Assume the worst
Editor's note: In DC, a family is filing a wrongful death suit after a man died of a heart attack hours after medics said he was suffering from acid reflux. Editorial Advisor Art Hsieh says sometimes, medics have to assume the worst.
This lawsuit is just beginning to make its way through the legal system, so it's premature to comment on its outcome. Based on the article, there are a couple of strong reminders about how we provide care:
1) Err on the side of caution. The deceased appeared to be young, and it's very possible that the signs that were being reported could have easily been mistaken for a low acuity event.
Anatomy and physiology tells us that many body systems run through the epigastric and substernal regions of the abdomen and chest, which requires investigation and precise assessment. If in doubt, practice conservatively and assume the worst. If the patient did not want to be transported by EMS, make sure he or she is adequately warned about the potential risks associated with the decision, including possible death.
2) Document all calls carefully. In busy systems, this can be a challenge. The development of ePCRs hasn't helped either. Even for the EMT, there is a lot to evaluate and document even on low acuity patients. These records will serve as the only "true" recollection of the events as they transpired. It makes sense to make sure they are complete, each and every time.
3) I was stunned to find out that the District of Columbia had a law on the books that prevented malpractice lawsuits to be filed against emergency responders. Again, the facts in this case are not yet fully known. However, there must be accountability for each action we take as emergency care providers.
Long ago it was drummed into my head that responsibility was a big word, with a big load that comes along with it. That's why it's important to continuously train and practice the craft of emergency medicine daily. The decisions we have to make on a moment to moment basis have the capacity to greatly affect the outcome of an EMS incident. We can't forget that.
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