Mistaking Yours For Patient's Pulse

[Richard B the EMT]

In the following article, the daughter of 2 of my friends wrote of a call where she mistook her own pulse for the patient's. There is no indication, or contra-indication, as per the article, that she had her fingers feeling for a pulse in an incorrect position.

Has anyone else ever heard of this happening?

The parents are both good EMTs, but I have never met the daughter, but can, as can anyone in EMT City, commiserate that she "lost one".

http://www.nytimes.com/2008/05/04/nyregion...amp;oref=slogin

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May 4, 2008

New York Observed

The Man in the Blue Pajamas

By JEN UMLAS

MY parents were volunteer emergency medical technicians for two decades, so I expected I would be great at the job. I certainly had parental support. When I mentioned to my mom in 1996 that I was thinking of becoming an E.M.T., she all but picked me up and carried me into the training hall, right down the block from our house on Eaton Court in Gerritsen Beach, Brooklyn.

I imagined that I would be like my mother, a technically competent E.M.T. who also was not afraid to get dirty and had a knack for providing psychological first aid. Instead, I took after my father, who looked like Super Mario and got almost perfect test scores but was not so great with actual patients.

Still, I had a good stretcher-side manner and I could splint and bandage as well as anyone. I loved walking onto an accident scene and knowing exactly what I was supposed to do. I felt like Dr. Cameron, the compassionate immunologist on “House.”

Gerritsen Beach is a tiny corner of southern Brooklyn, and our unit, the Gerritsen Beach Volunteer Fire Department and Ambulance Service, had only one ambulance. If a call came in when the ambulance was already out and more than five minutes away, the dispatcher called 911 and we reported to the scene in the rescue truck, treated the patient, and then signed the patient over to the city E.M.T.’s when they arrived.

That’s what happened one day in the late 1990s with John, a 75-year-old who was lying on the couch of his home in his pajamas, light blue as I remember, when we arrived. He reminded me of the men in my Grandpa Tom’s bridge club, all gray hair and thick glasses and hearty laughs. He had been having chest pains, and as it turned out, he had undergone bypass surgery less than a week before.

The officer of my crew herded John’s relatives into the dining room to give us privacy. Our driver helped me take John’s vital signs. His blood pressure was low, but acceptable, his breaths were coming often enough, and his pulse was fine.

We gave him oxygen and I smiled reassuringly to let him know that this kid in jeans and a sweatshirt — I’m short and blond, and was in my mid-20s — was capable of taking care of him. He closed his eyes to rest while we waited for the ambulance.

I was eager to have John on his way to the emergency room at Coney Island Hospital, less than 10 minutes away. I knelt beside him, keeping my fingers on his wrist, constantly feeling his pulse. That beat meant that things were basically O.K., that there was nothing to do but wait.

Then, however, as I looked at his face through the oxygen mask, it seemed as if John wasn’t breathing regularly. I asked our driver to take a look. When a person’s breathing becomes inadequate, his pulse soon weakens, but because John’s pulse was strong, I was not sure what was going on. Because I’d been an E.M.T. for only two years and went on a few calls a week instead of a few a day, I hadn’t built up much experience. The driver, who was about my age, was even greener than I was and had somewhat less medical training. The officer had 15 years on us, but she was dealing with the family.

The driver moved the patient’s mask aside and called his name loudly. John took a deep, gasping breath. Relieved that he was at least breathing, we relaxed a bit. After another minute, the city ambulance pulled up outside and a clean-cut, uniformed E.M.T. appeared behind me.

“He’s taking a few gasping breaths a minute, but his pulse is good,” I said, trying to sound confident. The man exchanged a look with his partner.

The two city E.M.T.’s had John moved to the floor in case we needed to perform CPR, and then attached their defibrillator to his chest. I moved my hands away because I knew that anyone touching a patient would have his or her pulse appear on the monitor, too. But the partner waved me back toward the patient. I put my hand back on John’s wrist and, when I looked at the monitor, I immediately knew why I had been motioned back.

There was only one pulse. Mine. John’s heart had stopped sometime in the last few minutes and I had done nothing because I’d thought that my heartbeat was his.

WHEN John’s pulse was beating, the pulse in my fingertip was weaker than the one at his wrist. So when I took his pulse, I felt the beat in his wrist instead of the one in my own finger. But when John had no pulse, I could still feel a thump against my fingertips. People with thick skin could tell the difference easily. The rest of us had to learn.

The E.M.T.’s had me start CPR. If I had started it sooner, I thought to myself, John would have had a better chance. Also, he was swollen from the surgery a few days earlier, and his chest, covered in stitches, felt like foam rubber. Soon, still hoping, we were speeding with John in the ambulance toward the hospital.

Later that night, I told my mother about confusing my pulse and John’s. She said I wasn’t the first person to make that mistake. She was offering me absolution, but I didn’t think I deserved it. The next day, John’s family called to let us know that he had died. I wasn’t surprised.

In my first class, one of the students had asked the instructor: What if we kill someone?

“You can’t kill a patient,” the instructor had replied. We weren’t doctors or even paramedics. There was no danger of our giving someone the wrong drug or making some other potentially fatal mistake. “You can only fail to save them,” the instructor said.

