"DC Paramedics make Fatal misdiagnosis"

[Arizonaffcep]

Good points doc, but the problem is that our errors do result in death, so you can bet on a lawsuit when they occur. If a medic at your service killed my kid, you can display all the compassion and remorse you want to, and even if i believe it to be sincere, I would probably still sue.

I would buy that SOME of our errors result in death...not all. "In its report, To Err Is Human: Building a Safer Health System, the IOM estimates that 44,000 to 98,000 Americans die each year not from the medical conditions they checked in with, but from preventable medical errors." (from website listed below). Now, this is out of (roughly) "Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies." http://www8.nationalacademies.org/onpinews...?RecordID=11623 This is a FATAL error rate of 3 percent of the errors made. So...in other words, if there were 110.2 million visits to ED's (please see my post on page 2 of "Save 1-2 million patients in 2009 ??" for proper reference to the number given), and 1.5 million errors were made. This equals approximately 1.33 percent. So...of that 1.33 percent, approximately 3 percent are fatal errors. This is .00043 AKA 0.43% of the total number.

Here's an interesting article by the FDA. http://www.fda.gov/fdac/features/2000/500_err.html

[Just Plain Ruff]

At what point does the Chief just need to say, no more patient refusals unless witnessed by a supervisor ? Which might be good for all EMS services, think about how many lives would be saved, as almost every service has had one of these calls at some point in the last 5 years (most just dont get media attention), and if you multiply that out, that is alot of needless patient deaths.

Thats gonna be a very very busy supervisor. Nice segway to your new topic Crotchity

[spenac]

But I wonder how you could motivate companies or individual medics to tell on themselves by reporting these numbers, as the general rule is to cover-up and deny it when you can. There is no "reward" for reporting the errors, and some could argue that you could open yourself up to a lawsuit by doing so. We should want to know the true number of EMS mistakes that harm patients, but I doubt many would be willing to share their true numbers.

Think about the number of medication errors that happen on an annual basis alone (where no harm was to done to the pt).

Actually crotch not all are dishonest like you sound like you must be. When I or any of the other EMS people I work with have realized they made a mistake they have reported it so the hospital would know that wrong treatment etcf was done. None of those mistakes led to death. Again I would propose that 99.99999999999999999999999978653421% of all EMS mistakes do not lead to death or even long term problems. See I an throw unsupported percentages out there to.

EMS is and should be an honorable profession. Thankfully those I work with are not above reporting their mistakes as they put patients above themselves.

[firedoc5]

I couldn't decide to make an additonal comment, but I guess I will.

Paramedics can't "diagnose" a patient. You can only go by what is presented in the field. Only docs can diagnose someone, and they aren't going to do a full diagnosis without hosptial resources.

I'm all through now. I think I'm going back to bed.

[akflightmedic]

I couldn't decide to make an additonal comment, but I guess I will.

Paramedics can't "diagnose" a patient. You can only go by what is presented in the field. Only docs can diagnose someone, and they aren't going to do a full diagnosis without hosptial resources.

I'm all through now. I think I'm going back to bed.

Beg to differ.

We do diagnose, otherwise we would never initiate treatment of any kind. What are you treating if you do not diagnose?

This is one of the old school mind sets we need to lose within our profession as it is self limiting.

I diagnose all the time and prescribe antibiotics from a varied assortment on my shelf. I diagnose lacerations and suture them closed. I diagnose kidney stones and treat accordingly. I diagnose MIs, respiratory infections, and various abdominal complaints. Do I miss some or get some wrong? You betcha...but so do others in all medical professions.

My point is...as a PARAMEDIC, we do indeed make diagnoses. Yes, I am aware my examples are from remote medicine, but the diagnoses are made with my current level of licensure.

I still stand behind the statement that on the ambulance we diagnose every single time we go on a call, otherwise we would do no interventions and just transport. Does our diagnosis change or become more in depth once we hand off to a physician? Of course it does, but it is still a diagnosis.

[firedoc5]

Beg to differ.

