The Letter

The Letter

By Thom Dick Sep 27, 2011

If we’re lucky, we learn our most important lessons from the mistakes of others. You’re socializing with off-going crews in your agency’s dayroom when someone reaches over your partner Bud’s shoulder.

“Here,” she says. “This was in yesterday’s mail.”

Bud notes the return address, and his conversation ceases mid-sentence. The room goes quiet as he slits the envelope and unfolds a one-page letter. He’s still reading it when your supervisor enters the room and invites both of you into an adjoining classroom. The expression on her face is serious. There’s a similar letter for you, and she hands it to you as you each take a seat.

The letter is from your agency’s attorney. Your agency has been named in a lawsuit as a result of a vehicle failure several months ago, and the attorney wants to meet with you both. Your ambulance ran out of fuel on the way to a cardiac arrest, and a patient subsequently died. The call came in an hour after shift change, while you and Bud were having coffee with another crew. Bud received a written warning at the time of the call for falsifying the unit’s fuel level on your morning checklist. Even then, he had a reputation for pencil-whipping his documentation.

You’ve been expecting this letter. But now, reading the terse legal language, you feel a distinct prickly sensation at the back of your neck. Lots of people are being blamed for this person’s wrongful death, including Bud, you, your supervisor, your education coordinator and your ops manager. But especially Bud. And you.

This was Bud’s fault, pure and simple. He was the driver that day. I checked the patient compartment and Bud checked the mechanical systems. We take turns; that’s how it works. Not only that, but very few people survive cardiac arrests. We both felt bad after this call, but we didn’t cause the cardiac arrest. I don’t think it’s fair. Why should we be blamed for the person’s outcome?

You sounded about right there for a moment, until you brought up the patient’s survivability. It wasn’t the patient’s duty to survive. It was your duty to help, and due to issues that were under your control, that didn’t happen. Now this thing is in the hands of attorneys, and you’ve left it to someone else to decide who’s culpable and who’s not. I think you’re in trouble.

How is it my fault? I checked my part of the ambulance. I always do.

I’m no attorney, but I think we’re all responsible for what we know. You’re a trained observer. When you realize your partner has checked the mechanical systems without opening the hood, you’re responsible for that information. When you sit down at a coffee shop 10 minutes after clocking in, you know what kind of checklist you’ve done. And when you sign the checklist and see that your partner has just drawn lines through the sections that pertain to the mechanical systems, you’re responsible for your own doubts, too. Let’s face it: You’ve trusted your luck for some time now. You know better than that.

What am I supposed to do? I’m not Bud’s supervisor. I have enough trouble doing my own job without being responsible for his too. Besides, Bud’s a nice guy. I’m sure as hell not going to run to a supervisor and rat on him every time he screws up. Who wants to work in that kind of environment?

Continue Reading

You’re right, of course. On the other hand, your ambulance can either earn you a living or kill you, any day of your career. To be blunt, Bud is not your friend. He’s a slug. He cheats. He’s knowingly risked your life, your future, your family’s welfare, your agency’s financial resources, the good names of your colleagues and the lives of others rather than doing his job. And you’re enabling him to go right on doing it. If that doesn’t bother you, it should. And if it bothers you but you’re ignoring it, maybe you shouldn’t be surprised when somebody steps in and shakes you up some. Face it, that’s what attorneys do.

Like aircraft, ambulances consist of mechanical, electrical, hydraulic and structural systems. Every one of those systems is destined to fail eventually, and it’s your job to stay aware of yours every minute of every day.

See, your morning coffee is this whole other thing.

Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail



Patients living in rural areas can wait up to 30 minutes on average for EMS to arrive, whereas suburban or urban residents will wait up to an average of seven minutes.
A patient who was picked up for a mental health evaluation punched and pepper sprayed the EMTs, who managed to remove her from the driver's seat when she jumped in to try driving the ambulance.
The new helicopter will expand Rico Aviation's area coverage for emergency air transportations.
Firehouse Subs Public Safety Foundation donated a grant to paramedics to purchase a utility terrain vehicle to be better equipped for off-road rescues.
Paramedics are using safer alternatives to fentanyl for pain relief in ambulances to avoid exposing patients to the addictive opioid.
Changes include sending an SUV response vehicle to non-emergency calls instead of fire engines, assigning mental health specialists to residents who call 9-1-1 frequently to reduce their calls, and sending patients to alternative locations for care to save money on hospital visits.
Envoy America matches seniors and patients with mature, trained, secure driver companions to run errands, visit doctors, go out with friends, visit museums or shows, and attend to other daily needs outside the home.
A portable morgue originally designed for transporting victims of mass casualty events has been in use for the rise in heroin overdose victims.
Florida's Department of Health gave $87,000 to an agency to help provide better patient care with an up-to-date ambulance.

Emergency medical services is a physically demanding profession. We must frequently squat, lift, reach, twist and sometimes contort into unnatural positions. It’s no secret that exercise is beneficial in helping us do these things with less chance of injury. While any routine exercise is beneficial, it is important to evaluate what you are preparing yourself for with an exercise program and tailor your program around those desired outcomes.

State funding losses will threaten the availability of life-saving air ambulances.
Ambulance services will be reimbursed by insurance companies for trips that don't result in transporting patients to hospitals due to sufficient care from EMS providers.
EMTS and paramedics are being hired for Century Ambulance's new station in Panama City.
The Israeli group's new ambulance serves neighborhoods that need faster response times.
The award signifies that Maricopa Ambulance has met the requirements for utilizing data to improve patient outcomes for (STEMI) cardiac patients, stroke, major trauma and out-of-hospital cardiac arrests.