Posted by: medicblog999 | April 23, 2009

A lesson learned

beerA common saying that I am often heard muttering to new paramedics and ECSWs (Emergency Care Support Workers), is that

“Its always the drunks that will catch you out” (or rather the people you assume are just drunk)

We as paramedics are not infallible, despite our very best efforts, we make mistakes, or rather misjudgements, and at times like that we need to reflect and learn from our actions, or inaction’s, and make sure we don’t make the same mistakes again!

Some time ago, when I was still a relatively new Advanced Technician, I was sent on a job to a :

27yr old Male, Off legs.

No further information was forthcoming, but in all honesty myself and my partner (lets call her Susan) had already pre-judged the incident before we got there.

M999: ” Well, this is going to be nothing!”

Susan: “Its got to be a case of man flu or something!”

etc, etc.

We arrive on scene and are shown through to the patients front room by his mother. She seems a little concerned but certainly not displaying any overt panic or worry as if something serious was going on.

We find the patient, Lee, lying with his back to us on the sofa. He is a BIG lad (muscle, not fat) and has been vomiting, going off the evidence of the bucket of sick beside him. I ask him if he could turn over so that I could assess him properly, to which I got a grumble and a slurred reply of

“I cant!”

I ask his mum if he has been drinking?

Mum: ” He was out with his friends last night and didn’t get in until 4am this morning. I assume he didn’t want to wake us so he just crashed out on the sofa instead of going up to bed”

M999: “Lee? can you try and turn over so that we can see what we can do to help you”

Lee: “I said I cant!” (again a little slurred, from the alcohol?)

M999: ” Come on mate, your a big lad and its going to be difficult to try and turn you over, can you at least give us a little hand?”

Lee: “No!”

I’m starting to get a little ratty by this point, I want to get him sitting up so that I can check him properly. It seems pretty obvious that he is still drunk and suffering the effects of his binge drinking the night before. I’m starting to get that feeling of “why did you call an ambulance for this??”. I don’t think I said anything nasty or unprofessional, but at the time, I think I was a little short with him. I assumed that it was all down to the drink and because he is drunk and unwilling to sit up, we are going to have to do it and risk our backs at the same time.

I look at Susan and we decide that we will physically turn him over and sit him up.

M999: “Since you aren’t going to be able to sit up, we are going to move you into a sitting position. Before we do that, do you have any pain anywhere? Any neck or back pain? Were you assaulted or have you had a fall or anything?”

Lee: “No!”

We move him to a sitting position and I get a first good look at his face.

Oh Crap!!!!

Immediately, I notice a left sided facial droop.  Now he is in a sitting position, I can see that his left arm is hanging limply by his side and he is most definitely leaning to the left side too.

Lee isn’t drunk, Lee wasn’t being an obstructive young male – he was having or had had a massive stroke…..At 27!

We straight away changed gears, Susan went and got the chair whilst I placed a non rebreathing Oxygen mask on him. I tried to reassure him that we would look after him and get him to hospital as quickly as possible. I quickly spoke to his mother before we left scene and told her my thoughts. She was obviously distraught and decided to travel up in the ambulance instead of following in her car.

The whole journey, I tried to avoid her eye contact. I felt absolutely terrible! Her son was having a life changing, possibly life ending event, and I had prejudged him and assumed that he was nothing but a drunk man who was still hung over from the night before.

We blue lighted him to the hospital and once I had handed him over to the resus team, I went in search of his mother. I didn’t know what to say to her, but I really felt as though she deserved both an apology and an explanation into my actions. Maybe she hadn’t noticed and would be non the wiser. Maybe by me pointing this out, she would realise what had happened and may put a complaint in against me. Maybe she should anyway?

I found her outside and I explained how sorry I was if it appeared that I was less than professional in my initial assessment of her son. I explained that a stroke in someone as young and healthy as her son was very rare, and it wasn’t at the top of my list of differential diagnosis when assessing him. I admitted that I had been led by the history of his heavy drinking the night before and that had clouded my initial history taking and assessment. I again apologised and said that I sincerely hoped that he would recover well.

She was very gracious and said that she understood what had happened and also stated that she would assume that most if not all would have thought the same thing. She thanked me for my help and then went into resus to be with her son.

I left feeling very disappointed with myself but also determined that something like that wouldn’t happen again.

I have come to the conclusion since, that the vast majority of similar patients since Lee have only been drunk and a little obnoxious, but I have never come to that conclusion before ruling out all of the other differential diagnosis first.

It was a lesson learned 8 years ago, and it obviously stays with me to this day.

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Responses

  1. Well done – having the balls to apologise to someone unprompted when you feel you’ve wronged them says a lot about you.

  2. I remember when I was new being told that there is nothing wrong with pre judging a situation, infact you will find it almost impossible not to, however 2 important points, don’t let the patient or relatives know you’ve prejudged it, and ALWAYS be willing to change your mind!!

  3. This happens in hospitals too. When my dad was first admitted with query TIA’s, for the first two weeks they were treating him for alcohol poisoning on the basis that my Mum had mentioned that he liked a drink. We had to fight to get them to realise that he wasn’t suffering from this and eventually they realised. Unfortunately we didn’t get an apology.

  4. Fi – I had a flash of enlightenment yesterday while reading an article which mentioned the use a certain vitamin preparation iv in alcohol withdrawal. I spent 24 hours in hospital earlier this year because of what was most likely a transient global amnesia. During that time a drip was put up with a hurried “Oh it’s just some vitamins …” The admitting consultant was patronising in the extreme (originally from a location rather east of here but not terribly so) and tried to insist it was a TIA to my husband (when he finally clocked he was also a consultant in the same place) despite it already having been ruled out. I noted in the info about this preparation that it’s only recommended as being needed for alcohol withdrawal where the intake (for women) had been more than 12 units per day! I only drink wine, never more than 1/2 a bottle, and I haven’t found any wine THAT strong – though I will admit it is stronger now than it used to be, something to do with global warming, more sugar in the grapes, more alcohol in the wine. What worries me now is – what did that consultant put in my notes? Am I labelled as an alcoholic because my husband – trying to be helpful said I’d had a drink the night before the episode? On that basis almost the entire clinical staff could be classified so – and I bet I won’t get an apology either.

  5. Eileen – what a worrying exerience ! Funnily enough my Dad was also put on a variety of vitamins. He is also probably recorded as an alcoholic ! He has developed severe vascular dementia – I hope the staff on the original feel guilty, but somehow I think not.


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