Qoute from The EMT Spot

"There is a patient out there who is on a collision course with your skills. They don't know you yet. You've never met them either. They have no idea that they are going to meet you in the future, but the day they do, they will test you." From The EMT Spot

Sunday, September 26, 2010

You want to do what?


The link above is a post by Mark Glencourse an English Paramedic who who has taken the patient refusal question to a whole new level. He is and he isn't advocating so much a change policy as he is advocating a change in mindset. Nobody wants to lose a patient and none of us wants a patient to die on us, (For the most part) but we all know that we are going to make mistakes and a patient may die as a result. We in EMS seem to have this mindset that we can never say no to a patient and it doesn't mater if the patient ends up being discharged before we get the paperwork done.
I am quoting Mark: "Now think what our job what look like if it was accepted that some patients may slip through the net. Not through negligence, but through a natural disease process that was not present at the time of the assessment by the paramedic."
In my opinion that kind of a change would be nothing more than an acknowledgement that sometimes we don't get it right. We can evaluate a patient and they may seem fine, but we may overlook something or there may have been no signs or symtoms of another issue that would happen a short time later. I am reminded of a patient that I transported that showed absolutely no signs or symtoms of a cardiac problem and was transported for a minor injury, they began having nausea and had a major MI while at the hospital. I could have let them sign a refusal and it would have been perfectly fine for me to have done so. That MI would have occurred in their own car or at home and who knows what the result could have been.
I guess what this really boild down to is, are we really willing to admit that we don't always get it right and we may mistakes if we say no to a patient and tell them that right now you don't need to go to the hospital by ambulance and you can be appropriately treated another way, such a an appointment with your regular doctor or transport some other way than a 911 (999) ambulance. This would be a major change for the EMS industry in the US and I am not sure it would or could be accomplished without quite a bit of grandstanding by outraged politicians who would claim racism or some other false charge to make the transition difficult. I honestly think we need to make that attitude change but it will be very difficult and there will be a few missteps along the way. By missteps I mean people getting fried by the media because some politician felt it was more important for them to get reelected than for them to tell the truth and admit that sometimes mistakes happen, and we need to realize that sometimes STUFF HAPPENS!
Isn't that why we are here? Because sometimes stuff happens and it really is nobodies fault?


  1. Great points Mark!

    Thanks for taking the time to put your perspective on my post.

    I always find that there are two completely different views when it comes to this sort of question. The UK/European view and the US View. Understandably, there is so much litigation and 'protective practice' in the States that this would indeed be an enormous challenge to bring in, but one which I think would make a huge difference to the resources available to the community as a whole.

  2. "post hoc ergo propter hoc" comes to mind.