, just burned out, etc. In the emergency medical profession it's one of the most common misdiagnoses, also the one with the worst consequences. Sorry to those EMS only folks, but it seems like the EMS only crews have a much higher burnout rate and a far shorter career ladder, leading to unhappy employees who may cut corners, lose their compassion or otherwise not really do the right thing when it's inconvenient.

Hopefully there is more to the story and maybe this wasn't as reported, but all medics know the right way, but some choose the easy way. No different than firefighters, cops or any vocation.

ckroll: "The EMT did not kill the patient, the heart attack did." Seriously, consider another career if you think this argument is at all valid. If these guys failed to do a proper assessment and blew off the chest pain as non-cardiac, it can be liken to giving the gun to a suicidal teen. If it was as reported, then they had a duty to act and failed in a negligent manner.

What a remarkable amount of anger here. I have to ask why the rush to condemn providers when so little is known about what happened? There is a follow on story indicating there may be two sides to events. It bears noting that family members who do not use particularly sophisticated grammar also refer to failure to follow protocols...... as if someone else is guiding this situation towards litigation.

Given that events described by distraught family are so egregiously criminal, I think we owe it to our fellow providers to withhold judgment until emotions have ebbed and an investigation is complete. Apparently there were 6 firefighters including a paramedic on scene for 25 minutes... and the family was capable of taking the victim to the hospital themselves.

Many things contributed to this man's untimely death and as health care providers we bear the lion's share of responsibility for seeing that all patients of concern seek definitive care, no one questions that. That said, launching a tirade against any and all EMS on wild speculation is inappropriate.

[Guest feraldan]

A big +1 for ckroll. I don't understand the speed to condemn this crew which has not yet told its story. We're getting one version, one side and yet willing to accept that as absolute truth?

Shame.

Edited December 6, 2008 by feraldan

[Fex404 0]

The family was capable to bring him to the hospital?

THEY CALLED AN AMBULANCE who made them believe that there was no serious threat. I dont know about you but when I ride the ambulance we dont act like MD's, we act like EMS.

[antiquefirelt 994]

A big +1 for ckroll. I don't understand the speed to condemn this crew which has not yet told its story. We're getting one version, one side and yet willing to accept that as absolute truth?

Shame.

No shame here. As I said, if the call went as originally described, then they were in the wrong. If, as many contend may have happened (we can only hope), they did try to convince this pt. to go, then all is not lost. As has been noted a few times, this incident will be decided by the quality of documentation. But so many make it sound like this is incredulous. It's not, it very well could be very poor care. I certainly don't hope this is the case, but let's keep our heads above the sand.

[antiquefirelt 994]

... and the family was capable of taking the victim to the hospital themselves.

But they called 911 and got an EMS response. I'm not angry, and I truly hope there is more to this story. But to basically call this family liars, and further question their motives by commenting on their language skills and the use of the words "failure to follow protocols" is ridiculous. I'm sorry I don't see the burden of proof here being laid at the families feet. I see the DC Fire/EMS system needing to prove that they did follow protocols and a standard of care.

And as a supervisor in a career Fire based EMS service, I am intimately familiar with BS complaints, real complaints, burned out providers, half truths and everything in between. Sadly more often than not, the patients are rarely totally making stuff up, though they may exaggerate.

[Guest stephentyler20]

I'd also like to echo a couple points.

First and foremost, this is a NEWSPAPER article. It's downright foolish to take a third, fourth, or fifth party account as fact. It sure sounds bad doesn't it - well do you think newspapers are interested in boring headlines, no matter how factual? Of course not. "Paramedics Misdiagnose Heart Attack" sounds waaaaay better than "Paramedics Unable to Convince Man Dying of Heart Attack to Consent to Treatment and Transport to Local Emergency Department Despite Hours of Attempting to Persuade Him that his Chest Pain was NOT Acid Reflux." Use your head!

That does not preclude the possibility that these medics screwed up royally. Perhaps these were firefighters who were forced to be medics, and they don't give a damn about medicine, and just wanted to go back to bed. Blame the system then. What do I know.

I agree though with NWFDMedic - I writet 2 paragraphs for a typical medical call where the patient was transported. And I write 2 or 3 TIMES as much for the average RMA. Situations like this remind me that such documentation practices are intelligent. Even if they had BLS'd the dude into the hospital, they'd be in a hell of a lot less hot water than they are right now.

Edited December 6, 2008 by stephentyler20

[ckroll 101]

The family was capable to bring him to the hospital?

