How did this flight paramedic kill his patient? Why are we okay with these deadly mistakes? (10)
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- เผยแพร่เมื่อ 3 ส.ค. 2022
- In this episode, I will tell the story of a flight crew who were called to transfer a patient from a small rural hospital to a larger tertiary care facility in a big metropolitan city. Something went wrong and the patient ended up dying during transport. Would it have happened anyway? Was there a deadly mistake committed by the flight crew? How might situational awareness have played a role in this story? All of this and more on this episode.....
What do YOU think? If you are a paramedic or flight nurse, have you ran a call like this? Have you made costly mistakes that led to the death of a patient? If you have a story to share, please email it to me at staff@thedoctormedic.com Be as detailed as possible but please leave names, locations, and agencies out of the story or just change them. Let's talk about these situations out in the open so we can ALL learn from what others have already done or been through. Keep it classy ;-)
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Good on you for owning your mistake and putting it out there for everyone to learn. I have been saying it for many years that we need a central reporting and information sharing mechanism in EMS, specifically, pre-hospital care to assist all of us in learning from our own mistakes and others. I have been a civilian Paramedic for 26 years and have been involved in emergency medicine pre hospital care since 1991. I have been a U.S. Armu Flight Medic since 2003. A simple look at the patients XRay would have been all that was needed to avoid this tragedy. The patients presentation in the ER combined with her stable V/S and mildly elevated troponin should have been cues to the care team that they were not dealing with a M.I. and to look at alternative diagnosis especially with a normal EKG. Slightly elevated troponin with normal EKG, normal cardiac enzymes except the troponin, yet pain in the chest non radiating, should have prompted the team for an echo and at the very least a look at the chest xray, which in my opinion should have been the first thing the team looked at after the cardiac enzymes came back normal. This was a classic case of "predisposition" to one diagnosis, a M.I. and this tunnel vision shaped the outcome and end result of this patient dying. I really would like to know how the patient presented to the ER, how her initial assessment went down in triage, what her social history is if any; smoking, drug use, etc, if she is a repeat in the ER, and what kind of insurance she had. This is a sad case and reminds those of us in EMS, especially, pre hospital care that the ER Doc is not the end all be all to patient care and that we ALL as a team must always make sure that the basics of treatment are met and monitored throughout the patients care. Peace and love to all my colleagues. Stay safe ✌🇺🇸🤙
As a retired physician and former paramedic I’ve learned that the initials behind your name is not a sign of intelligence, but it does prove perseverance
I am a retired Flight Medic with 30 years flying experience and 10 years of EMT and ground medic experience prior. I was taught many years ago to do a differential BP and a >10-15mmHg drop in the opposite arm suggested a dissection in the chest area. I'm not saying if this was done the arrest would have been prevented but I have a great story that documents as to why this should always be assessed with CP patients. Wonderful channel and keep it up, it’s greatly needed.
Yes! Several years later I ran into a similar situation where exactly what you are saying occurred. Massive different BPs in both arms and very erratic BPs as well. What you were taught is exactly what I now teach. Thanks for watching!
@@TheDrMedic Non EMT here but systolic , diastolic, or both? Thanks. ….retired Biomedical Equipment Tech.
Pilot and critical care paramedic here. I cannot agree more! After 31 years in EMS I am so saddened by watching errors occur, and then be covered up without giving others a chance to learn to prevent future harm and death. I tried to implement Just Culture and it went nowhere. Tried to implement TEAMSTEPPS and it went no where, yet we recently had a medic administer 1 mg of Breathine for a COPD patient and was told to just change their PCR. No remedial training. I am willing to do whatever I can to assist!
@douglastisdale1582
what is the problem of giving 1 mg of Breathine for a COPD patient?
@@gavnonadoroge3092 the dose is 0.25 mg for COPD.
Retired RN here. I so appreciate your openness. It feels terrible for years after making a medical error. I have children in medicine so thankfully we can discuss these things and keep learning. I know this video will help many people. Thank you!
Ultimately, this is on the referring physician. Ordered a deadly medication without properly waiting for the radiology read. Like giving TPA to a brain bleed without getting a head CT result prior - should never happen.
