Your Honor

There's an article in the paper this morning about a family suing an ambulance company because the ambulance allegedly got stuck in the mud while at the scene where a family member -- a previously healthy young man had collapsed while in training. The article also reports that the ambulance arrived within minutes of the collapse and the patient was still brought to the hospital within seven minutes.

I have no details of the case. But just reading it, you want to shout out "Shit Happens!"

I've gotten the ambulance stuck before -- not on purpose, and not really through carelessness. I've been stuck in a snowbank and my partner once got us stuck in mud -- both times we got out. When it came to the snowbank we got out with an assist from the patient who helped push us out. (He really wasn't that sick -- he just wanted a ride to get his prescription refilled.)

I have dropped patients. Again, not on purpose. Once it happened on ice. The wheels went up, the patient went down. Believe me I felt bad about it. I felt like an idiot.

Another time I did a call once at a nursing home where we found this big fat woman who wasn't feeling well. Her family wanted her transported, even though the staff felt she was fine. She is on one of these big double wide beds, so we push our stretcher over next to the bed, then instead of sliding her all the way over in one pull/push, we decide to go to the edge first. My partner is on the stretcher side, doing the pulling. I'm on the bed side doing the pushing. We go to the edge. I am now up kneeling on the bed, holding the sheet we're using to move her. Then it happens.

She appears to start to sink. I look up at my partner and he is very slowly moving away from me. Now she starts to sink not quite so slowly and I see now, she is falling between the bed and the stretcher, as the stretcher slides away from the bed and the hole between the two where the woman is now descending, is swallowing her up. I hold on to the sheet and quickly scramble across the bed, and do my best to control her fall. She still hits with an audible "Thud."

Oh, my God.

To hear the family and the patient go on.

Daughter: "I can't believe you dropped her."

Mother: "They dropped me, Oh Lord help me, they dropped me!"

Daughter: "I'm getting my lawyer. You dropped her. Right in front of my eyes. Right in front of my very eyes."

Mother: "Oh, put me back in bed. You ain't taking me nowhere now. You dropped me. You dropped me. Oh Lawd, have mercy!"

Daughter:"You dropped my mama. They dropped my mama!"

Me: "Sorry, sorry, sorry."

While continuing to apologize, I assessed her. I went and got the staff. Told them, what happened. Had a nursing supervisor come in and document it all, including on the W10, so the hospital could check her out for the fall as well. I documented it later on my run form. Told the hospital about it. I wrote an incident report. Etc. Etc.

The lady wasn't hurt and I heard no more about it, though who knows five years from now I may be called in to court, and find the lady wearing a neck brace, and instead of being in a double wide wheelchair, she is now in a triple wide one.

Mother: "That's him, your honor. He is the one who dropped me! I recognize that rascal anywhere!"

Daughter: "That's him. He's the one, who dropped my mama, my mama who suckled me with her own breast milk. He dropped her on the cold ground, heaven have mercy."

There are so many things that can go wrong on a call. I had no idea my partner stood on the stretcher railing whenever we moved a patient. At my height I am always on the ground, anchoring the stetcher, but I guess a lot of people stand on the rail. Things you don't know. We slide the lady a little too far over. Her weight pushed the unanchored stretcher away from the bed as she fell into the slight hole that turned into a giant opening in the earth.

***

Get a call while I am writing this. Check this out for things going wrong:

Lady with pulmonary fibrosis having severe difficulty breathing. I find her in the upstairs bedroom on home 02. Barely moving air. Heart rate in the 160's. The first responder is standing there. She's already on home 02 by cannula. I ask my crew to hook her up to the a nonrebreather.

Guess what?

Our tank is empty. We used it on the last call for about ten minutes at 2 lpm. I didn't check it. I never check it. I wrote the run form and put away my gear. My partner is supposed to put the stretcher back together and check the 02 and change the tank if it is low. Should I check on the crew? Yeah, I guess I need to. Maybe there was a leak. Maybe they didn't change it. I'm the medic. Its my responsibility and I'm the one who looks foolish.

Fortunately, the responder has a tank, and we use that.

One crew member sets up the stair chair. He's done it many times before. I've gone over it with him. He doesn't lock it. I point it out to him. You have to lock it. I make certain it holds. I get the woman on the chair, buckle her in. I say, I'm going to take the feet. I ask the first responder to take the top because he has some strength, which my crew members do not. I look for a crew member to carry the 02 and one to watch my back, but they have both disappeared.

The woman is having a really hard time breathing. I shout for my crew. They are outside. What they are doing, I don't know.

I have to enlist the woman's daughter to carry the 02 bottle behind the responder who grabs the head of the stretcher while I take the feet. I almost tumble coming down the stairs. I have no one on my back and this responder is not one who likes doing the medicals and is not really used to doing carrydowns. We make it outside where the crew is trying to figure out how to get the stretcher into the proper down position. They are having a terribly hard time working the stretcher. It seems on this call they have forgotten everything they know. (I can't say it hasn't happened to me before. My crew foregetting on me and yes, sometimes, me forgetting).

