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thethinker42
12-27-2009, 12:14 PM
I still need help with the question I posted in the Sandbox about paramedics performing procedures (http://www.absolutewrite.com/forums/showthread.php?t=166365) in the field, but I have one more (and I'm sure this won't be the last...write what you know indeed...)

If a paramedic is accused of discriminatory practices (specifically, not treating a victim because of their race...i.e., they triage a scene with multiple victims and treat a person of X race before Y race), how would something like this be investigated? (Assume the medic in question is attached to a fire department in the U.S.)

ETA: And yes, I'm googling the hell out of it, just figured I'd throw it out here in case anyone knows. :)

ETA: To clarify: This is NOT a mass casualty situation. The paramedic in question is a first responder (two man crew), but there are only three victims to triage.

jclarkdawe
12-27-2009, 06:45 PM
Let's start with your scenario of a mass casualty as a basis for a discrimination charge. A mass casualty is where there are more than three to five patients. Once you get above a certain point, you start having to institute certain procedures to make it work.

First unit to arrive is an ambulance consisting of a two person crew. Radio reports based upon phone calls from people at the scene indicate multiple persons, and when they arrive, they realize there are multiple patients injured. Crew consists of a paramedic and an EMT-Basic. Interestingly enough, the paramedic will not treat patients, most likely. The paramedic will immediately take charge of the entire scene. Initially he will be on the radio with dispatch, marshalling resources, putting together a rough estimate of patients and severity, working to alert hospitals, et cetera. He might not even get out of the truck, as he's mainly going to be working radio.

The EMT will get out and grab the Mass Casualty bag. Usually this consists of tags, and vests. He'll grab the vest that says "TRIAGE," toss the "INCIDENT COMMANDER" vest to his partner, and grab a handful of tags. You can see these tags at Triage - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Triage)
. Bag will then be placed conveniently so that the next responders to be assigned jobs can take vests.

The EMT with the tags will be starting to see patients. Assessment will consist of a visual inspection for blood loss, breathing, skin color, obvious deformities, and anything else you can see in less than 10 seconds. Each patient will be given a tag. Tags are ripped off to signify whether patient is:


Black = dead
Red = OH SHIT!
Yellow = Treat
Green = Walking wounded

Idea is a quick, thorough approach to discover what you have. Then the EMT counts tags, and counts how many of each color. An incident with a lot of red tags compared to green requires different resources. The EMT reports back to the Incident Commander with these numbers so that resources can be allocated more accurately.

Then the EMT goes around, doing a secondary triage.

The next arriving unit grabs their jump bags and head for the first red patient they see. Each subsequent unit takes on another red patient until they're gone, when you start dealing with the yellow.

Bottom line is it would be next to impossible to figure out whether someone was discriminating unless it was incredibly obvious. Any mass casualty is a cluster fuck for quite a while, and may never move from that status.

As far as an investigation, it would depend. EMTs are employed by their department and licensed by their state. The fire chief could investigate or the state department. If the charges are at all credible, the EMT would be suspended pending the investigation. Witnesses would be questioned and the EMTs record would be checked.

Best of luck,

Jim Clark-Dawe
Former EMT/firefighter

kayleamay
12-27-2009, 11:51 PM
Lori,

I haven't read your scene to know the exact circumstances, but if you are looking at a small group trauma scene, a big discriminatory oopsy-daisy would be to inappropriately triage a victim. Remember: Airway, Breathing, Circulation, Disability (neuro), Exposure. Anytime a paramedic does not prioritize their treatment based on this criteria, it could be deemed discrimination.


Motto for the day: All bleeding stops eventually.

Happy slashing,
km

thethinker42
12-28-2009, 04:23 AM
I haven't read your scene to know the exact circumstances, but if you are looking at a small group trauma scene, a big discriminatory oopsy-daisy would be to inappropriately triage a victim. Remember: Airway, Breathing, Circulation, Disability (neuro), Exposure. Anytime a paramedic does not prioritize their treatment based on this criteria, it could be deemed discrimination.