Keeping patients and medical personnel names confidential is very professional. Taking ownership personally is by far the most noble and unselfish action I have EVER witnessed!
You sir, are an honour and we are all touched by your compassion and dedication to your patients, colleagues and us, your viewers!
Saying Thank you can hardly say enough!💕🇨🇦
I still don't understand why they gave thrombolytic to a non-STEMI patient. And the doc that sent the patient is the one who effed up-they gave the first dose at the hospital. I'm a former paramedic/current PA in a rural critical access hospital. If I send a patient to the "big house" it's my job to interpret studies before transport. A couple things that could keep this from happening: portable x-ray machines with instant display screen (kind of a new thing, within the past 5 years in my facility), expectation of stat (within hour) x-ray reads by radiology, and most importantly judicious deployment of point of care US. Tells you so much.
Way to own up to the mistake (even though it wasn't really your fault in my opinion. Sucks when mistakes happen. Impossible to avoid in this business.
Also, TAAs are not easy to diagnose! When I first started as a PA I had a lady come in-40 something, short of breath, hypotensive. D dimer was off the charts. CXR didn't show much-not a huge, wide mediastinum. So I sent her for a CTA chest, thinking PE. She had a TAA.
Thanks for sharing the story!
I had a granddad who had a intestinal infarction and it was diagnosed way too late. I wanted to fill a complaint, not to blame anyone but to learn from it but my family didn't want to. It's astonishing how many times these kind of (fatal) failures are passing by unnoticed and thus stay hidden. It might have been different if my granddad was in his 40 or so to take him more seriously. He suffered more than a day excruciating pain in his tummy (which was very unusual for him). An uncle took him into A&E but he wasn't taken seriously. They let him suffer and dying because his intestines were litterally dying. They performed emergency surgery way too late (they brought him in and he was put in a general department while he needed to go to an operating theathre and intensive care.
So I wanted to fill a compaint to make them find out what went wrong in order to avoid the same mistake to be happening again. Yet it's some kind of taboo or so. Docters are threated as gods while they are only human. And humans make mistakes. I could live with that but not with the fact it can happen over and over again.
This is a Belgian story and I'm not native English, sorry for that.
I just want to support your idea 1.000.000% to learn from mistakes instead of hiding them "nothing happened". What makes it so different compaired to aviation? The ego of people?
Damn. I've seen an aortic dissection on an x-ray once. As a co-op student (and after), I spent 6mo working in the x-ray dept when I was 15-16. We had a 'visiting' radiologist daily, so 10 - 12 in total, and I'd always look at the scans we've taken on the way over to their office down the hall. Mainly to see if they were good/if we'd need to do another, but also because it looked 'cool' to walk and read the scans like you see on TV! Because I was a student, but NOT out of high school, the radiologists were cool with me telling them my guess (most were obvious), and then they'd read the scan and make their notes for the treating physician. Needless to say, I kinda got some cool 'training' that I'd never use. With one Radiologist, I'd say what I thought when I walked in, she'd put up the film, and send off/call the notes. When I said aortic dissection, she stopped me, looked over the film, asked me what I saw. It was barely visible, but there. I pointed it out and she kinda had this 'holy shit' moment, that I had seen something that wasn't all that visible. Funny thing is, it's the way my grandfather taught me to hunt...get drawn in to the thing that DOESN'T belong... I'd seen enough scans of good hearts to know when something was off...
The physicians' order killed the patient.
Hi, I’m a former EMT and current ICU RN; my experience is all Level I Trauma Centers. While I agree that it would have been good practice for the Flight RN or Medic to have asked to review the XRay. I really question the practice of giving tPA at all under the symptoms you describe. I know that none of the teams I have worked with would have done this under the circumstances. tPA has too many potential problems it can cause to give it unless there is a known clot that has been identified and there are no contraindications (which has been carefully checked). For a patient whose only symptom is a minor Trop elevation, this seems a little crazy. I know as an ICU RN, I would have questioned the tPA administration if it were ordered in this case. I really feel this one should be set at the feet of the doctor and that hospital’s protocol. Second, I’d look to the patient’s RN in that facility. If the the flight crew had caught this, I’d really commend them, but…
Excellent points, @Eric
Totally concur with your assessment. As soon as tPA was mentioned, I skipped back 20 seconds to listen again.... clearly I must have missed the indication for such a high risk intervention?
