SlideShare a Scribd company logo
Monumental
Mistakes in
EMS
Disclaimer
• I
• AM
• Not
• A
• LAWYER
Hanlon’s Razor and Clark’s Law
• Hanlon’s Razor: “Never attribute to malice that
which is adequately explained by stupidity.” -
Robert J. Hanlon
• Clarks Law: "Any sufficiently advanced
incompetence is indistinguishable from malice.”
– Fred Clark
It all started back in 2006
“pervasive culture of deliberate
indifference” to EMS
Times are
changing
Times are
changing
Times are
changing
Objectives
• Describe the elements of Negligence
• Describe the concept of vicarious liability
• Describe the role of anchor bias, fatigue, anger and fear in EMS
decision making
• Review the case of Kyle Vess
• Review the case of Paul Tarashuk
• Review the case of Crystal Galloway
“Negligence” and Malpractice?
Negligence
• a professional duty owed to the patient
• breach of such duty
• injury caused by the breach
• resulting damages.
Medical Malpractice
• Medical malpractice is defined as any act or omission by a physician during treatment of
a patient that deviates from accepted norms of practice in the medical community and
causes an injury to the patient.
Common Sense
• Res ipsa loquitur:
• The Thing speaks for itself.
• Essentially bypasses the 4 elements of
negligence
• The “Sniff Test” /The
“Newspaper Test”
Respondeat Superior
• Vicarious Liability: “Known or should have known” an incident or problem
could, or would occur
• Negligent Hiring
• Negligent Supervision
• Negligent Training
• Negligent Retention
• Negligent Termination
“Willful Indifference”
• Willful indifference to the safety of others
means that someone intentionally disregards
the safety of others and doesn't take proper
care to prevent harm.
Some important terms: “Normalization of
Deviance”
Some important terms - Bias
• Cognitive biases in health care: Cognitive biases are flaws or
distortions in judgment and decision-making.
• More than 100 cognitive biases have been identified
• The big ones:
• Anchoring
• Diagnostic Momentum
• Framing
• Availability
• Confirmation
The Case of the Freeway
Firestarter
August, 2019
Kyle Vess Brian Cox
Background
• Dallas TX
• DFD Responds to a grass
fire on the interstate
• DFD arrives to find a
mostly extinguished grass
fire and Kyle Vess walking
nearby
Discussion
Discussion
Does “Negligence” apply?
• (1) a professional duty owed to the patient
• Was on duty
• (2) breach of such duty
• Allegedly assaulted the patient outside of legal parameters
• (3) injury caused by the breach
• Facial Trauma
• (4) resulting damages.
• Pain, Injuries, etc
Respondeat Superior?
• Vicarious Liability: “Known or should have known” an incident or
problem could, or would occur
• Negligent Hiring
• Negligent Training (and retraining)
• Negligent Retention
• Prior incident(s)
• Included falsification of documentation
• Negligent Termination?
Res ipsa loquitur:
• Kicking patient on the ground
• Taunting the patient
• Incriminating txt/SM Messages after the
fact.
The “Aftermath”
• Initially no action
• After body cam released (Sept. 2021):
• Mr. Cox was terminated (Oct, 2021)
• Mr. Cox Paramedic license was suspended ( Oct,2021)
• Mr. Cox was reinstated to DFD (Sept. ’23) on appeal
• Civil Case still pending
The Case of the Midnight
Rider
Paul Tarashuk Allison Harmon and Jamie Givens
Background
• Orangeburg County, SC
• OCSO and OCEMS respond to
a “Naked Man” jumping on a
Semi truck.
• OCSO arrives just before
midnight.
Discussion
Discussion
Discussion
Does “Negligence” apply?
• (1) a professional duty owed to the patient
• Was on duty
• (2) breach of such duty
• Failure to assess for /recognize potential life threats (AMS)
• Failure to transport
• (3) injury caused by the breach
• Released to LE when should have been transported
• (4) resulting damages.
• Death
Res ipsa loquitur:
• Inappropriate use of Ammonia Inhalants
• Inappropriate Demeaner
• Falsification of ePCR
•Described as A and Ox4
•Described as refusing to sign ePCR
refusal
Respondeat Superior?
• Vicarious Liability: “Known or should have known” an incident or
problem could, or would occur
• Negligent Hiring
• Poor background checks on Harmon
• Falsification/Omissions on application
• Negligent Training (and retraining)
• Negligent Retention
• Negligent Termination
The “Aftermath”
• Initially no action
• After body cam released (May, 2019):
• State Law Enforcement Division (SLED) opened investigation
• Paramedic Alison Harmon terminated for unrelated incident
• OCSO Deputy Clifford Doroski still on duty.
• Civil Case still pending
The Case of the Misdiagnosed
Mother
July, 2018
Crystal Galloway Lt. M Morris
Background
• Hillsborough County, FL
• HCSO dispatched
• Rescue 43 and SQ 1 dispatched
• 4 paramedics total
• 2 LT’s
• 1 “Acting” LT
• 1 FF/Paramedic
HCSO arrives
• Arrived shortly before HCFR
• Finds Galloway on the floor with a
complaint of “Headache and
sensitivity to light and sound” and
had a C-section recently
• HCSO advises R43 and SQ1 of this
information on their arrival
HCFR Arrives
• Patient now “hysterically crying” in pain.
• Vomited in presence of HCFR
• Unable to stand and walk.
HCFR On Scene
• HCFR Lt. Morris reports that the
patient “looked like she had a little
too much to drink” and “there was
no reason for them to transport her
to the hospital.”
• Advised the mother that if she
wanted to take her to the hospital
she could take her herself
• Did use the stair chair to help get
pt. into car for POV transport
POV Transport
• Mother began to
transport Galloway to
local free-standing ED
• Galloway began to have
seizure enroute
Possible contributing Factor
• Area of response
• Time of day
• Run volume
Does “Negligence” apply?
• (1) a professional duty owed to the patient
• Was on duty
• (2) breach of such duty
• Did not take vital signs
• Did not assess
• Did not recognize potentially life-threatening issue
• (3) injury caused by the breach
• Death
• (4) resulting damages.
• Loss of a mother, Loss of income, impact to the family
Res ipsa loquitur:
• No documented vital signs
• Left after 13 minutes
• Documented as:
•(R43) “Non Transport/No Patient Found”.
•(SQ1) ““Non-Transport/Cancel”
Respondeat Superior?
• Vicarious Liability: “Known or should have known” an incident or
problem could, or would occur
• Negligent Hiring
• Negligent Supervision
• Failure to follow established policies
• Negligent Training (and retraining)
• Negligent Retention
• Negligent Termination
The “Aftermath”
• Responders placed on leave during 3 month investigation
• Found to be “grossly negligent” based on lack of assessment
• "[They showed a] lack of remorse," and "In some cases, even outright
arrogance.“
• Lt. Morris was terminated
• "The fact that he said he would do it again, the same way, and that he can
tell, by looking at a patient, what they need, I think is horrendous,“
• Other responders suspended 30 days w/o pay and demoted.
• Lt. Morris was later reinstates after union arbitration
• Settlement for 2.75 million (2020)
What have we learned?
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf

