# KC Council looking into death of patient in ambulance



## MMiz (May 8, 2011)

*KC Council looking into death of patient in ambulance*

A patient being transferred between hospitals in a Kansas City ambulance allegedly died en route without the ambulance crew knowing it.

Kansas City Council members have asked for details about the Jan. 19 death of Frank M. Nigro Jr., 52, who was being taken from a Northland hospital to see a neurologist at St. Luke’s Hospital near the Country Club Plaza.

Read more: http://www.kansascity.com/2011/05/05/2853017/kc-council-looking-into-death.html


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## Tommerag (May 8, 2011)

Very interesting, I'm curious to hear what happened.


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## Aidey (May 8, 2011)

Tommerag said:


> Very interesting, I'm curious to hear what happened.



A BLS FD affected a hostile take over of the 3rd service ambulance company that served the area?

Sorry, my bias is showing. I know exactly where they are talking about, and I have a pretty good idea what hospital was the sending hospital. Assuming not much has changed, that hospital has a small ED and we took a lot of people out of there. Including some active MIs and CVAs. I'm almost positive St. Luke's is the primary neuro hospital for the area. I remember the drive being 15-20 mins under normal conditions. 

It almost sounds like no one was in the back with the pt.


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## samiam (May 8, 2011)

How often do you IFT guys get vitals on your patient in the back? Does someone always sit in the back or if stable will you move up front?


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## NomadicMedic (May 8, 2011)

There's more than a few issues in KC. Check out this Op-Ed piece.

http://www.kansascity.com/2011/04/23/2821080/the-stars-editorial-kcs-ambulance.html#ixzz1L844hhek


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## JPINFV (May 8, 2011)

samiam said:


> How often do you IFT guys get vitals on your patient in the back? Does someone always sit in the back or if stable will you move up front?


Every 15 minutes or so for stable IFTs. If the patient is stable (stable =/= not sick), then at most I'll move to the captain's chair. At no time am I going to leave a patient alone in the back of the ambulance during transport.


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## Epi-do (May 8, 2011)

> Nigro III said ambulance documents obtained by his attorney showed the crew didn’t know about his father’s death until they opened the ambulance’s back doors.



While this certainly makes it sound as if no one was in the back with the patient, I would hope that isn't SOP.  I put my time in doing private service/IFT jobs, and never worked for a company that would allow someone to be unattended in the back of the ambulance.  Even when we were sent to pick up a wheelchair van patient, because all of the wheelchair vans were busy, and we were only giving them a ride, someone still had to ride in the back of the ambulance with them.

Of course, the flip-side would be, that if someone was in the back of the ambulance with the patient, what the heck were they doing that they didn't realize the patient had expired?

Either way you look at it, I am sure that the answers wouldn't be good.


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## Veneficus (May 9, 2011)

I read both articles posted and watched the video.

I just have to ask...


Is anyone really surprised?


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## usalsfyre (May 9, 2011)

Veneficus said:


> I read both articles posted and watched the video.
> 
> I just have to ask...
> 
> ...



Nope, but it's happened around here to multiple different services as well. 

This is why I hate the airway seat/bench seat configuration. 

To me this was an ALS transfer, so there should have at least been a cardiac monitor involved.


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## Veneficus (May 9, 2011)

usalsfyre said:


> To me this was an ALS transfer, so there should have at least been a cardiac monitor involved.



I would think that also.

I am not convinced the outcome would have been different though. It sounded like the guy had a CNS infection possibly with an abcess. ACLS isn't going to help that. Nothing on the average ambulance is.

But one of the best pieces of advice I ever got was from my EMT-B instructor. 

"Always ask yourself: How is this going to look on the 6pm news?"

Just from the very scant report, it sounded like this really needed to be a CCT handling this guy, not the local 911 ALS and IFT. 

As you know I am undoubtably against FD EMS, but I think it is only fair to say that this was probably a complex patient and most 911 providers may have been in over their head on this one. 

Aside from watching the guy code and doing a few rounds of the appropriate ACLS algorhythm, what really could have been done without considerably more advanced interventions? 

But if their position was there was nothing they could do, they should have stated that and stood by it. Somebody should also have had the balls at the sending facility to tell the family how dire the situation was. 

Anyway you look at it it was a fail. 

But I don't think any individual is responsible for this one.