I agree that the RN who administered the initial dose would have been the ideal candidate to question this medication. The fact that they didn't question it makes me wonder if tPA was being routinely overused at the facility.
I couldn't agree more, as a critical care nurse, the nurse should've said hey why are we giving tpa? There's no st elevation on EKG,tpa isn't indicated for minor trop elevation. Without evidence of stemi, minor elevation of trop have multiple differentials.
I am aware of a person who was a Hearing instrument Specialist for 10 years before moving careers, its not direct medical but it is in the Heath-care scope under HIPAA. Anyway, the practitioner worked with an individual who was a 20+ year veteran who one day forgot to do an otoscopic exam before making an ear impression for custom fit hearing aids. Long and short of it is a patient who had significant deformation of the auditory canal which was not noticed and so the quickly setting impression material had to be surgically removed….not good. A simple lapse in judgement caused a traumatic event for the patient and the practitioner.
I had surgery, BEFORE I WAS PUT UNDER, I was asked by the Surgical Team, and the Anesthesiologist, "What are you here for today?" In very Specific Terms.
I also saw a very experienced RN who programmed a heparin gtt wrong. She entered the concentration as 2500 units/500ml instead of 25,000. There was no double check and the error was only discovered after the bag ran dry after 2 hours instead of 20 hours. The pt was having a massive MI and was in cardiogenic shock, but began bleeding from the eyes, nose and mouth. The pt was DNR and eventually died but the bleeding should not have occurred. Witnessing that mistake has caused me to be more careful and to actually do the double check that is required with all high-alert medications.
I've only been a subscriber for a short time. I'm not in the medical field myself, but I've always been intrigued by it. After watching this video, my respect for you putting that out there with no excuses and talking so passionately about keeping it from happening again is immense. This world would be a lot better if we had more people like you. You've proved to me there are still good people out there. Thank you so much!
Appreciate the kind words. Thanks for watching 🤙🤙🤙🤙
Knowing a mistake you made caused the death of a patient is a horrible feeling. in 25 years of Nursing I have made mistakes and have seen a mistake that killed a pt. My mistake: I had a pt who was having an acute stroke and we were going to give TPA (the same drug as yours). I was tasked with mixing and administering the drug. Back then, it came as a 50mg dose, a powder that you had to dilute with 50ml of sterile water. We did not have 60ml syringes and as a result, I used a 20ml syringe to mix it. I was interrupted while mixing and forgot to draw up the additional 30 ml's and there was additional staff at the bedside that were rushing me, "come on, time is brain". I started to give the bolus dose and my co-worker picked up the vial and said "why do you have deluent (sp?) left? I then realized I had more than double dosed a pt with TPA. I felt the blood drop out of my body from my head to my toes and felt nauseated. We had to do quick calculations and changed the amount of the 2nd infusion and the pt did fine and waved goodby to us as he was taken upstairs to the ICU (that arm was previously flacid). I did get written up as I failed to follow the 2-RN check procedure, but no further discliplinary action was take.
Th and for sharing, @Steven
Just found this video and your site. Semi retired paramedic from Tennessee. I'm currently working as a lab instructor for a ems program at a community college in Tennessee. Sharing the video for my student! Great learning tool. Keep up the good work!
I'm a firm believer that mistakes like this are a systemic issue. If humans are relied upon to get things right 100% of the time then situations like this are bound to occur.
Something similar happened to me early in my EMS career. I had just finished EMT school and was working as a tech in my local ED. We had a patient that was in a "non-traumatic rollover MVA" (those are the words of the medic that brought him to our non-trauma hospital). He came in alert and oriented, with stable vitals and no remarkable pain. Blood tests and X-ray were unremarkable. His family came in to see him and he was discharged. After picking his young child up and placing them in the car he collapsed and went into cardiac arrest. Turns out he had a weakened area in his aorta that burst when his heart rate and BP rose. He was pronounced after over an hour of CPR and emergency transport to a trauma center. There's little we could have done at our level of care that would have saved him, but it's still something I think about often. One of the defining moments in my career. He met trauma criteria and shouldn't have been at our hospital in the first place. My 10 years in EMS have taught me to always verify for your own peace of mind.