More Related Content

Similar to 2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf

First aid-principles-and-practice-1208005555838235-9
First aid-principles-and-practice-1208005555838235-9First aid-principles-and-practice-1208005555838235-9
First aid-principles-and-practice-1208005555838235-9
kong huatmin
 
Tink Palmer,MCF, Presentation for day workshop.
Tink Palmer,MCF,  Presentation for day workshop. Tink Palmer,MCF,  Presentation for day workshop.
Tink Palmer,MCF, Presentation for day workshop.
mckenln
 
Pollock ethics 8e_ch09
Pollock ethics 8e_ch09Pollock ethics 8e_ch09
Pollock ethics 8e_ch09
windleh
 
Stevens story-hoist-Fatality
Stevens story-hoist-FatalityStevens story-hoist-Fatality
Stevens story-hoist-Fatality
Deborah Harrison
 
False positive
False positiveFalse positive
False positive
Alan Haller
 
2023 MSU.pptx
2023 MSU.pptx2023 MSU.pptx
2023 MSU.pptx
Bill Marler
 
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...
iCAADEvents
 
Chapter 9
Chapter 9Chapter 9
Chapter 9
glickauf
 
ethics notes ethics notes ethics notes ethics notes
ethics notes ethics notes ethics notes ethics notesethics notes ethics notes ethics notes ethics notes
ethics notes ethics notes ethics notes ethics notes
KRISTELLEGAMBOA2
 