In the scene, he does properly triage, but a witness claims otherwise...it's not a mass casualty situation, just a "more victims than manpower" scenario. Basically, he makes the right decision, someone else thinks he didn't, blah blah blah. So, I'm just wondering how it would be investigated if such a claim was made. :)

thethinker42
12-28-2009, 04:40 AM
The investigation isn't going to go very far, just needs to be enough for someone to question him, etc. It'll be dropped in fairly short order, but it's necessary for some bumps in the road for the MC.

B Neil Brown
12-28-2009, 04:51 AM
From an EMT-B perspective... The EMT as already noted, would be the one to decide whether or not someone gets treated before any other, initially. When the Paragod gets done setting up camp, so to speak, he will evaluate, or re-evaluate the triage of his partner.

I guess what I would need to know, who is the accusing party, and what is their perspective? Were they someone hurt, who happens to be the color blue, when the Paragod is the color green? And that blue victim thinks he was discriminated against on the basis of his color, or whatever? Or was it a bystander? What was the type of trauma? If you pull up on a mass casualty scene and someone is not breathing, and has gray matter showing, they actually go lower on the priority list, then say a bleeder who is going into shock.

So, the investigation would depend on the tag color (again noted above) of the victim. If the color protocol was properly adhered to, and the para/emt team has a good rep with the brass, then their might not be much of an investigation at all.

You have to understand something, here. If these are Fire Fighters that also run ambulance crews, they are very self protective of each other. The first response is always going to be "Those people are just upset, my crew is top notch!"

They may hate each other, but in the station, the wagons will circle up when outsiders start taking pot shots at the crew.

Whatever the SOP's (standard op procedures) of the station, city or county would truly dictate where the investigation comes from, and who does it.

On a small dept, the chief, or asst chief might do the investigation. On larger dept's, they might have an IA officer just for this.


I know this isn't the greatest answer, so give a little more info..

How big a department
Who is accusing
Was the accused hurt at the mass casulty
What are they being accused of

Give us that info, we can put you in a better direction

Kaiser-Kun
12-28-2009, 04:58 AM
Black = dead
Red = OH SHIT!
Yellow = Treat
Green = Walking wounded
You've got it all wrong...

Black = Death
Red = Rage
Yellow = Fear
Green = Willpower
Blue = Hope
Indigo = Compassion
Star Sapphire = Love
Orange = Greed

http://upload.wikimedia.org/wikipedia/en/a/a0/PowerBatteries01.jpg

thethinker42
12-28-2009, 05:02 AM
You have to understand something, here. If these are Fire Fighters that also run ambulance crews, they are very self protective of each other. The first response is always going to be "Those people are just upset, my crew is top notch!"

I'm married to a cop/former firefighter, so I understand, don't worry. ;) My biggest concern is simply the logistics of this kind of thing. WHO in the department would be involved, what kinds of questions would be asked, etc.

The investigation isn't going to go very far. He wasn't discriminating, he made a triage decision based on the proper criteria, etc.


On a small dept, the chief, or asst chief might do the investigation. On larger dept's, they might have an IA officer just for this.

So IA would get involved with something like this, then? (I guess it's the hierarchy and dept structures I don't totally understand, so this is the info I'm looking for...who would be involved, etc)


I know this isn't the greatest answer, so give a little more info..

How big a department
Who is accusing
Was the accused hurt at the mass casulty
What are they being accused of

Give us that info, we can put you in a better direction

Still working out how big the department is...this is the early planning stages for the book, a lot of it is up in the air. Just trying to get a general idea of how I could address this, so large or small department info is helpful.
The accuser is a witness (relative of the victim who died) who believes the paramedic ignored the victim.
NOT a mass casualty.
He's being accused of electing to treat a victim of one race over another, when in reality he was triaging based on extent of injuries. As I said, the paramedic did the right thing, but questions are raised, and I want to make sure it's addressed properly.

