The Biggest Mistake of my Career

I have never talked about this call…ever. It shows my humanity, how even I, Ms. Super Medic, could make huge mistakes. I owned up to it through Medical Command and a Medical Review and I didn’t even get a slap on the wrist due to the circumstances. What remains is that, I could have very easily killed someone and I was damn lucky I didn’t.

The call started out on a bad day in January. I got into work on a blustery, rainy morning and I had come in early because we were supposed to get slammed by a bad snowstorm. I didn’t have a four wheel drive vehicle, so I wanted to avoid the slick roads. By 0900, what was supposed to be a snow storm ended up being an ice storm. The roads were coated in a thick sheen of ice. I could hear accidents going out all through the area, but for some reason, our 5 miles of highway and side roads remained free of accidents. Around 1000, we got dispatched for a female complaining she was dizzy.

The distance from our station to the scene was no more than a quarter of a mile if that. I could see the freaking apartment building from the station. I called the dispatch center and told them to relay to the patient that it would be a minute; we couldn’t even get out of the parking lot because we were just slipping and spinning on the ice. Once we got on scene, I remember getting out of the truck and immediately face planting in the parking lot. I smacked my face off one of those parking berms and I gave myself a black eye and nose bleed. My partner slipped on the ice and fell on his back; he ended up having a bruise the size of a Cadillac on his ass. It extended from the top of his butt and halfway down his thigh. Trying to walk the fifty feet to the front door had us falling twice more apiece; I added a bruise on my side after I slipped up the concrete steps where I thought I broke a rib and a fall on my butt, but because of the junk in my trunk, I was fine. My partner fell on the same spot both times which contributed to the bruise. Once we got to the apartment, we both looked like hell. I had already shoved a 4×4 up my nose to staunch the bleeding and my partner was limping. When the woman answered the door, she smiled smugly at us and said, “Took you long enough. You went en route fifteen minutes ago.” I apologized, saying we had to drive very slowly through the hilly, cobblestone streets and we had slipped and fallen outside. She rolled her eyes and told us to come in. We walked in and she sat back down on her couch. I set down the ECG (A LP-10. This is very important), my House Bag, and the O2 tank. I sat next to her and went into my normal conversation; I introduced myself and my partner, asked her what was going on, all the while I had gently taken her wrist and began to feel her pulse. It was fast under my fingers, but I caught it at between 100-110bpm. The patient told me that she had woken up when she heard her scanner going off and she sat with a cup of coffee listening to everyone run around. She admitted that she had stood up too quickly when she heard that a cop car had wrecked at the bottom of the hill and she felt a bit woozy, but she felt fine immediately. I took her blood pressure, which was normal and I put her on the monitor. The rhythm was Sinus Tach, but the rate number was flashing and kept going back and forth between 110 and 240bpm. I printed out a strip and counted out the QRS complexes manually and I got 118. As I was working, I asked her if the dizzy spell was why she called 911. She then admits that, she wanted to see how quickly we could get there in bad weather, so yes, that was why she called. I remember wanting to throttle her at that exact moment. She was feeling fine, no ill effects, and she called 911 to see how fast we could get there. I held my composure and asked if she wanted to go to the ER and she rolled her eyes and said, “Well, duh. I’m not paying taxes and your salary just for you to check my blood pressure. I paid for your truck, lady.” I was itching to tell her that none of her taxes went to paying for our ambulance as it was purchased in the early 90’s at an auction in Texas. The funds were raised from various bake sales and private donations, but I bit my tongue and asked which hospital she wanted to go to. I cut her off immediately by saying that we couldn’t go to one of the hospitals in the city due to the road conditions; we were more likely to crash than to make it, but she had the choice of two community hospitals, one of which was a cardiac center. She chose the cardiac center. I asked if she wanted to walk to the ambulance; she had been walking around the apartment putting food down for her cat and dog, getting changed into clothes, and tidying up in the kitchen all the while ignoring our objections. She gave us the line that she paid for our salaries, so we needed to do our job correctly. She then began demanding oxygen because “my taxes paid for it”…even though she sat’ed above 98% the whole time. We put her in the stair chair and wheeled her to the lobby where we left the stretcher (stretcher didn’t fit into the elevator, even broken down). We lowered the stretcher and placed it right next to her chair. I asked nicely for her to stand and pivot, then sit on the stretcher. She crossed her arms over her chest and stared at me with this evil, soul stealing gaze, so we picked her up and put her on the stretcher.

I had the LP-10 slung over my shoulder and I kept looking at the rate; it never popped over 110. We wheeled the stretcher outside, managing to not kill ourselves, and we loaded it into the ambulance. I did a quick IV and hung a bag of saline KVO while I fitted her with a nasal cannula at 4lpm. It took us over 20 minutes to get to a hospital that usually takes us less than 10 without lights and sirens. We slipped and slid all over the road…at one point we spun out and I remember looking out the back windows and I realized we were sliding backwards down this little hill. The woman kept criticizing us; we were horrible ambulance drivers and she couldn’t believe we were having that much trouble driving. What she didn’t realize and what she couldn’t see is that my partner managed to keep us from wrecking I don’t know how many times. I remember looking up front and the MPH gauge was below 5 and my partner was sitting funny. He told me later on that he was standing on the brake, yet we continued to slide on the ice due to forward momentum. The entire time, I kept her on the LP and it kept up a steady rhythm at 110. The pulse ox, which had its own pulse monitor had her at 99% and 112bpm. Feeling her pulse, I got her at 110. Her BP never wavered from the 130’s systolic. We got into the ER and out of pure habit, I hooked her up to the hospital monitor while waiting to give report. The hospital machine started alarming and I looked up; she was in a full SVT at 198. A nurse ran in and started yelling at me; this wasn’t a dizzy spell, this was SVT. I grabbed the Adenosine from my house bag that was on the stretcher and the nurse grabbed it out of my hand and pushed it for me. I remember standing up against the wall, not sure what to do.