A Practical Look at Legal Issues in Emergency Management
A Practical Look at Legal Issues in Emergency Management A Practical Look at Legal Issues in Emergency Management
A Practical Look at Legal Issues in Emergency Management
Partners in Emergency Preparedness Conference
 
Agentic state
Agentic stateAgentic state
Agentic state
gbaptie
 
Social care claims club, October/November 2017
Social care claims club, October/November 2017Social care claims club, October/November 2017
Social care claims club, October/November 2017
Browne Jacobson LLP
 
Incident Investigation ASSE 2014
Incident Investigation ASSE 2014Incident Investigation ASSE 2014
Incident Investigation ASSE 2014
John Newquist
 
Cacuss 2015 sexual violence
Cacuss 2015 sexual violenceCacuss 2015 sexual violence
Cacuss 2015 sexual violence
Dan Michaluk
 
Macquarie University
Macquarie UniversityMacquarie University
Macquarie University
John Andrew Ellis
 
Week 3 – 91417Today• 2nd Research Example• Q.docx
Week 3 – 91417Today• 2nd Research Example• Q.docxWeek 3 – 91417Today• 2nd Research Example• Q.docx
Week 3 – 91417Today• 2nd Research Example• Q.docx
cockekeshia
 
Crime scene awareness
Crime scene awarenessCrime scene awareness
Crime scene awareness
VASS Yukon
 
Methods of Philosophizing.pptx
Methods of Philosophizing.pptxMethods of Philosophizing.pptx
Methods of Philosophizing.pptx
JereenaCruz
 
Case Management of Child Maltreatment Cases
Case Management of Child Maltreatment CasesCase Management of Child Maltreatment Cases
Case Management of Child Maltreatment Cases
Health Easy Peasy
 
Prosecuting Fatal Child Maltreatment Cases
Prosecuting Fatal Child Maltreatment CasesProsecuting Fatal Child Maltreatment Cases
Prosecuting Fatal Child Maltreatment Cases
Children’s Trust of South Carolina
 

Similar to 2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf (20)

First aid-principles-and-practice-1208005555838235-9
First aid-principles-and-practice-1208005555838235-9First aid-principles-and-practice-1208005555838235-9
First aid-principles-and-practice-1208005555838235-9
 
Tink Palmer,MCF, Presentation for day workshop.
Tink Palmer,MCF,  Presentation for day workshop. Tink Palmer,MCF,  Presentation for day workshop.
Tink Palmer,MCF, Presentation for day workshop.
 
Pollock ethics 8e_ch09
Pollock ethics 8e_ch09Pollock ethics 8e_ch09
Pollock ethics 8e_ch09
 
Stevens story-hoist-Fatality
Stevens story-hoist-FatalityStevens story-hoist-Fatality
Stevens story-hoist-Fatality
 
False positive
False positiveFalse positive
False positive
 
2023 MSU.pptx
2023 MSU.pptx2023 MSU.pptx
2023 MSU.pptx
 
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...
 
Chapter 9
Chapter 9Chapter 9
Chapter 9
 
ethics notes ethics notes ethics notes ethics notes
ethics notes ethics notes ethics notes ethics notesethics notes ethics notes ethics notes ethics notes
ethics notes ethics notes ethics notes ethics notes
 
A Practical Look at Legal Issues in Emergency Management
A Practical Look at Legal Issues in Emergency Management A Practical Look at Legal Issues in Emergency Management
A Practical Look at Legal Issues in Emergency Management
 
Agentic state
Agentic stateAgentic state
Agentic state
 
Social care claims club, October/November 2017
Social care claims club, October/November 2017Social care claims club, October/November 2017
Social care claims club, October/November 2017
 
Incident Investigation ASSE 2014
Incident Investigation ASSE 2014Incident Investigation ASSE 2014
Incident Investigation ASSE 2014
 
Cacuss 2015 sexual violence
Cacuss 2015 sexual violenceCacuss 2015 sexual violence
Cacuss 2015 sexual violence
 
Macquarie University
Macquarie UniversityMacquarie University
Macquarie University
 
Week 3 – 91417Today• 2nd Research Example• Q.docx
Week 3 – 91417Today• 2nd Research Example• Q.docxWeek 3 – 91417Today• 2nd Research Example• Q.docx
Week 3 – 91417Today• 2nd Research Example• Q.docx
 
