Faking Vitals, Faking Interest, Faking Your Way Through EMS

Evening in Milwaukee. The call is dispatched as NAUSEA/VOMITING AND DIZZINESS. We arrive on scene and find a male patient sitting in the driver's seat, pulled over on the side of the road. His son is with him. We begin our assessment. He's been feeling this way for a couple hours. He takes a number of cardiac medications. I begin to take vitals, find a blood pressure of 92/60. Pulse is rapid, respirations are rapid and shallow. He's had an MI in the past. As I'm assessing him, his implanted defibrillator begins to fire. We follow protocol and request ALS on scene. I know this is a mixed blessing. On the one hand, it would be nice to have ALS responders on scene with their bigger bag of tools to bring to bear on the patient. On the other hand, our fire department--plainly put--hates EMS. Paramedics here are for the most part firefighters who got stuck in the academy with the task of going through paramedic training. They wanted to fight fires, not coronary artery disease. Now they're putting in their two years on a MED unit and waiting until they can get back to what they really wanted to do. But my protocols say I call them, so I do.

The Engine Company arrives at the same time as the MED unit. We give our report, and the paramedic directs one of the Firefighter/EMTs to get a set of vitals. I stand by and watch. He turns around and tells the paramedic, "120/80." In Milwaukee, this is what we call "Engine 12ing the vitals." Make 'em up. Out of thin air. ER docs and nurses use the phrase, as do paramedics and EMTs. It's a common phrase because it's a common event.

I cannot imagine a scenario in which Engine 12ing vitals might be justifiable. It's falsifying a patient care report. And in the case of a patient with a cardiac history, who describes his symptoms as exactly the same as when he had his previous heart attack, and his defibrillator is firing right in front of us--no. Unacceptable. Perhaps even criminally negligent. This is a cardiac case--the next step might very well be to administer nitroglycerin, which is contraindicated in patients with a systolic pressure under 100mmhg. This guy is 92, but the paramedic thinks it's 120. If he gets nitro, he might crash. He might not die, but losing consciousness due to a screw-up in medication isn't a good thing.

I'm taken aback by the audacity of an EMT to not only fake a set of vitals, but to do so in such a blatant manner as to pick the textbook 120/80 as the set. My reaction was involuntary--I laughed. Not the amused laugh of someone who just heard something funny. It was more the, "I can't believe you just said that," laugh--a guffaw.

The paramedic heard my reaction, and asked, "Why, what'd YOU get." I glanced at my gloved hand, where my vitals were still written down, and read him my set. The firefighter/EMT glared at me as I did it. I can't bring myself to look at him, because I'm calling him a liar to his face and I'm embarrassed for him. The paramedic enters my set into the computer. I walk back to my rig and begin writing up my PCR.

I spend the next few weeks fuming about the incident. I'm an applicant to this department. I'm high enough on the eligibility list that I'll probably be hired sometime in the next year. And I don't want to work with these guys. I don't want to be the only guy who cares about EMS in my crew. I don't want to tell people, "I work for MFD." I imagine it now, and I'm imagining the embarrassment I'll feel if I'm speaking to someone who knows the department--the need to qualify that statement with something like, "and I'm not like those other guys, I promise."

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Comment by Phoenix on June 18, 2009 at 5:23pm: Todd,
First off don't ever be embarassed about calling someone out whose BSing their vitals, I don't care what their title is. I wouldn't title this person as an EMT either just because they passed a class. A true EMT cares about their patients, not the piece of equipment their assigned to. I promise you if I had been you, this clown would not have had a license/ job the next day. As far as working for MFD, it sounds like they need professionals just like YOU. Remember, you don't have to be an Officer to lead. All it takes is someone standing up and doing the right thing everytime and eventually one of 2 things will happen.....The others will fall in step with you or they will leave because they won't like being the outsider. The big issue is, will you be able to stand by and let this type of thing continue and have someone lose their life, be able to look yourself in the mirror knowing you could have prevented it?
Integrety is the most important part of patient care. You have it.....don't let anyone sway it. Keep fighting the good fight.

Comment by Matt Whitmire on June 18, 2009 at 5:03am: Rob, you hit the nail on the head...

Comment by Todd D. on June 17, 2009 at 4:09pm: All good points. FWIW, I removed my name from the eligibility list on Monday. I love where I'm working and what I'm doing. I'll get some more time under my belt and see what opportunities open up down the road.

Comment by Christy on June 17, 2009 at 9:35am: So why didn't the paramedic take another blood pressure and do it himself? Thats what I would do.

Comment by Rob Farnum on June 17, 2009 at 2:52am: Todd,
If what you say is true, and I'm not doubting you, then MFD does need you. More importantly, the people of the community do. While saying "I'm not one of those guys" won't work, you will build your reputation up. It will take time, and the boat may rock at times, but it is worth it. Stay strong, and pick your battles.

Tom, while I would expect the BP to go up, who in their right mind would expect a perfect 120/80? Beyond that, the Medic punching in the numbers Todd provided speaks volumes. If the Medic belonging to the same FD doesn't believe the FF, it does raise flags to a core problem. I do understand all FF stand together no matter what, but there does come a time when that thin blue line needs crossed...

Comment by Kerry Monroe on June 13, 2009 at 7:15pm: If they're being negligent, hopefully it will catch up with them, SOON. All you can do is do the right thing, and teach those new ones coming up to do the same. Start a new trend, you 'll be respected for it.

Comment by Evan Gunter on June 10, 2009 at 8:30pm: Sorry, I meant to say "Todd, keep rockin'......."

Comment by Evan Gunter on June 10, 2009 at 8:29pm: Todd, listen here. 2 words. Gross Negligence. That is exactly what happened on the call you described. I wasn't there so I can't pass judgement and neither can any one else. Since you are an EMT I will hold you to a high standard and assume that you are telling the truth. That being said, I agree with you 1,000%. It sounds like this is a common thing and happens so frequently that even the hospitals and nursing staff have caught on to it. DON'T WORK THERE! You decide what is right and wrong and obviously make good decisions. Tom, back off! A rock's blood pressure would increase if it was defebrillated! Tom, keep rockin' bro, I got your back.

Comment by Todd D. on June 7, 2009 at 10:17pm: Good question. I wrote a story about why I applied in a much earlier post:

Here it is.

The short answer is that I applied because I thought what they needed was a few good medics. It turns out, the problem isn't ajust a few bad apples, it's one of organizational culture.