Mess Ups..

[Ethanol4all]

...just a random question, but has anyone ever completely messed up on a call ? like, just blatantly misdiagnosed, mistreated, or even simply had no idea what was wrong and what you had to do..? ...sorry....EMT school's been kinda making me paranoid of approaching a victim, and just choking completely h34r: :sad: :blush:

 

[firecoins]

we don't diagnose so you can not mis diagnose.

I didn't do a complete physical assessment and major bruises were found on the patient's back. The pt was disoriented and could not tell what was wrong.

 

[FF/EMT Sam]

That's a normal fear, and all of us make mistakes (except for RidRyder, of course ). As long as you know your stuff and keep a level head in the midst of chaos, you'll be fine.

 

[Epi-do]

Sam is right. No one is right 100% of the time. We have all made mistakes at one time or another. Your fear is one that all of us have experienced at one time or another. Stay calm, make sure you know your stuff, and don't be afraid to ask for help from others on the scene. You will do just fine!

 

[HorseHauler]

#1 on the list of pearls...

*Always involve someone with deeper pockets...

When in doubt... call medical control

 

[akflightmedic]

First, I have to disagree with the statement "we don't diagnose".

This is filled with complete ignorance if you believe that. You do make a diagnosis or you will never be able to do any treatment as you would not know what the problem is. The only caveat is our diagnosis may not be the same the ER comes up with, but it is the one we formed in the field to intiate treatment.

Another fine example of where education comes into play because if we truly understand A&P, amongst many other things, and eliminate the "if we see this we do this" mentality, it is easy to form an educated diagnosis and render appropriate care.

Now for the question at hand.


We all make mistakes. We are pacticing medicine, emphasis on practicing.

Some mistakes are minute and some are fatal. Yes it happens and no the person who made the mistake does not always get caught or penalized. As you advance in your knowledge, situations will present themselves that may lead you to choose one out of several appropriate treatment modalities. You go with what you know and the person suffers. Were you wrong? Who knows, but you will second guess yourself for a long time and that is something you should not do. Discuss it afterwards, constructive criticism is fine, but do not leave your mind to always wonder what if you had done something else.

Freezing up on a call is normal as well but the way to avoid this is to be sound in your knowledge and confident within yourself. You may find yourself surprised at how quick you actually react to situations when you least expect it.

 

[firecoins]

First, I have to disagree with the statement "we don't diagnose".

This is filled with complete ignorance if you believe that. You do make a diagnosis or you will never be able to do any treatment as you would not know what the problem is. The only caveat is our diagnosis may not be the same the ER comes up with, but it is the one we formed in the field to intiate treatment.

Another fine example of where education comes into play because if we truly understand A&P, amongst many other things, and eliminate the "if we see this we do this" mentality, it is easy to form an educated diagnosis and render appropriate care.

wedo not diagnose because it is against New York State and National Standards for basics to do. Our interventions on an EMT Basic level are opening airways, oxygen therapy, stoping external bleeding and stabalization. In some cases we can give aspirin, epi-pens, abuterol and nitro depending on protocols and usually with permission from medical control who will make the diagnosis.

Even if someone has an obvious broken arm we are not allowed to say they have a broken arm but we are allowed to splint the non broken, broken arm.

 

[ffemt8978]

wedo not diagnose because it is against New York State and National Standards for basics to do. Our interventions on an EMT Basic level are opening airways, oxygen therapy, stoping external bleeding and stabalization. In some cases we can give aspirin, epi-pens, abuterol and nitro depending on protocols and usually with permission from medical control who will make the diagnosis.

Even if someone has an obvious broken arm we are not allowed to say they have a broken arm but we are allowed to splint the non broken, broken arm.

You make an assessment, correct? I hate to bust your bubble but assessing a patient's problem is essentially diagnosis - we just call it something else.

 

[VentMedic]

First, I have to disagree with the statement "we don't diagnose".