Crime scene awareness
Crime scene awarenessCrime scene awareness
Crime scene awareness
 
Methods of Philosophizing.pptx
Methods of Philosophizing.pptxMethods of Philosophizing.pptx
Methods of Philosophizing.pptx
 
Case Management of Child Maltreatment Cases
Case Management of Child Maltreatment CasesCase Management of Child Maltreatment Cases
Case Management of Child Maltreatment Cases
 
Prosecuting Fatal Child Maltreatment Cases
Prosecuting Fatal Child Maltreatment CasesProsecuting Fatal Child Maltreatment Cases
Prosecuting Fatal Child Maltreatment Cases
 

More from Robert Cole

DRAFT Ventilator Rapid Reference version 2.4.pdf
DRAFT Ventilator Rapid Reference  version  2.4.pdfDRAFT Ventilator Rapid Reference  version  2.4.pdf
DRAFT Ventilator Rapid Reference version 2.4.pdf
Robert Cole
 
2024 Selective Spinal Motion Restriction in the 21st century
2024  Selective Spinal Motion Restriction in the 21st century2024  Selective Spinal Motion Restriction in the 21st century
2024 Selective Spinal Motion Restriction in the 21st century
Robert Cole
 
Smile for the Camera DRAFT V0.03.pptx
Smile for the Camera DRAFT V0.03.pptxSmile for the Camera DRAFT V0.03.pptx
Smile for the Camera DRAFT V0.03.pptx
Robert Cole
 
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...
Robert Cole
 
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf
Robert Cole
 
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
Robert Cole
 
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...
Robert Cole
 
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf
Robert Cole
 
Proposal to establish a new training center for Multi Agency EMS Training v1....
Proposal to establish a new training center for Multi Agency EMS Training v1....Proposal to establish a new training center for Multi Agency EMS Training v1....
Proposal to establish a new training center for Multi Agency EMS Training v1....
Robert Cole
 
2021 A Storm is Coming.pptx
2021 A Storm is Coming.pptx2021 A Storm is Coming.pptx
2021 A Storm is Coming.pptx
Robert Cole
 
2021 Adrenal Disorders.pptx
2021 Adrenal Disorders.pptx2021 Adrenal Disorders.pptx
2021 Adrenal Disorders.pptx
Robert Cole
 
2004 EMS charting
2004 EMS charting2004 EMS charting
2004 EMS charting
Robert Cole
 
2007 SOAP Made Easy- cole.ppt
2007 SOAP Made Easy- cole.ppt2007 SOAP Made Easy- cole.ppt
2007 SOAP Made Easy- cole.ppt
Robert Cole
 
2006 S&C-06-21- EMTALAPtparking_1.pdf
2006 S&C-06-21- EMTALAPtparking_1.pdf2006 S&C-06-21- EMTALAPtparking_1.pdf
2006 S&C-06-21- EMTALAPtparking_1.pdf
Robert Cole
 
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...
Robert Cole
 
National ems scope_of_practice_model_2019
National ems scope_of_practice_model_2019National ems scope_of_practice_model_2019
National ems scope_of_practice_model_2019
Robert Cole
 
2021 national ems education standards
2021 national ems education standards2021 national ems education standards
2021 national ems education standards
Robert Cole
 
Ems education standards_2021_v22
Ems education standards_2021_v22Ems education standards_2021_v22
Ems education standards_2021_v22
Robert Cole
 
Access bt - 2022 01 hp cpr update
Access   bt - 2022 01 hp cpr updateAccess   bt - 2022 01 hp cpr update
Access bt - 2022 01 hp cpr update
Robert Cole
 
2022 high performance cpr update
2022 high performance cpr update2022 high performance cpr update
2022 high performance cpr update
Robert Cole
 

More from Robert Cole (20)

DRAFT Ventilator Rapid Reference version 2.4.pdf
DRAFT Ventilator Rapid Reference  version  2.4.pdfDRAFT Ventilator Rapid Reference  version  2.4.pdf
DRAFT Ventilator Rapid Reference version 2.4.pdf
 
2024 Selective Spinal Motion Restriction in the 21st century
2024  Selective Spinal Motion Restriction in the 21st century2024  Selective Spinal Motion Restriction in the 21st century
2024 Selective Spinal Motion Restriction in the 21st century
 
Smile for the Camera DRAFT V0.03.pptx
Smile for the Camera DRAFT V0.03.pptxSmile for the Camera DRAFT V0.03.pptx
Smile for the Camera DRAFT V0.03.pptx
 
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...
2018 Out-of-hospital cardiac arrest termination of resuscitation with ongoing...
 