Boy, did I get chewed out by the nurse, the patient, and the ER doctor. I swore they were going to cut up my Medic card right there. The rhythm broke with the first dose of Adenosine, but I handed them the strips I printed out; all the strips were time stamped as well as marked with the BPM: 110. I told them I never felt it go above 110 and I don’t know why I didn’t see it.

Several weeks and several meetings went by. Come to find out, the patient went back into SVT while in the ER. The nurse was manually feeling a pulse and she herself didn’t feel a rate over 100. The patient never became symptomatic and it was documented in her chart that she had a history of Asymptomatic SVT. It was also found that the monitor was malfunctioning, but I was never told exactly how.

I honestly feel that this was the biggest mistake of my career. For weeks, I felt so ashamed, as I had done something horribly wrong. At the time, I was a pretty new Paramedic, but I was making one heck of a name for myself by being spot on with every differential diagnosis I made. I felt that my reputation would be tarnished by what had happened. What I didn’t realize was, these things happened. Several of my well seasoned partners came out and told me their “newbie” mistakes; forgetting to take Nitro Patches off while administering Nitro, using Latex gloves on a patient with latex allergies, and even worse things that I refuse to even write about.

Once I was vindicated, I remember being almost neurotic in my actions afterwards for several months. I was double and triple checking all of my actions, my vitals, everything. I became a scared Medic, which is never a good thing. I would hesitate before doing something without an okay. It took one of my command physicians who was a dear friend and mentor to sit down with me and go over every one of my cases with me. He showed me that, outside of that one thing, I had made no mistakes. He even pulled up a case that had been used in Grand Rounds, showing how I identified that the patient was having an Antro-Inferior MI; the monitor printout showed Anterior, but the patients’ BP and heart rate had me wondering if the patient was also having an infarct of the Inferior wall. There was ST elevation in V2-4 as well as II,III, and avF. It was a weird presentation and I remember pondering why I wasn’t seeing the reciprocal changes in II,III, and avF, but I saw the reciprocal in I, avL, V5, and V6. Med Command told me to follow the print out, but I told them that due to low BP, I couldn’t follow protocol by giving Nitro. Once in the ER, I got my butt chewed, but I showed them both the strips and my vital signs. My command doc gave me huge kudos for knowing the different STEMI’s and used my case in presentation to show how the print out and subsequent transmission of 12-leads could lead to mis-interpretation.

I realized then that mistakes were a part of the business. I’m not talking about giving the wrong drug or doing a procedure wrong, but shit happens on scenes and all we can do is fess up immediately and try to move on. I’m sure all of us can talk about an instance where our equipment failed us and we went about, doing our thing, only to find out later that the ECG failed us or the BP cuff had been damaged and the needle didn’t go past 130 or even the Glucometer wasn’t working properly and was giving false highs and lows even after a proper calibration. As careful as we are with equipment checks, sometimes Murphy’s Laws of EMS come into play…there’s nothing like losing all power to the ambulance during a Cardiac Arrest while you are on some road in the middle of nowhere…and it just came back from the shop.

If you learn anything from this, I hope you learn that a mistake isn’t the end of the world as long as you are willing to step up and own up to it immediately.

Have fun and be safe.
MT.

Comments

  1. scot phelps says:

    Somehow, I must be misreading this-it doesn’t seem like you did a damn thing wrong- patient was asymptomatic (after initially standing up), was perfusing with no problems, and was “difficult….”
    Even if you KNEW she was having transient runs of SVT, so long as she is perfusing and doesn’t have symptoms, you wouldn’t necessarily treat it, you would call OLMC and discuss it. She needs a pacemaker, not adenosine. My guess is your pulse was higher than hers, given the scenario.

    As an instructor, I always told my students “You’re not really a medic until you have almost killed somebody.” but this doesn’t fit the bill…not even close 🙂

    -Scot (25 year medic)

    • Medic Trommashere says:

      Thank you, Scott!

      In the end, that’s what my wonderful Command Physician said; it was a failure of equipment, not a failure of the provider. The only thing provider wise that was mentioned was that, it would’ve been possible to pick up the rapid rate while I was listening to lung sounds, but the patient wasn’t exactly sitting quietly for any exam, so it wasn’t like I had done something dramatically wrong. I chalk it up to being a mistake, but I learned a lot from it. Thank you for your comment!

  2. thanks for sharing the story … as a newbie in EMS but being over 50 years old, I have a slight advantage over a 19-year-old newbie in having some ‘life experiences’as a patient and as a relative of patients… but that isn’t a whole lot of advantage. Sounds to me like you really did everything right.. maybe (just maybe) the patient really suspected something was really amiss but was ‘putting a bold face on it’ because she was too scared to admit it, even to herself? one can hope. Then again, maybe she really WAS just that much of a b*tch. Those people are indeed out there. I’m glad you kept with the field. May your kind prosper & multiply. 🙂

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