Scuba Death Leads to Lawsuit Settlement Against American Medical Response

[Cacia]

I am really eating this thread up! So much good stuff.

I used to take advanced trauma life support with MD's, RN's and paramedics at USCD and I have to agree that the MD taught classes by level one trauma docs are the best.

I mean, I can't believe someone can be on heroin and work in the EMS field, let alone two of them at the same time

Hey, I wasn't going to say this, BUT:
I was thinking along similiar lines about private ambulance employees (in my experience) and the way they get scheduled VS say Firemen/paramedics and the likelihood of getting two junkies who get to work together, have their habit, etc. I honestly cannot fathom this to be very likely in the firehouse work environment.

Firemen generally have pretty health conscious wholesome lives. Yes..it's a generalization, but I think it is an accurate one. A couple of heroin addicts would have a hard time remaining incognito amongst them. Try passing the "run up 60 flights with the fire hose" test stoned.

 

[DandyDon]

well, this thread has shown me that if paramedics in an ambulance are not qualified to stop CPR, neither am i

so ... i will continue to administer CPR until relieved by the ambulance guys and won't stop even if i think "there's no hope"

i'm not qualified to make that call

Isn't that what we are taught in First Responder class - continue CPR until relived or until we give out - can't anymore...?

 

[dashark]

I am a 12 year Fireman/Paramedic in California
As far as determining death in the field: in L.A. County we will not determine a patient dead that doesn't meet "obvious death criteria" until we have made contact with our base physician over the phone.I'm not sure how they operate in Monterey county, but, if they were on the phone and instructed to continue I assume it is much the same.
If they did call the code before they made contact with a base physician, that is where they may get in trouble.
I haven't read this entire thread, and if I am repeating what another has said, i'm sorry. there is an old saying rearding cold water drownings."their not dead 'till their warm and dead".
This was probably why the physician was reluctant to allow these medics to call the code in the field.
To answer the question on EMT vs. Paramedic. If they were on the phone with the base station physician, they were Paramedics.
I will say this: don't believe everything you read or see on television. Nothing can reproduce or convey to someone that wasn't there what the conditions in the field were for these guys at the time.

 

[ParamedicDiver1]

You KNOW I am gonna have to comment on this.

Not to slight yourself, nor any other medics, us doctors do have to take the same ACLS courses, and we usually just find the most convenience and cheapest to renew our ACLS certificate.

I have MDs in the classes I teach all the time, granted they tend to be IM or Family doctors, but they attend. I should also crarify that I teach through a Level 1 trauma center and with Memorial Hermann Life Flight Education. I think we give one of the best programs around. It is taught by RNs and Paramedics with decades of experience in ACLS and CPR...most of the instructor are flight nurses or flight paramedics.

However, since I've been certified long before they allow non MD/DO's to teach the courses, I can tell you , clearly, the quality of the instruction has dropped tremendously since non physicians are taking over the teaching.

Again, gotta take issue with this, I think this statement should be limited to the programs you deal with individually. The programs I deal with are high quality and provide a great deal of information.

Both the RN instructors and paramedic instructors have shown very poor skill in the didactic and the practical sessions. It is a huge disappointment from the days that ER doctors taught the classes.

I will limit this response to the practical aspect. The paramedics I have worked with can run a code with the best of them...and are as good as many ER physicians I have worked with. And I would put up any of my fellow instructors against an ER doctor in the practical sessions.

An ER physician does not have to take ACLS - as they live it. You will not find an ER doctor taking your ACLS class. They do have to take yearly exam for their board certification. An MD is a worthless degree when it comes to emergency medicine... I would trust an experienced paramedic to run a code before I would.... But an ER doctor, in my opinion, should be the final authority to end a code.

Interestingly enough, most paramedics live it too. I would wager that most codes happen in the field before the ER. The paramedic intubate, start IVs, and push several rounds of medications before getting anywhere near the ER. In fact, a lot of the codes that I see come into the ER last about 5 minutes because EMS has already done everything for the pt.

I am not slighting RN's or paramedics at all... We can never approach the skills of an ER physician, and it is unfortunate that the ER docs are not teaching ACLS like they used to (they cost more).