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf
2018 Out-of-hospital cardiac arrest outcomes with pitcrew and LUCAS.pdf
 
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
 
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...
 
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf
1963 COWLEY Clinical Shock: A study of the Biochemical Response in Man.pdf
 
Proposal to establish a new training center for Multi Agency EMS Training v1....
Proposal to establish a new training center for Multi Agency EMS Training v1....Proposal to establish a new training center for Multi Agency EMS Training v1....
Proposal to establish a new training center for Multi Agency EMS Training v1....
 
2021 A Storm is Coming.pptx
2021 A Storm is Coming.pptx2021 A Storm is Coming.pptx
2021 A Storm is Coming.pptx
 
2021 Adrenal Disorders.pptx
2021 Adrenal Disorders.pptx2021 Adrenal Disorders.pptx
2021 Adrenal Disorders.pptx
 
2004 EMS charting
2004 EMS charting2004 EMS charting
2004 EMS charting
 
2007 SOAP Made Easy- cole.ppt
2007 SOAP Made Easy- cole.ppt2007 SOAP Made Easy- cole.ppt
2007 SOAP Made Easy- cole.ppt
 
2006 S&C-06-21- EMTALAPtparking_1.pdf
2006 S&C-06-21- EMTALAPtparking_1.pdf2006 S&C-06-21- EMTALAPtparking_1.pdf
2006 S&C-06-21- EMTALAPtparking_1.pdf
 
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...
Improving Drug Calculation Performance in Paramedics Practicing in an Emergen...
 
National ems scope_of_practice_model_2019
National ems scope_of_practice_model_2019National ems scope_of_practice_model_2019
National ems scope_of_practice_model_2019
 
2021 national ems education standards
2021 national ems education standards2021 national ems education standards
2021 national ems education standards
 
Ems education standards_2021_v22
Ems education standards_2021_v22Ems education standards_2021_v22
Ems education standards_2021_v22
 
Access bt - 2022 01 hp cpr update
Access   bt - 2022 01 hp cpr updateAccess   bt - 2022 01 hp cpr update
Access bt - 2022 01 hp cpr update
 
2022 high performance cpr update
2022 high performance cpr update2022 high performance cpr update
2022 high performance cpr update
 

Recently uploaded

Pediatric Emergency Care for Children | Apollo Hospital
Pediatric Emergency Care for Children | Apollo HospitalPediatric Emergency Care for Children | Apollo Hospital
Pediatric Emergency Care for Children | Apollo Hospital
Apollo 24/7 Adult & Paediatric Emergency Services
 
一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理
40fortunate
 
National Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptxNational Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptx
Jyoti Chand
 
Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.
Vishal kr Thakur
 
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Levi Shapiro
 
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTNURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
blessyjannu21
 
Bath patient Fundamental of Nursing.pptx
Bath patient Fundamental of Nursing.pptxBath patient Fundamental of Nursing.pptx
Bath patient Fundamental of Nursing.pptx
MianProductions
 
CCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer RehabpptxCCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer Rehabpptx
Canadian Cancer Survivor Network
 
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.
SamboGlo
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
Carolyn Harker
 
Professional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine LectureProfessional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine Lecture
DIVYANSHU740006
 
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
Vedanta A
 
R3 Stem Cell Therapy: A New Hope for Women with Ovarian Failure
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell Therapy: A New Hope for Women with Ovarian Failure
R3 Stem Cell Therapy: A New Hope for Women with Ovarian Failure
R3 Stem Cell
 
Vicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdfVicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdf
Arunima620542
 
FACIAL NERVE
FACIAL NERVEFACIAL NERVE
FACIAL NERVE
aditigupta1117
 
practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...
practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...
practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...
د حاتم البيطار
 
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
English Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptxEnglish Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptx
MatSouthwell1
 
Hypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in itHypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in it
Vishal kr Thakur
 
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DR Jag Mohan Prajapati
 

Recently uploaded (20)

Pediatric Emergency Care for Children | Apollo Hospital
Pediatric Emergency Care for Children | Apollo HospitalPediatric Emergency Care for Children | Apollo Hospital
Pediatric Emergency Care for Children | Apollo Hospital
 
一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理
 
National Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptxNational Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptx
 
Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.Pneumothorax and role of Physiotherapy in it.
Pneumothorax and role of Physiotherapy in it.
 
