“Medical control, this is Rescue 1.”
“Go ahead, Rescue 1.”
“We’ve been called to the home of a 76-year-old male complaining of chest pain. He describes a non-provoked, dull, sub-sternal pressure that radiates up into his jaw and down his left arm. Patient states the pain started about 30 minutes ago and rates it at a seven out of 10. He denies any shortness of breath.
His vital signs are as follows: pulse is 98, strong and regular; blood pressure is 176/60; respirations are 18. Lungs are clear bilaterally with good tidal volume…”
And your report goes on and on in fine, concise, organized detail.
Treatment orders are given, received and executed.
The patient is transported to the closest STEMI center, rather than the patient’s hospital of choice. You explained that his preferred hospital is another 15 minutes away and is not equipped to handle his [probable] acute MI as well as the closer specialty center.
He survived his first heart attack because of your good work and clear communication; another job well done. Unfortunately, after he was admitted to the CCU from the ER, he contracted a staph infection and died.
The family is now suing you — among others — for the wrongful death.
They are claiming that, had you taken him to his hospital of choice, he would not have contracted the infection that ultimately killed him. Their lawyer is arguing that any ER can handle a heart attack and you cannot diagnose an MI in the field anyway.
Before you get mad and stop reading, I know the lawsuit is a bunch of crapola. But it’s just the kind of crapola that ambulance-chasing shysters file all the time — and it’s just the kind of crapola you need to be prepared for if you want to make it go away as fast as it comes up.
Develop good documentation
The amount of concern you need to have in a situation like this is inversely proportional to the quality of your documentation and radio report. Simply put you will have very little to worry about if your documentation and radio report are organized, methodical, complete, and accurate; based on the objective findings of your thorough, systematic assessment; and reflective of proper treatment and transport based on local protocols, policies, and procedures.
On the other hand, if your documentation and radio report are choppy, incomplete, disorganized, and weak, you will have plenty of reason to be concerned, because a skilled attorney will use every means you give him or her to make you look incompetent — and incompetent providers lose lawsuits.
Not to worry, though. Your own protection and security are as easy as these three steps.
Step 1: Get your facts straight
Take a minute; take a breath.
Remember that the call you make to medical control is recorded and you have to assume that recording is going to be played back for an entire courtroom to hear.
Before you make that report, be certain you understand what is going on. Make sure you have enough relevant information to paint the appropriate picture without having to say “stand by” or “I’m not sure, let me check.”
Also be sure that the information you are relaying is correct and be clear in your own head before you start speaking; too many pauses, “ums” and “ahs” will not only frustrate the person on the other end, but it will create the appearance that you are clueless.
Step 2: Be predictable
Follow a prepared, consistent format. Deliver each report in the same organized manner, following the same systematic formula every time.
If you follow the same format on each and every call-in report, you will be far less likely to miss anything and far more likely to paint the proper picture and get the necessary orders without delay or confusion.
Step 3: Make it match
All too often, providers forget that the recorded call-in reports to medical control are a form of documentation, and the recorded report and the narrative on the written patient care report are frequently at odds.
Be sure that the content of your call-in report matches the content of your narrative documentation. Once again, a prepared and practiced formula or consistent system for documenting will help assure that nothing is missing and that the correct picture is painted.
Think about the lawsuit proposed in this hypothetical scenario, and the excerpt of the call-in report on which it is based. You will quickly see that if you are the provider, and your documentation is as clear and organized as your report, you have nothing to fear.
Even the greenest of providers knows you are describing the signs and symptoms of an acute MI and your choice of receiving facilities was medically justified and exactly right.
Another lawsuit bites the dust.
