The 11th Hour Syndrome


Last Thursday, I was given the opportunity to participate in an episode of EMS Garage. The topic that night was Liability, and revolved around a news story from Missouri. You can read about it here but the gist of it is this:

A crew goes to a chest pain call. They evaluate the patient, tell him its most likely GERD and has him sign a refusal. Later, his family calls 9-1-1 again, and the patient, who is still having difficulty breathing and chest pain, is transported to the hospital where it is revealed that he actually has a Pulmonary Embolism. He dies later that day.

First of all, in my eyes, there is no defending this crew. They went outside of their scope of practice, and gave advice that they did not have the right or the training to give. If they had done the right thing from the start and said “well, we don’t know why you’re having this chest pain, but let’s go to the hospital and find out” then this patient might have had a different outcome.

I was lucky to be on with a great panel, and there were lots of thoughtful, well informed points made. I urge everyone to take a listen to it. One of the most interesting points and topics to me though was about what should be called “The 11th Hour Syndrome.” Wonder what that is? Well, the 11th Hour Syndrome is what makes a Paramedic change the way they take care of their patient when it’s close to the end of their shift. Do your speed, depth of assessment, and motive change just because it’s almost time to go home? It shouldn’t, but in some cases, it just might.

Whether you’re rushing through your assessment, looking at a poor 12-lead because its “good enough” and bypassing that occasional necessary prep work to get a good clean picture, or trying to burn through that last Patient Care Report, the only person that suffers is the person who is receiving the care you’re providing.

The hours that one works in EMS can be demanding. This is not your typical 9-5 Monday through Friday job and I think people forget that sometimes. People don’t pre-schedule their emergencies and as a result, one might get out late. Calls take longer than expected but remember this is your job, this is what you signed up for, and I’m hard pressed to find a more vital or noble profession.

Take pride in that patch on your shoulder. You worked hard for it. And remember, when those tones go off at the 11th hour, or you get dispatched to that call so late in your shift that you can taste that dinner that’s waiting at home for you, look at the patch and remember what you went through to get to where you are. Remember all of the tests you took, and all of the clinical hours that you put in. A lot of work went into getting where you’re at today.

When you get to that address, and you walk into that patient’s house, equipment in hand, remember that at that moment, there is nothing more important than this person in front of you. They’re counting on you to deliver to them the best care possible. You’re there to do more than just take them to the hospital, you’re supposed to comfort them, and bring some order to their chaos. Sometimes, that takes time.

The cure for the “11th Hour Syndrome” lies within. It’s in your conscience and it manifests itself in the care that you deliver to each and every patient. When you’re put to the test, make sure you do the right thing for yourself and your patient. They deserve to have a trained professional at their side, not an Ambulance Driver.

  • msparamedic.com

    AMAZING post! I can't tell you how many of my colleagues I have seen suffering from the 11th Hour Syndrome… I saw one crew I was backing up on a cardiac arrest doing one handed chest compressions and hadn't pushed an epi 6 minutes into the code!!

    Some people don't get that this is what we do- day in day out, night or day, no holiday or weekend plan in our way… this is our life and the lives of countless others at our hands. *rant*