Mistakes, I've made a bunch of them

 I saw an IG post recently by someone that I follow that really struck a chord with me. They compiled a "non-exhaustive list" of mistakes they've made in their career. Being in EMS for over 20 years I can say that I have made my share of mistakes as well. I have told many people that the worst mistake is the one that you don't admit and that you don't learn from. I have also said that a lot of what I have learned is from my mistakes as well as the mistakes of others. Below I will list a few of my mistakes. 

1. This first one pops up in my mind from time to time...I had a call in the middle of the night for chest pain. I got to the person, and they said the pain came on suddenly, he was nauseous and really sweaty. I got him in the truck and put him on the monitor and it didn't say STEMI(heart attack). We went in route to the hospital(which wasn't far away at all), I gave a report, and as I got to the ramp the monitor gave me another 12 lead and it did say STEMI(heart attack). The rhythm on the monitor looked the same. I notified the Dr. as I walked in that there was a STEMI notification. After that call, I spent a lot of time learning 12 lead ECG's. The first thing that I do now is cover up what the monitor says the rhythm is and read the strips. I have many patients who have been having heart attacks that the monitor did not show as a heart attack. 

2. I was dispatched to a nursing home for a patient that was altered. A lot of times when we get sent to these calls we wonder what makes this patient altered when their normal status is altered. Anyway we got on the scene and the staff stated that the patient was altered, they checked the blood sugar and it was lower than normal. They gave the patient glucagon(a medication that is given as a shot to bring up the blood sugar) and there was no change. We loaded up the patient and transported them to the hospital. I failed to take a blood sugar on that patient as I figured that the glucagon should have fixed that problem. I got the patient to the ER and gave my report to the Dr. and nurse at the bedside. About an hour later I was dropping off another patient at the ER, the Dr. treating my altered patient said "Hey Darrin, that altered guy...his blood sugar was 40. We gave him D50(IV sugar water) and he is fine". So That night I learned that glucagon will only work if the patient's liver has enough sugar stores to increase their blood sugar. I also learned to take the blood sugar on every altered patient no matter what.

3. Another lesson learned courtesy of an ER friend. I brought in a trauma patient who could have used some fluids while in route to the ER. I looked at both arms from the hands to the a/c(crook of the arm) and I couldn't find any veins at all. When I got to the ER I gave my report to my friend and I apologized for not getting an IV on the patient but I couldn't find anything. The nurse told me it was ok and I walked away to do some paperwork. I was walking out of the ER when I heard my friend..." Hey Darrin", I looked up to see my friend slide up the left sleeve of the patient's shirt and there was the biggest most beautiful vein running up the patient's bicep I've ever seen. I told them "You will NEVER see me miss that again...EVER". I can honestly say that I haven't missed something like that again. 

4. We were sent to a person who was having back pain. The person had surgery several weeks prior and they were still having really bad back pain. We loaded up the patient(very carefully) and got her into the truck. I started an IV on her with no issues. My partner started driving to the hospital and I could tell that the patient was truly in pain and they were not "a seeker"(that is a person who is just looking for drugs), So I gave that patient some pain meds. When we got to the hospital I gave a full report without an issue. When I got back to the truck my EMT partner asked me if I got orders to give that patient pain meds. I asked why I would need to do that, and they said "It's in the protocol book that you have to call for orders to give pain meds for back pain".  I said, "To hell you say". I grabbed the protocol book and looked it up...my partner was right. This wasn't really a mistake, it was more like an oversight. The protocol book is a guideline and if we are going to deviate from the book we need to call for the ok to deviate. The Dr. receiving my patient said nothing of the fact that I improved the patient's situation by giving pain meds without calling. 

5. Here's a funny one. I was working with a very seasoned partner, we dropped off a patient at the ER and then cleared the call. I rode the call to the hospital, so my partner was in charge of putting the truck back together. That means putting the cardiac monitor wires and tubes away, picking up any trash I might have left, putting a new sheet on the stretcher, and putting the stretcher back in the truck. I came out of the ER and my partner was in the passenger seat. Upon seeing that, I assumed everything was done and we were ready to go. I cleared the hospital with dispatch and they sent us downtown. As we got down there I just happened to look in the rearview mirror(not something you do much unless there is a patient in the back) and there was no stretcher. I looked at my partner and said "Where is the stretcher?" They looked in the back and said "I thought you grabbed it". Nope, why would I, I rode the call. So we decide that we are going to sneak back to the ER and get it. Well as luck would have it, we catch a call downtown. So, I tried to discretely ask to give it to another unit. That didn't work, I tried another sly tactic and that didn't work either. So over the radio, I had to say that we did not have a stretcher and that we were out of service until we got our stretcher. Needless to say, that never happened again. 

My mistakes, or errs in judgment helped me to learn to be better. There were no catastrophic outcomes from my mistakes, no one was further injured or had a worsening condition. In retrospect...they probably helped many other people as I would use my mistakes as teaching moments to the new people that I was training. I tell new people that we all mistakes, the key is how you handle the situation after a mistake is made. You need to own up to it, you need to learn from it and you need to never let it happen again.