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A MedStar ambulance drives out of the ambulance bay at JPS Health Network. (Cristian ArguetaSoto | Fort Worth Report)

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A MedStar ambulance drives out of the ambulance bay at JPS Health Network. (Cristian ArguetaSoto | Fort Worth Report)

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Dr. Jeffrey Jarvis remembers working as a paramedic more than 35 years ago. 

While it wasn’t easy, he appreciated the opportunity to take care of people at their most vulnerable. Those days, he said, served as a stepping stone to making more impact in emergency medical services.

In recent years, Jarvis, who now serves as medical director for the Metropolitan Area EMS Authority in Fort Worth, has dedicated his time to research examining clinical performance measures among paramedics at MedStar Mobile Healthcare. The goal is to find errors in the quality of care and prevent more from occurring.

Still, when getting a patient from one place to another, there’s the potential of making mistakes, said Jarvis. 

In October, MedStar investigated roughly 65 reported complaint cases out of 16,054 calls regarding the quality of care made by one of its paramedics. 

Here’s what happens when a MedStar paramedic makes a mistake when providing care to a resident: 

Staying up to date on procedures

When MedStar hires people, they are required to complete an EMT training process, in addition to earning their paramedic license before earning their credentials. It includes teaching them about protocols and letting them shadow Fort Worth paramedics before they are ready to go on the street, said Jarvis. 

Training lasts between five to eight weeks. Trainees then have to complete written and scenario-based exams to receive their MedStar certification. 

MedStar currently has over 150 paramedics, which serve the city of Fort Worth and the nearby cities of Blue Mound, Burleson, Edgecliff Village, Forest Hill, Haltom City, Haslet, Lakeside, Lake Worth, River Oaks, Sansom Park, Saginaw, Westover Hills, Westworth Village, and White Settlement.

Training doesn’t end there. The EMS provider frequently reviews protocols with its paramedics to ensure it improves quality of care, said Jarvis. 

“Paramedics have to renew their certification once every two years to show competence. That’s how they stay up to date on changing medicine,” he said. 

What happens when there is a mistake?

Before MedStar can investigate complaints among one of its paramedics, there has to be a report submitted. There are multiple ways the EMS provider finds out when that happens, said Jarvis.

Paramedics can submit a self-report to the health system and explain the situation in-depth via email.  

“If it’s a medication error or they used the wrong size equipment or if they want to know what they could have done better, then they can self report to us,” he said. 

MedStar’s hospital partners, including JPS Health Network, Texas Health Resources, Medical City Healthcare and Baylor Health Care System, can also report paramedics if the hospitals believe a crew did a poor job transporting a patient. 

Patients and their families can also file complaints with MedStar or Texas Health and Human Service if there is a concern about the quality of care. 

Once a report is submitted, MedStar will investigate the case and determine the severity on a low, moderate or high level. 

Examples of each level’s offenses:

• Low: Paramedic is concerned about the care they provided to a patient and are looking for way they could have done better 

• Moderate/medium: Paramedic deviates from protocol based on patient’s situation

• High: Paramedic incorrectly inserts tube into patient’s trachea without proper preparation; dosing errors (depending on medication)

If a case is either low or moderate, the paramedic will meet with Jarvis and the Office of the Medical Director to discuss the situation and find room for improvement. It’s about making sure they understand the problem so it doesn’t happen again, said Dwayne Howerton, chief of staff for MedStar.

On a case-by-case basis, the EMS provider will contact patients and their families to provide updates on the paramedic’s status.  

If a case is high, there are extra levels of precaution by restricting the paramedic’s ability to practice until they’ve come in and discussed the situation. If multiple reports come in about a recurring issue, which means the paramedic keeps making the same mistake, then MedStar will remove their credentials. 

But, that is a very rare occurrence.

Since joining as MedStar’s medical director in 2022, the EMS provider has never taken away a paramedic’s credentials, said Jarvis. 

In October, over 70% of the complaint investigations were low level, 25% were moderate and roughly 5% were high. 

“A paramedic really has to make such an egregious error, that it turns out to be a choice, for it to happen,” he said. “There’s zero tolerance for that, but it’s unbelievably rare.” 

Any case relating to the death of a patient in an ambulance that is believed to be linked to negligence or malpractice is handled differently. EMTs and paramedics in Texas are unable to be sued individually, but the department or company they are employed by can be sued and held liable for malpractice. 

Still, the EMS provider wants to ensure it continues to hold its paramedics accountable through education.

“Punishing clinicians can actually increase the number of errors,” said Jarvis. “We try to separate out what happened to the patient from what could have happened to the patient because we’re trying to learn from it. It’s important for us to focus on systemic changes.”

David Moreno is the health reporter at the Fort Worth Report. Contact him at david.moreno@fortworthreport.org or via Twitter.

At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.