Everyone Can Teach Us Something

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As I type this, I’m watching the video below. It’s a “how not to” provide EMS. The patient in the video died after the paramedic and EMT allegedly refused to treat him. The deputy drove the man, Paul Tarashuck, to a closed gas station some distance away.

Tarashuck then proceeded to walk out into traffic where he was struck and killed by a motor vehicle.

We have video below of the entire encounter from the time the ambulance arrived until the late Mr. Tarashuck was escorted to the police cruiser.

To be clear, the deputy isn’t completely blameless in this incident either. I’m sure his department is going to review its policies on this sort of thing.

The EMS crew (and maybe the deputy) made a basic mistake that no EMS provider of any level of training or experience should make.

They assumed that the patient was drunk or on drugs. They never got beyond trying to get his name. No examination, not even vital signs.

At best what they did is known as “Anchoring Bias.” Which means that they had a preconceived notion of what was wrong with the patient and just never moved on from that.

That’s not the worst thing they did. Even being snarky and nasty to the patient isn’t a fireable offense. It’s wrong, but on the scale of things that they (allegedly) did wrong, it’s probably at the bottom of the list.

It’s hard to know who is in charge on this call, because the uniforms give us no clue. We also can’t see much of what is going on because the deputy is standing behind a broom and so his body camera isn’t showing us much.

The thing that they shoved up his nose is likely an ammonia inhalant or “smelling salts” if you prefer. Many systems stopped using them years ago because there are a lot of potential adverse effects. Not only did they use them, which might be allowable in their system. They used them inappropriately by shoving the capsule up his nose. That’s the white object sticking out of his nose.

I’ve lost track of the number of times that they asked his name. For whatever reason, they didn’t seem to be able to get past that. They did take a set of vital signs.

As the contact progressed the providers became less patient. There came a point where one of them should have gotten into the front of the ambulance and driven to the hospital.

That’s not what they did. Instead, they let the patient go into the custody of the deputy.

Here is what the providers allegedly did,

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

This is the classic definition of Patient Abandonment. It is about the worst thing that you can do if you are an EMS provider.

At it’s best, this is an undocumented patient refusal, but that’s stretching that term almost to the breaking point.

Or maybe beyond.

In order for a patient refusal to be valid, the first thing that providers need to establish is that the patient is competent to refuse. There is a process for that, and the providers in this video did absolutely no steps in that process.

There was no way for the EMS crew to know that Mr. Tarashuk had a history of mental illness and was having a schizophrenic episode. What they did know, or should have, was that he was not oriented and obviously could not make an informed decision regarding being transported.

What they should have done is transported him to the hospital for examination and possible treatment.

What they should have done at the least is check his blood glucose level to see if he was hypoglycemic. That’s EMS 101 for patients that don’t answer questions appropriately (or at all).

This happened back in September and the latest report, from last month, says that the paramedic is still working “at a lesser capacity.” Whatever that might mean.

A couple of notes about the process of recording the encounter.

The deputy was wearing a body cam. Which is fine from a law enforcement standpoint, but not so much from an EMS standpoint. Which probably puts the EMS providers at more risk than the police officer. It would have been appropriate to ask the deputy to turn off his camera while he was in the ambulance. Or step outside.

That aside, the larger issue is that EMS providers should always act as if they are being recorded. It’s really that simple. Patient privacy laws apply to EMS providers, probably not to police officers, and definitely NOT to bystanders and patients.

This video seems to be pretty clear cut, but it’s not at all uncommon for random people to record snippets of what is going on and then release the video to the Internet. Or the news media for that matter.

Since the vast majority of the public has no knowledge of EMS or medicine in general, it’s easy for a video to portray something in a negative light and have the general public immediately condemn what ever actions the person making the recording didn’t like.

That happens to the police on a daily basis and is the reason that a lot of officers are wearing body cameras. Interestingly, the number of civilian complaints has dropped since body cameras have become common with police officers.

The debate now is whether that’s because police are behaving more appropriately or because people are less likely to make a BS complaint if they know that the police will have video of the events.

I’ll let you guess which way I think.

No, the answer is NOT body cameras for EMS. I can think of no easier way to end an EMS career than to have a video of a patient encounter.

We deal with a lot of very ill people and often they act out inappropriately when they are feeling horrible. Or family and friends act out inappropriately.

Which is why we have to be careful when dealing with uncooperative patients and belligerent family. Recording them is likely to make the situation worse, even if they record us.

Be careful if someone whips their cell phone out and starts pointing it at you. The only thing that you can be sure of is that they are NOT doing that for your benefit.

It’s most important to be more professional than you normally are when the patient or family is acting out at a scene.

I’ll close by reposting my five keys to a long and successful EMS career.

  1. Answer the radio, pager, or phone when dispatch calls.
  2. Go to the call.
  3. Be nice to the people at the call.
  4. Take the patient to the hospital.
  5. Give the patient a nice, warm blanket.

If you do those five simple things, you’ll likely spend little to no time writing incident reports.

I learned that the hard way, so you don’t have to.


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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.

2 COMMENTS

    • I’m trying to figure out a way to incorporate this into my “How to document a patient refusal” class. It’s the one we give to all new client agencies. I think this has EVERYTHING that you should not do rolled into one.

      If you didn’t know better, you’d think that it was some sort of comedy routine.

      Only it’s not funny because the patient died.

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