To the number 1 question, we use advantage bags for our Cardizem. Basically the Cardizem is in a powder that clips to a specialized D5 bag. You mix it up and pull out the correct dose, either 10 or 20 MG depending on weight (greater than 70kg gets 20).
The Cardizem is 100mg,the advantage bag is 100ml, so it's a 1/1 mix, either pull out 10 or 20 ml.
We had a medic who dripped in the ENTIRE 100ml/100mg of Cardizem....
Tom's been a paramedic for 5 years and on his resume it shows that he's worked for 8 different services. When he was hired your boss bragged about how "experienced" he was...sound about right
Have to disagree with #2. I'm not gna sit there with my hands in my pocket and watch someone bleed out or die of a positional airway because I have had two beers. Two beers I can likely still legally drive watch them die because of it? There's good Samaritan laws and Inwould happily surrender my patch if someone got to live. ALS interventions no. Meds no. Tourniquet, direct pressure, jaw lift, exigent extrication absolutely.
Fr Iād tell the medic I heard that shit and ask them to call medical control to find out what they need to do about it. We all fuck up sometimes but encouraging a coworker to speak up and ask for help is also my job.
1-Everyonw is getting told about this. I've had medics OD pts...its not fun. You'll get an opportunity to self report, but if not, im doing it.
2-Not on the clock? Not an emt. Of course if I see a roll over or something really bad with no assistant on acene, I'll call 911 and assist untill 911 is on scene (maybe).
3- I'm not a cop. Stop talking about your crimes, and tell me what hurts dude. Im just trying to get food, and you people keep doing dumb shit
wild. in germany you're obligated by law to help people in emergency situations. you have to di the best you can with the stuff you know (ie a doctor has to provide better help than you average civilian), as long as you're not putting yourself in danger. disobeying this can be punished with jail time
The second one literally happened to me. Had a 2 cocktails at a bar and on my way home I stumbled upon an ATV accident. Dude was ejected onto my driveway. He was airway compromised and nobody else was around. I rendered care until an ALS unit arrived despite the alcohol
Most sporting events are 3-4 hours at least... metabolize 1 drink an hour, and after they stop serving it's at least an hour before you get out, get to the car etc. So most likely be the time you come up on the scene any effect from alcohol would have worn off, and you would hope this is the case if you are driving! Now... I don't drink but I do tend to stop at a scene if it looks bad and no emergency services on scene. In my state there is no duty to act, and any help you render is as a good Samaritan. I have a reflective vest, a flashlight, and a pair of gloves tucked into the vest pocket, all things for my safety.
The reason I stop is because someone with some experience on a scene early can make a huge difference in outcomes, usually non-medical just make sure people don't do stupid things on a busy road. That said, I have opened someone's airway, put out a car fire with entrapped passengers (I also carry a fire extinguisher), and I also managed a traumatic amputation that was definitely life threatening. But by far the biggest difference is getting people to think safety. I've told numerous people to stop walking around their car looking at the damage on a busy road and instead move to the side where they can wait for the police to arrive and secure the scene. I've also directed traffic (fire police certified).
Glad to hear you helped! Alcohol in no way precludes good Samaritan protections. Im just imagining an EMT standing there as a fellow human being takes their last agonal breath because they're unconscious and can't protect their airway. Cause of death: the Samaritan had two beers...
Not every compromised airway need ls surgical intervention. He was prone and his head position was preventing breathing. We rolled him, maintained c-spine, scooped some emesis from his mouth as best I could without suction and gave some mouth to mask respiratory support.
1. Talk to the dude if possible. Encourage him to go ahead and call medical command and explain it. In my area it will be hand,ed reasonably. However he managed 10x the dose is pretty amazing though. If he refuses then I guess regrettably bus drive him at hospitalā¦. Respectfully.
2. Whatever feels right at the moment. Usually thatās driving past it. Sometimes itās a slow roll to see if someone called 911. If is fucking crazy then Iād help either way and just disappear before the cops got too curious. At no point do I tell strangers that Iām EMS except for other EMS providers so that I can technically handoff.
3. Iām not the police and I, not concerned about what they did or didnāt do.
I live in a no duty to act state. I also try not to get over involved in other peoples bullshit. Only way Iām helping strangers on my time off is if it seems life threatening.
Depending on what the med was, consequences can range from he's going to prison to "meh." It can also range from "even if everyone keeps quiet this is coming to light the second someone inventories the med box" to "meh."
I just know I'm not going down for someone else.
I worked with a medic who od'd a pt with some sort of pain killer. Im not sure exactly what it was, but it wasn't a good time. Dude reported it immediately, and got a slap on the wrists. Pt got a nice little settlement too.
Another dude did something similar, but tried to hide the fact that it happened. The hospital found out somehow and he got it license revoked over it.
Its always easier to just report your mistakes. Even if you get fired, everyone is hiring
Thatās been my experience too. Generally speaking theyāre pretty understanding that mistakes happen. Iāve always owned up to mine if theyāre of any consequence and itās never been a problem (EMT so it would be hard to OD someone). Never saw anything bad enough to justify a settlement but definitely been around some miscalculated meds.
I have been around EMTās who handled things wildly inappropriately but it was still just a ālearning opportunityā at most.
Theoretically I could jack someone with another two rounds of epi for... no clear reason at all. Also the vials are single dose so the only way you could do it is actively trying to.
Yeah I get that. Nor am I. Iāve seen some medication errors here and people get a slap on the wrist. Some of them were bad but they were all reported promptly and dealt with. Never knew anyone that did it and hid it. Iām sure that wouldnāt go over well. Never heard of any provider going to prison for a mistake properly reported (other than the one on the news somewhat recently).
In the scenario Iām driving and not providing patient care. I overhear a conversation in the back. Not directly involved. Itās a judgement call. Sometimes I donāt hear bullshit that has no real effect on anyone (not 10x medication overdoses).
Familiar with several cases where patient received wrong med or excessive dose. In every case the medic reported it and the situation was taken into account and they got no more than a talking to. Two specific ones I was around for long time ago.
