Yet another hit against Intubations

[flight-lp]

Interesting read! From Jems.com............

http://www.jems.com/Columnists/emslaw/articles/85201/

And people wonder why Intubation is under such scrutiny currently!!!!!

[n5iln]

Interesting read! From Jems.com............

http://www.jems.com/Columnists/emslaw/articles/85201/

And people wonder why Intubation is under such scrutiny currently!!!!!

Hrm, the site seems to be down...

[Ghettomedic351]

Piss poor documentation on the part of the medics in this case, also sounds like a bit of poor judgment to boot!

[JakeEMTP]

Interesting read to say the least. The 2nd class I attended in Basic class, the instructor stated and I quote, " If it isn't documented, you didn't do it". That seems to be the case here. As for how the medics handled the attempted RSI, I wasn't there so I can't judge them. That being said, it sounds as if they failed to follow protocols and the assistance of a MD. I'm really not qualified to say, however I think I would have let him insert the tube in the Urgent care centre.

[n5iln]

The 2nd class I attended in Basic class, the instructor stated and I quote, " If it isn't documented, you didn't do it".

The corollary to that, of course, is "If it's written down, you'd better have done it!" Fudging a PCR is a really good way to get your gluteus in a sling.

End mildly humorous sidenote...

[JakeEMTP]

The corollary to that, of course, is "If it's written down, you'd better have done it!" Fudging a PCR is a really good way to get your gluteus in a sling.

End mildly humorous sidenote...

But of course, how forgetful of me :oops:

[PrissyEMT]

We've also had documentation driven into our heads over and over and over again... if it's not in the PCR, then it wasn't done. Simple as that. Like everyone else, I can't judge these guys, but from the outside looking in, I think the lack of documentation is gonna come back to kick 'em in the rear.

[DwayneEMTP]

What I find surprising is that after this patient had died, you would think they would have documented the bejeebers out of it to CYA, wouldn't you? I know it's not for me to say....but it seems like this case had a high probability to be scrutinized.

Dwayne

[Ridryder 911]

A couple of things...

Let's look at the statements : Pro actions of EMS -

1) Airway from HELL!!

2) One, you can not place an oral airway in "clenched jaws"

3) Why did the urgent care Doc not administer Epi prior to arrival of EMS ?

4) I doubt allowing to have the "urgent care Doc" assist, would had helped. If he failed to tx initial anaphylaxis, he probably was a dumb-ass & I would not allowed to "assist either"

5) This article was flawed to point out that since there was no IV .. etomidate, could had not been administered.

Cons of EMS actions:

1) Bad call document your butt off !!!!

2) Bad call document your butt off !!!

3) Bad call document your butt off!!!.. did I mention to document ?

4) Hmm ...30 minutes, okay time can get out of hand, but something should had been done faster

5) I assume the Versed was given nasal ?.. since there was no IV

6) You did not intubate the patient : You have 3 criteria:

A) EtC0[sub:042106d0db]2[/sub:042106d0db] capnography waveform *

Direct visualization of the ETI

C) Clinical findings of bi-lateral lungs sounds and no abdominal air movements

7) When all else fails ..

A) Resort to BLS with BVM & supplemental oxygen.. (if the patient does not have airway obstruction secondary to

anaphylaxis)

If possible intubation with blind intubation devices ( LMA, Combitube)

C) Surgical airway

8 ) Bad call document your butt off!!!

This call sounds like hell.. and yes, they did wrong ! No, I believe they were probably got an airway from hell... and I am sure it was a cluster as well. So, the main problem I see is not so much the treatment is the failure of the documentation. Their testimony and their paperwork demonstrated separate actions?.. Make your paperwork, at least sound like you had a call from hell.. and be sure to include the measures & actions you did to cover those problems.

This is why I have endorsed EtC0[sub:042106d0db]2[/sub:042106d0db] capnography. Colormetric is enough to get by.... but they are worthless for documentation purposes and unreliable if secretions and emesis have occurred. If you don't have a capnpgraphy wave form displaying EtCo[sub:042106d0db]2[/sub:042106d0db].. then you did NOT properly inutbate ! I don't care how much you chest rise & fall... etc.. There is no "false" waveform....Folks, without this Paramedics are not going to be allowed to intubate! They cannot go against waveforms!! This is our only proof of proper placement ! I would had rather pulled the tube and tell the Doc. could not get her tube than to have a tube in the belly...

QI/QA or even the shift supervisor, should had screened the paper work and asked for an "addendum" to cover their butts and the agencies. Should had caught the no documentation of Epi.. and explanation of delay at scene.

Glad this call was theirs not mine.. I have been on several like these.. and I still have nightmares.. they are not easy, and there is so much external factors that one do not include. Sorry this happened, and the medics payed the price as well as the service, medical control physician, the profession and the ultimate .... the patient.

Be safe.. and document your butt off !

R/R 911

[n5iln]

Hrm, the site must have been Slashdotted when I tried looking at it last night. But now that it's up, and I've read it...

RMMS orientation for Techs (read: anyone not hired to function as a Paramedic-in-charge; this includes Basics and Intermediates) spends a full day on documentation. I have to presume that paramedics get at least two days on documentation. And rightly so; the PCR may be seen by some as an evil of EMS, but it's most definitely a necessary evil. This call is going to cost an EMS service a crew, a bunch of money, and a serious PR hit, all because the crew didn't take the time to either completely document a bad call, or (hopefully this isn't the case) did document it fully, but didn't follow their protocols and then decided to try and talk their way out of it.

At the risk of sounding crass and obnoxious, I'm going to repeat what's already been said by several others. Two rules of EMS documentation: 1) If it ain't written down, it wasn't done. 2) If it IS written down, you better have done it! And don't think for a moment that nobody outside the crew will know if something was or wasn't done. Post-mortems reveal much.

I'll shut up now.