From what I have heard about this particular system, it is set up to fail and it performed that function perfectly.


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## medicdan (May 9, 2011)

I just want to make sure... from those who may have some knowledge of the circumstances... Are the following assumptions correct?
-- this was a paramedic level ambulance, staffed PB?
-- this ambulance was doing an IFT (presumed hot), between two hospitals
-- a fire department ambulance was doing the transport
-- no cardiac monitor was involved (but were meds/pump involved??) What interventions are permitted in KC ALS? 
-- a normal 20-25 minute drive took over an hour and a half (even in a blizzard)??
-- Do we have a sense of the stability or medicated state of this patient? 

http://www.kctv5.com/news/27806600/detail.html


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## usalsfyre (May 9, 2011)

emt.dan said:


> I just want to make sure... from those who may have some knowledge of the circumstances... Are the following assumptions correct?
> -- this was a paramedic level ambulance, staffed PB?


This was what MAST used, so I doubt the FD could get by with anything less. 



emt.dan said:


> -- this ambulance was doing an IFT (presumed hot), between two hospitals


I doubt they were running hot. 



emt.dan said:


> -- a fire department ambulance was doing the transport


KCFD is the ONLY ambulance service transporting patients in Kansas City 



emt.dan said:


> -- no cardiac monitor was involved (but were meds/pump involved??) What interventions are permitted in KC ALS?


I don't know for sure...but I'm not sure how you could ignore the "check patient" alarm if the patient was on any modern cardiac monitor.  




emt.dan said:


> -- a normal 20-25 minute drive took over an hour and a half (even in a blizzard)??


Yes 



emt.dan said:


> -- Do we have a sense of the stability or medicated state of this patient?


No idea, but it's not uncommon for many medics to overestimate the patient's stability. I've seen many people that blow of patients not actively crumping when they get there and ignore subtle signs of oncoming trouble, only to have it bite them in the @ss later into the transport.  

I wasn't there, I didn't see the patient so I can't really pass judgment. All I will say is I would skinned alive by my medical director for not transporting a new onset of CNS lesion without ALS monitoring in place.

It's also telling to me there's no mention of the medical director on the KCFD's webpage, despite having the names and pictures of a whole host of administrative and command staff minions.


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## medicdan (May 9, 2011)

Thanks. There is an interview with the supposed medical director at the link I included. He tries hard not to make statements about this case/patient, but insinuates that if the patient were chemically sedated, the medic could have overlooked death.


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## usalsfyre (May 9, 2011)

emt.dan said:


> ...but insinuates that if the patient were chemically sedated, the medic could have overlooked death.


Bull malarky, horse caca, call it what ever you want but that's crap, plain and simple. If the patient is sedated then you must be MORE vigilant in your monitoring, both technology and plain old assessment based. The standard for sedated patients (at least according to the ASA) is ETCO2 monitoring at all times. Given the sensitivity of this particular modality it would be almost damn well impossible to overlook a patient's death if you were being vigilant. If KCFD doesn't have or want to invest in this technology AND MANDATE IT'S USE on sedated patients, they don't need to be transporting those. patients.


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## Aidey (May 9, 2011)

Veneficus said:


> I would think that also.
> 
> I am not convinced the outcome would have been different though. It  sounded like the guy had a CNS infection possibly with an abcess. ACLS  isn't going to help that. Nothing on the average ambulance is.
> 
> But one of the best pieces of advice I ever got was from my EMT-B instructor.



What if the lesion/infection was directly affecting cortical function  though? Depressing the respiratory drive without there being global  damage or some sort of systemic failure like IDC? 



usalsfyre said:


> Bull malarky, horse caca, call it what ever you want but that's crap, plain and simple. If the patient is sedated then you must be MORE vigilant in your monitoring, both technology and plain old assessment based. The standard for sedated patients (at least according to the ASA) is ETCO2 monitoring at all times. Given the sensitivity of this particular modality it would be almost damn well impossible to overlook a patient's death if you were being vigilant. If KCFD doesn't have or want to invest in this technology AND MANDATE IT'S USE on sedated patients, they don't need to be transporting those. patients.



As of 2006 MAST was using Zolls that were not equipped with ETCO2  monitoring. I have no idea if that changed after KCFD took over. I would think that in 5 years the equipment has been updated, but who knows about ETCO2.