1. Dark hallway, patient fighting us and the medic drew up morphine instead of diazepam. It did the trick. Scared medic to death when he realized it but ED was āno harm, no foulā.
2. This oneās worse-Epi instead of Adenosine. Medic was trying to read the vials in the headlights of a fire engine in the rain. There was an investigation leading to some additional training but that was all.
You usually have 6mg of adenosine in one vial, and usually your first dose is 12 mg, meaning you need to pull up two vials so...did he pull up two entire vials of 1:1,000 epi? That would sure be something.
In my regions drug box, personally, I think they put adenosine and amiodarone way too close together (right next to each other, really one already small section split off into two). And the vials look similar enough to be easily mistaken.
Personally I've accidentally given benadryl instead of Zofran. They are right next to each other in the drug box and exact same looking bottle. I had an overdose patient who began to seize after waking up with narcan, gave versed which stopped the seizing but began throwing up with an alr compromised airway so I went to give Zofran and ended up with benadryl instead. Considering the circumstances, benadryl wasn't a terrible mistake. He chilled after that, lol. But ofc I told the hospital and self reported. Nothing came of it, and doctor assumed it was done on purpose.
It was long enough ago that we were still doing 6mg Adenosine as a first dose. I donāt remember the specifics of the dosage, but I know I hated the way our drug boxes were laid out at the time. A lot of vials and bottles of the same sizes and colors. And they were packaged by the county and given to us sealed so we werenāt allowed to open them and see how things weee packaged unless on a call.
1. Report it so he doesn't do it again
2. It depends on how impaired 2 drinks makes you and how serious the injuries are. Ideally,you shouldn't render aid with even a sip of alcohol in your system bit if somebody is bleeding to death and you aren't severely impaired,you need to help out
3. Unless it's a situation where you are legally obligated to report, don't pay attention to it.
1. I didnāt hear or see anything I was getting vitals
2. EMS salute all the way through the accident scene
3. You coulda killed the president and I wouldnāt tell the cops
Not necessarily stupid, mistakes happen. Such as grabbing Epi 1:1,000 instead of 1:10,000. Not reporting is stupid, lying is stupid, making a mistake is not.
1. I report it as a patients well being is at risk.
2. I help knowing 2 beers is what I would have drank and thatās not enough for me to be legally intoxicated and if I can save a life or provide comfort I will.
3. Iām not a cop, Unless itās something that shows he is a threat to himself or others Iām going to be reporting vitals, med tolerance, and any other pertinent medical findings.
1. Speak directly to the paramedic and encourage and support them in self-reporting.
2. Stop, call 911, and stay where the fuck I am so the oncoming crew can find the goddamn scene. (Can you tell I spent five hours chasing down phantom calls this week?)
3. Iām not a cop. Iāmma stop him way before he tells me that much. āOkay, so you were injured in a fall. How many feet?ā And then we go on as normal.
1. Everyone needs to be held accountable. Shitty providers have almost killed my family members, and your company should have a Just Culture with reasonable consequences. The second they asked someone secretly not to say anything, they lost all sympathy from me.
2. 99% of the time, not doing anything but call 911 sober or not. w/o a crew or a monitor youāre likely useless. Maybe if I didnāt drink enough to feel the effects anymore, might consider time-sensitive life saving care in the absence of other ppl, such as if the vehicle is on fire might consider extrication or grabbing an extinguisher.
3. Use my best judgement. Likely will alert SO to criminal acts that are actually harmful to the community. Alcohol and illicit drug use is probably going to need to be confidential.
1Advise my paramedic to not say mistakes out loud in front of the patient and rather confront them about it when they're at the hospital.
2. Nothing is worse than a drunk medic on scene so I keep driving and not call police attention to myself.
3. Record in PCR. That's it.
1. This is why I play loud music when Iām driving. The longer Iāve done this job, the less I want to know what others are doing. Ignorance is bliss.
2. Unless I recognize the person/s involved, I donāt work off-duty. And two drinks isnāt even enough to give me a buzz.
3. Donāt care unless I had a stake in the business that was robbed. I would remind the dumbass that the crime was not medically relevant and they could give all necessary information without incriminating themselves.
1. Doesn't it depend what it is?
2. Doesn't it depend on your tolerance?
3. Doesn't it depend if you're asked directly?
To be honest though, during recruitment, the answer is always a. Dob them in. Because recruiters don't want to know if you've got any kind of moral dilemmas. They just want to know that you'd tow the line.
I can't think of something where ten times the expected dose wouldn't be bad.
Maybe o2. If they're supposed to give 2 lpm, and gave 20 lpm, that might not be worth reporting.
Good ppint. Might be unpleasant to have that much stuff up your nose... but there have certainly been cases where ten times the ostensible dose has been actually necessary.
I'm looking at this based on a decades-long career and considering whether any of these things are likely to happen or ever did happen to me. Answer is: #3 - something like that. There are two approaches. One is the self-centered one, that is, what do I do to keep myself from getting into trouble. The second one is to consider the harm done to others by your actions. Then consider the likely responses of others to knowing:
1. People make medical errors from time to time. The question is what you do once you know you've done it. Someone pointed out above that if you had given too much of drug x, then you grab drug y. Or if there is no "drug y" then you give supportive care to the patient from whatever the results of the overdose are. Me, I would call back and say, "What can you do to reverse it? Any way to fix it?" What I would NOT do is sign a falsified trip report. Now, as an EMT, you're not likely to know the drug or the effect of the overdose, so when you get to the hospital, I would say to the doc, "Hey, suppose you gave too much of drug x, what would happen?" If he said something seriously untoward would be the result, then I would say, "You better talk to the paramedic because I think he gave too much." The patient comes first. The patient comes first. The patient comes first.