This is filled with complete ignorance if you believe that. You do make a diagnosis or you will never be able to do any treatment as you would not know what the problem is. The only caveat is our diagnosis may not be the same the ER comes up with, but it is the one we formed in the field to intiate treatment.

Another fine example of where education comes into play because if we truly understand A&P, amongst many other things, and eliminate the "if we see this we do this" mentality, it is easy to form an educated diagnosis and render appropriate care.

You might call it a "field diagnosis" which is appropriate in some circumstances. However, if called to give a legal deposition on your "diagnosis", it would be wise to stick with the DOT terminology of Assessment Based Management or Clinical Decision Making. Saying you diagnosed (even if your agency says you can) could bring another set of questions that you may not be prepared for. Essentially that is what is also done in the ER initially until more definitive testing is done. Many disease processes have the same presentation but very different treatments.

Making a "diagnosis" may skew your clinical judgement into trying to fit what you see into that "diagnosis". Thus, you may miss some very important information during your assessment.

 

[firecoins]

You make an assessment, correct? I hate to bust your bubble but assessing a patient's problem is essentially diagnosis - we just call it something else.

I hate to burst your bubble but I am suppossed to assume the worst based on the nature of illness. That is not a diagnosis. I assume th worst and give interventions based on that assumption and what medical control says.

If I could diagnose, half the people I backboarded wouldn't have been.

 

[Ridryder911]

That is why field care is changing, to rule out and prevent many from being CID and LSB.

Clinical impression, field diagnosis is just wording semantics, like other profession other than physicians can diagnose as well.

R/r 911

 

[VentMedic]

Semantics can be scrutinized in the legal arena.

The term diagnosis is often overused and misunderstood. Other health care professionals also make a "working" diagnosis based on their clinical assessment to follow certain protocols or clinical pathways. Their diagnoses are separate from a medical or disease diagnosis. In many circumstances, without the additional diagnosic testing, the "educated diagnosis" is no more than an educated guess. You can see that from some of the different forums around the web.

Example; The nursing diagnosis is a patient problem as identified by the nurse based on the nursing assessment. It is NOT a disease diagnosis. The terminology nursing diagnosis is legally acceptable if the nurse is not making a medical/disease diagnosis or ordering care. Problems arise when the nurse fails to understand the difference and writes a medical diagnosis on a patient.

CV nurses have advanced practice protocols but are doing clinical assessment and initiating their care pathways from that. They may have a "working" diagnosis in mind but are not making a medical diagnosis.

Nurse Practitioners can make a diagnosis by ordering differential testing as needed. Their practice protocols must identify the area of practice to be performed by the nurse practitioner in collaboration with a physician. Collaborative practice arrangements are written agreements between the physician and NP.

Example: For Physical Therapists, it is the determination of the physical therapy diagnosis as well as recognition of clinical findings that would require referral to a medical care provider when the medical diagnosis (ie, diagnosis of the pathophysiologic condition) is in question. The Physical Therapist has a minimum of a graduate degree of at least a Masters, preferably Ph.d.

The same is true for the Speech and Occupational Therapists who have similar educational minimums.

For a good legal stand, choose your words carefully.

 

[Ridryder911]

I agree, even physicians have to word as such. My point though is that the word diagnosis can have more than one connotation and meaning.

P.S. Not all states require Nurse Practitioners to be directly associated with physicians, in fact very few unlike PA's, since they work on their own license. In fact 16 states allow NP's to work free standing and as well have the ability to bill on the their own, without a physician oversight or participation and yes they too can as well legally medical diagnose as an advanced practitioner. This is reason I changed from PA program to a NP program.

R/r 911

 

[VentMedic]

My point though is that the word diagnosis can have more than one connotation and meaning.

True, many diagnoses for both working and admitting are actually "symptoms" such as chest pain and shortness of breath. CHF or Pulmonary Edema can be used as a symptom and diagnosis. PNA, COPD and RAD (in children) are broad catch alls. Even the term ARDS is used in a broad sense and yet it is a specific diagnosis. As you know from also being a Reg Nurse, we have changed the "wording" of our cardiac protocols several times over the past few years; R/O MI, Chest Pain, Acute Coronary Syndrome etc.