B Neil Brown
12-28-2009, 05:37 AM
OK, let's see. Pardon my "mass casualty" usage. If it is more than 5 ppl, it is mass casulty to me. LOL

OK, once again drawing from what I have seen on a small department.

I was in a situation once where my partner called a black person an ugly word, didn't think anyone else could hear. We were an emtX2 team, BLS ambulance department.

I was a witness, so to speak. The complaint came in a few days after. Or at least, that's when we heard about it.

It was the chief who did the questioning. Our dept has one chief, 2 asst chiefs, and 2 captains. Each shift has 1 asst, 1 capt, and 2 FF on shift, a 4 man team.

EVERYONE was questioned. Even the asst and capt who were at the station, not at the patient's home.

The important thing here is, small department, small town. I was also questioned by our Mayor. No biggie, I played football with his son back in high school, we all know each other in a small town.

The reprimand was handed out by the chief, but the entire city council heard about it at some point.

Nobody was fired, but my partner was written up, and had to go through some kind of HR class on non-discrimination.

That has been 6 or 7 years ago now.

A bigger department prolly wont go all the way to the mayor. When I say IA, I really mean the HR officer. This is really a human resources issue (the situation you arewriting about, that is).

So, goes through a station house chief in a bigger dept, possibly through HR.

Goes through the entire freaking city council and mayor in a small town.

Does this help? :)

N

thethinker42
12-28-2009, 05:38 AM
Very helpful, thank you. :)

jclarkdawe
12-28-2009, 05:38 AM
So you want a small mass casualty (anytime victims exceed manpower is a mass casualty) that would create some problems for your MC.

MC is first on scene of a two car accident, each car involving two occupants. MC tags one patient as yellow, two reds, and one black. Now one of the tricks with black is it doesn't always mean dead dead. It might mean that resources involved are greater than the chances of saving the person. As always at car crashes, there are lookers, who flip at decision to call person still bleeding dead.

First three patients are extricated and worked on in normal order, with black tag being ignored. Lookers are flipping out even more, but black tag is really entrapped in car. No measurable blood pressure, gray, unresponsive, pretty much dead. Person is taking pictures with cell phone and sending them to the news organizations showing how everyone is ignoring black tag.

Finally, resources free up sufficiently to begin getting the black tag out. We're now 30+ minutes into the event, with black tag being ignored. When dash is removed from black tag's chest, he sighs and starts breathing. They start working on him, get him to the hospital, where he can either have black tag live or die.

Next morning, photos of the black tag patient being ignored is all over the newspaper. MC is called in front of chief, who wants to know why the hell that was allowed to happen. While being yelled at, mayor calls chief. Throw in the medical director from the hospital. Big investigation, small investigation can happen depending on story needs. Bottom line is prudent medical decision.

Best of luck,

Jim Clark-Dawe

frimble3
12-28-2009, 06:20 AM
No actual knowledge, nothing useful to add, but, reading these informed posts, from people who appear to know their stuff, a thought occured to me. What if the witness, an outsider to the lingo, like me, and frantic over the fate of the relative, confused "Leave him 'til later, he's a black tag" with "Leave him 'til later, he's a black man?" Especially if they are in an area that had a history of discrimination in medical services?

thethinker42
12-28-2009, 06:25 AM
No actual knowledge, nothing useful to add, but, reading these informed posts, from people who appear to know their stuff, a thought occured to me. What if the witness, an outsider to the lingo, like me, and frantic over the fate of the relative, confused "Leave him 'til later, he's a black tag" with "Leave him 'til later, he's a black man?" Especially if they are in an area that had a history of discrimination in medical services?

Oh, good point...noted! :D

spike
12-30-2009, 07:44 AM
My late husband was an EMT/Paramedic for over 20 years, most of in Allentown PA. There, the EMS was overseen by the Department of Health, at City Hall. They would handle any complaints.

