dr-exmedic.com

I’ve heard some version of virtually all of the quotes in this journal article, which is how they ended up in part 1.  Medical errors are difficult for everyone to talk about, particularly one’s own, but there are several reasons they are especially difficult to tease out of an EMS setting.

Some of it has to do with denial (“Almost all of the negative events I can recall over a 30-year period in EMS have been in the ER”).  However, few people have this level of denial about other people’s medical errors, so we can count this as a somewhat smaller factor.  Of course, it’s always possible that this person was simply such a horrible provider that he didn’t realize how many errors are going on around him.

This last may or may not be his fault:  “Training is not the same all over.”  I would agree with this statement  (although I won’t delve into the different levels of EMS provider across the country).  Just in one particular county, you can find a nationally-recognized program run by a local university that has a reputation for turning out really book-smart medics; the same county has a program run by the community college with a reputation for turning out people who can’t pass the National Registry exam.  The first program is run by degreed medics whose names you periodically see on research papers; the second is run by a person with an unflattering nickname who left his previous EMS management job under ambiguous circumstances.  There may be quality differences among nursing and medical schools, but you won’t find anyone teaching at nursing schools without Master’s degrees, or anyone teaching at medical schools without MDs or PhDs.

Despite the training, there is still a bit of an older, macho culture out there that believes everything a medic should need to know can be stored in a single brain (“A good paramedic wouldn’t need to pull out a cheat sheet [reference card]“).  Fortunately, I see less and less of this every year, particularly in pediatrics (Broselow tapes have been fairly flying off the shelves these last few years).  Perhaps enough medics have seen doctors refer to their PDAs or little pocket books–I know I refer to my PDA unabashedly.  Perhaps the amount of stuff that a paramedic is expected to know nowadays has finally humbled a few people.

Of course, there’s no sense in training someone if there’s no way to discipline him (“There will be [no repercussions] as he is a volunteer”).  While there may be services out there that provide remedial training to volunteer providers, or even punish them, I have yet to meet one.  Instead, I’ve seen services which allow their volunteers to run calls in street clothes (even when responding from the station during a scheduled shift), that don’t require their volunteers to meet the drug test and physical exam standards of paid employees, or that have not kicked out members for taking a vehicle out on a drunken, celebratory joyride that resulted in a crash.

Once we start recognizing errors, though, there’s no real culture within EMS that understands some of these problems as system problems (which have bigger impacts when fixed) rather than as individual screwups.  It’s easier to chastise someone for making a mistake–but if the real problem is that button X on the monitor is too easy to bump while reaching for button Y, how is yelling at one person going to save any patients?