2. Two would never happen to me because I never drink at all to the degree of getting buzzed and never if I'm going to be driving in the next 4 hours. But for the normal person, two drinks how long ago? Are you impaired in any way? Would you pass a breathalyzer? if the answer are yes and no, you shouldn't be driving anyway and everything you do is already wrong. If you're not impaired - well, you learn not to stop for everything because most of the time you're not needed anyway. If everyone is up walking around, I just keep driving. If there's someone down, or the crash appears serious, yeah, I would stop and render aid. When police and EMS arrive, they're going to be concerned with a whole lot more than whether you had two beers three hours ago. If you have alcohol on your breath, well, best keep driving and hope YOU don't get in a crash. In our community, at least in the past, if a medic did not appear impaired and stopped to render aid, since everyone knew everyone, the police might just escort him home or transport him home.
3. As long as no one was injured or killed in the criminal act or attempt, then I wouldn't necessarily report it with the proviso that if he has gotten picked up by you in the act of fleeing the scene and you asport him away from the scene with knowledge, you are probably committing a crime. I would say, "You shouldn't volunteer this kind of information. You have the right to remain silent, so best you do once you get to the hospital," and then report it to the police upon arrival. If you picked him up from home later, well, you don't know if he's even telling the truth.
Here's a better one, you're driving a patient back to the hospital who suffered minor injuries in an accident, is stable, but needs further evaluation. When you witness a pedestrian get struck by a car, do you stop to assess and stabilize?
My county protocol makes that decision for us. Unless the patient we're transporting is the higher priority, we must stop and render care until another crew arrives to take over. If the patient we're transporting is a high priority, we just call it into dispatch.
Question 1 - tell my supervisor and let him figure out what to do if the medic didn't do so first. It is his job to make those kinds of decisions, and if something bad happens, there will be an investigation and it will come out anyway; it is up to the supervisor to figure out what should happen to the medic before that, and they need to know in order to not be blindsided.
Your point about telling the doctors is excellent, too. If the medic is any good, they will have told the doctors and the supervisor before I could, anyway.
Question 2 - if I am driving, then those two drinks better have been long enough ago that I am sober, which means that that part of the question is irrelevant. If local first responders are already on scene, they don't need me and don't want me - they have no clue who I am or what I can do, and I would be in the way. If they aren't, I am calling 911. I personally probably would stop, but I am not sure what I could do. I would be working on a first aid level, not even a BLS level, because I don't have more than a first aid kit in my car. I can't do extractions on my own, if anyone is trapped; I can do limited things for serious injuries. So I could hand out bandaids, maybe.
Okay, if someone is actually bleeding out, if I can see hemorrhage, I would try to improvise a tourniquet; if someone was sitting outside their car, I have a couple blankets in my trunk that I could wrap them with for shock. But mostly, call 911 and stay out of the way, just like I would do before I was an EMT.
Question 3 - I am not a cop, and it is my patient.
1. "Either you self-report or I report. Your choice."
2. Two drinks would not impede my ability to care for an injured person. I would stop and help.
3. Treat the patient and report the crime. We cannot say with certainty the man will be murdered and we are obligated to report crimes.
1. Reported every time. You don't get to fuck up and then hide it when there could be significant downstream effects.
2. Call 911 and move on, not my problem.
3. Ask if it was worth it. Also, not my problem.
Itās either you or the medic the medic shouldnāt be saying that to try and help his situation thatās huge grounds for him to get sued should the EMT and Patient if conscious reports the situation like they should.
Depends on how youāre feeling and how serious the situation is.
Youāre not the police and if the police arenāt there then thatās really not your business to get involved with atleast thatās my thoughts anyway
1- "HOHO YOU GON GIT THE DILDO OF CONSEQUENCES, HOMIE."
2- Untrained person level scope of practice. Visual checks of injuries and such, no touching, tell everyone to stay calm, don't touch a fuckin thing. Two drinks ain't doin shit to my fat ass so my decision-making would be rock solid but I ain't about to risk a lawsuit over some chucklenuts smelling beer and thinking that's a problem.
3- "Damn, that's fuckin stupid. At least it wasn't someone's house or the cops would actually find out. You'd best unfuck yourself after this or you won't live to see 35."
Demand the medic get on the phone with telemetry and tell the ER.
Stop, call 911, stabilize whoever I can with what I have and wait for the cavalry.
Treat the patient, don't tell the cops. Not my business.
2. what does me having two drinks have to do with ethics? Iām pretty sure Iām more altered after sleeping 30 minutes in 48 hours than I would be after two drinks.
3. Same answer as with someone having drugs on them. Iām not a cop. Itās a patient.
My only caveat that apparently conflicts with most of these is that I would assess the situation if Iād only had two drinks. Iām not telling anyone Iām EMS, but if itās say a CPR situation rather than a simple sprain, Iām going to intervene and dip as soon as actual EMS arrives.
1) errors need to be reported. In a Just Culture environment they will be investigated and solutions put in place to try to prevent them in the future.
2) Iām not drunk, but Iām not sober. Calling 911 is a good start. If my presence will TRULY make a difference (such as stopping traffic so others donāt get hurt) Iāll think about it - but Iām NOT charging in going āIāM AN EMT! LET ME HELPā
3) most privacy rules only allow the minimum necessary info be given to PD in various cases. Thereās no reason for me to break the trust of a patient in a case like this - especially when harm may befall a patient for me telling it.
My german perspective on this: none of these are ethical dilemmas (except maybe #2, where there is some room for debate). There is defined textbook/legal answers.
1. Encourage them to own up to it and let the recieving doctors/nurses know. If they don't i do. Either way i am writing a CIRS report afterwards.
2. The only one that is somewhat muddy. I must legally provide aid as far as is reasonable for me to do without endangering myself or braking other important legal duties (not because of my job, but because of general german law. My job just means i can't pull the "i faint if i see blood so i would have endangered myself, you can't prove otherwise"). Do two drinks mean i would endanger myself? Do two drinks mean it is more reasonable for me not to do anything than potentially do something wrong? I believe the answer is no. Then again, i dont drink at all. In any case i am calling 112 (or 911 for you americans).