Anyway, thanks for posting this. I'm sure it took a lot to be so vulnerable in such a public space, but we should all learn from each other. A rising tide raises all ships.
Most patients with Aortic Dissection do NOT have Widened Mediastinum on chest x-ray. Diagnosis for Aortic Dissection is by CT Angiogram.
The way I see it, the doctor made the call on the medications and the paramedics didn't see any reason to challenge that decision. But taking another cue from aviation, maybe some crew resource management such as asking, "Do we have any contraindications?" maybe could have helped. All a crew can do, is work with the information they have on-hand at that time.
I agree. Reading x rays is not a paramedic level skill
Hi Russell - In this case, reading x-rays is well within the scope of practice of a paramedic. Many things can be within the scope of practice for paramedics that are not listed in any state department of health documents. National scope of practice for ground paramedics (ambulances) is generally set by NHTSA and can be found here www.ems.gov/pdf/National_EMS_Scope_of_Practice_Model_2019.pdf
But - states can go above and beyond this scope and, more commonly, local agencies and medical directors can go even farther than that as long as there is medical director approval and proper education and training.
In this case, we are referring to flight paramedics which are billed as special care transport which requires “education above and beyond that of an entry-level paramedic.” Accredited flight agencies require (but not back in 2009) their paramedics to gain national Flight Paramedic Certification, or FP-C. This FP-C does include the requirement for flight paramedics to have the ability to read and interpret some radiographs, one of which would be a widened mediastinum on a chest x-ray. www.ibscertifications.org/resource/pdf/IBSC-FP-C%20Candidate%20Handbook.pd
@@ramb1914 This is wrong. A Paramedic is trained and fully capable to view and interpret Xrays.
@@TheDrMedic Apparently the xray wasn't available at the time of transport? which makes all of that irrelevant
wow thankyou for sharing and what a great idea for simulations in the emergency medicine field. thankyou for telling your own personel event its a tough one but hopefully its used as a great training tool
It takes MORE bravery to be vulnerable enough to admit your mistake than it does to hide it… I appreciate your openness to admitting your mistakes and would just like to say thank you for your honesty and I’m sorry for the loss of ANY patients! 💚
😱🥺😥
As the words were coming out of your mouth! I realized it was you. 😢
Thank you so much for sharing. I am so glad you have been able to heal! 💗
I could only imagine the toll that would take on a person. I truly will not forget this. Thank you for educating EVERYONE.
I am not in a Healthcare field, and yet I truly believe this is a valuable lesson for all.
In the Air Force we were taught trust but verify. I follow it to this day
Very great and humble of you to put that out there.I hope your still flying as a flight medic. I do have a story when I was going through clinical’s for my NRP.
Dude, sooo commendable that you would tell this story so honestly and excuse free. Its so refreshing to see both personal accountability, and the desire to not let your mistake happen to anyone else. Much respect and thank you
Thank you, sir. And much appreciation for watching!
@@TheDrMedic i love this channel!!
was it his own error??
Very interesting to watch your content, it's always cool to learn from a true professional. You are always careful to not be judgemental, relying on the facts and not emotion. That's kind of rare, but very refreshing.
Amazing story. Massive props for your courage. Thank you. And you're absolutely right.
I appreciate that!
I'm glad you shared your experience and I'm glad you also shared that it was you. I imagine you put yourself through a hell for a while after that. But if it kick-started you to look at things the way you do now, then it has produced a positive side effect. I worked in healthcare for many years mainly as an ED/ER Tech, and i found myself questioning the ethics of so many policies (patient and employee policies) and was very unhappy with the cutthroat nature of most of my colleagues that I decided to get out and go back to college to finish my degree. I loved my job, but I am much happier as an IT professional, and I get to show of my knowledge and expertise much more now because computers was always my thing. But really there's no better high than saving a life and I really miss being in those intense situations doing CPR and helping with defib, hoping to see a patient cheat death. But i see a lot of things that made me lose sleep, I think the worst mistake I myself made was poking around for a vein too many times in my early days to get blood samples. Then I found out that I had been trained to do things that I really wasn't allowed to do even with extra training, when I refused and remarked that myself and the hospital could get in major trouble they made my life hell. They new it wouldn't look good to fire me, so over a long period of time they wore me down till I had had enough and I walked out that morning and never went back. People were practicing out of thier scopes left and right, and when I reported all this nothing happened to them. If I had to go to that hospital today, their is a list of people that I have that should not be allowed to treat me or interact with me.
