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    Default How Many More Monica Yins?

    How Many More Monica Yins?

    By Colbert I. King
    Saturday, April 15, 2006; Page A15

    What if the patient care report or the Form 151 "run sheet" that the D.C. Fire and Emergency Medical Services Department (FEMS) uses to document a patient's treatment turns out to be at variance with the facts? That appears to be the case with Monica Yin, the Northwest Washington woman who had two disturbing encounters with D.C. FEMS ["Monica Yin's First Responders," op-ed, March 25].

    To recall: Four years ago, on the morning of Nov. 23, 2002, Yin experienced bouts of nausea, dizziness and disorientation. A call to 911 brought a response from fire and emergency medical technicians who, according to Yin (and eyewitnesses), failed to take her blood pressure or check her vital signs; forced her to undergo physical "tests" (standing, raising and holding her arms above her head); and decided she didn't need to go to the hospital, suggesting instead that she might be "faking."

    Hearing that assessment and bothered by the tests, Yin asked that the EMTs leave her home. Her friends took her immediately to George Washington University Hospital, where a "leaking aneurysm" was detected. Yin had emergency surgery the next morning, followed by a medically induced coma, three days in intensive care and eight days in the stroke unit.

    Yin's second EMS encounter occurred on Feb. 12 when she slipped on ice, injuring her head. Her friends called 911. Yin went through what she called a "bullying" experience with one EMT who demanded that she respond to his commands, transported her to the ambulance in a rough manner and attempted to cut off her clothing during the ride to the hospital, although she had a head injury.

    After my March 25 column was published, Yin was contacted by Assistant Fire Chief Douglas Smith. Yin agreed to meet with Smith but said she first wanted copies of the EMT logs or medical reports filed in the 2002 and 2006 incidents. Smith gave Yin copies of the patient care reports -- though one page of the 2002 incident was missing. Smith offered two meeting dates that didn't work for Yin. They are now trying to arrange a mutually convenient time to meet.

    This week Yin and I reviewed her patient care reports.

    She was surprised to see that the November 2002 report stated she was "oriented," that her eyes opened spontaneously, that she could obey orders and that her pupils were normal. How could that be, Yin wanted to know, because she recalled that she couldn't stand as ordered by the EMT and that she was unable to respond to his other commands.

    She said she was far from being oriented, having had several vomiting episodes and spasms. She also failed to understand how the EMT could assess her eye movement because her eyes were shielded by her arms most of the time. Yin also maintained that the EMT did not monitor her blood pressure, pulse and respiration -- a point eyewitnesses confirmed. The report was also silent on the test of her vital signs. The report, however, correctly noted that Yin released the EMT from providing further treatment. But that, she said, was after the EMT had tried to put her through physical tests of standing and holding her arms erect. She just wanted the EMTs out of her house.

    Yin was also surprised to see that the February FEMS report stated that her past medical history was unknown. In fact, she said, her roommate as well as her best friend told the EMTs at the scene that she had a history of aneurysms. They also asked that the stretcher on which she was placed not be rolled to the ambulance over a cobbled alley; they even offered to lift and carry Yin, but the EMT ignored them.

    So much for discrepancies in the reports. Yin and Chief Smith can examine the others in their meeting. There is, however, a much larger point -- one that extends beyond Yin and the case of the "drunk John Doe" (actually a 63-year-old retired journalist who had been beaten and robbed), previously reported, and other unreported D.C. FEMS incidents that have been called to my attention in recent weeks.

    For some time the D.C. Federation of Civic Associations, representing more than 45 citizen organizations, has been concerned about the delivery of emergency services in the District. Anne Renshaw, the federation's first vice president, asks whether the D.C. Fire and Emergency Medical Services Department, in a city with a daytime population of 1.5 million, is up to the task of responding, ministering and transporting victims to hospital emergency rooms with speed and quality care. The federation believes the answer is no, and there's no reason to dispute that conclusion.

    The federation points out that the city's emergency medical service handles 75 percent or more of the 911 calls to the fire department. Yet it is the emergency medical service side of the fire department that gets short shrift -- in staffing, pay and top-level support. "Why are ambulances frequently not available in certain times and parts of the city?" Renshaw asks. "Why must we rely on large expensive fire apparatus, staffed with four or five firefighters, to do what ambulances do in other large cities? Why must firefighters be persuaded and sometimes forced to 'ride the ambos'?" Renshaw wants to know.

    She wrote in a federation newsletter that "D.C. firefighters are now required to become EMTs as a condition of employment. Here, too, not all firefighters want to staff EMS ambulance units (referred to disparagingly as 'ambos' or 'gut boxes') and many do so grudgingly. ('Suck it up and ride the ambo,' one D.C. firefighter said to a disgruntled colleague.)"

    Forcing people to minister to the city's emergency patients is not what we should want, Renshaw said. That fact alone may help explain the bad attitudes that residents encounter and complain about. There is also concern that the turf battles between career firefighters and trained civilian EMS personnel may compromise response times to medical emergencies. Over the years, the federation observed, citizens have died waiting for D.C. ambulances.

