A Medic Roast in Tennessee

Some time ago I worked for a service that had a governing board made up of community members from various walks of life. Most of them were business leaders around the area and only one or two of them had any EMS experience. One day I overheard one of the board members talking about problems he was having with the quality control at a factory his company ran in another area.

I was fascinated.

It seems that the workers at this factory just didn’t seem to care about the quality of the product they created. Products came out with grievous manufacturing errors that turned a lot of their finished products into unsellable junk. He described these errors as things that any reasonable person would notice had they spent more than one day on the job.

Joining in the conversation, I asked him “So, how much does the average worker at that factory get paid?”

He replied with a wage that was actually above my hourly rate as a paramedic. It was significantly more, actually.

It shocked him when I said “So they make that much more than I do, and when I make a mistake someone dies and my career is over? That doesn’t seem right at all”

And no, it doesn’t seem right. Every human being on this planet is going to screw something up on occasion. We’re not perfect. Medical professionals and especially EMS people are constantly challenged to adapt their knowledge to unfamiliar situations with incomplete information. On top of that, the body of our knowledge is constantly changing and it’s up to us to know exactly how to seek it out so we’re consistently doing the best for our patients. It’s not easy to be a good EMT or Paramedic and it’s a responsibility that we’re largely not well-paid for. Top that with the fact that even one simple mistake can be a career ender and…

You get this article that I saw this morning in JEMS: Tennessee Paramedic Demoted after Drug Mistake

If you’ve been a paramedic in the field for any length of time and this article doesn’t scare you, you’ve not been much of a paramedic for any length of time. This is real folks. This is something we all should sit up and take notice to.

The article concerns a paramedic who made a medication error. While it doesn’t state what error he made, it seems that he had mixed a medication in a bag of normal saline and infused it to a patient while intending to give a different medication. The article doesn’t specify the medications given but from the patient’s condition an educated person may be able to infer what they were. It also specifically does not mention the condition of the patient before or after the medication was given, leading me to believe that the patient suffered only minor ill. Yes, I know that I’m assuming… but you can’t tell me that the newspaper wouldn’t have been more than happy to blast the headline “MAN DIES AFTER MEDIC POISONS HIM WITH WRONG MEDICATION” if he had died. My guess is that if they downplayed his condition, there wasn’t much to sensationalize about it.

The medic, who had been with the service for 9 years and who had only been disciplined once in that time for missing something on a rig check, had received “above average performance reviews” and more than one commendation in his tenure.

From reading the article, it looks like an experienced medic made an honest mistake. He was reprimanded for it, suspended for 28 days, and demoted to an EMT.

Yeah, you read that right. They voided 3 years of education that this man had completed and knocked his license all the way to EMT-Basic.

They did this for one mistake. One mistake that even the medic’s chief stated was “… accidental and an oversight on his (the medic’s) part”. An honest mistake that everyone reading this article has already made or will probably make in their career. A mistake that was apparently easy to make, even by an experienced paramedic that most probably did not result in grievous harm to anyone.

If the facts truly are as reported in the article and there are no other unreported wrinkles to this case, I call shenanigans. The discipline this medic received simply does not fit the crime. It’s too heavy-handed. The discipline seems arbitrary, unnecessary, and patently unfair.

The chief was quoted in the article as saying that their agency, which is reported as responding to around 29,000 emergency calls each year, has a “success ratio” of “100%” and that “this is not the norm.”

So he’s saying that the all of the EMTs and Paramedics that must handle 29,000 emergency calls per year are expected to be 100% perfect 100% of the time or he will negate their education, harm their lifetime income potential, and defame them in the national press? I know that he probably didn’t *intend* to say that… but he very much did say it. I know of no other single profession that has so much at stake every time they go to work. To my knowledge, no other profession has so much risk of long term harm to their lives, their family, and their professional career riding on a very much unrealistic goal of being 100% perfect 100% of the time. It’s shockingly unfair… and terrifying. No human being can maintain those expectations. We’re just not able to always be perfect all of the time for an entire career.

