Narrator: [00:00:00] Please be sure to like, share, and subscribe.

Matt: The thought of an EMS provider being charged criminally with something really has only been within the last couple of years

Erik: covering up a mistake with another mistake doesn't do anything.

Narrator: You are listening to EMS with your hosts, Erik Axene and Matt Ball.

Erik: [00:00:30] Well the blue in this matches my, it does. Your top. My, my top. Your top. Thank you. My top. Your blouse. That's what women call their shirts, sir.

Matt: Well, what do you, your sweatshirt? Your quarter zip. That's what it's called. Quarter

Erik: zip. That's too technical for me.

This, I was, what do you call it?

Matt: I was, well, it's not a shirt. I call this a sweatshirt. Okay. Yeah. Sweatshirt or quarter zip.

Erik: No. Do you

Matt: have a hard time getting like shirts to fit your gigantic arms in?

Erik: No, I do not. Man, you're [00:01:00]

Matt: so lucky.

Erik: I was talking to my workout partner this morning and, uh, He's not a doctor, um, and no medical bone in his body.

Um, Well, he's got medical bones in his body. He truly does. And actually it's about a bone. I, uh, we were talking about something and I gave him the technical term for this, the zygomatic arch, you know, in the face and, uh, no, that's a face bone.

Matt: The phalanges. No, those are finger bones. Oh, that's funny. The zygomatic arch.

Erik: You know, that's, that's kind [00:01:30] of, you know, when we, when we do our stuff, we, you know, teaching people stuff, making things simple, right? So we had some interesting stuff happen in the news again.

Matt: Yes. Another, uh, well, the paramedic, uh, this time, which seems like most of the time it's a paramedic because it's related to medications, but another.

Pre hospital provider has been charged with manslaughter as of right now. This is out of Sioux City, Iowa.

Erik: Last week Friday, I think, right? Yes.

Matt: Now, this [00:02:00] incident actually happened in August of 2023. So it's been a little over a year.

Erik: But the, is it the indictment or the, yeah, whatever they call it, whatever they call it.

The legalese happened Friday. Yeah. They're legal zymatic,

Matt: zygomatic arches.

Erik: That's what I'm talking about. Yeah.

Matt: Everybody's got their legalese. So yeah, this made

Erik: a decision.

Matt: Correct. Uh, yeah, it happened a year and a half ago, roughly, uh, the incident. Um, and this is all over social media right now, all of the EMS influencers and everybody's kind of talking [00:02:30] about this.

And so I thought it was good that we discuss this because like we were talking and kind of prepping for this podcast that the thought of an EMS provider. Being charged criminally with something really has only been within the last couple of years. I mean, you go back 10 years ago, I never heard of a, we never made mistakes back then.

Of course, everybody was perfect back then. These jet, these Jen's ears or whatever they need to get. No, I'm just kidding. Seriously though.

Erik: [00:03:00] Why are we seeing it more now? I mean, what do you think? Well, I think it was happening just. Well, I mean, I think it was still happening. Everybody makes mistakes. It could be happening more frequently now.

It could be happening less frequently. But I think there's certainly more of a limelight on us with recent controversies looking in the pre hospital environment for some. pretty notable cases that have occurred. Yep. So people are looking at us more, maybe? Um, especially within the healthcare industry.

I've spoke on this at EMS World. I mean, the pre hospital environment now is [00:03:30] really becoming more part of the whole healthcare continuum where it used to be what happened before the ambulance bay doors didn't really matter. You're an ambulance driver. It does. It matters more now. So I think there's more accountability there.

I also think that, um, Or like you've actually said, I mean, how, I mean, I think you told me recently your protocol book went from 50 pages to over 205,000 pages. I'm kidding. It feels like that when you're trying to, but, but we, I guess my point is that I think we're held accountable more. We're the limelight on [00:04:00] us more and we're doing more too Yes.