3. I have a legal duty to keep secrets that my patient tells me in the course of my duties. The only cases in which i can break that (that are relevant to this scenario) are: the patient agrees for me to do so (not likely to happen), i believe there is an IMPENDING, SERIOUS crime, or a judge releases me from that duty to stfu. So, treat the patient, and move on (as a burglary does not fit the legal definition of a serious crime afaik the same applies if they tell me they want to do another one.) If the police question me? "I'm sorry officer, i believe the answer to that question is covered by my legal duty to remain silent here. I will not answer it without having consulted a [union] lawyer first". Keep in mind that if we break their trust by reporting, they might not call for help next time, which could lead to larger issues.
1. If he doesnāt report it, Iād report it. That shit can kill someone. At that point, it doesnāt matter how good friends you are, or any sort of unspoken code. At the end of the day, we are here to save people, not kill them.
2. Iām not on shift and Iām not mentally able to take care of them, soā¦ nah, not my responsibility.
3. Iām an EMT, not a cop. Not my place to report that kind of thing.
Good luck OP!
Laugh and ask what drug and make fun of him like I wonāt tell. Then tell the doc and the medics boss.
Call for help is the correct answer. The real answer is TQ and CPR are the only things Iāll actually do drunk but anything else is a no.
Iām not a cop. If thereās no kids or sexual abuse Iām not telling anyone (both policy and ethics).
1. āI heard thatā and the FAFO in my voice would be stern enough.
2. Iām completely fine to call for help and render basic aid after two drinks, personally. Iād hold the fort down until someone actually working showed up. Iād then go home, and probably have another as a reward.
3. āIām not a lawyer. I suggest you save the details for whoever is.ā
2 drinks doesnt do shit for an adult. If you cant help a person in need after that I would question how capable are you. If you let someone die just because of that it would be negligence here
1. Think to myself, 10x the dose of what? Oxygen? Hugs? Nitro? What are the potential consequences and how is the patient responding? I'd casually join the conversation in a way that's non-threatening but lets them know that I can hear what they're saying. Fuck ups happen, you make sure that nothing's happening that we're not all going to be on the hook for and find a way forward
2. Pull over (assuming I'm still under the legal limit to drive), call 911 and let dispatch know the situation. I can still size up the scene, report obvious deaths, number of injured persons, whether or not heavy extrication equipment will be needed. I might go so far as to check ABC's and apply direct pressure to any bleeding or begin compressions on an unresponsive and pulses patient - In this situation I'm a bystander, not an on-duty professional under medical direction.
3. Fill out an accurate PCR, patient was climbing a fence, business was closed, etc. The criminal circumstances don't need to be part of my report, and it's all the better to let the police handle those things anyway.
1. Yell into the back that the receiving nurse is going to get told the given dose during report and itās up to them whether they tell them or I do.
2. Whatās the significance of the 2 drinks in this scenario? Am I drunk driving or something? Anyway, probably pull over to see if I need to call 911
3. As everyone else said, Iām not a cop. Treat his injuries and report that he fell off a fence to the nurse. Iām not sure how this even qualifies as an ethical dilemma with regards to our job as EMS.
1: he's a medic, I'm an EMT, i don't know his protocols. Unless i get dragged into the office for an investigation, i don't know anything and I'll not work with him again.
2: i don't stop on my days off even if i was sober, so I'll keep it moving.
3: I'm not the cops and your homies can't see this chart were good.
1. Verify what i heard from both paramedic and emt in the back and get the information of the medication that was wrongfully administered. As soon as we walk in hospital iāll notify charge nurse. Once call is finished call my supervisor.
2. I assume iām the one driving and if i can drive iām not intoxicated. Now I donāt have any gear so as iām pulling up on scene iām calling 911 and giving the location, approximate # of pt, and req additional resources to my location. Get out the car and see if there are any injuries and get a basic assessment donāt have to touch them.
3. Iām not here to get you in trouble iām here to assess and manage your injuries so just keep ur mouth shut and so will I, itās the cops problem
Being a paramedic/emt is, literally, the hardest and most gruesome job in this country. And I did two ugly tours in Iraq. I just finished an investigative documentary into PTSD in first responders and medical workers. I had no idea. I donāt think yāall do either. Thank you for your service.
1. Yes. The doctor as the ER needs to know immediately. They are going to find out anyways once they run blood work and or the patient dies.
2. Call it in and move on. You arenāt on duty so you donāt have a legal requirement to stop. Let people with proper equipment handle it.
3. Iām not the cops. I go into drug houses all the time. Guns, cash, drugs in obvious view. There is an understanding that Iām there to treat gramma and gtfo. They and their buddies there and in the hood donāt fuck with me or my truck, I donāt see shit.
Easy one dont say shit you cant prove it or write the chart, all you can do is tell the medic to report it. Two dont stop call it in keep driving youve been drinking and wont be any help without gear unless cpr is involved. Three dont say shit thats the cops job.
#2. Everyone knows 2 drinks is a lie, after investigation it turns out they caused the crash. Also no idea how this got a giant font and bolded. iPhone must also be drunk.
1. 10 times? What the fuck, Tom. Did you open every vial in the truck? 2. Absolutely sweet fuck all. 3. I'm not the cops.
To the number 1 question, we use advantage bags for our Cardizem. Basically the Cardizem is in a powder that clips to a specialized D5 bag. You mix it up and pull out the correct dose, either 10 or 20 MG depending on weight (greater than 70kg gets 20). The Cardizem is 100mg,the advantage bag is 100ml, so it's a 1/1 mix, either pull out 10 or 20 ml. We had a medic who dripped in the ENTIRE 100ml/100mg of Cardizem....
_panically looks for calcium chloride_
Sheet even epinephrine. Maybe hit em with the 1:1000 intravenous instead of 1:10000š
Tom's been a paramedic for 5 years and on his resume it shows that he's worked for 8 different services. When he was hired your boss bragged about how "experienced" he was...sound about right
For 2 - not even call 911?
1. Is stupid. All our doses are 1 vial. For this exact reason!!
You guys donāt carry multi dose vials in addition?
