It's not safe to "do the right thing"

The issue keeps popping up in my mind, over and over again, in various disciplines and guises.

It might be called "Doing what is Right, instead of what is Safe."

More commonly, it's called "CYA" (Covering Your Anatomy).

We live in such a litigious society, that one error -- no matter how trifling -- could result in lawsuits and bad press that can bring a company to its knees. One misquote, one misunderstanding, one misapplication of product or service... and BOOM!

Unfortunately, it is harder to track errors of omission of service than errors of poor or misleading service. Even worse, that fear of litigation -- doing what is "safe" for one's corporate bottom line, rather than what is "right" for the clientele -- costs lives.

We hear this time and time again with respect to drugs that don't make it to the market because they aren't "safe enough"; yet, if they are life-saving drugs that work for 98% of the "nothing else works" population, that's still 98 lives saved per hundred users. Yet we focus on the two who died, ban the drug, and sentence the other 98 to death. We blame the drug companies and the FDA for allowing the drug to be sold, and award the lawyers for those two families exorbitant amounts of damages, when the only choices available were "death if the drug doesn't work" and "death from not having the drug". Where is the legal ability to say, "I understand this drug does not work for everyone. I understand there is no other option at this time. I want the drug because I like the odds of having a chance to live -- and I'll sign whatever paperwork needed so my heirs can't sue you if I'm in the small minority for whom it fails"?

We're currently hearing the same sort of fear that suggests our children and teens with diabetes may not be allowed to use insulin pumps, even if they are suitable candidates.
  • The same fear could kill an adult with an anaphylactic allergic reaction to food.
  • The same fear could kill one of us caught out on the road, with a sudden low, even if there is a glucagon kit right by us.
  • We could be killed by omission because the EMT who answered the call to save us was not trained to test blood glucose, or administer an epi-pen or glucagon -- and G-d forbid we should be the one to administer the glucagon kit, or the epi-pen, to the person who needs it NOW!

Good Samaritan laws are meant to protect well-intentioned passers-by from litigation if their lay medical intervention should fail; however, it only covers that citizen if he or she has already been trained to cover that medical issue, and if that training is current. They do not cover medical professionals, such as basic-level EMTs, who have not been trained and qualified to check blood glucose levels or administer injectable medications, if they should do either. They may not cover those of us who have never been trained to administer epinephrine, glucagon, or insulin (injection or bolus).

There's a horror movie that runs in my mind, any time someone talks about these sorts of "life changes in an instant" medical emergencies. This is how it goes:
  • The patient's medication -- epi-pen, glucagon kit, whatever -- is just outside his/her grasp, and s/he is too far out of it to self-administer.
  • Someone calls 911. Nobody around the patient is familiar with what could be happening, and they are unable to assist.
  • Barely in time, an ambulance rolls up with a pair of EMTs. They are certified in only the most basic of procedures. They find the patient's medical ID and they see the kit. The patient is on the last gasps of life; however, the EMTs can't administer the epi-pen or the glucagon -- they have to call in to the hospital and speak with a doctor.
  • The doctor on the other end of the line is familiar with the issue -- but since the EMT is not trained to administer, the doctor is legally prohibited from talking him (or her) through the procedure.
  • The EMTs are directed to transport the patient, sans treatment, to the hospital.
  • With all the time it's taken to get the information and to transport the patient, the patient dies before ever getting to the hospital.

By being "safe" and avoiding liability, someone -- you, me, or someone close to us -- could be dead.

I'd like to believe this only happens in horror films and in the dark fantasies of our minds... I'm old enough to suspect otherwise.

I believe we need some sort of protocol to make sure we are treated appropriately, in a timely fashion. In doing so, we must address the following issues:
  • Awareness. We need better awareness in the general community of the symptoms of extremes of blood glucose; our friends with severe allergies need better awareness in the general community of anaphylaxis.
  • Training. CPR is offered to the general community as a matter of course at most Red Cross chapters, and also by many community Emergency Services personnel. General First Aid (wounds, basic trauma awareness, cardiac emergencies) is taught to the general public, though fewer of us avail ourselves of that training. Couldn't "severe allergy awareness and mediation" and "glycemic excursion awareness and mediation" be offered as well? (Yes, call them something the public can understand -- I've no quibble with that -- just make the training available!!) And while we're at it, please make this training -- including onsite recognition/testing and remediation -- a part of the most basic, bottom-level EMT/Rescue training?
  • Legal Liability. Is there a limited sort of medical power-of-attorney that can be tucked into the glucagon kit, the epi-pen kit, the glucometer, whatever -- both explaining the basic protocol and absolving our rescuers (trained or not) of legal liability if they follow that protocol? If so, how does one set that up? If not, what would be needed to make that possible?
  • Professional Responsibility. If the EMT sees the patient's medic-alert and can identify the appropriate mediation, make that EMT and his upline responsible FOR delivering the appropriate medication, IN time, with legal consequences if death (or serious, avoidable injury) occurs because that medication was NOT delivered in a timely manner.

Since I'm not a lawyer, nor a doctor, nor an EMT, I'm sure I've missed a few issues here. I hope, though, that raising the questions will get folk thinking along the lines of providing answers and protocols that will preserve life. That will make doing the right thing, the legally safe thing.

Views: 7

Tags: EMTs, Good Samaritan Laws, emergency medical training, emergency medicine, legal liability

Comment by christina on May 27, 2008 at 4:51pm
Hi there, Thanks for the post.. I'm a childcare worker and when we did (updated) our first-aid we did work using the epi-pen. Until that point I had never heard of it. Now I have and If ever I need to use one I now how..(I hope I never will have to though)

Cheers
Christina
Comment by elaine peterson on May 27, 2008 at 8:16pm
Whoa! Can we start some sort of grass roots thing to make sure all EMT's are trained to check and administer glucose? I naively thought that was a standard proceedure!
Comment by Sweeter Cherise on May 27, 2008 at 8:37pm
Wow!!! Things that make me go....HUMMMMM!
Comment by tmana on June 30, 2008 at 2:05pm
Something akin to this horror scenario really did happen not long after I posted this blog entry.

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