Monday, May 9, 2011

KCFD EMS: Best It Can Be?

I am becoming convinced that a vital part of life is dealing with failure and defeat. Failure is something that will happen to us as we live our lives. Some things we do will not work. We will exhibit bad judgement. We will commit, we will omit. It is going to happen. I wanted to follow up with part two of KCTV 5's report on the death of Frank Nigro. Mr. Nigro died while being transported between hospitals in inclement weather in January of this year

Dana Wright interviewed Dr. Joseph Salamone, Kansas City's EMS medical director. I found this interview troubling in many ways. However, this exchange really bothered me. First of all, Ms. Wright had to really chase Dr. Salamone around for an answer--he kept hiding behind not being able to discuss "this case."
"Give me a general example of how someone dies and a paramedic sitting a few inches away doesn’t notice he's dead," Wright said.

"I think that there are a variety of things that can happen, just as in a health care setting and depending on the degree of illness, the patient who has been medicated and appears to be comfortably sleeping," Salamone said. "You know we're not watching every, every heartbeat and respiration ...."

"Don't you think people will be surprised, though, that if you're in an ambulance someone's not necessarily paying attention to you?" Wright asked.

"Continuously paying attention to you? I don't think that's any different unfortunately than any health care setting in the country today, if not the world," Salamone said. "Nurses may sit at your bedside and document. They may not be watching you absolutely every second. And that's just part of medicine because unfortunately medicine is actually practiced by humans, too."

Wright: "I wanna know this won't happen again."
I can't guarantee that (it won't happen again)," Salamone said. "I couldn't guarantee that in my hospital, unfortunately."
When Wright pressed the issue of protocols that might prevent such failures in the future, an off camera voice interceded.
Wright: "There's no protocol that would prevent this from happening."
Then a voice comes from off camera--the camera backs out so you can see the person talking. No doubt, he's a lawyer.
Off camera lawyer: "You're saying that can happen and that leads to this specific case."
Wright's response: "I can't change the fact that a man died in the back of an ambulance and no one noticed," Wright said. "There's no protocol that would prevent that from happening."
Salamone: "I cannot discuss that case."..."...or how protocols may apply or be changed..." [snippets from Salamone's last statements.]

Watch for yourself--here's the link to the KCTV5 report. I wanted to quote that exchange exactly, not just taking the written report off the web, because I think it says something important about dealing with failure, first this failure and then failure as a whole. Because, as I said, it's gonna happen. The problem is when health care has fails, usually somebody gets hurt. It's disturbing to me that instead of going into a problem solving mode--Dr. Salamone goes into CYA mode after opening the door to the reality of human failure. Here we have a tragic case of an individual human failure and the medical director is too bound to the doctrine of CYA (with the help of Mr. OffCamera) to say well, yes, we might have an issue with protocols here--to say either the protocols need changing or we need training to make sure they are followed. If this is the best he can do, perhaps he should not have given this interview or at least not have given it right now (and no, throwing the individual paramedic under the bus, while tempting and rational sounding, will not address any systemic problem that is present.)

This is the EMS system we have right now--as political and ill advised as its conception was. Perhaps it is time to make it the best it can be--or evaluate different models for its administration if need be. If this sad case, a case which due to privacy laws (our old friend HIPAA) and possible lawsuits about which we may never learn the full truth, should demonstrate anything to us, it should show us that we have a lot of room for improvement and that there is no substitute for a corporate and individual commitment to excellence, both in planning and protocol and in delivery. That commitment includes taking full responsibility as an organization--even an organization that is government run--for failures and times that the work falls short of expectations.


SOS said...

And now the KCMO Public Safety Committee, simply newly renamed, which will "oversee" publicsafety including KCFD, is charied by non other than John Sharp, who, more than any other single individual brought the excellent MAST system to its current sorry state. And the vice-chair is Jermaine Reed, whose major backer in the campaign was Al Brooks with the expressed purpose of gettin ad Hoc back on the city taxpayers' gravy train.
What could possibly go wrong?

Anonymous said...

I found the KC-MO EMS rep's comments frightening among other- more earthy terms.

You can BET I'll be listening-to and watching the medicos VERY closely now.

In regard to the Nigros- can you spell l-a-w-s-u-i-t?


The Observer said...


Yeah, it doesn't inspire confidence, does it?

I just hate that almost all the scenarios of doom that the dozen or so of us of Save MAST came up with are all coming true...

Thanks for coming by!

The Observer

The Observer said...

Remember I had just posted that big bit from Harvard business review about failure management not too long ago?

I don't think this was what they had in mind. Way to inspire faith in the service--acknowledging that humans doing health care are finite, yet refusing to discuss the systems you might have to help keep the quality of care up. And the stink of CYA--wow!

Also you should see how some of the national EMS blogosphere has blown up--I'll get some links together over on Facebook.

Lots to watch here for sure. Thanks for coming by--stay cool tonight and batten down the hatches for tomorrow.


Groucho K. Marx said...

Heh T.O....

I'm ALWAYS cool and keep my hatches battened... LMAO!