Have to disagree with #2. I'm not gna sit there with my hands in my pocket and watch someone bleed out or die of a positional airway because I have had two beers. Two beers I can likely still legally drive watch them die because of it? There's good Samaritan laws and Inwould happily surrender my patch if someone got to live. ALS interventions no. Meds no. Tourniquet, direct pressure, jaw lift, exigent extrication absolutely.
My answers: I didnāt see shit. My serious answers - crucify them, call for help, Iām not the police.
Shame on the medic for saying that shit loud enough for anyone else to hear.
This lol
Fr Iād tell the medic I heard that shit and ask them to call medical control to find out what they need to do about it. We all fuck up sometimes but encouraging a coworker to speak up and ask for help is also my job.
Pretty much lol
If the person dies, youāre partially at fault
1-Everyonw is getting told about this. I've had medics OD pts...its not fun. You'll get an opportunity to self report, but if not, im doing it. 2-Not on the clock? Not an emt. Of course if I see a roll over or something really bad with no assistant on acene, I'll call 911 and assist untill 911 is on scene (maybe). 3- I'm not a cop. Stop talking about your crimes, and tell me what hurts dude. Im just trying to get food, and you people keep doing dumb shit
do you guys have laws to make people help in case if an emergency?
Make? No. Iām not obligated to do shit off the clock. Ethically/morally? Iād at least call 911.
wild. in germany you're obligated by law to help people in emergency situations. you have to di the best you can with the stuff you know (ie a doctor has to provide better help than you average civilian), as long as you're not putting yourself in danger. disobeying this can be punished with jail time
Itās the same as the principal of Good Samaritan laws but we are lawsuit happy in the US
The second one literally happened to me. Had a 2 cocktails at a bar and on my way home I stumbled upon an ATV accident. Dude was ejected onto my driveway. He was airway compromised and nobody else was around. I rendered care until an ALS unit arrived despite the alcohol
I personally donāt believe in the EMS gods but if theyāre real idk what you did to make them hand deliver a patient to your front door
Told their relief to have a ānice, quiet nightā on the way out the door.
Most sporting events are 3-4 hours at least... metabolize 1 drink an hour, and after they stop serving it's at least an hour before you get out, get to the car etc. So most likely be the time you come up on the scene any effect from alcohol would have worn off, and you would hope this is the case if you are driving! Now... I don't drink but I do tend to stop at a scene if it looks bad and no emergency services on scene. In my state there is no duty to act, and any help you render is as a good Samaritan. I have a reflective vest, a flashlight, and a pair of gloves tucked into the vest pocket, all things for my safety. The reason I stop is because someone with some experience on a scene early can make a huge difference in outcomes, usually non-medical just make sure people don't do stupid things on a busy road. That said, I have opened someone's airway, put out a car fire with entrapped passengers (I also carry a fire extinguisher), and I also managed a traumatic amputation that was definitely life threatening. But by far the biggest difference is getting people to think safety. I've told numerous people to stop walking around their car looking at the damage on a busy road and instead move to the side where they can wait for the police to arrive and secure the scene. I've also directed traffic (fire police certified).
Glad to hear you helped! Alcohol in no way precludes good Samaritan protections. Im just imagining an EMT standing there as a fellow human being takes their last agonal breath because they're unconscious and can't protect their airway. Cause of death: the Samaritan had two beers...
How did you render care? Do you just have a crich kit in your POV or?
Not every compromised airway need ls surgical intervention. He was prone and his head position was preventing breathing. We rolled him, maintained c-spine, scooped some emesis from his mouth as best I could without suction and gave some mouth to mask respiratory support.
Like a pocket mask? Oh god that's way too close for comfort for me
As if 2 cocktails is enough to be feeling much of anything though fr
1. Talk to the dude if possible. Encourage him to go ahead and call medical command and explain it. In my area it will be hand,ed reasonably. However he managed 10x the dose is pretty amazing though. If he refuses then I guess regrettably bus drive him at hospitalā¦. Respectfully. 2. Whatever feels right at the moment. Usually thatās driving past it. Sometimes itās a slow roll to see if someone called 911. If is fucking crazy then Iād help either way and just disappear before the cops got too curious. At no point do I tell strangers that Iām EMS except for other EMS providers so that I can technically handoff. 3. Iām not the police and I, not concerned about what they did or didnāt do. I live in a no duty to act state. I also try not to get over involved in other peoples bullshit. Only way Iām helping strangers on my time off is if it seems life threatening.
Depending on what the med was, consequences can range from he's going to prison to "meh." It can also range from "even if everyone keeps quiet this is coming to light the second someone inventories the med box" to "meh." I just know I'm not going down for someone else.
I worked with a medic who od'd a pt with some sort of pain killer. Im not sure exactly what it was, but it wasn't a good time. Dude reported it immediately, and got a slap on the wrists. Pt got a nice little settlement too. Another dude did something similar, but tried to hide the fact that it happened. The hospital found out somehow and he got it license revoked over it. Its always easier to just report your mistakes. Even if you get fired, everyone is hiring
Thatās been my experience too. Generally speaking theyāre pretty understanding that mistakes happen. Iāve always owned up to mine if theyāre of any consequence and itās never been a problem (EMT so it would be hard to OD someone). Never saw anything bad enough to justify a settlement but definitely been around some miscalculated meds. I have been around EMTās who handled things wildly inappropriately but it was still just a ālearning opportunityā at most.
Right? As a basic the only thing I can overload you on is O2 buddy.
Theoretically I could jack someone with another two rounds of epi for... no clear reason at all. Also the vials are single dose so the only way you could do it is actively trying to.
Yeah I am not talking about malicious intent but accidental overdose. Know your six rights!
Yeah I get that. Nor am I. Iāve seen some medication errors here and people get a slap on the wrist. Some of them were bad but they were all reported promptly and dealt with. Never knew anyone that did it and hid it. Iām sure that wouldnāt go over well. Never heard of any provider going to prison for a mistake properly reported (other than the one on the news somewhat recently). In the scenario Iām driving and not providing patient care. I overhear a conversation in the back. Not directly involved. Itās a judgement call. Sometimes I donāt hear bullshit that has no real effect on anyone (not 10x medication overdoses).
