Do you fail if you kill a patient?

Our friend, Becky Valentine, posted a note on her Facebook page telling a story where she heard a student waiting to take their final practical ask, “Is it a fail if you kill the patient?”

It is a great anecdote—and one of the many questions our students ask that make us both smile and shake our head. It also added a level of interest for me because the relationship between the actions of an EMT and the death of a patient is largely misunderstood by students.

Certainly dropping patients or negligently operating an ambulance that crashes “fails” the patient, the community and the EMS system. But these are the clear-cut fails. What about the real-life situations that seem like a failure but are just part of another day in EMS?

Much of the material in an EMT class is presented linearly and always for the good of the patient. We rarely talk about the reality that our actions aren’t ones that will save the patient but are more realistically the ones we have time for that hopefully won’t kill the patient. The true realization that we will move a critical trauma patient to a transport device while at best only attempting to keep fractured extremities from flopping around (as opposed to splinting) is far from the mind of an EMT student at the end of class.

The concept that an unresponsive patient could vomit so much that our only choice is severe hypoxia vs. aspiration is far from the mind of the EMT student in the lab setting who delicately suctions according to that mysterious (and false) 15-second rule.

Most students today recognize that a patient found in an unwitnessed arrest situation may die. However, it wasn’t always that way. When I first wrote in EMS textbooks MANY years ago, I wrote a scenario where the patient died after CPR. When the publisher contacted me asking why, I said it was because it was a common outcome on the street. Their response was, “But no one has ever died in an EMT book.” I assured them that it happens quite a bit in real life.

We’ve come quite a way since then. Yet we still need to introduce students to the practical reality they will face with critical and challenging patients for them to better understand the relationship between life and death—and how the EMT plays a role in that outcome.

Do you introduce these realities to your classes? If so, how? We know time is limited and reality is in short supply. We’d love to hear from you.