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
 
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTNURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
 
Bath patient Fundamental of Nursing.pptx
Bath patient Fundamental of Nursing.pptxBath patient Fundamental of Nursing.pptx
Bath patient Fundamental of Nursing.pptx
 
CCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer RehabpptxCCSN_June_06 2024_jones. Cancer Rehabpptx
CCSN_June_06 2024_jones. Cancer Rehabpptx
 
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
 
Professional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine LectureProfessional Secrecy: Forensic Medicine Lecture
Professional Secrecy: Forensic Medicine Lecture
 
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
 
R3 Stem Cell Therapy: A New Hope for Women with Ovarian Failure
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell Therapy: A New Hope for Women with Ovarian Failure
R3 Stem Cell Therapy: A New Hope for Women with Ovarian Failure
 
Vicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdfVicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdf
 
FACIAL NERVE
FACIAL NERVEFACIAL NERVE
FACIAL NERVE
 
practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...
practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...
practical guide of obesityfinal hyper1د حاتم البيطار القمة اكاديمي 0120238902...
 
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
 
English Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptxEnglish Drug and Alcohol Commissioners June 2024.pptx
English Drug and Alcohol Commissioners June 2024.pptx
 
Hypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in itHypotension and role of physiotherapy in it
Hypotension and role of physiotherapy in it
 