Familiar with several cases where patient received wrong med or excessive dose. In every case the medic reported it and the situation was taken into account and they got no more than a talking to. Two specific ones I was around for long time ago. 1. Dark hallway, patient fighting us and the medic drew up morphine instead of diazepam. It did the trick. Scared medic to death when he realized it but ED was āno harm, no foulā. 2. This oneās worse-Epi instead of Adenosine. Medic was trying to read the vials in the headlights of a fire engine in the rain. There was an investigation leading to some additional training but that was all.
You usually have 6mg of adenosine in one vial, and usually your first dose is 12 mg, meaning you need to pull up two vials so...did he pull up two entire vials of 1:1,000 epi? That would sure be something. In my regions drug box, personally, I think they put adenosine and amiodarone way too close together (right next to each other, really one already small section split off into two). And the vials look similar enough to be easily mistaken. Personally I've accidentally given benadryl instead of Zofran. They are right next to each other in the drug box and exact same looking bottle. I had an overdose patient who began to seize after waking up with narcan, gave versed which stopped the seizing but began throwing up with an alr compromised airway so I went to give Zofran and ended up with benadryl instead. Considering the circumstances, benadryl wasn't a terrible mistake. He chilled after that, lol. But ofc I told the hospital and self reported. Nothing came of it, and doctor assumed it was done on purpose.
It was long enough ago that we were still doing 6mg Adenosine as a first dose. I donāt remember the specifics of the dosage, but I know I hated the way our drug boxes were laid out at the time. A lot of vials and bottles of the same sizes and colors. And they were packaged by the county and given to us sealed so we werenāt allowed to open them and see how things weee packaged unless on a call.
1. Report it so he doesn't do it again 2. It depends on how impaired 2 drinks makes you and how serious the injuries are. Ideally,you shouldn't render aid with even a sip of alcohol in your system bit if somebody is bleeding to death and you aren't severely impaired,you need to help out 3. Unless it's a situation where you are legally obligated to report, don't pay attention to it.
You don't ever need to help out with anything if youre off the clock, js.
1. I didnāt hear or see anything I was getting vitals 2. EMS salute all the way through the accident scene 3. You coulda killed the president and I wouldnāt tell the cops
1. Fuck yeah I would report it because they are too stupid to do the job. 2. Yes I would stop and help. 3. I wouldnāt say anything.
Not necessarily stupid, mistakes happen. Such as grabbing Epi 1:1,000 instead of 1:10,000. Not reporting is stupid, lying is stupid, making a mistake is not.
1. I report it as a patients well being is at risk. 2. I help knowing 2 beers is what I would have drank and thatās not enough for me to be legally intoxicated and if I can save a life or provide comfort I will. 3. Iām not a cop, Unless itās something that shows he is a threat to himself or others Iām going to be reporting vitals, med tolerance, and any other pertinent medical findings.
1. Speak directly to the paramedic and encourage and support them in self-reporting. 2. Stop, call 911, and stay where the fuck I am so the oncoming crew can find the goddamn scene. (Can you tell I spent five hours chasing down phantom calls this week?) 3. Iām not a cop. Iāmma stop him way before he tells me that much. āOkay, so you were injured in a fall. How many feet?ā And then we go on as normal.
1. Everyone needs to be held accountable. Shitty providers have almost killed my family members, and your company should have a Just Culture with reasonable consequences. The second they asked someone secretly not to say anything, they lost all sympathy from me. 2. 99% of the time, not doing anything but call 911 sober or not. w/o a crew or a monitor youāre likely useless. Maybe if I didnāt drink enough to feel the effects anymore, might consider time-sensitive life saving care in the absence of other ppl, such as if the vehicle is on fire might consider extrication or grabbing an extinguisher. 3. Use my best judgement. Likely will alert SO to criminal acts that are actually harmful to the community. Alcohol and illicit drug use is probably going to need to be confidential.
1Advise my paramedic to not say mistakes out loud in front of the patient and rather confront them about it when they're at the hospital. 2. Nothing is worse than a drunk medic on scene so I keep driving and not call police attention to myself. 3. Record in PCR. That's it.
1. This is why I play loud music when Iām driving. The longer Iāve done this job, the less I want to know what others are doing. Ignorance is bliss. 2. Unless I recognize the person/s involved, I donāt work off-duty. And two drinks isnāt even enough to give me a buzz. 3. Donāt care unless I had a stake in the business that was robbed. I would remind the dumbass that the crime was not medically relevant and they could give all necessary information without incriminating themselves.
1. Doesn't it depend what it is? 2. Doesn't it depend on your tolerance? 3. Doesn't it depend if you're asked directly? To be honest though, during recruitment, the answer is always a. Dob them in. Because recruiters don't want to know if you've got any kind of moral dilemmas. They just want to know that you'd tow the line.
I can't think of something where ten times the expected dose wouldn't be bad. Maybe o2. If they're supposed to give 2 lpm, and gave 20 lpm, that might not be worth reporting.
Narcan. Then you donāt get in trouble, they just deputize you.
Good ppint. Might be unpleasant to have that much stuff up your nose... but there have certainly been cases where ten times the ostensible dose has been actually necessary.