THEY CALLED AN AMBULANCE who made them believe that there was no serious threat. I dont know about you but when I ride the ambulance we dont act like MD's, we act like EMS.

You need to present some evidence to back up that allegation.

[NJMedic 96]

In 1987 I took a several classes at George Washington University and one of the first topics that was discussed was the system failures with DC Fire/EMS. Speaking to those same people over the years and nothing much has changed in DC. The stories are numerous and well documented so you can imagine what doesn't make the paper. Given those circumstances and problems are going to be well covered by the media. Most medical directors finally give up after a while and pull the rip cord. Most of their CODs last a few years and then move on so any long term improvements stop dead in the water or run out of money.

Edited December 6, 2008 by NJMedic

[ann11682 1]

http

://www.cnn.com/video/#/video/us/2008/1...th.wjla

this is HORRIBLE.

first- EMTs do NOT diagnose. EMTs are trained to treat SYMPTOMS and nothing more.

second- this just proves how unbelievably lazy people are getting these days.

[ckroll 101]

I just read the Washington DC paramedic protocols, at least the pertinent sections. They have a remarkably complex and thorough procedure for any RMA and any call of an ALS nature needs to be RMA AMA. Supervisors need to be contacted as well. So this should be pretty straight forward. If the patient was properly RMA'd there should be a significant trail. If the patient was not properly RMA'd then the burden of proof for EMS becomes overwhelming.

[Guest stephentyler20]

this is HORRIBLE.

first- EMTs do NOT diagnose. EMTs are trained to treat SYMPTOMS and nothing more.

second- this just proves how unbelievably lazy people are getting these days.

True, but you could argue that Paramedics are are trained to diagnose. I certainly don't "treat symptoms" in the field, or I'd be doing a lot of stupid things out there. For example, if a patient has difficulty breathing, we don't willy nilly go off giving bronchodilators, nitrates and diuretics - we first assess, and come up with a set of differential diagnoses, and narrow down accordingly.

In this case, I will speculate (meaning I'm not accusing them of anything because I don't have sufficient information) that those medics had a chest pain patient, so their differential SHOULD include cardiac - including AMI. If they can't narrow it down any further than that (which we almost always cannot - even with a normal 12-lead, AMI can still be detected with abnormal blood enzymes), the patient needs to be transported.

If that was the case, shame on them. But again, I don't know and neither does anyone on this board (unless those who were present happen to be here!).

[Guest stephentyler20]

I just read the Washington DC paramedic protocols, at least the pertinent sections. They have a remarkably complex and thorough procedure for any RMA and any call of an ALS nature needs to be RMA AMA. Supervisors need to be contacted as well. So this should be pretty straight forward. If the patient was properly RMA'd there should be a significant trail. If the patient was not properly RMA'd then the burden of proof for EMS becomes overwhelming.

That's the kind of thing you won't read in papers - good investigative work. Regardless of what went down, if they didn't follow procedural guidelines appropriately, they're in for it.

[Guest alsfirefighter]

True, but you could argue that Paramedics are are trained to diagnose. I certainly don't "treat symptoms" in the field, or I'd be doing a lot of stupid things out there. For example, if a patient has difficulty breathing, we don't willy nilly go off giving bronchodilators, nitrates and diuretics - we first assess, and come up with a set of differential diagnoses, and narrow down accordingly.

In this case, I will speculate (meaning I'm not accusing them of anything because I don't have sufficient information) that those medics had a chest pain patient, so their differential SHOULD include cardiac - including AMI. If they can't narrow it down any further than that (which we almost always cannot - even with a normal 12-lead, AMI can still be detected with abnormal blood enzymes), the patient needs to be transported.

If that was the case, shame on them. But again, I don't know and neither does anyone on this board (unless those who were present happen to be here!).

DING DING DING...we have a winner. A post that actually spelled out what it is to be a professional PARAMEDIC (in addition to CKroll...good wording Christy). I will say that I agree with one of my other colleagues point that it sounds like this from just the wording the article, should have been worked up as a potential AMI. However we don't know all the information. Any Paramedic who wants to sit here and say that they work up every single type of chest pain as cardiac might want to have a discussion with a respected experienced medic or educator. There are times where it is acceptable to BLS chest pain and from the names I see on this forum....we know this.

THEY CALLED AN AMBULANCE who made them believe that there was no serious threat. I dont know about you but when I ride the ambulance we dont act like MD's, we act like EMS.

