April 2016 case study
Date: 01 April 2016
Complainants sister called an ambulance for her mother. The patient went from being completely fine to getting a really bad pain in her head -- she shouted for help. The patient went to lie down and an ambulance was called due to the unbearable pain. A first responder was sent and did a general assessment. There was not a problem with the first responder, however, subsequently a solo Paramedic arrived and this is where the complainant had an issue. The patient was actually suffering from a brain haemorrhage but the Paramedic did not seem to do his job as well as he should have.
The patient had a horrendous pressure in her head but the Paramedic said that all of her observations were normal. The complainant asked him ‘is it possible she was suffering from a mini brain attack?’ (Similar to how people suffer from mini strokes / mini heart attacks). The Paramedic looked really smug at you and just shrugged it off. He insisted ‘it’s just a headache’ and gave Paracetamol (which was the patient’s medication, not supplied by the Paramedic). You heard on the Paramedic’s radio them asking if an ambulance was needed, in which the Paramedic replied ‘no’. However, the patient was in horrendous pain. The Paramedic eventually asked if the patient wanted to go to hospital, which she did. He took her to hospital in his car as he said no to an ambulance coming. The patient was taken to hospital under the symptoms of a ‘headache’, however, after the hospital did blood tests and a CT scan, it showed that she had a bleed in the brain. She was taken to resus and transferred to another hospital for further treatment. She was sadly still in a bad way at the time of complaining.
The investigating manager met with the complainant and discussed the events of the incident. Neurological assessment was explained and how important it is to complete this to uncover any pertinent problems and that although it is difficult for the patient at the time, this is a necessary part of the clinicians assessment process, especially when patients are suffering from such severe head pain. It was ascertained that the Paramedic did not administer any pain relief but instead asked for some Ibuprofen or Paracetamol to be found for the patient to take. Unfortunately, the patient vomited again straight after taking this. The Paramedic did not offer the patient any other pain relief.
The investigating manager explained that the Paramedic was trying to follow a stepwise pain management process starting with the Paracetamol and Ibuprofen to see if that would work first but unfortunately he did not move on to the next stage when this did not work, which he should have done.
The Patient Care Record (PCR) was reviewed as part of the investigation which detailed all of the Paramedic’s findings from the assessments he had carried out. The main abnormalities on this were the severe head pain the patient was suffering and her raised blood pressure. The neurological assessment which he carried out came back within normal ranges. From these findings, the Paramedic would not have been able to make a definitive decision as to what was causing her headache, so the decision for a hospital assessment should have been made.
Being taken to the Accident and Emergency (A&E) department in a Rapid Response Vehicle (RRV Car), meant potentially the patient would have arrived much quicker than if she had to have waited for another transportable Double Staffed Ambulance (DSA). The patient walked into the A&E department where the Paramedic spoke with a nurse and advised her of the patient’s headache. After the Paramedic left hospital, the patient was taken for a CT scan, given some IV Paracetamol for pain relief and then taken into Resus. She was later transferred to a more appropriate hospital for specialist surgery, as she was diagnosed with having a brain haemorrhage.
- Lesson learnt / action taken:
Instruction disseminated to all staff to be more aware of how their conduct and mannerisms are perceived by patients and their families. The Paramedic was asked to work through the stepwise pain management process more quickly when ineffective pain relief is given, with appropriate communication to the patient and their family as to the reasons behind this process. The Paramedic has also been asked to provide a reflective account of his actions.
- Date:30 March 2015