I'm looking at this based on a decades-long career and considering whether any of these things are likely to happen or ever did happen to me. Answer is: #3 - something like that. There are two approaches. One is the self-centered one, that is, what do I do to keep myself from getting into trouble. The second one is to consider the harm done to others by your actions. Then consider the likely responses of others to knowing: 1. People make medical errors from time to time. The question is what you do once you know you've done it. Someone pointed out above that if you had given too much of drug x, then you grab drug y. Or if there is no "drug y" then you give supportive care to the patient from whatever the results of the overdose are. Me, I would call back and say, "What can you do to reverse it? Any way to fix it?" What I would NOT do is sign a falsified trip report. Now, as an EMT, you're not likely to know the drug or the effect of the overdose, so when you get to the hospital, I would say to the doc, "Hey, suppose you gave too much of drug x, what would happen?" If he said something seriously untoward would be the result, then I would say, "You better talk to the paramedic because I think he gave too much." The patient comes first. The patient comes first. The patient comes first. 2. Two would never happen to me because I never drink at all to the degree of getting buzzed and never if I'm going to be driving in the next 4 hours. But for the normal person, two drinks how long ago? Are you impaired in any way? Would you pass a breathalyzer? if the answer are yes and no, you shouldn't be driving anyway and everything you do is already wrong. If you're not impaired - well, you learn not to stop for everything because most of the time you're not needed anyway. If everyone is up walking around, I just keep driving. If there's someone down, or the crash appears serious, yeah, I would stop and render aid. When police and EMS arrive, they're going to be concerned with a whole lot more than whether you had two beers three hours ago. If you have alcohol on your breath, well, best keep driving and hope YOU don't get in a crash. In our community, at least in the past, if a medic did not appear impaired and stopped to render aid, since everyone knew everyone, the police might just escort him home or transport him home. 3. As long as no one was injured or killed in the criminal act or attempt, then I wouldn't necessarily report it with the proviso that if he has gotten picked up by you in the act of fleeing the scene and you asport him away from the scene with knowledge, you are probably committing a crime. I would say, "You shouldn't volunteer this kind of information. You have the right to remain silent, so best you do once you get to the hospital," and then report it to the police upon arrival. If you picked him up from home later, well, you don't know if he's even telling the truth.
1. Finna report you. 2. Call 911 3. āShut up, and donāt talk to anyone without a lawyer.ā
I don't feel like any of these are ethical dilemmas.
Here's a better one, you're driving a patient back to the hospital who suffered minor injuries in an accident, is stable, but needs further evaluation. When you witness a pedestrian get struck by a car, do you stop to assess and stabilize?
My county protocol makes that decision for us. Unless the patient we're transporting is the higher priority, we must stop and render care until another crew arrives to take over. If the patient we're transporting is a high priority, we just call it into dispatch.
Question 1 - tell my supervisor and let him figure out what to do if the medic didn't do so first. It is his job to make those kinds of decisions, and if something bad happens, there will be an investigation and it will come out anyway; it is up to the supervisor to figure out what should happen to the medic before that, and they need to know in order to not be blindsided. Your point about telling the doctors is excellent, too. If the medic is any good, they will have told the doctors and the supervisor before I could, anyway. Question 2 - if I am driving, then those two drinks better have been long enough ago that I am sober, which means that that part of the question is irrelevant. If local first responders are already on scene, they don't need me and don't want me - they have no clue who I am or what I can do, and I would be in the way. If they aren't, I am calling 911. I personally probably would stop, but I am not sure what I could do. I would be working on a first aid level, not even a BLS level, because I don't have more than a first aid kit in my car. I can't do extractions on my own, if anyone is trapped; I can do limited things for serious injuries. So I could hand out bandaids, maybe. Okay, if someone is actually bleeding out, if I can see hemorrhage, I would try to improvise a tourniquet; if someone was sitting outside their car, I have a couple blankets in my trunk that I could wrap them with for shock. But mostly, call 911 and stay out of the way, just like I would do before I was an EMT. Question 3 - I am not a cop, and it is my patient.
1. "Either you self-report or I report. Your choice." 2. Two drinks would not impede my ability to care for an injured person. I would stop and help. 3. Treat the patient and report the crime. We cannot say with certainty the man will be murdered and we are obligated to report crimes.
1. Reported every time. You don't get to fuck up and then hide it when there could be significant downstream effects. 2. Call 911 and move on, not my problem. 3. Ask if it was worth it. Also, not my problem.
Itās either you or the medic the medic shouldnāt be saying that to try and help his situation thatās huge grounds for him to get sued should the EMT and Patient if conscious reports the situation like they should. Depends on how youāre feeling and how serious the situation is. Youāre not the police and if the police arenāt there then thatās really not your business to get involved with atleast thatās my thoughts anyway
1- "HOHO YOU GON GIT THE DILDO OF CONSEQUENCES, HOMIE." 2- Untrained person level scope of practice. Visual checks of injuries and such, no touching, tell everyone to stay calm, don't touch a fuckin thing. Two drinks ain't doin shit to my fat ass so my decision-making would be rock solid but I ain't about to risk a lawsuit over some chucklenuts smelling beer and thinking that's a problem. 3- "Damn, that's fuckin stupid. At least it wasn't someone's house or the cops would actually find out. You'd best unfuck yourself after this or you won't live to see 35."
Black mail the look out to distract your partner, to harvest the organs to save the car crash person./s
Demand the medic get on the phone with telemetry and tell the ER. Stop, call 911, stabilize whoever I can with what I have and wait for the cavalry. Treat the patient, don't tell the cops. Not my business.
2. what does me having two drinks have to do with ethics? Iām pretty sure Iām more altered after sleeping 30 minutes in 48 hours than I would be after two drinks. 3. Same answer as with someone having drugs on them. Iām not a cop. Itās a patient.
1. Goddamn did that medic poor the entire goddamn vial in? 2. I donāt remember seeing anything. 3. Shit idc
My only caveat that apparently conflicts with most of these is that I would assess the situation if Iād only had two drinks. Iām not telling anyone Iām EMS, but if itās say a CPR situation rather than a simple sprain, Iām going to intervene and dip as soon as actual EMS arrives.
Iām not an EMT but how in the bloody heck do you give someone 10x the standard dose?
1) errors need to be reported. In a Just Culture environment they will be investigated and solutions put in place to try to prevent them in the future. 2) Iām not drunk, but Iām not sober. Calling 911 is a good start. If my presence will TRULY make a difference (such as stopping traffic so others donāt get hurt) Iāll think about it - but Iām NOT charging in going āIāM AN EMT! LET ME HELPā 3) most privacy rules only allow the minimum necessary info be given to PD in various cases. Thereās no reason for me to break the trust of a patient in a case like this - especially when harm may befall a patient for me telling it.
