Ignorance and Litigation

Last month, a group of us created a new Facebook page called Modern EMS Issues. We wanted to give people an outlet to discuss what they felt were the important challenges that we are facing both today and tomorrow. One of the first questions that we asked everyone was to name what they felt were the biggest challenges that we face today. There were some terrific answers, but I feel like the root of much of the issues that we deal with comes down to two things, ignorance and litigation.

Far too often, we allow people who do not understand our profession and what it is capable of to make decisions about how we perform our jobs. We allow the general public to believe that response times are more important than high quality care. Some of this is he fault of those who prey on the ignorant, but for the most part it is our fault for not properly educating those that we serve.

I cannot count the number of news stories that I have read that either cite what people interoperate as “poor care” that was directly related to response times. Take a look at the situation in Minnesota last week where a family was “outraged” by a seven minute response time to their residence. There was no talk about what happened after the ambulance responded in what many would say is a reasonable amount of time.

There was an article that got a decent amount of attention a few years ago when the Super Bowl was held in Dallas regarding MedStar’s response times during that week when they also faced a sizable Texas snow storm. Many responses were made to “emergent” calls in a “non-emergent” fashion with no marked reduction in patient mortality.  The thing that I like about the information that MedStar released was there was no “spin” to it.  It was just straight facts backed up by statistics.  Not many places take that road.  Far too often, they rely on public opinion and speculation of what the public thinks is important.

Furthermore, we allow ourselves to continue to believe that while urban responses require someone to be on scene in less than 5 minutes, and that these precious moments save lives, the same is not true for suburban or rural systems with longer response times who have similar and in some cases better morbidity and mortality rates.

If this were true, systems like FDNY for example, with the volume of ambulances that they have, and the response times that they maintain would have the best ROSC rates in the country, not systems like Hilton Head, MedStar and Wake County.

And then there is the constant challenge of litigation. There are so many things that we do in our day to day practices that are designed to reduce the amount of liability that we open ourselves up to. With all of the evidence that exists regarding C-Spining patients, why do we continue to do it? It does not benefit patients, however one missed c-spine injury could bankrupt an EMS system if not properly handled.

Think back to just about any documentation class that you have taken in the last fifteen years. I know the majority of mine have revolved around the concept of litigation. Almost every speaker opens up with “think about how your chart would look if you were sitting on the witness stand.” The afterthought of “think about what that ICU resident would think if he was reviewing your patient’s records and came across your chart.”

Litigation trumps patient care.

One point that has been heavily missed in health care reform has been malpractice and litigation reform. No one thinks about what happens when someone is sued, or how much malpractice insurance a company has to carry in order to make sure they are not rendered ineffective should they be sued.

There was a case a few years ago where a newborn suffered brain damage presumably at the hands of the paramedics that were transporting them. Everyone involved in the lawsuit, the hospitals, the primary care doctor, the obstetrician, all settled. Except for the ambulance company.

While I do not recall the exact figure that was awarded to the family, I do remember that the company faced potential bankruptcy after the settlement. While one might say that the lesson here is if everyone settles so should you, in my opinion, the bigger picture lesson is let’s try and limit the amount of money that is being awarded. Sometimes it is justified but more times than not, it is way over the top.

Do you want to see pay rates increase for paramedics and EMT’s? Litigation and malpractice reform could potentially free up that cash. The money is there, it is just needlessly tied up elsewhere.

Sometimes i feel like a broken record. It upsets me that so many are content with just sitting back, looking at the people around them and saying, “You don’t get it. You just don’t get it.” We are at such an opportune time to make sure that everyone knows how vital a high quality (not fast) EMS service is to their community.

If we can curtail the ignorance that we encounter and garner more support both from the general public as well as the policy makers who dictate not only what we do but who can influence how we do it, then and only then will we be able to make the necessary changes that our field so desperately needs.

It’s time to stop being the red headed stepchild of public safety. It is time to stop being the whipping boy whenever something goes wrong, or someone overshoots an address by two blocks.

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