Mike “Fossil Medic” Ward has a post over at Fire Geezer called Why Wait 10 Hours For An Ambulance? The post looks at the case of FDNY Engine 289 who waited on scene with an asthma patient for an ambulance that never came. Instead, after 10 hours and 26 oxygen tanks, the patient was finally transported by the Battalion 46 Chief in his command car to Elmhurst Hospital.
Mike makes the point that while on the outside the engine not transporting the patient seems “wrong”, it was in fact just following the policies and regulations set forth by both state and local governments as well as by the organization itself.
Here is my comment in all of its sarcastic glory…
While I can understand the concerns regarding liability and risk management by transporting a patient in a non-certified transport vehicle, at the same time I question the wisdom of tying up a resource that could have been used elsewhere for hours without providing a definitive solution for the patient within a reasonable amount of time when the power to do so, although not in policy, was available.
Since Engines don’t carry more than two portable oxygen tanks, I also question how the 24 additional tanks came into existence and how timely that happened for the patient’s well being. The fact that they continually depleted their oxygen supply when they could have transported is, again in my opinion, a greater risk and liability. If the system is failing, as it did in New York City during the blizzard, then it is our responsibility to do something reasonable.
In my opinion, and perhaps it is biased because I am a bit closer to the situation, but this seems to be a classic example of amoral policies that do not take the exceptional into account and are leading to potentially immoral behavior. The fact that liability and risk management aspects are being given a higher priority than patient care and transport mode decisions is an indication that we are becoming less willing to take the small risks when the larger risk mitigation effort has failed. The decreasing level of individual preparedness that has become a problem of the society we live in requires us to raise the bar when it comes to flexibility and achieving resolution to the problems we face.
We need to accept this fact and communicate it to our communities. We need them to understand that with greater fiscal constraint comes less resource flexibility and therefore we will need to be flexible in other areas to achieve reasonable solutions in times of great duress. This may result in people waiting longer for ambulances, it may result in patients being transported via fire engine, and it may result in life saving efforts being limited to a more basic level.
Of course, if risk management and liability concerns overshadowing the traditional “get’r’done” solutions our industry has been known for becomes the path that our society and country is taking, the next thing you know is they’ll be canceling football games for “safety” concerns and make them up on a Tuesday.
Perhaps its too late already.
I’ve already talked here about amoral policies leading to immoral behavior, and I think this is a great example of that. Had their been a negative outcome for the patient after 1 or 2 hours of being on scene, let alone 8 or 9 hours, who would then be liable? There would undoubtedly be plenty of blame thrown around and this would have had the potential of focusing that blame on the individual responders who failed to take a reasonable and appropriate risk instead of on the systematic failure that actually occurred.
When fear of liability paralyzes us from taking definitive action we have to question the mission of the organization and perhaps re-evaluate whether we are empowering our members to fulfill that mission or whether we are hindering it.