Opinions: Medic Refuses Intercept

[Lone Star]

If the medic in question was 'on call', and was notified that he was needed, he now has a duty to act. The refusal to respond violates that duty to act.

As far as the family suing, I know from personal experience, that it's very difficult to prove that the medic's actions caused a deterioration in patient condition, or resulted in permanent injury to the patient.

Kudos to the department for stepping up immediately and launching an investigation into these proceedings!

I'm sure that since the 'testimony' of those involved seem to paint a 'consistant picture', the state will wade into this mess and someone's head (and license) will roll!

Furthermore, I support the BLS crew's decision to request ALS response from a mutual aid department.

Keep us posted as to the outcome of this case (as much as you're morally, ethically and legally able to do).

[cynical_as_hell]

My first question is with this medic being the Deputy Chief for your department, was he on call as a medic or was he just on call in the sense of supervisor? If he is in fact on call for the medic side of this, then yes, he is in breach of duty. But he cannot be held negligent because to be found guilty of such, the patient, or whoever is doing the sueing, has to prove that there was a duty to act, that there was a breach of duty to act, that the patient suffered actual damages, and proximate cause. All four have to be proven for a medic to be found guilty.

The lead emt made an apropiate decision in requesting the other fire department. Remember, ask yourself "What is in the patient's best interest?" and make your decisions in accordance to that. I'm glad to read that your department has handle the situation and is continueing to do so. The last thing anyone wants is to have any issues arise.

One more thing to add and a previous poster asked the same question...Would it have been quicker to just go ahead and transport to the hospital even though you are bls or would it have significantly benefitted this patient to wait for ALS?? If it would be quicker to transport and you wait on scene for ALS than you could potentialy get into trouble for a delay in getting the patient to defenitive care.

[Dustdevil]

Of course, the situation is rarely as black and white as it appears. What the medic actually said to the EMT, and what the EMT claims he said may be two very different things. The scene size up the EMT gave may well have been unconvincingly inadequate to present the severity of the situation. I don't know. What I do know is that a lot of EMTs have problems being told they are wrong, and take it poorly. Consequently, I'm not taking any of this for granted.

Regardless, immediate suspension is indicated, pending a thorough investigation. If the scenario did play itself out exactly as was presented by those on scene, then this guy should be history. If not, if there was a FAILURE to communicate that contributed to his misunderstanding the situation and making an inappropriate decision, then the blame must be shared, and the guy should be given the benefit of a doubt, along with STRONG counselling to ensure clearer communications and decision making in the future.

ALS intercepts are very much like HEMS call-outs. Three-quarters of them are bullshyte. Not justified. Not needed. And in fact detrimental to patient well being. Hell, half of all EMS calls are bullshyte and not justified. And if your EMTs are jerking medics around on a regular basis, this is exactly the sort of problem that results. And the EMTs and the organisation itself are just as responsible for it as the medic, if not more.

Would the patient have benefitted more from immediate BLS transport than from the EMTs dicking around on the scene for half an hour shopping for an intercept? Probably so. And, if so, that indicates some very poor decision making on the EMT crew's part, which should be dealt with as severely as the medic's poor decision.

The organisation clearly shares in the blame for this situation. What are the WRITTEN and clearly posted protocols and SOPs for this? Are they clear and concise? Is there room for misinterpretation? Were they violated? Making a bad decision, without breaking policy, is a very iffy reason to sack someone. The proper response to that would be to fix the broken system that resulted in the problem, not sack the people who were not given the proper tools to work with. As much or more emphasis should be put into improving the organisation and it's policies and procedures here as in trying to fix the blame on someone. Otherwise, the organisation continues to FAIL and put patients at risk.

[Adam Swartz]

Well let me ask this one. A friend of mine told me once that instead of waiting give the patient good ole' diesel therapy. Just my two cents anyway. Go Code 3 to the hospital and get the Definitive care asap.

[AnthonyM83]

Could you give me a detailed account of the medic's side of the story? Also, is refusing calls common in this agency. It might be a sign of a bigger problem with the department (though individual medic would still be accountable). What do protocols say?

I'm trying to get a bigger picture view on what factors would lead the medic to do what he did.

(Past hx with the EMTs, Protocols, a common mentality at the agency, etc).

How far was the call from the ER, to the ALS fire engine, and to the intercept location with the medic (had it happened)?

Edited August 23, 2009 by AnthonyM83

[mobey]

How far was the call from the ER, to the ALS fire engine, and to the intercept location with the medic (had it happened)?

This is the real question as far as I am concerned.

You have posted this wanting an "opinion", without giving all the facts for us to form an opinion from.

It should be noted that all the ALS intercept did was 12 lead & MS.

This may be more dramatic if your area had use of prehospital thrombolytics.

Another question.... Do your EMT's have access to a 12 lead monitor?

Since you now have vollies refusing calls..... perhaps it is time for some career/professional positions to open up in your system?

[paramedicmike]

I think Dust pretty much summed it up.

There is one question, however, which hasn't been addressed. How is the on call medic normally summoned? Is a cell phone call the normal means of notification? Or does that request have to go through the same system that dispatched the BLS crew for a formal ALS dispatch? If it's the latter, then the crew failed and should be disciplined accordingly. If the former, well, then your system needs some serious work. This would then go back to how the BLS crew described the situation to the on-call medic.

-be safe

[spenac]

Well let me ask this one. A friend of mine told me once that instead of waiting give the patient good ole' diesel therapy. Just my two cents anyway. Go Code 3 to the hospital and get the Definitive care asap.

Anyone promoting that way of thinking needs out of EMS.

[cosgrojo]

I guess I just don't understand "volunteer" EMS. This medic is at home with his kids, or is he being paid and sitting in the station? Does he have a department vehicle with appropriate responding apparatus, or is he supposed to be flying toward scenes with his personal vehicle and a post office strobe light? If you are at home, not being paid... how can you get in trouble for not responding? It is Volunteer... right? From my understanding when you are on a volly squad, you only go when you can or want to go, if you are indisposed... that is what mutual aid is for. When BLS crew called for medic... was the medic in between the call and the hospital, or would they have had to wait for the medic to arrive?

The way the call was presented it seems to have taken a long time to get ALS determination. If I was on that BLS crew I would have been requesting ALS on the way to the call... mobilizing them as soon as possible (are there dispatchers involved? Or are we still hopping phone-booth to phone booth to get emergency resources?). If I got there and it was BS (or nature of call was different than dispatched), then I would cancel them.

If this medic was truly "on-call" then he should have gone out when the original call came in, and responded with the BLS crew. If your system is set up to respond BLS on ALS criteria calls, and rely on updates from BLS to DETERMINE whether ALS even rolls out... then you guys should suspend your system without pay and leave the medic alone until you guys get your s#it together.

[Adam Swartz]

Anyone promoting that way of thinking needs out of EMS.

As I said. that was what a friend said. Not my opinion. The reason I bring it up is based on the question of how far away the hospital is? If it's close enough wouldn't it be better for bls and transport asap than wait?