Monday, May 5, 2008

Mistakes and Bad Paramedics

A few shifts ago, I made a mistake.

Not a regular every-day kind of mistake, but a critical one. It was something we've been taught from the beginning. Basic, and yet in the heat of the moment of a call wrecked with the unfamiliar and quick decisions, I forgot. And really, there was nothing more than that. I simply forgot.

What I should have done now appears impossibly clear. The benefit of time and conscious reflection has forced those decisions outward for inspection, starkly naked and illuminated in the harsh light of all that only now seems heartbreakingly obvious. I'd slap my forehead if the expression wouldn't so drastically underestimate the seriousness of my own omission. This time it was real, and it counted.

I suppose on a large enough scale, I can afford myself the opportunity to sit back and comment that these kinds of mistakes are unavoidable. We are put in a tough spot, us paramedics. Forced to deal with undifferentiated patients in unfamiliar environments, pressured by time and the sheer inadequacy of our own knowledge, day after day we blindly toss ourselves from scene to scene and patient to patient. As the census numbers climb, a statistician would probably conclude that the opportunity for error climbs as well. The probability most likely doubles with the inexperienced, and increases exponentially as the patients become more and more complex. ...And even though my rationalizing mind would like to point out such explanations, I still find myself looking back on those few minutes with great regret and dismay. I'm new. It was a tough call. But even still, I should have known better.

It brings to mind the oft-tossed around concept of "good paramedics" and "bad paramedics." There are a few at my service who are categorized as at the extremes of each definition, either through rumor or - in some cases - as the result of a few isolated incidents. We hear stories passed around all the time of so-and-so having made a terrible mistake, or another medic making a great call. Each of these stories, most likely taken well out of context, contribute directly to the reputations of people who - I know - work very hard to keep themselves upright against the constantly changing winds of EMS and the patients we find. With all that we are subjected to, I cant imagine that anyone is able to completely keep his head down, maintain an even keel and avoid the extremes. The big mistakes will happen. A stroke of luck sometimes swings our way. And all the while we do our best to maintain. A good paramedic, I imagine, is able to weather the storms at least as well as he rides the highest waves.

And so, as is the usual procedure after an experience such as this, I return to the work of weathering the storm. Not that I caught any real trouble for my mistakes, but there is most certainly a battle that I need to fight with myself. Even experiences like these can prove beneficial if I refuse to let mistakes become the focus, but it doesn't come without a fight. I will most definitely learn from this. I just hope in the meantime that nobody thinks I'm a bad paramedic.


Evil Lunch Lady said...

You are not "Bad", you are "Human"! The pressure you are under everyday can make things like this happen. Us non-medical people are still very glad you are out there saving our butts!

Anonymous said...

Thank you for plugging away at it! I think a good paramedic is one who learns from his mistakes, and keeps trying. Too bad though, that you can't tell us what happened...

Patrick said...

The difference between "good" and "bad" paramedics would seem easy to differentiate, but there are so many variables. One that you mentioned is the circumstances one finds him/herself in. Walk a mile in his shoes, as it were.

Others include God-given talent and brains, the ability to isolate work from other issues in life (I just got dumped by my GF/BF, the kids are all sick, etc.), the ability to isolate patient care from other work and interpersonal issues (do I like my partner, does my defibrillator have a battery that lasts more then ten minutes?), and my favorite - does a medic have a healthy attitude toward the job? (being self-critical, putting effort into continuing education and quality improvement).

Add all that together and you have what you have - a good medic still has bad days or calls or decisions.

I like the attitude of the Blue Angels flight team. They debrief each and every show and practice, and the members recap their performances and admit to every one of their errors, no matter how small (even their march out and back). Then they vow that they can fix all those things, and end with "glad to be here, Boss", indicating their understanding of how special their job is and how they will dedicate themselves to making those improvements.

Back when I was just a "yoot", I worked with a medic for only a short time (he was a medic contracted to our FD when one of our regulars got injured) who refused to be reflective. It was our custom to debrief after critical calls, as we had a lot of paid-on-call medics and our crews consisted of different folks call-to-call. So we'd review most critical ALS calls, admit what we did right and wrong (mostly things out of sequence or things that could have been done better), and make a plan to do better next time. This guy absolutely refused to take part in our informal QI process, and decried us for even doing such a thing. "I did the best I could and there's no point in going back".

He wasn't long for our agency.

Anonymous said...

"We are only as good as our last call" Is a fact of life in our job. The fact is though that we learn from each call and every patient is a learning experence.

My very first patient I respond to has the lone paramedic on the crew needs to be intubated. I miss...Telling the story to others they ask why I didn't put a comi-tube in. Amd while the real answer is "I didn't think of it" I kept his spo2 above 90 with a bvm/npa and got him to the ED to be intubated.

I'm sure you will never forget whatever happend and can relate being 5 shifts into working alone.

PC said...

You can't do this job and not make mistakes. The mark of a good paramedic is he acknowledges and is open about his mistakes, learns from them and tries to teach others to avoid them. A bad paramedic is someone who (and I don't know which is worse) ignores or doesn't recognize their mistakes.

Keep up the good work.

Chris said...

Ignoring them is worse - if someone just doesn't notice them, they can be helped to improve

Brett said...

I think your being too hard on yourself. And since I was there with you I know what your talking about. Could a better choice have been made, Maybe. Im not happy about the outcome but considering the options at the time it could have been worse. Is there something to be learned, most deffinatly. We did what we could with what we had.

Gertrude said...

As long as we continue to learn from our mistakes we will become better medics and better people. The hard part is not letting your mistakes allow you to get in your own way. You can do it. Just keep plodding along like the rest of us.

Anonymous said...

Your not a machine, you will make mistakes, get over it. Sometimes all you can is just remember it for next time and do better. Your not doing yourself a favor berating yourself, I have followed your post for over a year, and I can tell by what I read that you are a great medic, but you won't survive medicine if you keep being so hard on yourself.