And when you think that the pay for Paramedics and EMTs in this country is by and large pathetically low, you might wonder why anyone would ever consider doing the job at all.

I’ll say again, if the facts in this case are accurate and complete as reported, this is an outrage. It’s an abomination. It’s enough to generate national attention about the unfair working conditions and haphazard disciplinary standards that EMS must endure.

I’ll say this too: I support this paramedic and formally place a letter in the file of the agency responsible for doing this to him.

(This part is for Google) If you work for WRCB TV in Tennessee, please feel free to consider this my opinion.

(You can find the original article HERE: http://www.wrcbtv.com/story/15463233/ems-used-wrong-iv-in-melvin-davis-transport)

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

    Apparently, according to a followup article, he asked his EMT partner for an IV bag and the EMT handed him a pre-mixed bag of lidocaine.

    http://www.newschannel9.com/news/wrong-1004805-medication-paramedic.html

    Given the outcry in the blog-o-sphere, Facebook, and JEMS Connect, I imagine that the service has recieved a few emails and it will be interesting to see if they back off of the scorched earth style discipline.

    • in_the_city

      I just waded through the Hamilton Country TN EMS standing medical orders and unless I’m missing something there are no standing orders for a lidocaine infusion. That means that that pre-mixed bag of lido should never have been in the truck in the first place.

      That’s a compounding of multiple errors. The guy who put it in the truck, not seeing it and removing it during check out, not confirming a medication that someone else handed to you.

      It could happen to any of us. I guess.

      But (unless I missed something) it seems like that bag shouldn’t have been there in the first place.

      • Too Old To Work

        Just because it’s not in the standing orders, doesn’t mean that it’s not a medical control option. We have lidocaine infusion but we have to get an order to use it, other agencies are probably the same way.

        If it wasn’t in their protocols at all, then I doubt they’d go to the trouble of stocking it.

        All of that being said, the issue here is that the paramedic didn’t double check on what the EMT handed him. I never let EMTs select drugs for me and even when they put an IV together I check to make sure they use the right drip set.

        Even with the error, the punishment is draconian. Notice I used the word punishment, no discipline. They are two different things all together.

      • Too Old To Work

        Just because it’s not in the standing orders, doesn’t mean that it’s not a medical control option. We have lidocaine infusion but we have to get an order to use it, other agencies are probably the same way.

        If it wasn’t in their protocols at all, then I doubt they’d go to the trouble of stocking it.

        All of that being said, the issue here is that the paramedic didn’t double check on what the EMT handed him. I never let EMTs select drugs for me and even when they put an IV together I check to make sure they use the right drip set.

        Even with the error, the punishment is draconian. Notice I used the word punishment, no discipline. They are two different things all together.

        • in_the_city

          Just to be clear I was implying that the Lido bag was picked up by mistake not stocked normally.  And I agree that the punishment does not fit the crime. I just don’t think the situation should have been allowed to happen in the first place.

          I also think that we are all relying on information provided by people who have no idea what they’re talking about.  Was this guy’s license taken away? Or was he just put in a BLS ambulance till they can figure out how to an appropriate retraining?

          We’ll probably never know.

    • Medic12002

      The problem with this is there both at fault ,one for the EMT not double checking and verifying th type of bag he was giving him,another for the medic also not checking the bag being given communication between partners has to be on point.Ok a mistake was made and it could’ve happened to any crew,the pt did die thank God but does this mean you have to destroy a persons life for it….?? No! We are only human,no one is perfect unless you think your god,punishment in  this situation doesn’t fit the mistake learn an move forward.Send the Medic to his Medical Director to work out a solution take care of it inhouse instead of getting it blown into the outhouse(Public).People are quick to judge yet they weren’t there and they have no clue what there talking about…

  • http://hybridmedic.com HybridMedic

    The question is was this a state EMS board action or an agency action, because an agency cannot simply change someones license, that has to be the state. The ER doc must have filed a formal complaint, but there has to be more to the story than a simple medication error.

