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Shades of Gray…

4 comments

In EMS there are a thousand shades of gray. Possibly millions. We have protocols that direct us to which shade we should be occupying, but often your patient doesn’t present exactly how the protocols suggest they might.

One thing is clear: When you’re in over your head admit it, ask for help, and move on. Paramedics often don’t like calling for a helicopter because it as if they have to admit that there is something they CAN’T do. Thats right! You heard it here first. Sometimes Paramedics can’t do shit. Hell. Most of the time we can’t.

When people ask me what my job is like, I respond the same. It is 70% hand holding and soft talking, 10% prophylactic medicine(ASA, Nitro, Oxygen), 15% Bullshit(drunks, pseudo-psychs, et), and 5% real medicine(cardiac arrest, resp failure, resp arrest, allergic reactions, overdoses, trauma).

Most of the people that call 911 need an ambulance no more than they need a taxi. Such is life. The problem is those mundane calls put you in a groove that sometimes you(or your partner) can’t shake off in a real emergency.

This was the case recently with our SOB(dispatched as abdominal pain) call from last Thursday. I knew he was in bad shape, but didn’t realize how bad. When I couldn’t get a BP or line, my partner said for me to get on the road. I asked if he wanted a chopper. He didn’t.

Our service(for now) doesn’t have CPAP or RSI. He didn’t want to tolerate the mask. He needed an airway or assistance, but we didn’t have a line so we couldn’t calm him down… My partner attempted 14 IVs. I’m sorry, but at no point should 14 prehospital attempts be ok. If you really need a line, go IO.

If you can’t do that. Fly the patient. Do something. Do do ANYTHING just for the sake of doing something though. Do what your protocol says to do. If you can’t do that, contact medical control for orders. Admit you are in over your head.

Your patient will thank you. Unfortunately ours can’t and now we get to sit through 3 hours of M&M

People die–but when they don’t LIVE because you opted to provide a lower level of care than you are capable, you don’t belong here anymore.

Posted by on October 15, 2008 • Filed under: Code 3, Failure • Tagged: ,
  • Walt Trachim

    Sorry you got put through that. Although it was your partner's tech, it sounds like he managed to get you both thrown under the bus.I guess the only words of comfort I can offer you is that this was a learning experience, or at least it reinforces what you already know. And I agree with you that 14 IV attempts in the field is way, way too many. We're limited to 2 each, and after that it's either use the IO gun or wait until you get to the ED. If I know I've got crap for access and I'm able to pick it out, I'll use EJ's, and most of the time I can make it work.On the subject of protocols and intervention devices, where I work in NH – at both places, actually – we have CPAP, and I love it because it really does work. In Massachusetts we don't have it yet. They tell us it's on the way but I'll believe it when I see it.Having attended M&M for continuing education and not as the subject of a bad call or case, I can say I feel your pain. The people that have been subject to it (in our case, it's usually resident physicians who screw up; medics not so often but it happens) have been hammered pretty mercilessly.Take care of yourself.

  • MedicThree

    Fortunately I’m just a partial victim to this madness. The attending ED doc is also on the chopping block, and my partner may be suspended past the point of even being able to attend.

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