There’s been some discussion about the Prince George County Firefighters who transported a pediatric patient via a firetruck instead of an ambulance. Bob Sullivan blogged about it last year and asks if breaking the rules were what actually saved the patient. I don’t think there’s a way to get a definitive answer to that or the question of had they stuck to the rules would the patient have been saved? It’s a judgement call that was made with a positive outcome. I’m okay with that.
Scott Kier revived the debate by calling the decision 100% Absolutely Wrong. Whenever you use the word “Absolute” or a number like “100%” (especially in a blog title) you’re going to find out that there is nothing absolute or 100% guaranteed… except for death and taxes.
Tom Bouthillet made this excellent point on that post:
It’s easy to second-guess the boots on the ground but unless you’re the one there watching a child die you can’t know what it was like. There is no “absolute”.
I wholeheartedly agree with Tom. For that matter, reading the story reminded me of when the exact opposite happened and a fire engine sat with a patient for 10 hours and used 26 oxygen tanks while they waited for an ambulance that never came. While I realize there was no blizzard or reported extenuating circumstances, it’s important to keep in mind what happens when we practice defensively against liability instead of thinking critically.
I’ve burned the rulebook/protocols, both physically and metaphorically, probably more times than I can count. There were times when what I did was right, and there were times when what I did was wrong. Either way I learned from the experience, and right or wrong I always owned it and did it knowing there would be repercussions.
Brandon Otto raised another spectacular point with this comment on Bob’s post:
1. If it’s a bad idea and it works, is it still a bad idea? To me, the answer hinges upon whether there was good reason based on the information at the time to do it anyway. This isn’t clear from the story given, nor is it clear whether the providers were adequately trained to use such information anyway.
2. If breaking the rule was the right thing here, is it because this situation was an exception to the rule, or because the rule is wrong? In other words, not every fluke means the system needs to be changed, but it should always raise the question.
Rules can be wrong. That’s a possibility few people take into consideration, but an important possibility we always have to look at. Especially when we are leaders looking at the actions of our crews, which is why it was refreshing to see the leadership of Prince George County recognize the efforts of their crews with commendations instead of condemnations.
For that, I applaud them.
No related posts.
It seems to me that the firefighters made a considered judgement which included taking account of the prevailing circumstances.
Surely that’s what we expect professionals to do?
I would agree with you that is what we expect. Unfortunately, and part of this is due to both the fractured nature of protocols and the peer review nature of EMS, there are providers who view anything other than following the book as an atrocity.