30 July 2008
There is probably no worse feeling in the world than realizing you’ve made a medical mistake. The one that bothers me the most is failing to turn on the oxygen during a resuscitation; I feel slightly better knowing that the patient was a hospice patient and probably was going to die even with the O2 (and probably shouldn’t have even undergone the resuscitation–but that’s a whole different ball of wax).
However, unlike the rest of the medical world, there isn’t a whole lot of data on prehospital medical errors. That’s half the reason this study is interesting; the rest is because they didn’t try to use numbers, but instead captured descriptive data from interviews and focus groups. I’m just going to throw out some of the article’s quotes from study participants, and save my thoughts on the matter for another post.
- [Response and repercussions] “There will be none as he is a volunteer.”
- “Training is not the same all over.”
- “When you ask for an attending, you get an attitude.”
- “A good paramedic wouldn’t need to pull out a cheat sheet [reference card].”
- “Next time why don’t you call me to the scene to do your intubations for you?”–interview participant who refrained from rapid sequence intubation in a patient who was lethargic but could easily maintain an airway using basic measures, being chastised by peers for not paralyzing and intubating the patient.
- “Almost all of the negative events I can recall over a 30-year period in EMS have been in the ER.”
Filed under: EMS, EMS Research
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27 July 2008
While I’m sure that not everything on my site is spelled perfectly, I certainly don’t have anything major spelled wrong, do I?
Filed under: Sunday Silliness
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25 July 2008
It’s no secret that health care often isn’t as good in rural areas as it is in urban and suburban areas, and that’s probably doubly true of emergency care. You can point all the fingers you want, but it’s just a result of many small factors coming together rather than one large one. However, that doesn’t mean all of the finger-pointing going on is correct: according to one review, the latest group to look at stroke care in rural areas found that
inferior rural stroke care begins with the paramedics, who tend to be older and less educated than urban paramedics, and are often volunteers. “They have, in general, less training, less experience, and fewer learning opportunities to achieve the proficiency of their urban counterparts,” says the team.
While I agree that rural providers don’t get the patient volume or training opportunities of their subruban and urban counterparts, I can’t call EMS providers part of the problem with rural stroke care. Part of this is that there isn’t really anything you can do for a stroke in the field besides transport to a hospital. The other part is that despite the apparent reduced experience of rural medics, at least one study has shown their knowledge of stroke symptoms and risk factors to be just as good as non-rural medics (or, depending on how you look at the numbers, just as poor):
There were no significant differences between frontier and urban EMS respondents’ ability to correctly identify 4 or more stroke warning signs (58% vs 61%), 4 or more stroke risk factors (46% vs 43%), or the 3-hour recombinant tissue plasminogen activator (rt-PA) treatment window (56% vs 57%).
Someday, I’ll actually be able to get a copy of that article to find out how they came up with these numbers. It frightens me to think that a third of EMS providers couldn’t come up with 4 stroke symptoms or the t-PA window–maybe the methodology was poor.
Filed under: EMS
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13 July 2008
In America, self-defense means having a loaded handgun or shotgun readily available. In the UK, where handguns are much more strictly regulated (yet people don’t apparently feel more secure), you have to get a bit more creative.
Filed under: Sunday Silliness
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9 July 2008
I was talking to a few third-year students today, and they asked if I had any advice. The best I could come up with is something I still like hours later: Always Look Busy. Keep moving, or if you’re sitting still, make sure you’re caught reading or writing. This is the way to avoid being assigned unpleasant tasks that don’t actually help your education.
I guess in that sense, medical school is kind of like a union job.
Filed under: Medical School
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8 July 2008
As EMS types, it’s pretty easy to rail against system abusers: people who call 911 for buttock abscesses, medication refills, or rashes–none of which need an ambulance. In fact, to hear some people tell it, EMS responds to far more calls like that than calls which actually have a sick patient.
It’s always interesting to hear the other argument. Previous studies have shown that ambulance patients were sicker than (i.e. had twice the admission rate of) non-ambulance patients, and now a new study shows that the ED docs ultimately treating ambualnce patients agree with their ambulance use in two-thirds of cases.
Of course, that’s just one mixed system in a smallish town in PA (Bethlehem), so their experience probably isn’t representative of, say, a more urban area. However, I must admit that when I was working for a more urban ambulance service, I didn’t get the sheer volume of system abuse that I expected. Maybe I’m just lucky. 
Filed under: EMS Research
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7 July 2008
There’s no particular shame in not knowing something the patient doesn’t know–a social security number, for example, or the patient’s name if found unconscious. What’s interesting is how often the EMS record doesn’t match the hospital record: as much as 3 out of 4 times. If you take social security number out of the mix, this drops the error rate to a mere 25%.
Some of the 360 cases analyzed had errors that were fairly simple: misspellings, use of diminutives instead of full first names (e.g. Tom/Thomas). Some were a bit more serious: 219 missing social security numbers (given that the population was chest pain patients, there shouldn’t have been that many people who didn’t know their numbers), and 10 with illegible handwriting.
This last is the most serious, and is actually no longer a problem. (The study was performed in Pittsburgh, using tripsheets from 1996, and city EMS has since switched to computer documentation; this is an excellent illustration of how long it can take to get research through the pipeline.) However, it shouldn’t have been a problem in the first place, just as it should never have been allowed to become a problem among doctors.
Filed under: EMS Research
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6 July 2008
One of the earliest computers in the modern sense was never actually built–Charles Babbage’s Difference Engine. There were many reasons it never got built, but apparently an utter lack of Legos was one.
Filed under: Sunday Silliness
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4 July 2008
Just thought I’d return from vacation with a link to this timely column decrying restrictions on fireworks, which are safer than ever: over the last decade and a half, there have been between 8-10,000 injuries a year despite the ever increasing amounts of fireworks Americans are using. According to one source, there has actually been over a 90% decrease in injuries per pound of fireworks since our nation’s bicentennial. (For added humor, read some of the descriptions of the fatalities in the CPSC report, like the guys letting off bottle rockets in the dorm.)
So let freedom ring, and bang, and boom…just be careful doing so.
Filed under: Other random stuff
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1 July 2008
I’ve occasionally noticed people who don’t live in my apartment complex sitting in their cars. I’d always assumed they were meeting their dealer, but when I noticed one of the drivers today wearing scrubs and taking a long drag on a cigarette, it finally clicked: they were getting around the campus smoking ban. So by taking steps to “promote health” by disallowing smoking anywhere on campus, the university has managed to convince people to hop in their cars for a 30-second drive to a parking lot where they can smoke, thereby burning added gasoline. I guess it all comes down to their belief that the inconvenience will force people to quit, thereby making the added pollution a temporary thing.
Filed under: Random Humor
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