Stop! Do not be eager to delete this article. It is not about a government job, but another chapter of emergency medicine. Have you ever noticed that we repeat stories that we have heard from other professionals, but we have not fact checked them? So often, these stories prejudice our thoughts about people, places and events, rather than expand our medical knowledge. Wouldn’t it be better not to go down a rabbit hole on conspiracy theories or assumptions which are not based upon reality or fact? As clinicians and professionals, we are often a bit too quick to point a finger and blame each other based on our standards and training instead of learning to pause and take the time to discern an encounter with a fresh set of eyes and with a desire to praise each other for our intuition and results. My dad memorized quite a few one liners; a quote that can segue into our subject is “If you have nothing constructive to say, don’t say anything at all.” If we followed this thought in our encounters with our colleagues and ceased from being hypercritical, we would be a stronger profession and we would have less lawsuits. Pointing the finger alerts others to an infraction but remember another adage: “…three fingers are pointing back at you.” Please allow me to tell a positive story of a healthcare encounter.
Our story commences with a 76-year-old veteran who went to the W.G. Heffner VA facility in Charlotte, NC. He dutifully went to his medical department and obtained a Flu immunization. As he approached the elevator, the door was closing. So he stuck out his foot, lost his balance, fell to the hard tile, hit the back of his head and was rendered unconscious. Fortunately, the VA has cameras on all their floors, and he was seen by security, who quickly called a trauma code. Our veteran was unconscious for five minutes and, upon opening his eyes, he saw the faces of two VA police officers, three nurses and an EKG technician. They were there immediately for him, quickly performed their duties and spoke to the gentleman who was alert by this time, but his memory was a trifle fuzzy. A stretcher was brought in and he was lifted onto it and, without incident this time, entered the elevator. This was handled expeditiously and, upon entering the ambulance, he was attached to cardiac monitors, given BP, pulse and oxygen saturation assessment. He was told that he was going to CMC, a level one trauma center, just fifteen minutes away. He was attended by an EMT and a paramedic, who deftly started an IV and reassured the patient. These professionals were excellent and performed their responsibilities with speed and assurance.
Upon entering the ER, he was brought at once to a trauma bay and was surrounded by nurses and doctors and technicians. They quickly undressed the patient and performed a primary survey; a hard collar had been applied at the scene at the VA, so they removed it, checked the cervical spine and back of his head, reapplied the hard collar rolled him over to his side and continued a secondary survey while attaching new leads. Within fifteen minutes of arriving in the trauma room, he was wheeled to radiology where he underwent a CT scan of his head and C-Spine. It was read within ten minutes, was found to be negative for fractures, dislocations and sub-dural hematoma. He was interviewed by the resident physician, the nurses and, of course, the admitting clerk. His wife arrived at his bedside and told the resident that he recently had an ICD implanted because of his HCM and AF and the resident immediately ordered an interrogation of his pacemaker. Fortunately, for this old soldier, his labs, cardiac studies and CT were all negative and he had a hematoma at the back of his head. Neurologically, he was intact and now awaited discharge from the ER. As a PA of fifty years, I was impressed with the teamwork of the VA staff, the nurses and paramedics, the hospital ER and the coordination of acute care in his time of need. Lao Tzu once wrote that; “the journey of a thousand miles begins with one step.” I guess that the casual observer would have called this situation a “misstep” and hopefully this retired veteran will exercise more prudence and wait for the next elevator in the future. I’ve done a poor job of masking the truth: the impatient klutz is me! It has been said that sometimes angels come down to earth without wings. In this case, the ministers of excellence were exemplary medical teams, both at the VA and the medical center. They earned their wings, just ask this veteran and former PA.
In summary, because this is a malpractice article, I must report an incredible personal encounter with emergency services. They screened for age, past and present medical history and realized that with my cardiac history, I would be on anticoagulants. They we careful to note that, with my HCM and pacemaker history, this could have been a syncopal event. I was discharged in a timely manner and was proud that my colleagues were a well-trained, well-oiled, competent team doing what they were trained to do. This is an example of how to prevent a litigation and, fortunately today, many of our colleagues have purchased a professional liability insurance policy, even though they are insured by the institution. No one can defend you like family and when you choose an excellent malpractice policy, you become family, and the legal team works for your benefit. This morning, I read an article where a hospital system allows their nurses to obtain their own insurance, personalize the coverage, and they permitted this on their dime. Perhaps the readers of this article, PAs and NPs and nurses will investigate having your institution pay for some, or all, of your malpractice insurance. This, my colleagues, is how you can sleep peacefully and securely, knowing that both you and your family are in the safe zone.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