We do diagnose, otherwise we would never initiate treatment of any kind. What are you treating if you do not diagnose?

This is one of the old school mind sets we need to lose within our profession as it is self limiting.

I diagnose all the time and prescribe antibiotics from a varied assortment on my shelf. I diagnose lacerations and suture them closed. I diagnose kidney stones and treat accordingly. I diagnose MIs, respiratory infections, and various abdominal complaints. Do I miss some or get some wrong? You betcha...but so do others in all medical professions.

My point is...as a PARAMEDIC, we do indeed make diagnoses. Yes, I am aware my examples are from remote medicine, but the diagnoses are made with my current level of licensure.

I still stand behind the statement that on the ambulance we diagnose every single time we go on a call, otherwise we would do no interventions and just transport. Does our diagnosis change or become more in depth once we hand off to a physician? Of course it does, but it is still a diagnosis.

I knew I'd hear something on that. :wink:

AK, you are in an unique situation. You are still in a clinical setting, aren't you? Yes, you may be a Paramedic, but how many of us has/ had antibiotics, especially in the field. And sure a Paramedic can identify things. Kidney stones, sure. I've had enough of them myself. But even in the ER they won't do much prior to at least an x-ray to make sure. There are a number of ailments that can present themselves as kidney stones...

Anyone can diagnose a laceration, or an obvious fx. That's the calls that would always kill me. You call your resource hosp. with an "obvious fx." and the nurse on the other end would ask how you would know without an x-ray machine. Then you bring them in and they take one look and say, Yep, it's fractured. You can even determine a flailed chest, but you can't diagnose the full damage done.

If we could actually diagnose, what would be the point taking them to the hospital? And it's been a little while but I don't recall ever seeing on any report from the field that asks for a diagnosis. A "first impression", which is all medics in the field in the states (or Canada) can do that I know of.

[crotchitymedic1986]

I think you guys are argueing semantics (diagnose versus diagnosis)

di⋅ag⋅nose   /ˈdaɪəgˌnoʊs, -ˌnoʊz, ˌdaɪəgˈnoʊs, -ˈnoʊz/ Show Spelled Pronunciation [dahy-uhg-nohs, -nohz, dahy-uhg-nohs, -nohz] Show IPA Pronunciation

verb, -nosed, -nos⋅ing.

–verb (used with object) 1. to determine the identity of (a disease, illness, etc.) by a medical examination: The doctor diagnosed the illness as influenza.

2. to ascertain the cause or nature of (a disorder, malfunction, problem, etc.) from the symptoms: The mechanic diagnosed the trouble that caused the engine knock.

3. to classify or determine on the basis of scientific examination.

–verb (used without object) 4. to make a diagnosis.

If a mechanic can diagnose why my car isnt running, I would hope that my paramedic can diagnose why i am having trouble breathing.

[WolfmanHarris]

Would it help to avoid being bogged down in semantics if we used the term diagnose interchangeably with "field diagnosis," "working diagnosis," "findings consistent with," "best educated medical guess," etc? That way regardless of whether you believe our assessment and treatment decisions represent a diagnosis or not we can discuss the issue at hand on the same page.

[akflightmedic]

No more clinic for me. Yes, I have carried antibiotics prehospitally with two different services.

For the argument sake, I will say it may be a case of semantics, but for the record it is self defeatist to say we can not. Firedoc, did you not see the other parts of my post...the "working field diagnosis" part. So, in essence, we do diagnose.

[firedoc5]

Would it help to avoid being bogged down in semantics if we used the term diagnose interchangeably with "field diagnosis," "working diagnosis," "findings consistent with," "best educated medical guess," etc? That way regardless of whether you believe our assessment and treatment decisions represent a diagnosis or not we can discuss the issue at hand on the same page.

We went through all that for our local paper work with a lawyer, before IL went to a state wide form. Also, we had an ER doc that was also a lawyer. At that time we were not allowed to have the word "diagnose" in any form. We could say things like, "possible, apparent, appers like, etc." Maybe laws have changed and allows it now on forms.