It’s an EMT (or Paramedic) Card, Not a Hero Card

Recently, the Internet has “blown up” over the two firefighters who, instead of waiting for an ambulance, put a seizing infant in their engine company and transported to a local hospital.  Of course, I wasn’t there and as such, it’s virtually impossible to know everything about the call in question.  However, that’s never stopped the attorney (or medic) in me from applying the 20/20 hindsight spectacles.

First things first.  Pediatric calls scare all of us in EMS.  We rarely have either much training or experience in pediatrics.  Combine that with the all-too-natural instincts to panic when there’s a sick child and it’s a recipe for making some rash decisions.  Not necessarily a wrong decision, but a rash decision.  Most pediatric seizures resolve on their own and those that don’t require ALS medications.  Also, the cab of most fire trucks aren’t set up for patient transport and/or treatment.  Much like the National Registry exam, much of EMS (and medicine in general) is about choosing the “best” answer to your problem.  I can think of very few cases in which transporting a patient in the back of a fire apparatus is the best answer.  The legalities of using a vehicle not licensed for patient transport aside, it’s a potential legal quagmire in the event of a bad outcome.  The back cab of a fire truck is NOT set up to safely transport a patient, especially a child, much less provide working space (or even equipment access) for a medic to treat a patient.  For the overwhelming majority of medical patients, “scoop and run” or “load and go” went out with the Cadillac high-top ambulance.  We’re medical professionals.  We need to be taking care of business, making good decisions for our patients, not panicking, and then playing the “hero card” when we are held accountable for our decisions.

Of course, like anything in law or medicine, the more you know, the less absolute your answers become.  But that’s another topic for another post….

Comments

  1. James Orsino says:

    Why is it that folks who put on boots, bunker gear, and helmets and drive fire engines to medical calls are fire fighters right up to the point when something goes wrong…and then they are EMS providers?

    • theambulancechaser says:

      Because if you hold an EMS certification, you should be held to the standards of an EMS provider…

  2. ImJusSayin says:

    Dont judge till you’ve walked a mile in their shoes. A decision needed to be made and they made it.

    • theambulancechaser says:

      The reality is that, in medicine as with all fields, there are right and wrong answers. There are also shades of gray, but part of being a professional is making the best decision you can. Transporting an infant with a febrile seizure with BLS treatment in the back of a fire truck going with lights and sirens is definitely not the best choice.

      • I’ll bet if it was your child it would have been the right answer. You weren’t there, don’t try to say if they were right or wrong.

    • Nancy Magee says:

      The decision they made should not even have been a consideration. This case is understandable but not excusable . Well meaning is fine for bystanders not professional EMS providers which is the response expectation when 911 is called. The issue needs to be addressed that they were either not competent or confident- maybe both- to provide the appropriate care on scene until an ambulance arrived. If they are receiving accolades instead of remediation that will never get fixed.

    • I will judge, because they chose to put this out there on the national news, so we get to ask clinically relevant questions. I walk in their shoes everyday by the way. My first two calls the other day were pediatric seizures. Using your logic, you yourself don’t have enough information on whether it was the correct decision. Did they actually save the kids life by doing this, or was it inevitably going to be a good outcome regardless?

  3. Old Truckie says:

    You’re right. You weren’t there.

    • theambulancechaser says:

      Nope. But it’s a rare situation when a trained provider should be panicking and putting a patient in a vehicle not designed for patient transport. The goal of EMS is to handle a situation better than a bystander would…

  4. Greyisabigahade says:

    I have worked in both extremely rural towns, extremely busy cities. I have worked out in the boonies where als is not an option in the county and bls is the only way. The ambulance is 20+ mins after you have already done with patient assessment(no kidding, took 35 mins). It is a tough call to make, but give the benefit of the doubt. Unless they were grossley negligent I see no reason to look for the fualts that may have occured in decision making. They are TRAINED ems providers are they not? They are the front line to medical emergency before they end up in doctors care. There are so many questions that can be asked but being the devil’s advocate in this instance is in my opinion not needed. Policies may have been broken, so be it. You are just as accident prone in an ambulance being transported than a fire engine. The list can go on. I totally understand the importance to following policies and to give the best and safest care possible. It varies, where I work it is to follow the policies unless circumstances are beyond policy. At the end of the day, if I am in a shit situation and I don’t get the care I need becuase someone else said we have to wait for the ambulance. For goodness sake toss me in a back of a pickup and get me to the guy that’s going to fix me period. There’s honostly nothing EMT and paramedics can do on some calls except high flow diesel to the hospital.

    • theambulancechaser says:

      Wow. Lots of old school EMS dogma here….. the good ol’ BLS worship and “diesel bolus.” EMS is supposed to have advanced as a clinical profession.

