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

- Rogue Medic

Drunk? or Auto vs. Pedestrian With Major Injuries?

 

Sometimes we miss things that we are expected to miss, such as an atypical presentation of an uncommon condition.

Other times we miss something that even a rookie should not miss.
 

A paramedic has been suspended for a year after he mistook as drunk a man who had in fact been victim of a hit-and-run, suffering a broken back and 12 broken ribs.[1]

 

Suspended for a year is a serious punishment, right?

Maybe not if the medic is retiring anyway – after 30 years on the job.

How does someone with 30 years of experience miss those injuries?
 

A passerby found Mr Wonnacott at 4am on November 20, 2011, and the paramedic failed to establish any of his injuries and made him walk into the ambulance.

While en route to hospital, Mr Gaiger called Mr Wonnacott’s parents and said he was “absolutely plastered” and it was only on arrival to the hospital that his injuries were discovered.[1]

 


Image credit.
 

4 AM on a Sunday morning is a time when we expect to see a higher percentage of drunks.

I have missed things on scene, only to identify them during transport, and I have continued to miss things during transport, but, . . .

Maybe if there were only 11 rib fractures, it would be understandable.

Maybe if it were only 2 vertebrae.

Maybe if both the liver and the spleen hadn’t been lacerated.

Maybe if there hadn’t been a pneumothorax.

Maybe these injuries were actually quite subtle.
 

David Rosenbaum was just another drunk in Washington, DC.[2]

Except that he wasn’t drunk. He had a head injury and died before anyone realized that he was not drunk.
 

“This is not a witch hunt. I just don’t want another family or patient to go through what we have been made to go through as a result of Mr Gaiger’s actions.”[1]

 

The Rosenbaum family said the same thing.

We don’t want money. We want to fix the system so that this does not happen again.

Did anything really change at DC Fire and EMS?

Will anything really change at South East Coast Ambulance Service?

This is a medic they have employed for 30 years. Was this the first time something like this happened? Was this the first time that the news media became aware of the problem? Was he burned out after 30 years? Was he having a horrible day – although a day infinitely better than his patient was having? Out of sight, due to retirement, out of mind? The articles have not been very helpful.

Maybe Mr Wonnacott was gently run over, by someone who really was drunk, and suffered a brain injury that made him appear to be drunk, and only the hospital people could identify the multiple fractures and brain injury.

Maybe, but maybe we should discourage people from concluding a patient is just a drunk, or that the epigastic pressure is just indigestion, or that the hyperventilation of the young female is just hysteria, or . . . .

Hmmmm. Those are things I learned in my original paramedic class that have not changed.

Footnotes:

[1] Chessington paramedic suspended for a year after treating seriously Esher injured man as though he were drunk
By Laura Proto
6:10am Thursday 20th March 2014
Elmbridge Guardian
Article

[2] The Death of David Rosenbaum
By Colbert I. King
Saturday, February 25, 2006
Washington Post
Article

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