Off the top of my head, I’d say they weren’t, but you folks can be the jury.
I was reviewing a report done by a medic who works for one of our client services. It had already been reviewed by one person who had given it a high infraction score. Which is why it ended up on my screen.
The call was for a person who passed out. The crew arrived and did the usual and correct things. They determined, again correctly, that the patient had a GI bleed. Which is where things went off the rails.
The first mistake was that they decided to remove the patient to the ambulance before the initiated ALS treatment. In some cases that sort of OK, but in this case it’s definitely the wrong thing to do. The protocol calls for immediate treatment of serious conditions at the patient’s side before extrication. Which they definitely should have done in this case.
Why you ask?
Because as documented in their patient care report, the patient’s blood pressure was 74/40. Supine.
So, what mode of conveyance did these paramedics decide to use to get a profoundly hypotensive patient out to their ambulance?
Scoop stretcher. No way.
Reeves stretcher. Uh uh.
I mention these three devices because I know that they have them on their ambulances.
No, my friends, our life saving duo chose to put the patient in to their stair chair. Which of course required taking the patient with a profoundly low blood pressure lying supine and sitting him up.
Which, again according to the written report, caused the patient to have a “short period of syncope”. Of course they didn’t seem to relate the two which is perplexing and concerning since it’s kind of basic medical science.
For my non medical readers, try this. Take a bottle of soda or even water. Consider the bottle cap the head of a person. The neck of the bottle is of course the neck. The rest of the bottle is the rest of your body.
Got that? Good.
Now drink or pour out half of the contents.
Now lay the bottle on it’s side.
You’ll see that some water is still in the area of the cap.
Now stand the bottle up into it’s normal position.
Where is the water now?
The water is blood, the cap is where the brain is. If you stand the bottle up the water goes to the bottom and leaves the cap high and dry.
The same thing happened to the patient when the medics sat him up and put him the stair chair. Which is why he passed out. The resilience of the human body is why he regained consciousness, but I can tell you that his brain took a bit of a beating during the interim. Not to mention the increased demand on his heart.
The most annoying thing about this is that these guys are paramedics. They are supposed to know this stuff. If EMTs did it, I’d still score it as an infraction, but it would be more understandable. But not with paramedics.
I took the report and raised the infraction level and then sent it on to the medical director. Who would have raised it more, but I had maxed out the points.
I can tell you if I were still working on an ambulance and anyone on the call with me had suggested or tried that sort of thing, the results would not have been pretty. When it came to making sure that we didn’t do stupid stuff to patients, I was uh, less than diplomatic.
Not that I can do that since we are a “customer centric” operation using coaching and education to correct errors.
Now I have to go out to the client service and do some remediation for the medic in charge of the call. In a coaching and supportive kind of way, of course.
Some days I just shake my head.