  5. Scenario: You have been sent on an emergency call. You arrive to find a child not breathing and slowly turning blue. You are not an emt, but have rudimentary first aid training. This training teaches that this is a sign of lack of oxygen and can lead to death or brain damage if medical help is not given quick enough. Medical response will be slow, but there is a hospital fairly close. A decision must be made with no time for lengthy debate. Go or stay, quick help or slow. A child is dying.
    I know what my choice would be, At the time and even after 20/20 hindsight (which of course is always perfect).
    And when I reach the hospital and see the people rushing to help, I will be able to live with that decision.

    • theambulancechaser says:

      The difference is that public safety professionals can be and are held to a higher standard than a member of the general public. We are in a position of public trust and through our training and actions, we should prove ourselves worthy of that trust.

      • He did in the eyes of the public and to the parents of the child. The public assume that we will make the right decision at the right time at any cost. So waiting 7-9 min for the ambulance and delay ALS care (assuming the fire department was BLS non transport) or loading the child into the apparatus and driving 3 mins to a receiving facility for the proper ALS care of the child needed

  6. If they think they should have waited on the Ambulance then the Em’ts or medics should have given a ETA the captain asked twice and they didn’t give a clear ETA they just said they were En-route that was not enough information to go on so he made the decision to Transport. So maybe the Em’ts and Medics should be suspended also for not doing their job and giving a ETA. When a emergency is going on an ETA is important information that the Captain needed !

    • theambulancechaser says:

      I don’t necessarily disagree. There’s clearly some strong evidence for system failure. Personally, I think some remediation on pediatric emergencies and safe transport of a patient would be much more warranted than a suspension.

  7. If you are EMS and you need to get a patient to the closest hospital, you take whatever ride is available — ambulance, fire engine, chicken coop truck.

    • theambulancechaser says:

      If you are “EMS” as you put it, you have a professional obligation to do the right thing, which includes following reasonable laws and policies. Putting a patient in an vehicle not designed for patient transport is not the right thing as a medical professional. It’s barely even acceptable for a layperson anymore.

    • If you’re transporting in a fire truck because you panicked, you aren’t “EMS”. You’re a panic stricken dope no matter what the parents or uninformed public thinks. If the kid had died, no one would be calling these guys heroes.

  8. John Pignataro says:

    One of the major problem with the current Fire/EMS service is the ambulance (literally) chasers, lawyers who are not looking for justice but an extra dime. These firemen made a split second decision based on facts at hand thank god the lawyers will disect it and see what they did wrong with all the comforts of time and no pressure.

    • theambulancechaser says:

      And a bigger problem is lack of accountability when providers make bad decisions. Part of being an EMS professional is making good decisions in critical circumstances. Another part of EMS is continuous quality improvement…

  9. what the hell is wrong with you people???? a child was in possible trouble, you medics should be glad that the child was taken directly to the hospital , who knows how long you may have been to get there. Shame on you.

    • theambulancechaser says:

      I’ve said it before and I’ll say it again. When your work phone number is 911, it’s a reasonable expectation that you 1) don’t panic and 2) try to do a better job than a bystander.

  10. From the way I understand it, the child was cyanotic. Which indicates respiratory distress, and as we were all taught when treating children “respiratory respiratory respiratory” also having a 7-9min wait for the ambulance, or loading go to a 3 minutes to a receiving facility. Do I feel I’m a have made it different decision even as an EMT, no! There decision was based on the treatment of the patient. NOT THE HERO CARD. As it was so eloquently put. Always error on the side of the patient. I can understand being a stickler for the rules because I am myself, but sometimes decisions and situations don’t fit rules

    • theambulancechaser says:

      How well can you manage an airway in the back of a fire truck? If it’s respiratory, a BVM combined with BLS airway maneuvers should buy plenty of time until better trained and equipped providers can arrive. That’s erring (not error) on the side of the patient.

      • Thank you for the correction I’m typing this from a phone. Yes a bvm with proper BLS care would be sufficient. But according to the article on firefighter nation the estimated e.t.a was 10 to 15 minutes for the nearest medic, and according to the vcu neurologist stated ” timing is extremely important”

      • But I believe they did justify there actions without throwing up the hero card that was the public and the family. And you also have to know part of good leadership is making decisions and then being accountable for any of your actions after the fact. And he was prepared to be accountable for those actions. The public maybe up roar.

  11. Great post!
    All too often people hide behind the hero card to avoid accountability even when they may be able to justify their decisions. There are too many blanket reactions of “I am the hero and you just don’t understand” or “it is our culture”. A part of being a professional is having the ability to justify your actions without throwing the card out.

    • But I believe they did justify there actions without throwing up the hero card that was the public and the family. And you also have to know part of good leadership is making decisions and then being accountable for any of your actions after the fact. And he was prepared to be accountable for those actions. The public maybe up roar.

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