P.S. Not all states require Nurse Practitioners to be directly associated with physicians, in fact very few unlike PA's, since they work on their own license. In fact 16 states allow NP's to work free standing and as well have the ability to bill on the their own, without a physician oversight or participation and yes they too can as well legally medical diagnose as an advanced practitioner. R/r 911

It has helped also that NPs have increased their education level to Masters in many states. The quickie 6 mth programs after 1 year nursing experience that Ohio State and Georgetown had weren't enough. It made people leary of giving them the indepence they have now. There are still several 1 yr and 18 mth certificate programs without the benefits of a Masters degree. The PA programs are also going to the Masters level in many states.

The only point I was trying to get at; know your audience and choose your wording appropriately.

 

[VentMedic]

...just a random question, but has anyone ever completely messed up on a call ? like, just blatantly misdiagnosed, mistreated, or even simply had no idea what was wrong and what you had to do..? ...sorry....EMT school's been kinda making me paranoid of approaching a victim, and just choking completely h34r: :sad: :blush:

I guess the thread got a little side tracked.

Probably everybody has choked on scene at least once in their career whether starting out or as an experienced provider. Just when you think you've seen it all, you really haven't. I am still amused, amazed and at times horrified by what I see. The big thing about making a mistake is knowing you've made it. Then it can be corrected and something will be learned in the process.

When approaching, make sure your safety is priority.

If the pt presents as a complex "who knows what's wrong", do your ABCs. Then, if the pt has his/her ABCs intact, you can take a deep breath and go on to do further assessment. Treating what you can at the BLS level, monitor the vitals, re-assess as needed and relay to the hospital staff what you saw at scene, signs and symptoms as presented by the pt. and any changes. Communicate/Listen to the patient. Hearing their voice tells you they are still ventilating and mentating to some degree. You will have a partner on the ambulance that can provide another set of eyes, ears and assessment. Don't get ahead of yourself. The paranoid feeling will fade after you get hands on experience in the field and put the book learned skills to use.

Most of the patients we get in the hospital, we just have to treat the signs and symptoms until more testing is done. Sometimes it might be days before we know the bug, disease or disorder we're dealing with. Much of the treatment is trying to stay ahead of things before something else falls apart on the patient. It would be nice if all the ailments would fit neatly into the few disease processes learned in EMT or Paramedic school.

Relax, EMT will be a nice beginning for future endeavors. See it as a compliment to your other college work at UCLA. Developing good communication skills in both areas will enhance your career prospects.

 

[Airwaygoddess]

Hi! I know that being in a learning situation can be overwhelming but you have to remember one thing, no question is ever stupid, it is better to ask and get an answer then not to ask and do the "what if " dance. Second, keep in your scope of practice. Your instructor should have gone over this information and if items come up and do not make sense, ASK! Last but not least, I'm going to give you a piece of advice that my mom passed on to me, and I have passed it along to students and brand new nurses along my way.
" It is always important to have just a little "healthy" fear, for your job. Because it teaches and reminds you to have the respest for your profession"
Keep on learning!

 

[EMTBandit]

Everyone makes mistakes. It just a matter of learning from them instead of worrying about it. Like one night I made an embarrasing mistake on the radio, or at least I was just embarrased that I did it. But instead of worrying about it, I learned from it. Same goes for calls, if you think you did something wrong on a call, or didn't do it as efficiently as you would have liked, ask for help or just take a deep breath and slow it down a bit so your not as frightful. As was once said, The only thing we have to fear, is fear itself. Fear can be a good thing, as long as you learn from it and don't let it paralyze you.

 

[mfrjason]

Even though people think we are computers,we're not,we do make mistakes.

 

[firecoins]

No! My protocols say I am in fact a computer.

 

[Jon]

you know.. we need to just start a "diagnose vs. don't diagniose" thread...

Anyway... We've all made mistakes at some point... the trick is to learn from them, so that you don't flub next time.