Veronica Campbell killed by "quality"

Veronica Campbell died from heavy bleeding caused by an ectopic pregnancy on December 31^st 2008. She was only 60 kms by road from Goulburn Base Hospital. Her life could have been saved if she was operated on urgently. The facilities and surgeon were there, ready, a mere 60 kms away. A trip one could take in 40 minutes. She waited in Cobram hospital for an ambulance for 2 hours. The ambulance said that they were not equipped to take her, so 90 more precious minutes were wasted waiting for an air ambulance. After 4 hours, she was finally en-route. She died in the air.

I am angry. This is a classic example of how our endless “quality improvement” agenda has gone way too far. Common sense has left us. I have been thinking about this for years. I am starting this blog to rail against the absolute stupidity and lack of common sense and political correctness gone mad that is killing people, and hopefully provide a counterpoint to reflexive, inane, useless and wasteful "quality improvement".

If they just jumped in the car and drove straight to the hospital her life would have been saved. Study after study has shown that it is the time to definitive treatment that is the major factor in survival, from anything from cardiac arrest to major trauma.

Here is a study that shows that survival in major chest trauma may be more than doubled if non-ambulance transport is used immediately. "Stay and play" by paramedics trying to follow all the right "quality" protocols leads to over double the deaths compared to an ordinary person chucking them into a car ("scoop and run") and driving fast to a hospital equipped to perform definitive treatment. Despite being staffed by the best "quality" paramedics dotting all the i's and crossing all the t's, subject to continuous and comprehensive "quality" improvement, always completing their documentation, in certain situations all this "quality" care is worse than useless, this "quality" kills.

In Veronica's case, no doubt the first ambulance paramedics were worried that they were not capable of dealing with a problem en-route. There are always punishments for those who break the rules of "quality", even if the patient lives as a result. There are no punishments for following procedures, even if the patient dies. They called for a more expert team. Sadly, the thing that was needed was an urgent operation in the quickest time possible. No amount of expertise and resuscitation can compensate for a loss of time to definitive treatment.

In this case, well over 3 hours were wasted getting the best possible high tech quality transport. Catching a taxi instead would have saved a life.

Important Note: time to definitive treatment is the important concept here. I am not disparaging ambulance services or paramedics, who do an amazing job despite often running into problems with "quality" policy and procedures and documentation requirements. For example, in most cases of cardiac arrest, definitive treatment involves defibrillation, which is speedily carried out by ambulances.