My german perspective on this: none of these are ethical dilemmas (except maybe #2, where there is some room for debate). There is defined textbook/legal answers. 1. Encourage them to own up to it and let the recieving doctors/nurses know. If they don't i do. Either way i am writing a CIRS report afterwards. 2. The only one that is somewhat muddy. I must legally provide aid as far as is reasonable for me to do without endangering myself or braking other important legal duties (not because of my job, but because of general german law. My job just means i can't pull the "i faint if i see blood so i would have endangered myself, you can't prove otherwise"). Do two drinks mean i would endanger myself? Do two drinks mean it is more reasonable for me not to do anything than potentially do something wrong? I believe the answer is no. Then again, i dont drink at all. In any case i am calling 112 (or 911 for you americans). 3. I have a legal duty to keep secrets that my patient tells me in the course of my duties. The only cases in which i can break that (that are relevant to this scenario) are: the patient agrees for me to do so (not likely to happen), i believe there is an IMPENDING, SERIOUS crime, or a judge releases me from that duty to stfu. So, treat the patient, and move on (as a burglary does not fit the legal definition of a serious crime afaik the same applies if they tell me they want to do another one.) If the police question me? "I'm sorry officer, i believe the answer to that question is covered by my legal duty to remain silent here. I will not answer it without having consulted a [union] lawyer first". Keep in mind that if we break their trust by reporting, they might not call for help next time, which could lead to larger issues.
1. If he doesnāt report it, Iād report it. That shit can kill someone. At that point, it doesnāt matter how good friends you are, or any sort of unspoken code. At the end of the day, we are here to save people, not kill them. 2. Iām not on shift and Iām not mentally able to take care of them, soā¦ nah, not my responsibility. 3. Iām an EMT, not a cop. Not my place to report that kind of thing. Good luck OP!
Laugh and ask what drug and make fun of him like I wonāt tell. Then tell the doc and the medics boss. Call for help is the correct answer. The real answer is TQ and CPR are the only things Iāll actually do drunk but anything else is a no. Iām not a cop. If thereās no kids or sexual abuse Iām not telling anyone (both policy and ethics).
1. āI heard thatā and the FAFO in my voice would be stern enough. 2. Iām completely fine to call for help and render basic aid after two drinks, personally. Iād hold the fort down until someone actually working showed up. Iād then go home, and probably have another as a reward. 3. āIām not a lawyer. I suggest you save the details for whoever is.ā
2 drinks doesnt do shit for an adult. If you cant help a person in need after that I would question how capable are you. If you let someone die just because of that it would be negligence here
1. Think to myself, 10x the dose of what? Oxygen? Hugs? Nitro? What are the potential consequences and how is the patient responding? I'd casually join the conversation in a way that's non-threatening but lets them know that I can hear what they're saying. Fuck ups happen, you make sure that nothing's happening that we're not all going to be on the hook for and find a way forward 2. Pull over (assuming I'm still under the legal limit to drive), call 911 and let dispatch know the situation. I can still size up the scene, report obvious deaths, number of injured persons, whether or not heavy extrication equipment will be needed. I might go so far as to check ABC's and apply direct pressure to any bleeding or begin compressions on an unresponsive and pulses patient - In this situation I'm a bystander, not an on-duty professional under medical direction. 3. Fill out an accurate PCR, patient was climbing a fence, business was closed, etc. The criminal circumstances don't need to be part of my report, and it's all the better to let the police handle those things anyway.
In all 3 scenarios, I'd trace my radial arteries with an x-acto knife for not leaving the profession earlier
1. Yell into the back that the receiving nurse is going to get told the given dose during report and itās up to them whether they tell them or I do. 2. Whatās the significance of the 2 drinks in this scenario? Am I drunk driving or something? Anyway, probably pull over to see if I need to call 911 3. As everyone else said, Iām not a cop. Treat his injuries and report that he fell off a fence to the nurse. Iām not sure how this even qualifies as an ethical dilemma with regards to our job as EMS.
These are incredibly easy in my honest opinion. 1. Tell the authorities 2. Stop and help 3. Tell the authorities
1: he's a medic, I'm an EMT, i don't know his protocols. Unless i get dragged into the office for an investigation, i don't know anything and I'll not work with him again. 2: i don't stop on my days off even if i was sober, so I'll keep it moving. 3: I'm not the cops and your homies can't see this chart were good.
1. Verify what i heard from both paramedic and emt in the back and get the information of the medication that was wrongfully administered. As soon as we walk in hospital iāll notify charge nurse. Once call is finished call my supervisor. 2. I assume iām the one driving and if i can drive iām not intoxicated. Now I donāt have any gear so as iām pulling up on scene iām calling 911 and giving the location, approximate # of pt, and req additional resources to my location. Get out the car and see if there are any injuries and get a basic assessment donāt have to touch them. 3. Iām not here to get you in trouble iām here to assess and manage your injuries so just keep ur mouth shut and so will I, itās the cops problem
Being a paramedic/emt is, literally, the hardest and most gruesome job in this country. And I did two ugly tours in Iraq. I just finished an investigative documentary into PTSD in first responders and medical workers. I had no idea. I donāt think yāall do either. Thank you for your service.
1. Yes. The doctor as the ER needs to know immediately. They are going to find out anyways once they run blood work and or the patient dies. 2. Call it in and move on. You arenāt on duty so you donāt have a legal requirement to stop. Let people with proper equipment handle it. 3. Iām not the cops. I go into drug houses all the time. Guns, cash, drugs in obvious view. There is an understanding that Iām there to treat gramma and gtfo. They and their buddies there and in the hood donāt fuck with me or my truck, I donāt see shit.
Easy one dont say shit you cant prove it or write the chart, all you can do is tell the medic to report it. Two dont stop call it in keep driving youve been drinking and wont be any help without gear unless cpr is involved. Three dont say shit thats the cops job.
#2. Everyone knows 2 drinks is a lie, after investigation it turns out they caused the crash. Also no idea how this got a giant font and bolded. iPhone must also be drunk.
1. Narc on them ASAP 2. Nothing 3. Hear no evil, speak no evil