So as you can imagine, seeing someone admit a serious mistake and then try to make it right with education for the entire industry makes me very happy. Keep it up.
These are great stories. Keep doing great things. Thank you.
Thank you! Will do!
How old was that young lady? It is rare to see a aortic dissection in young people.
This is a good example of why ultrasound should be point of care ...
Ultrasound could reveal in real time this issue...
Very true that point-of-care ultrasound would have been useful to identify the presence of a pulse!
@@TheDrMedic and more .... Could have the ability to detect the disection and could easily image the IVC for fluid loss.
That's what basic pocus can do and is easily recognized by properly trained paramedics who understand and know POCUS...
I’ve been with AE for 9 years. We started requiring a Med cross check about 6 years or so ago. Also-I ALWAYS look at rads and labs prior to leaving the sending facility.
I have no doubt that a proper medication cross-check would have prevented this mediation error.
Reminds me of the loss of John Ritter who was dissecting his aorta while the ER at St John's in Santa Monica was treating him for a MI.
"In aviation, nuclear engineering, even oil drilling the sharing of information is extremely important"... we NEED to get this (and CRM) into healthcare! The culture of coverup is too entrenched and has taken too many lives. Ethics demands we share our mistakes so that others may not repeat them. Doesn't HIPAA have an escape clause for "quality control" and/or "education"? Or did the lizards that rule us get rid of that?
Based on the information you presented, there was no indication to give thrombolytic in the first place. First error occurred on the part of the initial hospital physician.
I wonder if they gave thrombolytics based on a possible PE?
For clarification, Retavase is indicated in suspected acute myocardial infarction. While the patient's EKG did not show ST-elevation, or a STEMI, she had elevated cardiac enzymes and the sending physician believed, based on her presentation, that she was having what we call a "non-STEMI, STEMI." In other words, he believed she was having a heart attack but that it was not showing up on her EKG. In this case, since he believed she was having a heart attack, and she was still to endure a 90 minute transport time to the the cath lab, he felt that Retavase was indicated. Many thrombolytics are given for acute ischemic strokes but Retavase is specifically given to patients with a suspected heart attack.
@@TheDrMedic It takes 3-4 hours for cardiac specific troponin to elevate post infarction. Giving someone a thrombolytic agent based ONLY on a slight elevation of troponin with no significant electrocardiographic findings and without a negative chest CT to rule out dissection shows a serious lack of understanding. She should have been given aspirin, heparinized, and shipped.
Oh, I agree 100%. Was just giving some background on why the physician justified (probably incorrectly) to give it.
@@TheDrMedic I guess my point is that the medics onboard the airship were like lambs led to the slaughter when they were given orders to give the second dose. I hope they didn't suffer too severe of consequences for this.
Holy crap dude. That was an amazing admission.
I'm an anaesthetist and a pilot. My second job is in patient safety. Therefore I'm very interested in your channel and I think you do great work. In this particular case I think you are being a bit harsh on yourself. The patient probably would have died without you giving the second dose. The problem started with the ED physician started the cascade due to anchoring and bias. Instead of considering other diagnosis (and there were signs and symptoms of a dissection). He/she got fixated on an AMI as it is way more common than a dissection. Keep up the good work.
Thanks for the feedback @M_MTsc Always a learning opportunity,,,J
You’re absolutely right about the plane crash analogy.
I’m a Paramedic in UK although a manager now.
Oh surprise ending!