I think ER doctors would be great ACLS instructors, but I do not think they would be any better than the Paramedic and RNs that I teach with just because they are ER doctors.

 

[The Chairman]

But I'm still confused as to why the ScubaBoard Record is so important that something needs to be dredged up to be included in it. As a matter of fact, now that I think of it, I didn't realize there was a ScubaBoard Record in a research and analysis sense.

We stand as probably the most complete record of scuba diving events, protocols and gear in the entire world. There is no comparable searchable record for Scuba Diving that I know of. It's up to all of us to add to this repository in order to make our sport even safer.

 

[fisherdvm]

You KNOW I am gonna have to comment on this.


I have MDs in the classes I teach all the time, granted they tend to be IM or Family doctors, but they attend. I should also crarify that I teach through a Level 1 trauma center and with Memorial Hermann Life Flight Education. I think we give one of the best programs around. It is taught by RNs and Paramedics with decades of experience in ACLS and CPR...most of the instructor are flight nurses or flight paramedics.


Again, gotta take issue with this, I think this statement should be limited to the programs you deal with individually. The programs I deal with are high quality and provide a great deal of information.


I will limit this response to the practical aspect. The paramedics I have worked with can run a code with the best of them...and are as good as many ER physicians I have worked with. And I would put up any of my fellow instructors against an ER doctor in the practical sessions.


Interestingly enough, most paramedics live it too. I would wager that most codes happen in the field before the ER. The paramedic intubate, start IVs, and push several rounds of medications before getting anywhere near the ER. In fact, a lot of the codes that I see come into the ER last about 5 minutes because EMS has already done everything for the pt.


I think ER doctors would be great ACLS instructors, but I do not think they would be any better than the Paramedic and RNs that I teach with just because they are ER doctors.

Your points are all valid. But we both understand the economy of medicine. We often have RN's in the education or general medicine area, or paramedics in low utilization fields keeping instructor certificates and continue as professional instructors. Practice makes perfect, that is why I still say, the working paramedics are better at running a code than an MD with BCLS, ACLS, and ATLS......

Don't worry, I did not imply your ability as an instructor, I am just commenting my experience in both hospital ran and commercially ran ACLS programs - "professional instructors" can not replace real life practicing ER physicians, or in your case, practicing ACLS paramedics.

 

[Rick Murchison]

There are some mighty broad brushes here...
FWIW, the best (response time & level of care/competence) ambulance service I've ever seen was (and is) from a private company; the worst ER decisions have come from MD's (ER Nurse to MD: "I can do that, Doc, but it'll kill him").
Doesn't mean much, beyond saying that "private" doesn't make an ambulance company bad, and "MD" doesn't make a decisionmaker infallible.
I'd sum up my obvservations sorta like this... the best emergency care happens when
(1) it's quick (the best use of money today is in the acquisition and placement of AEDs, and training folks to use 'em)
(2) there's enough knowledge within a response team to have someone call "BS" when it's needed, and
(3) enough dedication to keep going until the patient is past dead & gone.
I say "past" dead & gone 'cause I've personally been "dead" but obviously not past retrieval, and I owe that retrieval to a competent ambulance crew, and a dedicated ER MD and his team who decided to keep trying.
('Course I believe they had help but that's a different story and subject.)
(4) last but not least... (my broad brush) never let a lawyer within a mile of a medical emergency!
Rick

 

[ParamedicDiver1]

Don't worry, I did not imply your ability as an instructor, I am just commenting my experience in both hospital ran and commercially ran ACLS programs - "professional instructors" can not replace real life practicing ER physicians, or in your case, practicing ACLS paramedics.

Ok...I re-read our original post and I understand what you are saying. Sorry if I came across over-defensive. Looks like we agree with each other.

 

[Code Monkey]

Meredeth came right out of her coma last night on Grey's Anatomy.

Yeah, I was watching the show with my daughter when she announced "Next week, on 'Yang's Anatomy..."

 

[Cacia]

never let a lawyer within a mile of a medical emergency!

Roger that Rick.

when you have a parent that's also a lawyer and they are in ambulance, sorta throws you off your game. (old days)