Copyright 2008 The New York Times Company

[DwayneEMTP]

Man, almost everything about that story, medicine wise, is horrible. I think she's going to take a beating here in that regard.

On pulses in your fingers...I was warned by one of my preceptors that you have pulses in your fingers, and to prover his point he had me push my fingertips from my right hand against those of my left.

He's right, there is a faint pulse, yet though I've tried, I can't really see it being mistaken, as he quality is completely different from any of the larger, arterial pulses I've felt before.

Dwayne

[Dustdevil]

I have heard of it happening. But no, I cannot imagine anybody who was competently educated and trained making that mistake. She was guilty of much more than simply mistaking her pulse for his. She was guilty of FAILURE to assess the whole patient, instead focusing on only one isolated sign. It's as unforgivable as a medic who stares at the monitor and FAILS to otherwise assess his crashing patient.

Even if her training and experience were so inadequate that she was incapable of competently taking a pulse, I cannot imagine that even a Long Island fire hall EMT school would have taught her that a pulse was all there was to patient assessment, so you probably can't really put this one off on the school. You can, however, place much of the failure on the volly system she is a product of. After all, she had two years of experience behind her at this point.

And with only a couple runs a week max, and no further medical education in her future (not too many NY vollies heading off to paramedic school), there is little hope that she ever got any better.

When she assured that dying man that she was capable of taking care of him, she lied. I couldn't live with that, myself.

[JakeEMTP]

Well written article for the most part. I can sympathise with her.

It's a shame she was sent on a call in which she was totally unprepared for. Not enough education, resources or equipment. I don't blame her solely though. Just a dysfunctional system.

“You can’t kill a patient,” the instructor had replied. We weren’t doctors or even paramedics. There was no danger of our giving someone the wrong drug or making some other potentially fatal mistake. “You can only fail to save them,” the instructor said.

WTF is the above statement all about? The inability to differentiate between her pulse and the patients proved fatal in this case. How exactly, could she save this guy? Other than rapid transport, and of course, the ability to recognise holding the gentleman's wrist and some high flow O2 wasn't cutting it.

Nice job by the instructor :roll:.

[JPINFV]

It's a shame she was sent on a call in which she was totally unprepared for. Not enough education, resources or equipment. I don't blame her solely though. Just a dysfunctional system.

To be entirely fair, the article is written in a manner to suggest that she was only a first responder with a NYC ambulance responding as well. Albeit, it could also be argued that there would have been a paramedic ambulance staffed in the area if it hadn't been for a volunteer agency covering the area (I don't get the entire "let's mix 911 responses between 15 different paid and volunteer agencies" that NYC seems to run).

Also, to be fair, I've heard my own pulse when taking a blood pressure before, but it was never in a manner that I could mistaken between my own and my patient's. Also, how can you miss that a patient stopped breathing? It sounds like it's more of a provider needing to put her big-girl panties on and make treatment decisions past 15 LPM NRB than a volunteer problem. Being a low call volume volunteer makes the problem worsen, but isn't an exact cause.

[JakeEMTP]

To be entirely fair, the article is written in a manner to suggest that she was only a first responder with a NYC ambulance responding as well.

I agree with you here. That's what I was trying to say. She was in no position to even begin to understand what the problem was functioning in low volume service as a first responder. I wasn't slamming her entirely, more so the system itself.

Also, to be fair, I've heard my own pulse when taking a blood pressure before, but it was never in a manner that I could mistaken between my own and my patient's. Also, how can you miss that a patient stopped breathing? It sounds like it's more of a provider needing to put her big-girl panties on and make treatment decisions past 15 LPM NRB than a volunteer problem.

Exactly.

[mshow00]

I think I have to place a chunk of the responsibility on the most experienced crew member, who left the two "rookies" to take care of the Pt. IMO he should have had "lead" on this call. He should have been there for the inital assessment, seen the potential for the danger the Pt was in, and sent one of the other to talk to the family. My basic instructor beat into our heads to keep all pt talking(except those with a c/c SOB) no matter what. Sounds like the arthur had a deadly case of tunnel vision as did her partner who was also treating the Pt.

[mrmeaner]

The officer had 15 years on us, but she was dealing with the family.

Yep, real quality system there.

Good thing they can't kill patients, wait, the patient is dead.

Oh, they just let them die, that's better.

[zzyzx]

This article is wonderful. Although it's about a terrible mistake, I believe that people reading this article in The New York Times will come away having a better appreciation for people who work in EMS. The author acknowledges her mistake, and she obviously still feels terrible about it all these years later. One stereotype of EMS workers is that they are cynical and that they have little compassion. Obviously this person is not any of that. I hope she is still working in healthcare.

[Dustdevil]

I hope she is still working in healthcare.

If so, I hope that she got an education and professional experience somewhere along the line, instead of spending the last fifteen years still believing that compassion and three weeks of first aid training is all that's necessary to care for the most vulnerable human beings on the planet.

I'd be willing to bet that she did not. And I'd be willing to bet that the man in the blue pyjamas is not the only body in her trunk.