JrFFKacy
12-31-2009, 06:12 AM
No actual knowledge, nothing useful to add, but, reading these informed posts, from people who appear to know their stuff, a thought occured to me. What if the witness, an outsider to the lingo, like me, and frantic over the fate of the relative, confused "Leave him 'til later, he's a black tag" with "Leave him 'til later, he's a black man?" Especially if they are in an area that had a history of discrimination in medical services?

This would add an interesting twist.

Around here (straight Volunteer fire service with a separate EMS organization that we assist on a regular basis) we always say 'crap rolls downhill'. Most complaints end up with the Chief, then filter down to wherever the issue started.

And yeah, around our hall, there are a few guys who don't like each other, but at a scene, we're all one team and are going to stick up for each other regardless of whether we're actually friends or not. It's the very strong 'Everyone goes home' mentality.

It's interesting to see how bystanders react to stuff we take for granted. I really like the suggestion I quoted. We try out best to keep civilians as far away from the actual scene as is possible, because you do get people who come in and think they know better than you, or Command, and cause issues. (who cares that they've never had any med training, they watched a situation like this on TV so they're experts!). It would be easy for someone to overhear a comment, get it wrong then start a rumour.

frimble3
01-02-2010, 01:20 AM
Especially if things go wrong. I'm betting that there are few complaints about behaviour and attitude if all the victims go home alive and intact. It's only if things end badly that people go home and start to pick things apart in their heads, trying to make sense of it.

thethinker42
01-02-2010, 04:10 AM
Indeed, the "black tag" victim dies. Hence the backlash. :)

Tsu Dho Nimh
01-05-2010, 05:06 AM
When you have N victims and fewer than N rescuers, someone is going to be ignored and they may die. Deciding who to let die so you can save another isn't a cut-and-dried science even with the published protocols, and it's a gut-wrenching decision to make.

If the autopsy on the dead one, and the medical records of the two who live back up the judgment of the EMT, he's not going to be in trouble. In Phoenix the investigation would be handled by the Fire Department, since they run the EMT services.

ideagirl
01-06-2010, 07:11 AM
In the scene, he does properly triage, but a witness claims otherwise...it's not a mass casualty situation, just a "more victims than manpower" scenario. Basically, he makes the right decision, someone else thinks he didn't, blah blah blah. So, I'm just wondering how it would be investigated if such a claim was made. :)

This sounds more like a momentary blip of bad PR than anything serious, and it's only a PR blip if the random witness somehow gets airtime by complaining loudly to the press, city officials, etc. A random witness can't sue anyone for discrimination--they don't have standing. The only person who could sue would be the person allegedly discriminated against, or, if that person died or was incapacitated, their closest family members (parents, kids, spouse). So in short, the random witness has no power to do anything but complain. In such circumstances, I would expect the paramedic's employer to do a cursory investigation and then, for PR reasons, to make a public announcement that the investigation found no wrongdoing. For it to get hairier, the victim (or his relatives, if he died etc.) would have to take up the cause.

thethinker42
01-06-2010, 07:14 AM
This sounds more like a momentary blip of bad PR than anything serious, and it's only a PR blip if the random witness somehow gets airtime by complaining loudly to the press, city officials, etc. A random witness can't sue anyone for discrimination--they don't have standing. The only person who could sue would be the person allegedly discriminated against, or, if that person died or was incapacitated, their closest family members (parents, kids, spouse). So in short, the random witness has no power to do anything but complain. In such circumstances, I would expect the paramedic's employer to do a cursory investigation and then, for PR reasons, to make a public announcement that the investigation found no wrongdoing. For it to get hairier, the victim (or his relatives, if he died etc.) would have to take up the cause.

And that's really all I need...it isn't going to turn into a major investigation, just enough for them to grill him and find out what happened.