Perils of Paramedics Pursing imProper Patient Refusals

Inspector General Faults DC Paramedic’s Response to ‘Acid Reflux’ Case

This article comes to us from JEMS.com which has a link to the full article over at The Washington Times. It’s not necessary to read both articles, but since JEMS originally called it to my attention it’s only fair to link the boys over there first. Read the full article, please… I want to see if you feel the same way about it that I do.

Ok, ya back? Good.

In this case that is very reminiscent of the case law I wrote about last year in “EMS Case Law – AMA Refusals, Death, and Documentation” – A DCFD EMS paramedic obtained a signed refusal from a patient who called 911 for chest pain. According to the < sarcasm> stellar, just friggin’ stellar < /sarcasm> journalism employed in the story by the reporter (I mean seriously, can any reporter anywhere ever write a story about EMS that doesn’t sound like a 5 year old’s understanding of Mozart?) the Evil paramedic did bad things that caused someone to die.

And, well… Here are some quotes from the piece, although I still think you should read the whole thing:

“The crew found Givens, 39, on the floor of his home after his mother called 911 — “an indication that he may have experienced something more serious than what was later described as simple acid reflux,” the report says.

Although they asked Givens multiple times whether he wanted to be taken to a hospital and he declined, the report suggests responders should have done more to persuade him to go.”

So they find some guy, a 38yo guy, a young guy who lives with his mother (maybe) laying on the floor probably being all dramatic and stuff… I’m sure he was all like “Ow. My chest hurts” and the medics were all like “Dude, we have a low index of suspicion for your condition being cardiac related due to the fact that you’re young and don’t appear to have many risk factors” n’ stuff.

Or something like that. At any rate, I’m sure they were less concerned about this guy than they would have been with say, a middle-aged male with classic STEMI (heart attack) symptoms. Yes, they signed him off AMA while telling him to take Pepto-Bismol, and yes… the article does indeed say this:

“The inspector general’s report also faults emergency workers for not recording fundamental information, such as Givens’ first name, age and medical history and interactions with his family members on a patient care report. The reports are typically passed on to hospital personnel when a patient is taken to a hospital but are considered necessary even in cases in which a patient is not taken to a hospital to provide medical and legal documentation of responder’s actions.”

But that doesn’t mean that they just plain didn’t care about the guy and were encouraging the refusal, right?

“When Givens asked one of the four emergency workers who responded if he needed to go to the hospital, the responder replied, “That’s up to you; if you want to go we will take you,” according to the report.”

Yea… I’m just going to come out and say that the only time I ever use that line is at 0330hrs when I’ve been called out for a stubbed toe in the winter time and I am actively encouraging the AMA.

But this can’t be a systemic problem with the whole administration of the DC Fire Department EMS division, can it? I mean… that’s one of the nation’s busiest fire-based EMS providers and I’m sure they care a great deal about EMS and give it the full attention it deserves.

“A 2009 investigation by The Washington Times into the training and education of the District’s paramedics found many could not pass basic written exams testing their medical knowledge or that they mishandled basic life-saving procedures during videotaped assessments.

The test results of the paramedic who treated Givens were among those criticized by experts in the report by The Times, and the lawsuit filed by the Givens family accuses the fire department of being aware of the paramedic’s “poor performance” but leaving him in the field.”

Um… but that was in 2009! And I’m sure that the DC Fire Department EMS Division has progressed greatly in improving their EMS care and service delivery, right?

DC BLS Ambulances out of service as Hot Weather Arrives

<sigh>

I will admit, there isn't enough information or proof here to make a decision on due to the *amazing* clarity of the reporting here. I'll admit that I read between the lines when I made my judgement and then pulled back from my original thoughts. Then again, it does seem like my worries about this case are correct… I don't know exactly what the truth is, but I'm guessing it's not favorable for DC Fire EMS.

Excuse me, I mean "FEMS."

<sigh>

—————————————————————————–

Have you ever read my post on the ultimate, most off-limits “no go” topic in EMS blogging? It might tick you off as well.

 

  • Las3100

    I would not do this job. I feel that patients are adults and have a responsibility for their own decisions. Some people abuse the EMS System. I he signs a paper he doesn not want treament, fine. There is always someone who really does need and will use the system wisely.
    L Smith RT, RN ,BSN

    • CBEMT

      If he signs a refusal without a proper exam and explanation of what the potential consequences of signing are, it’s worthless.

      This is not something unlucky that happened to a system abuser- get that idea out of your head right now.

  • CBEMT

    Chris I think what’s really going to screw the District is the fact that DCFD had prior knowledge via the 2009 skills testing that this particular paramedic was not performing to expectations, and left him on the street anyway.

    It would have been bad enough discovering a moron for the first time when he does something stupid and kills somebody out in the street. But if you already KNEW he was killing people in the sim lab and didn’t take serious remedial action (which he then passed)….It’s just a matter of how many zeroes the check has now.

  • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

    Oh, can I add an indictment against EMS education? Because, you know, if EMS providers were taught the basics of diagnostic processes and expected to use things like differential diagnoses, the provider might have included the magical words like MI and pulmonary embolism (which was the final diagnosis in this case). Is GERD a reasonable consideration for this patient’s diagnosis? Sure, but as long as the DDx list includes “Danger Will Robinson, Danger” diagnoses like MI (including NSTEMI) and pulmonary embolism, a “Dude, just take an antacid and follow up in the morning” is inappropriate.

  • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

    Oh, can I add an indictment against EMS education? Because, you know, if EMS providers were taught the basics of diagnostic processes and expected to use things like differential diagnoses, the provider might have included the magical words like MI and pulmonary embolism (which was the final diagnosis in this case). Is GERD a reasonable consideration for this patient’s diagnosis? Sure, but as long as the DDx list includes “Danger Will Robinson, Danger” diagnoses like MI (including NSTEMI) and pulmonary embolism, a “Dude, just take an antacid and follow up in the morning” is inappropriate.

  • Too Old To Work

    Now you’re going to make me go and read this article, aren’t you? Why do I have the feeling that this will just be more of the same from DCFDEMSOHDADODAHDAY?

  • Pingback: The Name Has Changed, Has Anything Else? | Too Old To Work, Too Young To Retire

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    mr618
    Welcome to the Club
    Well said, Chris. We can't save everybody, but the ones we don't save tend to stick around a lot longer than the ones we do save.
    2014-10-18 14:40:00
    Steel City Medic
    Welcome to the Club
    Particularly appropriate for me this week. Thanks.
    2014-09-23 21:46:00
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00
    DiverMedic
    My Blogroll
    One of these days you'll figure out where my blog is... :)
    2014-09-17 22:11:00
    emtterri123
    Six Tricks You Can Use Today to Improve Your EMS Narrative Report
    The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. - Me thinks this should have been restructured as it does not flow and caused me to reread it several times. lol :)
    2014-09-17 08:27:00

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