    The nation's capital, these civic leaders fear, is losing veteran EMS professionals, especially well-trained, full-time paramedics. Their complaints, they contend, are falling on deaf ears in the D.C. Council and the mayor's office. The result: Monica Yins, cavalierly treated "drunk John Does" and many other horror stories that get swept under the rug.

    kingc@washpost.com
    Last edited by MalahatTwo7; 04-15-2006 at 02:19 PM. Reason: title change
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

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    This article appears to be another case of a journalist embellishing the facts to make it sound worse than it is. Where is the interview with the EMT or PIO to rebut her information? I'm sure they sell 10X the papers when they turn it into a hatchet job.

    Granted, DC Fire is not accumulating an enviable record for it's EMS work-but how does a patient who is having an aneuryism, and has no emergency medical training, judge how she should be treated? For examples, an EMT who held her hand could have established her vitals (pulse, respirations, BP over 80, skin warm and dry)without being obvious to an untrained bystander. She complains she fell and had a head injury, and they tried to cut her clothes off. That is referred to as a secondary survey in every EMS book I know.

    As far as the shortage of ambulances and medics, that horse has been beaten too many times to count. Budget cuts, abuse of 911, burnout, and giving positions away based on residency or minority status contribute to people who don't want to do the job.

    One rant, and I'm sure I'll get flamed for it, but here goes-I'm sick of hearing FFs complain about running medicals. If EMT was part of the requirement for you to be hired, then too bad. I do sympathize with those -like FDNY-who had it added on after hire, but you approved the contract that added it. Whether you want to do EMS or not, whether you agree with it being part of the job or not, IT IS, so DO YOUR JOB. There is no excuse for treating a patient like a second class citizen-even though many of them are a pain in the azz. Being able to deal with them appropriately is just being professional. Those 20 medicals are the price you pay for getting to go to that one good fire. All the whining and discontent with patients is only causing us problems with the public. Rant off, let the games begin.

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    I have no further information at this time.
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

    IACOJ member: Cheers, Play safe y'all.

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    MalahatTwo7, I'm not gonna try to justify things that may or may not be going on in DC. I will say do a web search on the Cincinatti Stroke Stroke scale....It is the gold standard in pre-hospital stroke evaluation and sounds very similar to what Ms. Yin describes as the "physical tests" which appear to have offended her. As to her not being oriented since she was vomiting and having "spasms"........neither of which have ANYTHING to do with her orientation....Orientation is a measure of someones mental status. It involves asking if they know who they are, where they are, time/date, and what happened to them. She appears to remember everything that happened and where it was. I would venture a guess that she was completely oriented. That all being said...I absolutely believe she should have been transported to a hospital in an ambulance. I'm not trying to minimize the emergency because obviously a very serious one existed. I do think her care was hindered by her asking EMS to leave. I don't know if her reaction was in response to poor attitudes be the EMS crew or maybe they just did not explain things as well as they should. I would be the first to admit that some of the things we do may seam odd to the untrained eye. As for the second incident...again I can not explain the EMS crews attitudes if they were indeed out of line. But if we are called to help I do like to think we would require some assistance from patients to assist themselves in their care and will issue "commands". That is what we do. As for the clothes removal. A large percentage of Trauma patients lose their clothes. It is the only way to effectively see if there are any other injuries present. And as Gunny said it is tought in every EMT, PHTLS, Paramedic and any other EMS textbook around. Generally with isolated trauma it isn't necessary but not knowing the severity if this head injury, I will say it is VERY possible we would be checking for other injury. If I were involved in the call I would much rather the article was "Paramedic gets complaint for cutting of patients clothes" and not "Paramedic gets fired for missing broken (you pick bone) on patient with head injury." I will agree with a concern raised. ALL patients should have at a minimum vital signs checked. That is a minimum standard and as the saying goes...if its not on the chart it didn't happen! BUUUT I really don't think we have all the information in these incidents so time will tell.
    Last edited by Mesquite5010; 04-17-2006 at 02:20 PM. Reason: Grammar issues

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    The original message came to me from a member of Fairfax County FD, which was posted in the Washington Post. Beyond what is written, I have no further info. And actually I only posted the article for general discussion and edification. Since I was not present for either the original incidents nor for the subsequent interview, I have no formed or ill formed opinion of the events.

    However, as an employee of the Washington Metro area, I found the article interesting in general, which brings me to my original point regarding creating discussion only.
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

    IACOJ member: Cheers, Play safe y'all.

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    Sorry MalahatTwo7...I assumed you were either the author of the article or an uninformed member of the media. The specific items in the article just did not seem to reach the level of warranting an article in the Washington Post. Most of the patients complaints appear based on not understanding how EMS operates and what assemsments we may do. Washington DC EMS MAY have some problems, but based on what I read in this article, what occured to Ms. Yin is not a part of any problem. It just appears to me that if the author had done some research before sending the article to press he probably would have figured out that their just isn't much to this. I can hear a valid complaint if EMS was talking in front of the patient about how they thought she was faking. Even if they really thought it, there care should never have revealed it and should always be based on patient complaint. Again sorry for the misdirected rant

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