Than we used to in the past. Yeah. More, some more of the more progressive agencies are pushing meds that are, they're deadly. They're the big guns.

Matt: Well, I, that's, and I, we're gonna get to that point. Yeah. That very point, but also I think body cameras are another and like all the clothes, all the security cameras that people have.

Um, so I think obviously, like you said, there's a lot of factors coming into wire EMS providers being charged. Um, [00:04:30] all of those that you said, um, but back to the point of, We're doing a lot more, you know, if you go back 10 feet, like when I first started 20 years ago, uh, we, in my department, we did not have RSI.

We did not carry paralytics. Um, we have been doing it for a while. It's probably been 15 plus years that we have had the ability to do that. But I think that. More and more, if we're going, you know, expanding out across the country, [00:05:00] more and more departments, more and more private ambulance companies, services, whatever you want to call them, are getting more and more, I wouldn't say dangerous medications, but They're getting more comp, their protocols are becoming more complicated.

Their, um, treatments are becoming more complicated. The

Erik: impact we can have on human life and patient care is getting more powerful, I would say. For sure. You know, it's powerful to transport somebody, but during that transport now, you're delivering these meds, [00:05:30] you're securing the airway, you're, you know, it's, it's.

Matt: And when you think, and we've talked about this, you know, one on one, we were talking about it this morning, when you think about, You got your undergrad four years and we did a whole podcast on med school. Then you did med school for four years. Then you did residency for three or four years. I mean, you're talking about a decade of education, 50 years of schooling.

Yeah. I mean, literally you are a decade of education. My paramedic school was six months and three of that [00:06:00] was clinical time. It was really three months or maybe of classroom with clinicals and then I got out and then it was a month riding out with another paramedic and then it's like Here you go. And we are asked in some situations, we are asked to do the same thing that you do as a doctor.

We're asked to identify and treat the same things you are in the ED with all the resources that you have at your disposal.

Erik: Well, you know, a lot of this does, we'll talk about [00:06:30] more later, but that's what makes education even more important in the pre hospital environment. So tell us the story of what happened.

There are lots of stories we can tell, but this most recent story for folks that don't know.

Matt: Yeah, and again, I think it's good to preface it with, you know, neither one of us were there. We weren't, we're not on this call, obviously. Nobody was besides the people that are writing about it. All the articles and things that I've heard is, uh, Paramedic, Sioux City [00:07:00] Fire Department paramedic called out by PD, I believe.

46 year old, experienced. Yeah, it sounded like it. She'd been with the department for a while. Um, went on a 26 year old patient, I believe it was

Erik: 26.

Matt: And they were there, they were trying to move the patient over to the cot. He was in an emotional state of some kind. I haven't read anything about alcohol or drugs or I have no idea what

Erik: non cooperative poor behavior, whatever.

And they,

Matt: everything I've read said they could, they couldn't get [00:07:30] him on the cot. And so whether that was, he was physically fighting them to get on the cot or just refusing to get on the cot. I don't know. Um, I could

Erik: be wrong, but I think PD was on scene first. They may have been. I don't know. I thought I read that.

I could be wrong. Yeah, I don't know. So read it for yourself, but I thought they were there first.

Matt: And typically in most agencies, if you have a patient that's uncooperative, you know, PD is usually on scene to secure the scene before we get there. That's why they call us the second responders, but we're just not bullet sponges.

So anyway, we'll [00:08:00] debate that later. Um, no, I'm just kidding. I love my PD brothers, but uh, yeah. So she gets on scene or they get on scene patients being uncooperative again. Don't know if he's being physically. On cooperative or just whatever she decides she's going to give him ketamine Which we did a whole podcast on ketamine.

So And a lot of these cases If you look at them a lot of these cases ketamine is involved and we're gonna talk about medication But we don't want to specifically talk about kettles [00:08:30]

Erik: not the focus of this podcast, but we could we could Touch some of the high it's a

Matt: factor, but not the focus right so She intends to give him ketamine Which is my protocol is the same way if somebody's having a psychic psychiatric emergency being difficult I am injection of ketamine,

Erik: which is an appropriate use of that medication.

