Continuing from Part I.
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A hospital, or ambulance company, should not allow doctors, nurses, or paramedics to give substitute medications without educating them about the medication. Different concentrations. Different dosages. Different side effects. Different drug interactions. Different indications. Different routes of administration. Et cetera. Even for nearly identical drugs.
Likewise, a doctor, nurse, or paramedic should not give any medication without being familiar with the drug – concentrations, dosages, side effects, drug interactions, indications, et cetera.
Gosh, I’ve never given this before. Let’s play with it. It’s not like anything bad could happen.
Do doctors do this?
Do nurses do this?
Do paramedics do this?
Is this the kind of behavior that any hospital wants/accepts from its employees?
Is this the kind of behavior that any ambulance company wants/accepts from its employees?
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“In our mind, that’s just the tip of the iceberg,” Vaida says of the 15 deaths. “No one may be attributing a death because they really aren’t aware that a drug actually caused the death. If someone is notaware of the potency of one medication and gives too much so that the patient goes into respiratory arrest and dies, they may attribute it to the fact that the patient came into the hospital with respiratory problems.”[1]
Ex-Dr. Conrad Murray is going to prison for similar behavior.
How can any administrator claim that Conrad Murray behavior is to be expected from their employees, but not end up being investigated.
If I give a medication and the patient stops breathing, I should still be able to ventilate and oxygenate the patient. The same is true for any first responder, or basic EMT.
If the problem is respiratory depression
and the result is death,
is the problem the drugs,
the people giving the drugs,
or the oversight of the people giving the drugs?
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Why hire people who can tell the difference between one and 100?
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How is a death, under these circumstances, any different from the death of Michael Jackson under similar circumstances?
What are the circumstances of these deaths?
So far, 15 deaths attributed to the drug shortage have occurred nationwide, an Associated Press study found.[1]
One code-blue patient in an undisclosed city died because the preloaded emergency syringe epinephrine wasn’t available.[2]
In cardiac arrest, epinephrine, does NOT save lives.
Epinephrine does help to just get a pulse back, but that is not saving a life. If just getting a pulse back were saving a life, then we would not have large awards to the families of patients who went in to the hospital without impairment, but came out with just a pulse. That would be considered a good outcome.
If the doctors, nurses, and medics do not know what medications they are using, they should not proceed until they do know what they are doing.
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Footnotes:
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[1] Shortage of Lifesaving Drugs Reaches Epic Proportions
Beverly Ford Source: Telegram & Gazette (Worchester, MA)
December 21, 2011
EMS World
Article
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[2] Oklahoma EMS Face Drug Shortage
by Sonya Colberg
The Oklahoman
Monday, October 4, 2010
Article at JEMS.com
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Is it possible to kill someone who is already in cardiac arrest??
You can certainly assure that they STAY dead!
Giving an employee a drug to administer on which that employee has not been trained is called “negligent entrustment” in the world of the plaintiff’s attorney. Employers and medical directors beware!
Giving a drug of which you do not have the knowledge of the actions, contraindications, effects, pharmacokinetics, etc., sure sounds like “willful, wanton, gross negligence” to me!
Well stated. I couldn’t of said it any better myself.
Well yes, you can certainly do things that just about guarantee that said person will remain dead … giving a wrong or inappropriate medication could definitely qualify.
But when someone is in already in cardiac arrest, there is a pretty good chance that, epi or no epi, they are going to stay that way. I’m not certain they can say the inability to administer epi was the direct cause of the person’s death.
Prehospital RN,
We are much more likely to cause death, or ensure death persists, by giving a drug, than by withholding a drug.
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Those odds can be calculated for systems that track their resuscitation rates. Based on the presenting rhythm, whether bystander CPR was provided, whether it was witnessed, we can get a pretty good idea what the odds of survival are.
If the person has a 1 in 4 chance of survival, that is not negligible. What if the chance of survival is 1 in 3 or even 1 in 2?
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I am certain that they cannot find any evidence that epinephrine improves survival.
Epinephrine just seems to change the location of pronouncement of death, from prehospital to in hospital.
What epinephrine does not do is improve survival.
After decades of routine use in cardiac arrest, we still have no evidence that epinephrine improves survival, but we continue to give epinephrine to cardiac arrest patients. What we do have is a Standard Of Care that is based on wishful thinking and surrogate endpoints
The inability to give a drug that cannot be shown to improve survival is not a reason to claim that the patient did not survive because of the lack of that drug.
Not a direct cause.
Not even an indirect cause.
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SO, what you’re suggesting is that despite the hugely busy schedule of medical control authority officials, the horrendous drug shortages in benzodiazepines, narcotics, anti-arrhythmics, etc. that the time should still be taken to educate the population of providers on how the drug works, when it should and shouldn’t be given, what effects, both positive and negative it can produce and how to most appropriately manage them? And that those that don’t are at best being negligent? What about when these providers he’s talking of ask for said education and aren’t given it? What then?