This is an outstanding teaching video so I really appreciate you sharing it! Just out of curiosity I noticed it 16 minutes and 45 seconds you had footage from a Cath Lab from Mary Greeley. I’m actually from Ames and have hundreds of volunteer EMS hours at that hospital. Did you work there at one point? Again this is a fabulous video that I will be sharing with others. Thank you again!
It took incredible courage, and a good heart to make this. I like and subscribe, however if there is anything I can do to help you reach a wider audience, let us know.
Hi David! Thanks for the kind words and much appreciation for taking the time to watch!
Medicine is like that, snap... and shit just hit the fan..😂
The reference to southwest airlines procedures takes you to another level .
Overdo, overreact, overdiagnosis...
Sometimes its better not to touch a patient...wile it's stable
One detail I must’ve missed in the video - was this a medic/medic flight crew, or a medic/nurse crew? If I understood correctly the second person on the crew in this instance - more than likely a nurse - was in a position to better observe the patient sooner than the odor detection process that actually happened.
In this case, the paramedic was seated behind the patient and the nurse was seated to the paramedic’s right. They both had a pretty good view and both basically simultaneously detected her change in status within a few seconds. The patient went from awake and alert to posturing with a loss of bowel control in a matter of maybe 30 seconds.
You’re a good dude
surely, a contributing factor is the lack of hospital facilities in that rural town/village...
I mean, they might not even have had the experience to catch this... but, they did not have the tools... dead-reckoning is something you might do when sailing, it is not something you ever should need to do at a hospital.
Aortic dissection UFDA. Had encountered classic presentation of patient with HX of HTN and as he put it ...... "Tearing sensation across the shoulder blades" Sure enough there was systolic bp differences....., pain was unrelieved by NTG and Oz. MSO4 did touch the pain.... Beat feet to the ER!
Is diagnostic interpretation of x-rays within the scope of practice of paramedics? I don't see that in the state Department of Health scope of practice documents.
Hi @kevin rose. That’s a great question. Many things can be within the scope of practice for paramedics that are not listed in any state department of health documents. National scope of practice for ground paramedics (ambulances) is generally set by NHTSA and can be found here www.ems.gov/pdf/National_EMS_Scope_of_Practice_Model_2019.pdf
But - states can go above and beyond this scope and, more commonly, local agencies and medical directors can go even farther than that as long as there is medical director approval and proper education and training.
In this case, we are referring to flight paramedics which are billed as special care transport which requires “education above and beyond that of an entry-level paramedic.” Accredited flight agencies require (but not back in 2009) their paramedics to gain national Flight Paramedic Certification, or FP-C. This FP-C does include the requirement for flight paramedics to have the ability to read and interpret some radiographs, one of which would be a widened mediastinum on a chest x-ray. www.ibscertifications.org/resource/pdf/IBSC-FP-C%20Candidate%20Handbook.pdf
I have seen so many gross medical errors, in large accreditted hospitals, over the years that I've taken to using the term "alleged doctors".
It is not unique to flight medics. The entire medical care/provider industry simply doesn't give a damn, most of the time. And I make sure to thank the ones who HAVE gone the extra mile and shown that there still are some professionals out there.
Down with you on the situational awareness issue - if you can only determine that your patient has had a critical change when they poop their pants, you are significantly behind the scenario.
And troponine is not always shows MI..or can rise only after a time...
In this video you question why the medical evac system isn't under as much scrutiny as the airline business whenever an incident occurs. I live directly under the flight path that the local chopper takes to land at our hospital. [Quick sidebar here.... it's an extremely comforting sound hearing that chopper overhead and to feel the thumping in the ground that the power behind those blades indicates]. I agree that it doesn't make sense for the evac industry to ignore opportunities for learning & avoiding accidental repeats as the aviation industry does. It's genuinely bizarre. But I have a theory.
Not to belittle the strength of airline training but if you remove them from the equation, evac helicopter staff would easily take over the 'most trusted vocation' (next to pharmacists & doctors). I can't speak as a member of the evac community but as far as public opinion goes, I suspect we tend to believe that evac staff are just so highly trained they're nearly incapable of making mistakes. That's a belief that induces a state of trust that I think most of us simply see no reason to question.
