You Make the Call – Exam Prep – Scenario 4

Scenario 4-

As the EMS supervisor on duty you have been dispatched to a report of CPR in progress to assist units enroute.

When you arrive on scene you are given a verbal report as follows:

“We found Mr um, Jones, or whatever here on the bed, all blue so we pulled him down and started CPR at 30-2, the AED is broken, so no luck there.  Our medic has gone for the tube I dunno, maybe three times now with no luck so we’re just bagging right now.  We got a student Medic on the ambulance so he’s going for a line, got a 22g.  I think we have it all dialed in here Captain.”

Cite specific protocol or policy deviations and your actions both on the scene and after patient care has concluded.

Agree? Disagree? Have something to add? Why not leave a comment or subscribe to the RSS feed to have future articles delivered to your feed reader?

7 thoughts on “You Make the Call – Exam Prep – Scenario 4”

  1. “First off, if he was blue when you got here then somebody needs to check for lividity and rigor. Failing that, Engine Officer, why don’t you speak with the family and get demographic information, meds, history, and allergies, then meet us at the truck. Engine personnel, make sure the stretcher is set up and bring us a backboard. Ambulance senior medic, get your monitor and find out if we have a rhythm. Medic intern, good job on the IV, why don’t you push meds as dictated by the rhythm we find, then take over ventilation until we get in the truck. Then get another IV in a different site on the way in, preferably bigger than a 22. Ambulance junior medic/emt, take over CPR until the firefighters come back. And nobody leaves the ER until I talk to everyone. Yes, Engine, that means you’re following in.”*I take a quick look with the laryngoscope to see if there’s anything salvageable in the airway. If there is, I place an ET tube. If not, place a rescue airway or let the intern do it.**At the ER, speak with the attending physician privately to let him know that this code did not go according to policy or protocol, and that you are still gathering information and will follow up with him later. Then, when handover is complete, speak with both crews.*”Ok everyone, I don’t think it’s breaking news that this incident could have gone better. There are several policy and protocol issues that have to be addressed immediately. For starters, you’re all out of service until everyone onscene writes an incident report detailing your individual observations and actions from the time of dispatch until handover. Engine Officer and Engine Medic/EMT, you’ll need to include exactly what happened with your AED during the call, and why a problem or potential problem wasn’t discovered at the time of your truck check this morning. Whoever made ‘three or four’ attempts at intubation, I’ll be interested in reading why, exactly, you felt that was necessary when protocol clearly states that only two attempts are allowed onscene, and any further attempts are to take place enroute. Medic Intern, once your statement is complete you can go home for the day. Here’s my cellphone number, please have your clinical coordinator call me as soon as possible so we can discuss this event and your future placement. I’ve secured a conference room here at the hospital for us to use, here are your incident report forms, let’s head there now.” *Once the statements are collected, send the engine to wherever they need to go to get a new AED, send the ambulance to wherever they need to go to drop their intern off; both units can go back in service when completed. Write my own incident report. Review all statements with MY supervisor, suggest that s/he notify the department’s Medical Director (if there is one/if MD is involved in department affairs at all [you'd be surprised]) for a formal clinical review. When the intern’s clinical coordinator calls, review what you know of the incident, suggest that s/he also speak with the intern, and make arrangements for the intern to be placed with a different shift and crew.*

  2. “First off, if he was blue when you got here then somebody needs to check for lividity and rigor. Failing that, Engine Officer, why don't you speak with the family and get demographic information, meds, history, and allergies, then meet us at the truck. Engine personnel, make sure the stretcher is set up and bring us a backboard. Ambulance senior medic, get your monitor and find out if we have a rhythm. Medic intern, good job on the IV, why don't you push meds as dictated by the rhythm we find, then take over ventilation until we get in the truck. Then get another IV in a different site on the way in, preferably bigger than a 22. Ambulance junior medic/emt, take over CPR until the firefighters come back. And nobody leaves the ER until I talk to everyone. Yes, Engine, that means you're following in.”

    *I take a quick look with the laryngoscope to see if there's anything salvageable in the airway. If there is, I place an ET tube. If not, place a rescue airway or let the intern do it.*

    *At the ER, speak with the attending physician privately to let him know that this code did not go according to policy or protocol, and that you are still gathering information and will follow up with him later. Then, when handover is complete, speak with both crews.*

    “Ok everyone, I don't think it's breaking news that this incident could have gone better. There are several policy and protocol issues that have to be addressed immediately. For starters, you're all out of service until everyone onscene writes an incident report detailing your individual observations and actions from the time of dispatch until handover. Engine Officer and Engine Medic/EMT, you'll need to include exactly what happened with your AED during the call, and why a problem or potential problem wasn't discovered at the time of your truck check this morning. Whoever made 'three or four' attempts at intubation, I'll be interested in reading why, exactly, you felt that was necessary when protocol clearly states that only two attempts are allowed onscene, and any further attempts are to take place enroute. Medic Intern, once your statement is complete you can go home for the day. Here's my cellphone number, please have your clinical coordinator call me as soon as possible so we can discuss this event and your future placement.

    I've secured a conference room here at the hospital for us to use, here are your incident report forms, let's head there now.”

    *Once the statements are collected, send the engine to wherever they need to go to get a new AED, send the ambulance to wherever they need to go to drop their intern off; both units can go back in service when completed. Write my own incident report. Review all statements with MY supervisor, suggest that s/he notify the department's Medical Director (if there is one/if MD is involved in department affairs at all [you'd be surprised]) for a formal clinical review. When the intern's clinical coordinator calls, review what you know of the incident, suggest that s/he also speak with the intern, and make arrangements for the intern to be placed with a different shift and crew.*

  3. Pingback: nynsucqa

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>