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Thursday, August 8, 2019

Due Diligence - When reporting an incident isn't worth the keystrokes and calories burned to create it

Your patient is one of the dozens your system will encounter this week who's had an adverse reaction to an opiate ingestion. The patient is revived by law enforcement prior to your arrival with intranasal administration of Naloxone ® (Narcan), the popular opiate antagonist cited in every news feed in the U.S. The rest of the call is a ground ball, an all too familiar, routine transfer to the local hospital where your patient is likely a frequent consumer of health services.

Transferring Care 


When your team arrives, there are several ambulances in the ER bays dropping off, picking up, doing the business of their trade. You roll your stretcher inside with your now awake, and visibly annoyed, patient (annoyed because you ruined his high), get him registered, and attempt to give the triage nurse your patient report. A neighboring volunteer EMS agency is also giving report on their patient (completely unrelated incidents) when their "leader" happens to overhear your partner give the patient report. He interjects and confronts your partner with his strong political opinion about the opioid crisis and how he is against the now strongly encouraged public use of Narcan. Further, he actually blames your partner (and thus, all first responders) for "enabling" these people to overdose again and again without fear of consequence. He states that we (EMS and the public) are "perpetuating the opioid crisis." Your partner, now visibly disturbed, attempts to de-escalate the conversation as it is getting louder, and the pontificating EMT gets more emotional. It appears he enjoys hearing the sound of his own voice as he continues to badger your partner and loudly display his strong beliefs.

Eight to ten feet from this tirade, safely strapped to a stretcher and flanked by your BLS team, is your patient, who is now completely awake, alert, and aware of what's happening around him; his privacy and promised confidentiality-- breached. Three feet from his stretcher is the volunteer agency's patient, a young female in some form of emotional distress, evidenced by her crying, sobbing and increased agitation at the hospital's delay in her care. She's in a small, wheeled chair, unsecured and unprotected. The other three EMT's that are "caring for" her are scattered about the lobby, seemingly disinterested and not engaging with (or protecting) said patient. A crescendo is reached between her sobs and his blathering. His abject disregard for patient privacy and narcissistic passion for the, sound of his own opinions are on full display. Now hysterical, the female patient jumps up from her chair, rushes the sliding doors and knocks them clearly off their tracks as she elopes from the emergency department and races out into the night.

Stunned, your team escorts your patient into the ED, transfers the patient to the hospital staff and the story ends -- one would think.

Having witnessed this constellation of poor care, patient abandonment, and flagrant violation of patient's privacy rights, you - are -furious.  "This can't (shouldn't) happen" you think to yourself. "We're professionals. Professionals don't behave like this" you reason. Your mind on fire with equal parts frustration and embarrassment, knowing that if this event turns tragic (something happens to the eloping young lady), your hospital will likely point the finger of blame on EMS since that patient's care hadn't been officially transferred to them yet. Shortly thereafter, the media, with its penchant for getting the facts straight, may conveniently forget to name the agency involved, might even misreport this as an event involving your agency. It would be a disaster for sure.



You do "the right thing" and report the incident to your supervisor. In turn, your supervisor conducts an investigation. He/She questions your team individually and later, questions the nursing staff that was there. This is an obviously open and shut case you think to yourself. 
  • There was an incident. 
  • There were witnesses. 
  • There's video recorded on the security cameras for Christ's sake! 
We're not expecting miracles here, but one can hope that in such a case, justice can be delivered swiftly and accurately. The offending EMT needs, at the very least, to be re-educated - and probably a better option - to have his privilege to be around patients revoked given his exercised poor judgement and lack of respect for patients and privacy.



Almost forty days later, your supervisor responds to your incident report. In their brief message, it states that your case has been closed/resolved. They report that management is working on a plan to deal with agencies outside of their control. In short, nothing has happened. Nothing is going to happen. And you used your precious time and energy burning calories writing the stupid thing up in the first place for absolutely - nada. Tell me again why I should ever escalate anything to our "leadership team" when leadership is the last thing we can/should expect. They obviously have not the stomach or political will to engage one of these volunteer agencies, even when their people make an egregious error such as this.

My suggestions?


  • Your job probably requires that you report incidents you witness or are involved in. Don't jeopardize your employment. Do what they ask and do it well. 
  • Keep in mind that some management teams have the ability to make things go away. Sometimes complaints seem to just vanish into the ethos, particularly when convenient or expedient for someone - other than you. 
    • Documentation is KEY! Make notes. Record times, dates, locations, what happened, witnesses names. 
    • Make copies for yourself. Write them down. Record them digitally. Make a voice recording. Leave nothing to chance.
  •  Consider escalation or alternative reporting. When it involves a reportable incident such as the one described here, these behaviors are violations of policies/laws far beyond your agency's control. If they're unwilling/unable to follow through on this, perhaps your Dept. of Health or regulatory agencies may. Kick it up to them and see if anything comes of it. One thing you can be certain of is that your complaint gets memorialized there. If enough similar complaints, or something suggesting a pattern of behavior is noticed, they don't have an option to squash it. Rather, they're obligated to protect the public and hopefully can take action.

In Summary


This post can easily be misconstrued as anti-management and nothing could be further from the truth. I've spent over three decades working very hard at being an exceptional employee and role model for others. What I am guilty of is being:
  • Anti-cowardice
  • Anti-ineptitude
  • Anti-complacency 
People do stupid shit that can jeopardize all of us. You say document and escalate to "leadership." If I do that, I have a reasonable expectation that you might actually follow through (and I mean more than have a very concerned, high-level meeting). Use all that education I see appended to your email signature and execute! When you don't, we're left feeling like your team is more symbolism than substance; and like what we're writing is not worth the keystrokes or calories burned creating it.

"I'm the guy that does his job...
You must be the other guy."  - The Departed

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