Also, I think that if the public were made aware of evac accidents as much as airline accident reports, it could cause a backlash in the trust that they currently receive. Imagine how horrible it would be if EVAC staff were under the same over-scrutiny that police forces are currently experiencing..?
Hi @al Jensen. You make some great points. Even if you remove the “flight” portion from flight paramedic, the paramedic profession is typically regarded (as you say) as one of the most trusted and prestigious professions in the world, at least by the public. www.ncbi.nlm.nih.gov/pmc/articles/PMC7915597/
Airline pilots also hold this prestige. Airline pilots used to be like rockstars remember? They were almost looked at as celebrities and had groupies and everything! 😀.
To your last point - maybe paramedics SHOULD be held to more scrutiny - maybe not as crazy as what is happening with law enforcement - but just like the public won’t accept fatal law enforcement mistakes or fatal pilot errors, maybe they shouldn’t accept fatal paramedic errors either? Thanks for you comment and for watching. 🤙
Guarantee the patients family still got a bill
A paramedic killed my friend’s son.
And why should you have to do injection on a flight?????😮
Without any supervision???
So the physician that ordered it to be given is not held accountable? Just because your from a rural facility doesn't mean you have an excuse to be negligent as the higher level of provider. Flight crews are not radiologists and that would be hard to diagnose before transport. Obviously if it was a clot and the medic withheld the medication and the patient died he would also be crucified. The FP C and CFRN does not give you the ability to interpret radiology imaging fyi....
got an email? I can tell you 5 stories in my 28 years of being a medic that will make you worry about going to a rural hospital that uses contract physicians to cover shifts and they are almost always recent grads trying to pay off their school loans and 5 times I said OMG. Plus 1 that I would only discuss probably on the phone because I wouldn't want anything out there with my name attached to it because it was a complete disaster. Just a clip "4 am, bring in a pt with an asthma attack, gave a breathing treatment enroute to er and patient feeling better by arrival, move pt to bed, go to lounge to do my paperwork, doc comes in, sleepy, but worse, he is a diabetic and he BS is low, from the lounge I hear several nurses scream, run into the room, and from there it is like a bad dream"
'generally speaking flight paramedics have more training than ground paramedics' i think i am paraphrasing properly here..
I wonder why that is?
It seems to me that they are essentially the same job in the sense of,get the patient from A to B,giving medical care along the way..
Obviously i would imagine there would be the specifics of performing that care in a different setting but the care is the same,no?
There is one potential factor that just occurred to me..
In a helicopter,it could be argued that you are more 'on your own' potentially than in the back of an ambulance therefore the enhanced training..
Was this in Florida?
No he said Kansas or Nebraska
I mean I’m not a doctor so I can’t be sure but would it not have been to late after the first dose was administered so why then would the blame fall on you
Regarding the X-ray in question was the hospital usually quick with the X-ray results I mean we’re they usually ready and presented to you and the other crew members if not did you have to chase them up
Yes a critical mistake was made but I wouldn’t say any one person was to blame from what I heard there were several contributing factors that led to the error
I find it very difficult to believe a paramedic and a nurse don't know what a widening mediastinum was. I know in situations like this the Dr. who made the error likes to blame the flight team for the unfortunate dosage given to the patient. Did they have contact with their medical control throughout this flight? I think he/she would have been a little suspicious about administering Retavase. I sincerely hope everyone learned from this event.
Maybe they didn’t see the films; some rural places outsource them.. maybe they weren’t back yet? I worked ems and never saw films.
You don't always need x-rays to know your patient had a widening mediastinum. You look for JVD, increasing SOB etc.. It doesn't look good for them when this type of injury occurs long with multiple sign's and symptoms. @@bravo795mp
Why would the pt be given retavase when they only had a mild elevation of troponin. The pt had no ST elevation indicating a AMI the doctor dropped the ball on this patient.
If I recall correctly I believe the physician was thinking this was a non-STEMI AMI.
OMG, Mi is simply diagnosed with ekg ... facepalm....
What are your goals for this channel?
Was ultrasound performed by anyone !
TPA is fifty fifty game
That’s a very bad headline!
The fatal mistake was made by the ed doctor!