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
 

2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf

  • 2. Disclaimer • I • AM • Not • A • LAWYER
  • 3. Hanlon’s Razor and Clark’s Law • Hanlon’s Razor: “Never attribute to malice that which is adequately explained by stupidity.” - Robert J. Hanlon • Clarks Law: "Any sufficiently advanced incompetence is indistinguishable from malice.” – Fred Clark
  • 4. It all started back in 2006 “pervasive culture of deliberate indifference” to EMS
  • 8. Objectives • Describe the elements of Negligence • Describe the concept of vicarious liability • Describe the role of anchor bias, fatigue, anger and fear in EMS decision making • Review the case of Kyle Vess • Review the case of Paul Tarashuk • Review the case of Crystal Galloway
  • 9. “Negligence” and Malpractice? Negligence • a professional duty owed to the patient • breach of such duty • injury caused by the breach • resulting damages. Medical Malpractice • Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient.
  • 10. Common Sense • Res ipsa loquitur: • The Thing speaks for itself. • Essentially bypasses the 4 elements of negligence • The “Sniff Test” /The “Newspaper Test”
  • 11. Respondeat Superior • Vicarious Liability: “Known or should have known” an incident or problem could, or would occur • Negligent Hiring • Negligent Supervision • Negligent Training • Negligent Retention • Negligent Termination
  • 12. “Willful Indifference” • Willful indifference to the safety of others means that someone intentionally disregards the safety of others and doesn't take proper care to prevent harm.
  • 13. Some important terms: “Normalization of Deviance”
  • 14. Some important terms - Bias • Cognitive biases in health care: Cognitive biases are flaws or distortions in judgment and decision-making. • More than 100 cognitive biases have been identified • The big ones: • Anchoring • Diagnostic Momentum • Framing • Availability • Confirmation
  • 15. The Case of the Freeway Firestarter August, 2019
  • 17. Background • Dallas TX • DFD Responds to a grass fire on the interstate • DFD arrives to find a mostly extinguished grass fire and Kyle Vess walking nearby
  • 18.
  • 20.
  • 22.
  • 23. Does “Negligence” apply? • (1) a professional duty owed to the patient • Was on duty • (2) breach of such duty • Allegedly assaulted the patient outside of legal parameters • (3) injury caused by the breach • Facial Trauma • (4) resulting damages. • Pain, Injuries, etc
  • 24. Respondeat Superior? • Vicarious Liability: “Known or should have known” an incident or problem could, or would occur • Negligent Hiring • Negligent Training (and retraining) • Negligent Retention • Prior incident(s) • Included falsification of documentation • Negligent Termination?
  • 25. Res ipsa loquitur: • Kicking patient on the ground • Taunting the patient • Incriminating txt/SM Messages after the fact.
  • 26. The “Aftermath” • Initially no action • After body cam released (Sept. 2021): • Mr. Cox was terminated (Oct, 2021) • Mr. Cox Paramedic license was suspended ( Oct,2021) • Mr. Cox was reinstated to DFD (Sept. ’23) on appeal • Civil Case still pending
  • 27. The Case of the Midnight Rider
  • 28. Paul Tarashuk Allison Harmon and Jamie Givens
  • 29. Background • Orangeburg County, SC • OCSO and OCEMS respond to a “Naked Man” jumping on a Semi truck. • OCSO arrives just before midnight.
  • 30.
  • 32.
  • 34.
  • 36. Does “Negligence” apply? • (1) a professional duty owed to the patient • Was on duty • (2) breach of such duty • Failure to assess for /recognize potential life threats (AMS) • Failure to transport • (3) injury caused by the breach • Released to LE when should have been transported • (4) resulting damages. • Death
  • 37. Res ipsa loquitur: • Inappropriate use of Ammonia Inhalants • Inappropriate Demeaner • Falsification of ePCR •Described as A and Ox4 •Described as refusing to sign ePCR refusal
  • 38. Respondeat Superior? • Vicarious Liability: “Known or should have known” an incident or problem could, or would occur • Negligent Hiring • Poor background checks on Harmon • Falsification/Omissions on application • Negligent Training (and retraining) • Negligent Retention • Negligent Termination
  • 39. The “Aftermath” • Initially no action • After body cam released (May, 2019): • State Law Enforcement Division (SLED) opened investigation • Paramedic Alison Harmon terminated for unrelated incident • OCSO Deputy Clifford Doroski still on duty. • Civil Case still pending
  • 40. The Case of the Misdiagnosed Mother July, 2018
  • 42. Background • Hillsborough County, FL • HCSO dispatched • Rescue 43 and SQ 1 dispatched • 4 paramedics total • 2 LT’s • 1 “Acting” LT • 1 FF/Paramedic
  • 43. HCSO arrives • Arrived shortly before HCFR • Finds Galloway on the floor with a complaint of “Headache and sensitivity to light and sound” and had a C-section recently • HCSO advises R43 and SQ1 of this information on their arrival
  • 44. HCFR Arrives • Patient now “hysterically crying” in pain. • Vomited in presence of HCFR • Unable to stand and walk.
  • 45. HCFR On Scene • HCFR Lt. Morris reports that the patient “looked like she had a little too much to drink” and “there was no reason for them to transport her to the hospital.” • Advised the mother that if she wanted to take her to the hospital she could take her herself • Did use the stair chair to help get pt. into car for POV transport
  • 46. POV Transport • Mother began to transport Galloway to local free-standing ED • Galloway began to have seizure enroute
  • 47. Possible contributing Factor • Area of response • Time of day • Run volume
  • 48. Does “Negligence” apply? • (1) a professional duty owed to the patient • Was on duty • (2) breach of such duty • Did not take vital signs • Did not assess • Did not recognize potentially life-threatening issue • (3) injury caused by the breach • Death • (4) resulting damages. • Loss of a mother, Loss of income, impact to the family
  • 49. Res ipsa loquitur: • No documented vital signs • Left after 13 minutes • Documented as: •(R43) “Non Transport/No Patient Found”. •(SQ1) ““Non-Transport/Cancel”
  • 50. Respondeat Superior? • Vicarious Liability: “Known or should have known” an incident or problem could, or would occur • Negligent Hiring • Negligent Supervision • Failure to follow established policies • Negligent Training (and retraining) • Negligent Retention • Negligent Termination
  • 51. The “Aftermath” • Responders placed on leave during 3 month investigation • Found to be “grossly negligent” based on lack of assessment • "[They showed a] lack of remorse," and "In some cases, even outright arrogance.“ • Lt. Morris was terminated • "The fact that he said he would do it again, the same way, and that he can tell, by looking at a patient, what they need, I think is horrendous,“ • Other responders suspended 30 days w/o pay and demoted. • Lt. Morris was later reinstates after union arbitration • Settlement for 2.75 million (2020)
  • 52. What have we learned?