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T-Bone: You’ll Never Please ’Em All
EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don’t have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we’ll pay you $50. We don’t know everything, but we do know a lot of smart people. If we need to, we’ll contact just the right experts and share their advice with you. Send ideas c/o emseditor@aol.com.
You’ve responded to the scene of a garden-variety MVA involving two vehicles, in which a late-model Cadillac sedan has T-boned the passenger side of a 4Runner. There’s significant damage to both vehicles, but it looks like everybody is out of the cars except for the driver of the Cadillac. You see no smoke, no spills, no serious traffic problems and no other suspicious circumstances.
You locate two people with complaints: the front-seat passenger of the 4Runner, with right-sided chest pain and difficulty breathing, and the 70-year-old driver of the Cadillac, who is confused and does not remember the incident. A second medic unit is also on scene; you take the driver of the Cadillac.
The lady gets out of her car as you walk up, and you introduce yourself. She gives you her name and denies having neck or back pain. The driver’s area of her car is unremarkable except for the expended air bag.
She has a cut on her lip and a small abrasion where the air bag jammed her glasses into her brow. The wire-framed glasses are bent but otherwise intact. She’s answering questions and obeying commands, and her eye exam is normal. Her sensory function is normal. She has a full set of teeth, and her teeth and tongue appear intact. She again denies any soreness in her neck. The rest of her exam is unremarkable, except for some tenderness in her left lateral ankle. The cardiogram reveals a regular sinus rhythm with no ectopy and a normal axis.
Q. Based on this description, would you c-spine this lady?
A. You could justify that decision either way you choose. But considering her confusion, you might lean more in favor of stabilizing, especially since it’s not clear whether she was confused before the impact or just afterward. It may also be helpful to get police testimony before you leave this scene. For instance, did this lady do something unusual to cause this accident (like run a red light) or is she clearly not at fault? Sometimes a brief chat with PD just before you leave a scene can provide you with a valuable piece of a puzzle like this one. (It would be a mistake to presume she caused the incident just because she’s elderly and she’s confused.)
A month later, your operations director informs you this woman has accused your crew of forcing her to walk to the ambulance and board it under her own power, despite the fact that she had a broken ankle. You would never have done such a thing, and you’re pretty upset. You, your partner and the first responders did a very good job for this lady. Your boss has checked with the hospital, and they confirm a fractured left distal fibula.
Q. Is this lady likely to sue you and, if so, what can you do to protect yourself?
A. It’s extremely rare for an EMT or paramedic, with the support of good first responders, to do a great job for somebody and actually get sued for their actions. It’s even more rare for such a lawsuit to get to court. But there is something you can do to protect yourself and your colleagues, and chances are you already do that several times a shift: It’s called documenting your care.
This was a real call, and the paramedic who took care of this woman had no idea at the time of the call that she might eventually complain. But since he had made it a professional practice to chart his care in detail, it was easy for any investigator to see that he had done an excellent job for her.
Q. It can be pretty upsetting to be accused of something like this by someone you’re sure you treated well. How do you keep yourself from getting cynical?
A. You don’t need to become cynical, ever. Even if you’re very talented and you consistently do your level best to care for people, there are going to be some who won’t appreciate your efforts. The following tips work for lots of excellent caregivers:
- Remember your most important critic is the one you see in your bathroom mirror every day.
- Don’t take people’s comments too seriously whom you know to be confused when you encounter them.
- Insert the positive notes, letters and other comments you do receive in a scrapbook. When you do your very best for someone and they don’t appreciate it, you can go home and remind yourself how many people have been grateful.
- Some EMTs keep journals. A journal might help you to keep your balance in the same way as the preceding tip.
And finally, - Remember who owes what to whom. Although it’s nice to get, people don’t owe you their appreciation. You serve them because you’re a caregiver and that’s what caregivers do.