Well I'm sorry then. Because I conduct myself as a professional and as a medical clinician. Perhaps you could enlighten me and my friends in the thread of what it means to act like EMS. I BLS numerous calls a shift, ranging in all sorts of symptoms I have to swim through, weigh and make a clinical decision I feel comfortable. This sometimes includes chest pain. Am I acting like a MD? Or am I doing my job correctly and efficiently. And yes I have made mistakes. I don't have to say fortunately because I have never swayed from my one principle....if I'm not sure it goes ALS and if the word "borderline" goes through my head it goes ALS. I have had ones where the symptoms didn't match my impression. I learned from them and moved on.

this is HORRIBLE.

first- EMTs do NOT diagnose. EMTs are trained to treat SYMPTOMS and nothing more.

second- this just proves how unbelievably lazy people are getting these days.

Actually this is life. Even doctors make mistakes and they are part of the medical field as well. What makes anyone believe that any particular group in the medical field is I don't know.

Second...so apparantly they are just lazy? What if they were just incompatent? Of ignorant? And I'm with my brother I orginally posted...some EMT's do diagnose...EMT-P's. As we give some treatments based on the diagnosis of a condition. And in some cases the argument can be made that EMT-B's do as well on a very narrow basis for some conditions like hypoglycemia.

This isn't meant to offend anyone, but it amazes me, but doesn't shock me at the comments made by non ALS trained persons on this thread. CKroll is right the EMT's didn't kill this person. the heart attack did. They didn't shoot him, stab him, etc. They might not have helped, they might have contributed to the outcome, but in the end it was in fact that he was having a heart attack.

The final thing about RMA's...documentation is important. And remember to document all you checked and didn't find either and that you "advised the patient of the risks of his conditions, which he/she then again refused treatment/transport." Also "patient advised if symptoms re occur or worsen to activate EMS via 911 or seek the nearest medical facility."

NJ you hit the nail on the head. Both the Fire and EMS in DC have are back in the sewer. They were in the gutter but got flushed back down. The fed government stepped in after the fire on the roof of the treasury that should have been handled but a chief right on camera told a senator when asked "how come you haven't put the fire out?" and the chief said "because I don't have enough people to put it out." Fed government take over, mass hiring, even with a LODD that cited problems and back to square 1.

[antiquefirelt 994]

This isn't meant to offend anyone, but it amazes me, but doesn't shock me at the comments made by non ALS trained persons on this thread. CKroll is right the EMT's didn't kill this person. the heart attack did. They didn't shoot him, stab him, etc. They might not have helped, they might have contributed to the outcome, but in the end it was in fact that he was having a heart attack.

A lot of good points have come up in the latter parts of this thread. One thing most recognize is that patient refusals require more/better documentation than general transports. Actually, if we all just did damn good documentation as some here say they do, we'd be great. Most here should also recognize those who take the EMS profession seriously. I doubt many of those who might fail the system would be here sharing ideas and trying to discuss the good, bad and ugly of emergency work.

The above being said, I doubt anyone here needs to have the literal interpretation told to them that negligence didn't cause the patients death, his MI did. But if a subject is having chest pain and you are called to transport the person to the hospital you'd better have a damn good reason not to transport him/her. Obviously we cannot kidnap people. If you did not do your best to evaluate the patients condition, treat him and transport him, and he dies later? You're negligent. Negligence that leads to death is often criminal. The duty to act and follow prescribed protocols is not something that can be taken lightly. If this went down as described, they didn't kill him, but they very well may be responsible for his death.

I also don't see where anyone ALS or non-ALS trained made comments that have any bearing on medical training. One does not need to be a medic to understand the responsibility to act in a professional manner on every call. I highly doubt this patient was evaluated properly so that the EMS personnel were convinced he was having "acid reflux". I know I wouldn't nor do I believe any of our personnel would ever sign off a patient who was having chest pain and then said it was acid reflux. And maybe by some strange twist a BLS crew with little field experience might make this mistake, but not in a system where ALS is required for all chest pain calls.

I'm sorry if I offend anyone by believe the whole bad and ugly of it is possible. I hope in this case the original story is wrong. I also don't see anyone condemning this crew yet. Instead this has been a pretty decent frank discussion of care issues, documentation and a general reminder that we have a duty to do good and be good at what we do.

[Guest feraldan]

I also don't see anyone condemning this crew yet. Instead this has been a pretty decent frank discussion of care issues, documentation and a general reminder that we have a duty to do good and be good at what we do.

Really?

this is HORRIBLE.

first- EMTs do NOT diagnose. EMTs are trained to treat SYMPTOMS and nothing more.

second- this just proves how unbelievably lazy people are getting these days.

