DC Fire & EMS sucks me back in.

2 DC firefighters under investigation for failing to recognize patient was shot

WASHINGTON – The D.C. fire department is investigating two of its firefighters after they failed to notice a patient they were caring for had a serious gunshot wound.

The initial assessment was that the man was just high on PCP.

I’d love to know how they made that assessment.

“When we come on the scene as EMTs and paramedics, we are then the highest level of care,” said Aretha Lyles, president of American Federation of Government Employees Local 3721, the union that represents paramedics and EMTs. “MPD is not the highest level of care. We should not be following what MPD tells us. We need to do a physical assessment – meaning we need to touch the patient, we need to speak to the patient, the patient needs to speak back to us.”

This is absolutely true. What I don’t understand is why the union president is saying this to the press. It’s not going to help the paramedics case.

According to the police report, that man was taken to George Washington University Hospital by Ambulance 23 and it wasn’t until he was inside that doctors and nurses found a gunshot wound that went through the man’s back and out his stomach.

“That tells me that the EMT/firefighters did not do a complete assessment, they didn’t do a proper assessment, they didn’t follow protocol to the assessments that we have in place that should have been done to find these life-threatening injuries,” said Lyles.

This is true. The Primary Exam of a patient who is unconscious and not able to tell the EMTs or paramedics what is going on should go like this.

A – Airway. Make sure it’s open and there are no obstruction.

B – Breathing. Yes or no? If yes, is it sufficient or insufficient?

C – Circulation. Pulses, yes or no? Any pulse is better than no pulse.

D – Disability. Is the patient conscious, not conscious, conscious, but not able to speak or speak coherently.

E- Expose & Examine. As in remove (usually by cutting) the patients clothes. Once that’s done, look the patient over, touch the patient to exam for injuries that aren’t visible. That includes rolling the patient over so that you can look at his back. More than one EMT and paramedic has been embarrassed because they failed to look at the patient’s back. Also, it pays to lift the patient’s arms and look in the area of the arm pits. More than one stab or gun shot wound has hidden in that area. It also pays to look at the patient’s buttocks because injuries can hide in those nooks and crannies too.

We at least know that the two EMTs on that call didn’t do E.

Sources familiar with the investigation said the firefighters were immediately taken off the street after the error was discovered and placed in what is called “a no patient contact status.” They have both been assigned to the training academy.

I’m sure that they were assigned to the academy for retraining, but I laughed at the prospect that they might have been sent there to train others. Nothing DC FEMS does surprises me any longer.

A statement from DC FEMS to Fox 5,

“Our initial investigation has determined that the patient exam conducted by our personnel was not sufficient. “From the outset, one of our goals has been to establish a medical routine
that provides a high level of patient care. This month, hands on refresher training will begin that will reemphasize the basics of how our members conduct patient assessments, execute high performance CPR and accurately
document patient examinations. The training is expected to take about six to eight weeks to complete.
“Once the third party provider contract is implemented, additional training will begin each month allowing our members to become more proficient in our standard of patient care.
“There was a breakdown in upholding our standard in this incident; we must be diligent and thorough. The first leg in achieving and maintaining our standard of patient care starts with training.”

Channeling “Blazing Saddles” that is some first class management gibberish. This statement tells me that their current standard of care is sadly deficient. Which has been obvious for some years. So is their supervision of medical care, but that’s a different story. Actually, I think it’s fair to question their commitment to medical care at all.