There’s a good chance she would have died anyway my dude that sucks tho
For REAL dude?! You set it up throwing the Fight Medic under the bus for over half the video, then say it was the fault of the original ER Dr (and maybe the slow-reading Radiologist). You say you used to fly and you'd do your brethren wrong like this? The original hospital gave the first dose! Why blame lower licensures for the mistakes of higher licensures?! Ok maybe the Flight Team should have caught it but the DOCTOR for SURE should have!
The cause of this failure was the incorrect assessment and treatment of the patient by the original ER doctor, and the failure of the Emergency Transport Organization to educate their staff to industry standards. There. Fixed it!
Too many follow the rule: if you didn’t write it down, it didn’t happen. If you do write it down, that’s how it happened.
Too many accept the “churn and burn” mentality and take shortcuts.
I was suspended at the onset of Covid for decontaminating the ambulance (March 2020, my first shift back after almost dying from….Covid).
I guess I’m just ranting. There is so much ego and complacency (guilty). Too much protein powder and contempt towards patients. Too many medics that think they are physicians free to continue the malpractice already in progress.
It took almost 20 years as a paramedic until I ended up as the patient, and I was FINALLY SEEING THINGS FROM THE OTHER SIDE.
We are all people trying to make the best of a short life.
I worked in a high volume, rural Texas county, and I will have regrets for the rest of my life at things I said, or when a supervisor, allowed others to say. Too often just taking the word of other first responders over what a patient is telling me, allowing police and fire to often sway my assessment.
It nauseates me when I come across that frat house/brotherhood mentality that clouds so much in EMS.
Having “you’re six” just because of a title or uniform. Soooo much wrong with EMS, and other public servants.
But watching this video gives me a glimmer of hope that things will change for the better. Thank you.
You said repeatedly that the paramedic killed the patient. The ER physician killed the patient. The idea that the flight nurse or paramedic would, could or should doubt the credibility of the doctor isn't reasonable. Even though the doctor was ultimately very wrong, he wasn't contradicted at the time by anyone on the care team and the first dose was administered at the hospital. Worse than the initial mistake, the doctor was derelict for failing to track the radiology results, discover possible dissection and contact the air ambulance to order them to not administer the second dose.
So the Paramedic didn’t actually kill the patient? An undiagnosed AAA did?
She probably would have lived if she didn’t get the first or second dose of the tpa. The paramedic did her in though.
Paramedic didn't kill the patient. I understand that the title may be just to generate interest for the video and not supposed to be accurate as to what happened.
You’re still pretty young, but once you’ve gotten a few miles on you you’ll understand that what you’re proposing is NOT the best teaching tool. We learn from our mistakes and we move on.
He's advocating to learn from mistakes - ones own and others.
This is how effectice risk management works...how many aviation examples does he need to give to prove you wrong ?
Science itself progress from testing and failing - in effect learning from failures.
Except what he’s advocating for is already done in many Industries such as engineering
I'm curious why your title says "Did the paramedic kill the patient" You mean the Doctor right? The Doctor gave the orders for treatment. And unless something changed in the last 3 years since I retired, we never read xrays. So what if the medic withheld the drug bc he didn't know if the patient had an aneurysm but was actually having a MI and the patient died because he withheld the drug after being doctors orders to give it? That medic would be finished. This is the doctors fault 100%. He should have contacted the crew as soon as the report came back and told them to withhold the drug. This is squarely on the doctor and not the medic.
Why u keep smirking and laughing when talking about people dying
I've found your presentations on flight safety informative. However, I find your analysis of this event steeped in outcome bias and devoid of the organizational, operational, and system factors that might have contributed to the actions of the flight medical crew. You assault the lack of interest in systematic analysis of adverse events in healthcare hen pollute the environment with unsystematic analysis driving impassioned calls to change the system.
OK, so your TITLE is MISLEADING… OR you’re changing the story…. In the very beginning you said, “THE PHYSICIAN Prescribed & DIRECTED anticoagulant administration” NOT the Flight Medic…!
Are you actually a Board Licensed MD? Curious about the “DR” in your youtube channel name…
He probably has a PHD
@@danielrohde1595 True, just that doctor and medic used together sounds like a medical doctor.