Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

What is the Right Response to a Treatment Error – Part II

Continuing from Part I.

Within 30 minutes, the supervisors took Waldo and Jackson off duty pending the outcome of an investigation.[1]

Jackson is only identified as an emergency medical technician (which I abbreviate EMT).

Is Jackson authorized to give medication? Is he an intermediate, paramedic, critical care, or some other advanced level of EMT that would extend his scope of practice beyond basic EMT? Do EMTs in this location start IVs, give fluids, and/or give medications?

If not, why take Jackson off duty for something that is not within his scope of practice?

Was there a suspicion that Jackson was acting outside of his scope of practice? Or is it expected that EMTs in this system will exceed their scope of practice? Or is he an ex-medic, who was demoted to EMT for a drug error, or for some other kind of problem?

Some have suggested that it is essential for the person giving the medication to confirm the medication being given with a partner, so that may be one reason. If the medication is outside of the EMT’s scope of practice, does the EMT know what to look for when confirming that the medication is the intended medication? If the medication is epinephrine, does the typical EMT understand the difference between 1:1,000 epinephrine and 1:10,000 epinephrine? For an infusion, is the basic EMT supposed to check the concentration and calculate the rate of administration to double check the medic’s numbers? For example, calculate the mixture of dopamine, the concentration in mcg/ml, the rate in ml/minute, and the number of drops for the IV drip set being used.

If the EMT, or even another medic, is driving – is that person supposed to stop the ambulance and come back to the patient compartment to confirm the medication? Is it enough to pass the medication up to the driver for confirmation? Is this supposed to be the case for any change of drip rate, since this is a significant change? Is the medic supposed to pass the medication up to the driver, while the driver is still driving, for confirmation?

Jackson, 38, who was driving the ambulance, was absolved in the incident.[1]

Whatever they thought he might have done, he didn’t do. Not that this really is informative. Or was it that whatever they thought he might not have done, he did? Or is it both? By off duty, do they mean that he was he pulled of the street, but kept on the clock? Was he suspended at all from his regularly scheduled shifts? What is his job description, that would suggest that he is too dangerous working as an EMT to be allowed to continue to work?

Or did they just not have a partner for him and once they pulled his partner off the street they did not have anyone to partner him with? I would suggest putting a supervisor on a truck with him to maintain whatever number of ambulances on the street they had. This might be seen as a punishment, but I would not intend it that way. More likely, the supervisor staffing is going to be affected, because somebody is going to have to investigate this and that will take time, if they are thorough.

If he lost pay by being placed off duty, will he receive that pay that he would have received, or does this organization not do that kind of absolution.

On Wednesday, Waldo, 46, was demoted to EMT after being a paramedic for as many as nine years.[1]

Where are they getting this information from? Why does the person supplying the information not appear to know how long Waldo has been a medic? Have we exceeded the information provider’s number of available fingers for counting? Is it just that the reporter thinks this is a creative means of presenting information? Did the reporter forget?

The most interesting question may be, How was this information released? Does this come from the company, or a plaintiff’s attorney, or a family member, or the patient, or a neighbor, or a doctor, or a nurse, or a medic, or the medic’s union representative, or somebody else? Why release what has been released?

I am still just getting warmed up, but you should also read what others are writing about this –

Too Old To Work, Too Young To Retire writes about this in Scratching My Head

At Life Under the Lights, Chris Kaiser writes A Medic Roast in Tennessee. This post by Chris includes the Damoclean artwork to the right.

Footnotes:

[1] Tenn. paramedic demoted after drug mistake
On Wednesday, Timothy Waldo, 46, was demoted to EMT after being a paramedic for as many as nine years
By Beth Burger
Chattanooga Times Free Press
Article

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