    • Too Old To Work

      The agency can’t change his certification, but the medical director can change the level at which he allows the medic to practice. Which is what it sounds like happened. The state EMS agency can probably change his certification, require retraining, put him on some sort of probation, or take some other action.

    • Too Old To Work

      The agency can’t change his certification, but the medical director can change the level at which he allows the medic to practice. Which is what it sounds like happened. The state EMS agency can probably change his certification, require retraining, put him on some sort of probation, or take some other action.

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  • http://www.facebook.com/pyromedic216 Shane Steele

    on a personal note, i know mr waldo, i did some of my paramedic check rides with him 6 years ago when he was at cumberland ems in tn.  we had a disagreement about giving oxygen to a blue copd patient that eventually ended in me not being allowed to ride at that service anymore.  i have seen him work and heard even more horror stories from friends on some other co workers.  how he skated by this long without getting busted for being sub par i will never know

  • http://www.facebook.com/pyromedic216 Shane Steele

    yes the punishment is harsh and probably a little over the top, but as we should all know by now, dont trust everything that the news reports.  sometimes they do get the story a little twisted.  too old to work is right, the agency can not change his certification but by not allowing him to function at his level of license could be a liability also with the standard of care issue.  if a paramedic is onscene and acts only up to an emt level what are the implications of that on the paramedic and the service?

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  • http://www.firegeezer.com Mike “FossilMedic” Ward

    Hi Chris:

    To pick up on a year-ago conversation we had in Chicago, both the excessive discipline to this medic, and the much better pay for the factory workers could be due to …

    labor organization representing the employee’s rights and working conditions.

    (Mike ducks)

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

      Labor organizations (i.e. unions) are going to increase insurance reimbursement or tax rates? What about the auto unions, and their effect on the overall number of jobs in the USA?

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  • EJ

    The answer to the question of what should we do with providers who make these mistakes needs to be preceded by the question on how do we prevent them in the first place.  I agree mistakes will be made, its part of being a human being.  Education, safety precautions and standards of medication administration are in place to avoid a deadly mistake. Paramedic student education regarding medication administration and pharmacology, stresses the use of a systematic “6 rights” patient approach in conjunction with a “4 step” medication check.  If this system is used 100% of the time we could eliminate 100% of medication administration errors and thus the question of what discipline should be appropriate would never have to be answered.  Here is the list of steps I am describing:Patient 6 RIGHTS-      Drug-      Patient-      Dose-      Route-      Time-      Documentation Medication 4 STEP check-      Solution concentration-      Expiration date-      Discoloration-      Particulate matter    When we make such comments regarding things like color of the tops of vials, color of boxes, labels and size as an excuse or explanation on why errors occur is baseless.  Fueling the fire of complacency is the “benign” or “harmless” description of certain medications. Assuming a medication is the same medication, concentration, dose per cc/ml or is harmless based on past use or packaging is a dangerous behavior.     Why is it difficult to follow a standard of care that works and prevents or reduces the chance of an error like this?  If a Paramedic deviates from the standard of care the consequences can be disastrous for the provider, profession and most importantly the patient.  In the case you discussed on the show I don’t feel enough information has been provided to make an educated guess on what occurred and I am reserving my comment until more information is provided. To be considered professionals we have to raise the bar, not find ways to lower it.  I don’t feel that asking a provider to administer a medication correctly 100% of the time is unfair.  We ask an airline pilot to land the plane safely 100% of the time, would you feel comfortable if the pilot just assumed a runway was clear because he has been landing there for years?   I my own mind I am a professional EMS provider, but until we take responsibility for our actions, correct inadequacies and allow transparency of the service then only will the administration of pre-hospital care become scientific, uniform and successful, when it is raised to the status of a profession, and people specially trained for it, show unity in the profession, and gain the publics respect as done in other aspects of health care professions. Make changes, not excuses.

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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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