It can help in some situations, right?

Matt: No, so she gives him the medication Apparently [00:09:00] Well, she doesn't give the right medication, she actually ends up giving rocuronium by accident. Which is a paralytic. IM injection. Which is a paralytic, right? For our EMTs or, you know, whatever. Students that don't understand, that is a paralytic, so not ascendant.

Long acting. Long acting, almost an hour, 50 minutes. to an hour. So that's going to shut down your patient's respiratory drive.

Erik: Uh,

Matt: the patient is not going to be able to voluntarily breathe on their own anymore. So that's a bad thing,

Erik: correct? Yes, you're correct. I didn't know it was that long though. [00:09:30] We'd have to look it up.

Yeah. So the dad, the stuff that I've

Matt: said, so sucks typically is we carry sucks and we carry rock. So sucks is a very short acting 10 to 50 again as we all know it depends a lot on the patient, right? And what's going on? There are

Erik: different classes of paralytics, correct? And they're in two different camps We don't need to get into the pharmacokinetics on this but

Matt: Beck

Erik: and rock are the

Matt: two long acting which is why typically you know, rock has less, uh, contraindications than Sutton sucks does.

Erik: And [00:10:00] storage is easy. Storage is

Matt: easier. Yeah. There's some benefits to sucks, which is the short acting that if you can't get the tube, then the patient's going to start breathing on their own again. But again,

Erik: right. And, and, uh, the, one of the things too, with, uh, with, with some of these meds is that, uh, they're reversal agents, but we don't carry them, but.

Matt: Well, yeah, I know my agency doesn't. Maybe there's agencies, maybe some critical care flight folks that carry carry

Erik: are, we'll have them for sure. Yes.

Matt: But anyway, so she, she intends to give the patient ketamine. [00:10:30] She accidentally gives the patient rock. Apparently, from what I've read, does not realize that she gave it until she went to give a second dose.

Erik: And I think it was like, where this was occurring was there was a distance between the ambulance and where was. That's what it sounds like. And she's going back and forth, back and forth. Correct, correct. Which is a factor, I think. That's

Matt: a factor as well. Um, so realizes when she goes to drop the second dose that, uh oh, I gave rock.

And this is where, We all make mistakes right now with her. [00:11:00] So, well, I

Erik: do. I didn't know you did. It's very brave of you to come on. Um,

Matt: we all make mistakes. Yeah. So she, she realizes that she, and again, none of us were there, but what's being reported is She doesn't tell anyone on the scene that she has done this again.

I'm not accusing, accusing her innocent until proven guilty. You know, I give, I give our first responders all the grace and credit in the world until facts are come out and I'm not going to [00:11:30] take a news article that I read as fat. So we don't know what actually happened, but what is being reported is that the other providers on scene were not informed that the patient was given rock.

from what I've read is that she was the lead paramedic or the head paramedic. Don't know if there was other paramedics on scene or if everybody else was, maybe just don't know any of those factors. Um, but they. From what I read, we're not informed of what had happened, and allegedly the patient started complaining of trouble breathing, which makes sense.

[00:12:00] And then, I'm assuming, at some point, from what I read, he went into cardiac arrest. They started performing CPR. It's

Erik: funny what

Matt: happens to the

Erik: heart when it doesn't get

Matt: oxygen. Yeah,

Erik: and more importantly, the brain. Yeah, the brain will go first. The heart's the second most hungry. Well, that's the truth. I think the kidney's in there.

But, certainly, the heart gets pretty angry when it doesn't get oxygen. But ultimately. Unperfusing rhythms, yeah.

Matt: Right. And what, like we've talked about, is that, you know, we give Epi and all these meds to get the heart back, but really what we're trying to save is the brain. Right.

Erik: [00:12:30] Absolutely. Right. And

Matt: so that was the problem.