When we finally get her loaded on the stretcher, when the heavens open up and it pours rain on the poor patient and us. The ambulance has been turned off because we have a anti-terrorism policy that says you have to take the keys in the house with you and this ambulance doesn't not have the system installed that lets the car stay running without the keys. I always tell my partners to leave the keys in and the truck running, particuarly in the winter. Most of them do despite the policy. Today my partner is patting their pockets trying to find the keys that might be lost. No, here they are -- in the pocket all the time.

I look around for monitor. Not there. Where's the monitor, I shout.

Left in the house.

Where's my house bag?

Left in the rain.

Finally we get enroute lights and sirens and nothing I am doing for the woman is helping. She keeps saying help me -- I give her a breathing treatment, but that is about it. Her Sats are only about 80. Heart rate is 140. She is diaphoretic. She is breathing about 40 times a minute. Help me, she says again, give me something. I am tempted to say, I don't have anything I can give you until you stop breathing (or get worse), then I can tube you. I suppose I could try to nasally tube her, but I don't think she'll sit still for it.

She has crappy veins. I miss my first IV attempt. Then as I am getting it on the 2nd try, I see we are getting close enough to the hospital to patch in. They will need some notice, because I want them right there when I come in because I think she will need to be intubated. I have a partner start the patch, but the radio operator gives him a hard time because the driver didn't put us enroute. I am trying to draw bloods and talk to the hospital at the same time. For some reason I say "respiratory sarcadosis" instead of "pulmonary fibrosis."

When we pull the patient out of the ambulance, the blood pressure cuff catches on the wheel. I lean to pick it up, but my partner keeps pulling, and the patient's daughter has to grab the end of the stretcher before it careens around and spills her mother. I throw the blood pressure cuff into the back of the ambulance like I am throwing a brick at a window.

We get in the hospital, no one is looking at us. They are all on the phone or doing paperwork or talking to each other. The woman is still sucking. Finally (maybe only thirty second later, but frustration level is so high is seems long) they notice us and tell us the room.

We go in there, and I unhook the woman from my monitor and unhook the straps, and then we have to slide her over, but niether of my partners (due to strength issues) are able to effectively help, and I have to reach across and lift her by myself.

The staff comes in, helps change her and my partner switches the 02 to their plug as I give my report. The nurses are very nice, say they know the patient, but have never seen her this bad before.

A doctor comes in goes right to the patient, starts asking her questions. Then he looks at the nonrebreather, which doesn't look too inflated. What 02 level is she on? he asks. He then reaches over and cranks it up. The 02 whooshes out. I mean he has it on max -- way above 15. The woman's SAT is now 97, even though she is still struggling to breathe. "There you go," he says, "A little oxygen does it every time," he says, then walks out. Whether he says it or I merely imagine it, I think he says, "There was your problem."

I know this guy so I approach him later. "What was with the oxygen comment?" I ask.

"I've got to much on my mind right now," he says, dismissing me, "Must have just been my magic touch."

Normally things don't bother me, but I'm bothered now. I feel somehow belittled. And I'm frustrated about everything to do with the call, the clumsiness, the lack of help, my inability to help the patient, the doctor's cavalierness -- something I have not really seen in him before -- and most of all the awfull feeling of our response not being professional.

A nurse tells me later, my partner may not have turned the O2 up enough when she switched the connections in the hospital. I'm wondering why my SATs were so much lower than what they are getting. Could the difference between 15 liters and 25 liters make the difference? Or maybe my oximeter was giving me me too low readings?

I go back and look at the patient. She is satting at 97, but still huffing away, holding the mask tight to her face. Her respiratory rate is in the thirties, her heart rate is 138. I ask her if she is feeling better. She just stares at me, as if to say, "Do I look like I'm comfortable sucking on this oxygen mask?"

I don't want to sound like I am blaming my crew. They are nice people, and I am not without error or failing myself. This is a hard job to be infalliable in. And why should I assume my crew should know what they are doing when one is new and the other works infrequently. My crew is my responsibility. Instead of trying to teach them on the way back, I just ride silently. I need to teach them better, but feel without patience today.

Imagine if this was a worse call, if the patient had arrested. There are so many ways a call can go wrong, particuarly when you do not have an experienced crew who you work with on a regular basis. Most days I manage to handle it, not today.

"Your honor, their oxygen tank was empty."

Who do I sign the deed over to? Take my house, take my money, take my car, take my childhood baseball cards and my record collection.

I didn't mean to stuck in the mud, honest.

***

I guess lawyers are just starting to turn toward paramedics and ambulance companies. I have, at times, thought about going to law school. To go on in medicine I would have to take many years of prerequisites. Law school, its just three years of class, four if I go at night. As a paramedic lawyer I would be a hot commodity. But what would that entail, using my knowledge to show how some other medic screwed up. I could do that, but I could also illegally dump toxic waste for a couple hundred dollars a barrell.

Maybe I could represent paramedics and ambulance companies, using my knowledge to show shit does happen, and people do the best they can with what they have.

On the other hand, the EMS system could be a lot better than it is. Maybe people have a right to sue. I mean, who do you want coming to your house?

I guess there are always two sides. What you should expect and what the world delievers, and lawyers are there to argue each way.