Anyway, since when does a paramedic make a diagnosis? Someone calls 911 for chest pain and they tell him he has acid reflux?

They deserve what ever punishment they get and probably more.

Those both appear to be foregone conclusions to me.

[helicopper 1,050]

Really?

Those both appear to be foregone conclusions to me.

I think he meant in DC. They've already been tarred and feathered here!

[FirefighterJr 2]

My father was feeling ill. One day he had what seemed acid reflux, he burp and his chest burned. He tried to to sleep it off. That in turn did not work. The next day my mother forces him to go to the local emergancey room. When he gets there, the doctor find normal vital signs and diagnois my dad with a simple case of acid reflux. He goes home the symptoms last for another day and then go away. A week goes by. I am in school and I go to the offices because it near the end of the school year and my father promised to pick me up early. I call...my mom picks up and say that my dad is under going a cardiac catherazation. I instantly know that something is up. When I get home my mom tells me that my dad has had a heart attack. The doctor believes that when my dad went to the emergancey room he was really suffering from a small heart attack. Moral of the story...people make mistakes it gonna happen. In this case it was the hospitals fault in a way...do I blame them...no. I believe that in some case they can be if you see some one with normal vital signs and acid reflux syptoms it is possible to dismiss it as just acid reflux. And no, I do not blame the emt as misdiagnosis...sh*t happens.

Edited December 7, 2008 by FirefighterJr

[ny10570 745]

People also have to remember the body is dynamic. It changes constantly. Pt was watching TV laughing her butt off. Suddenly feels epigastric burning sensation and sharp pain so she calls 911. Obese, diabetic, african american, 40+ years old, no cardiac history and she pops nexium like candy. By the time we get there she's burped, popped another nexium, and the burning is almost gone. She wants to RMA so she gets a 12 lead. Everything is clean. The next day tour 2 gets called to the lobby of her building. She fainted out after walking down the stairs from the 8th floor (broken elevator). 12 lead shows massive inferior wall MI and she's in the cath lab 35 minutes later. Turns out she had significant blockage and the first call was probably a result of Chris Rock getting her heart rate up. She stopped before any damage was done and since I can't test troponin levels in my pocket lab (I keep it next to my pocket radiology dept) there wasn't much for me to see. Her 8 floor walk down was however enough to do enough damage to cause lasting changes in her 12 lead.

[Fex404 0]

Well I'm sorry then. Because I conduct myself as a professional and as a medical clinician. Perhaps you could enlighten me and my friends in the thread of what it means to act like EMS. I BLS numerous calls a shift, ranging in all sorts of symptoms I have to swim through, weigh and make a clinical decision I feel comfortable. This sometimes includes chest pain. Am I acting like a MD? Or am I doing my job correctly and efficiently. And yes I have made mistakes. I don't have to say fortunately because I have never swayed from my one principle....if I'm not sure it goes ALS and if the word "borderline" goes through my head it goes ALS. I have had ones where the symptoms didn't match my impression. I learned from them and moved on.

Deaming a call BLS is not what I am talking about. Paramedics are at a minimum and I am lucky enough to always be on a bus where a paramedic rides with me. Now I would hope i would not have to explain what it means to be EMS. I couldnt agree more with your "boarderline" principle always going ALS as that is the smart things to do, but i also know that we let the MD's make the diagnosis and we do our job of transporting to the hospital. Maybe you operate differently and if that works for you then great.

[50-65 205]

If this is the one I saw on the news last night, it was in D.C. They seem to be in the news alot for negative news with their EMS.

Anyway, since when does a paramedic make a diagnosis? Someone calls 911 for chest pain and they tell him he has acid reflux?

They deserve what ever punishment they get and probably more.

Well, I for one would like to retract my original post. There have been many good, thoroughly thought out posts here and some good in-depth discussion of professional ems. None of which my original post was.

All of us, regardless of the profession we are in, have made mistakes and errors in judgement. The true test is whether we learn from them or continue to repeat them.

Every medic I personally know, has made errors which either directly caused or contributed to a patients demise. But I also know that they will not make that same mistake again.

Even an RN I knew said she figured she'd "kill" a patient about every 10 years based on results in her career and mistakes she has made. My brother, a CCRN, said he may not have directly killed anyone but probably helped some on their way.

It's a fact of life. None of us are perfect.

Learning. From ours and others errors. Teaching. Don't be afraid to tell a co-worker about some of your errors and what you learned from it. You may be able to save more lives because of it.

[Guest feraldan]

50-65, very well said!