So anyway, don't know if he was intubated, if the patient was intubated during the code, don't know any of that information, but apparently they worked the cardiac arrest, transported the patient again. Uh, nobody else from what I've read knew that rock had been given. And then when they got to the ER is when the paramedic told the ER physician, Hey, this is what I gave by accident.

And from what I understand the patient. I [00:13:00] don't know if they, I'm assuming he must've got a pulse back at some point because he was young, he was 26. So the heart started ticking again, but the brain went without oxygen for too long. Uh, so, excuse me, 48 hours.

Erik: Every, every minute without oxygen, you lose seven and a half miles of fiber.

Myelinated fiber. What do you call it? If you lose what's called a pulse. Penumbra, which is like the area of, of ischemia or the tissue that's not getting blood, the bigger that area is, the more profound the [00:13:30] swelling, which has its own, the pathophysic, it's just a vortex of death with the brain. Yeah, it's not good.

Matt: Yeah, the brain does not go do well, like you said, without glucose and oxygen. And so anyway, um, so then the patient passed away, um, and then, like I say, this happened in August of 23. And then, so she, and the

Erik: autopsy too confirmed everything, correct? Ischemic damage globally, and then, uh, by, yeah, coronium.

Matt: So, yeah, so charges, manslaughter charges have been filed against [00:14:00] this paramedic.

And so, I think that any, you know, if there's new, Providers if there's young providers or people that are in EMT school and paramedics when there's they keep seeing these cases Maybe every six months to a year. They're like, oh my gosh This is, I'm scared, you know, I could get charged with negligent homicide.

There was a nurse a couple years ago from Tennessee, Redonda Vaught, I believe was her name if I remember correctly, who was, yep, from Vanderbilt that was charged in that case. Medication [00:14:30] error again. So I think that the first thing that's important to talk about is In all of these cases that we have seen pre hospitally, where charges have been filed against the providers, whether it was, in almost every case that I can remember, there was some error in the five rights.

There was some error of right patient, Right dose I know was a factor in one, right route, [00:15:00] right medication. Obviously that was the issue here is that the wrong medication was given, right time, all of those things. And so that if you are a provider and you're scared about these charges, like, Oh my gosh, I could make an honest mistake.

We all make mistakes, right? You're an ER doctor. You've been doing this a long time.

Erik: You brought up something that's kind of interesting. I'm glad you brought up the five rights, obviously, but you said a new person might be afraid. Yes. And I think you should be. Uh, let me explain it.

Matt: Yeah, a healthy fear.

Erik: A healthy fear.[00:15:30]

So, uh, when I learned, my first time being taught, uh, at a gun range and handling a, uh, uh, a firearm, I told the individual, uh, he actually is like a private security for folks. He's very, very comfortable with his guns. Yeah. Uh, I told him, I said, man, this is scary. Um, I feel nervous. And, uh, you know, and he goes, that's good.

I'm glad that you feel that way. You should feel that way. And I think we should feel that way in a respectful, in a way that we can still [00:16:00] function. Um, is that to be aware of the fact that these medications that we're pushing and learning how to handle Um, have complications and we should be aware of them and be prepared for them.

Um, the stakes are high. You are taking somebody's life in your hands when you choose to take an airway. Yeah. Uh, or give a medication like this. These are very tough. powerful medic is not vitamin C. This is a very, very powerful medication has dramatic effects on our body's physiology and creates the [00:16:30] potential for some very, very bad disease, which obviously manifests death in this patient.

The other thing with fear, I will say too, though, when I played football, our coach taught us that you cannot play afraid of getting hit. You play afraid of getting hit, you're going to get hurt. So we have to be able to find a way to walk into these situations with a positive mindset. We actually talked about this in a recent lecture, is being prepared and in a way where we're confident walking in there with our training.

But we also have the [00:17:00] safeguards of people around us, a team, but we can't walk in afraid of making a mistake.