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

- Rogue Medic

Rather than one excellent medic making everyone look better

What if the medics in the chart in my last post were not the bunch of bad apples with one good apple?

With these numbers representing the grade that an independent person, who understands what high quality EMS really is, gave to each of the medics in an organization?

Using the same chart, but switching the 50s to 90% quality scores, assuming that 60% (or even 65%) is the minimum passing score, what would this say about the medics in this organization?

What happens to the quality of care delivered by this organization, if the below average medic leaves?

Why do so many organizations seem to cherish the below average medics?

What is it that the other medics will say to this medic, if they recognize that the dangerous medic is dangerous?

Don’t be mean!

He’s got a family to feed!

Is that important?

Of course not.

Dangerous medics kill.

Dangerous medics kill people.

Dangerous medics kill people with families.

Dangerous medics kill people with families to feed.

Why is that so hard to understand?

Why is protecting the job of the dangerous medic considered so much more important than protecting the lives of the victims of the dangerous medic?

The dangerous medic is also making the good organization look bad.

Will the dangerous medic be remediated or fired?

Maybe, but how many patients will be harmed/killed by that one dangerous medic?

Six (0.36%) unrecognized esophageal intubations were discovered in the emergency department or at autopsy. Only one (0.06%) of these occurred since the addition of capnography and a tube aspiration device in 1990. In this patient, a zero reading on the capnograph was ignored and not verified by a tube aspiration device or by removing the tube and re-intubating the patient.[1]

With the addition of a technology (waveforem capnography) that is capable of dramatically cutting the unrecognized esophageal intubation rate to zero, the unrecognized esophageal intubation rate still did not drop to zero. Because one medic chose to ignore a zero capnography reading when the tube was in the esophagus. Did other medics do the same thing, except that they were lucky enough to have missed the esophagus?

Why?

At least one dangerous medic.

The average for the organization may look pretty good, but the few dangerous medics will still do a lot of damage – damage to defenseless patients. These patients are defenseless, because they depend on the EMS system to protect them from the dangerous medic the EMS system is sending to them. Patients who depend on EMS for emergency care maybe only one time, but that is all it takes.

Footnotes:

[1] Prehospital use of succinylcholine: a 20-year review.
Wayne MA, Friedland E.
Prehosp Emerg Care. 1999 Apr-Jun;3(2):107-9.
PMID: 10225641 [PubMed – indexed for MEDLINE]

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Comments

  1. Dangerous medics should be fired and their family should not be a factor. I have and do work with dangerous provdiers who should have been fired long ago, or at least remediated. But I sit and wonder why they are indeed cherished. Remediation should be for people who make honest mistakes or who need guidance. Not for those who are dangerous to patients, fellow medics and the overall industry……

    FIRST!!

  2. Reading your post reminded me of a call I had when I was still a very new paramedic. I won’t go into specific’s but lets just say my 8 year “veteren” partner that day told me there was no such thing as a cardiac wheeze, and that I might as well be saying that our patient has a kidney wheeze. That night I printed out a very long article about the dx and tx of cardiac asthma(cardiac wheezes) and left it in that person’s company mail box the next day. Then the company I worked for at the time had the audacity to reprimand me because that person complained that I was trying to make him/her look stupid. When I explained that I only wanted that person to be educated on the subject they told me it’s not my job to worry about that, and that if I did it to anyone again I would be suspended. That was when I figured out why all the ER nurse’s seemed to think that everyone from that company was an idiot until proven otherwise. And now that person gets to handle a lot more “kidney wheezes” because they work on a large city FD as a medic. /sigh

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