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## Veneficus (May 9, 2011)

Aidey said:


> What if the lesion/infection was directly affecting cortical function  though? Depressing the respiratory drive without there being global  damage or some sort of systemic failure like IDC?



The pathogenisis of cortical function has been demonstrated to be from neuronal degeneration, not inhibition.

http://iai.asm.org/cgi/content/full/68/2/615

http://jid.oxfordjournals.org/content/191/1/40.full

If this was indeed the case here, even short term ventilatory support may not have made much of a difference.

If it was a type of mass effect from a legion, that might be more amiable to short term ventilation and more definitive treatment, but that is a very hopeful scenario. 

I did not know the information that USAF presented about the patient being chemically sedated when I wrote that reply. If that was the case, that would make this very troubling. Since the patient may have then died from airway compromise.



Aidey said:


> As of 2006 MAST was using Zolls that were not equipped with ETCO2  monitoring. I have no idea if that changed after KCFD took over. I would think that in 5 years the equipment has been updated, but who knows about ETCO2.



So what? It doesn't take a monitor to determine if somebody is breathing or not.

As this story progresses I think the family is going to be paid a lot of money for a lot of reasons.

In an effort to save the city money, perhaps the fire chief and medical director will offer to pay some of the settlement out of their personal assets?

Somehow I doubt it.


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## mycrofft (May 9, 2011)

*Sorta sounds like the old Houston TX debacle a little*



All "blase'-blase'" and trim staff training and quality to the marrow. 

Next step in staffing will be hook the pt up to a VS monitor and run the readout to the cab, and operate with one man anyway. (Leave me in the back alone and let me wake up! Better have good insurance on the contents and equipment).

(In case you're too young to remember, many years ago Houston's EMS system got tossed because they were doing things like stopping to pick up a pizza during a code three run with pt on board, or documenting CPR in progress when in fact there was one person on board driving, or some such).


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## Veneficus (May 9, 2011)

mycrofft said:


> (In case you're too young to remember, many years ago Houston's EMS system got tossed because they were doing things like stopping to pick up a pizza during a code three run with pt on board, or documenting CPR in progress when in fact there was one person on board driving, or some such).



Well if what I hear about the rushed course down there now is any indication, is there really any change?


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## mycrofft (May 9, 2011)

*HAhahaha! The more things change the more they stay the same!*

I don't know. I DO know that hereabouts small private transport companies are sprouting like never before, and our County EMS is as hard as ever to get ahold of.


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## bstone (May 9, 2011)

We assess vitals every 15 minutes on stable patients. This should never have happened.


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## beandip4all (May 10, 2011)

stable or not, I can't even FATHOM sitting up front while a patient rode in the back!!  such negligence... that blows my mind.  

at least if you sit in the jump seat you can keep an eye on em/chat em up


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## MrBrown (May 10, 2011)

beandip4all said:


> stable or not, I can't even FATHOM sitting up front while a patient rode in the back!!  such negligence... that blows my mind.
> 
> at least if you sit in the jump seat you can keep an eye on em/chat em up



Its very disturbing.

And WHERE in the bloody hell is Browns bean dip?


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## tyler500e (May 12, 2011)

Aidey said:


> It almost sounds like no one was in the back with the pt.



You're right.  Both the EMT and the Paramedic were riding up front :angry:

This transfer took place during a heavy snow storm, which delayed the transport significantly.  I know I can speak for all of us here when I say that it is never appropriate to leave your patient alone in the back during transport.  

Unfortunately the Kansas City Missouri Fire Dept, KCFD, is union-protected which (even more unfortunately) has allowed employees to keep their jobs after unethical/dangerous/stupid things like this.  I can remember an incident within this department where an intoxicated firefighter hit and killed a kid while driving a department vehicle, and in lieu of being fired, he was moved to a different position.  He was promoted.  

Employees of this department have been known to watch hardcore porn on dayroom TV's and even bring girls back to the station for a 'casual encounter'

When KCFD first took order of a Quint fire truck, that very day that they received the first truck, some employees destroyed the transmission.  Apparently consolidation of units was threatening the job security of some employees, so someone decided that it was a good idea to put the new Quint in reverse while travelling at highway speeds.  

**Now take this all with a grain of salt, because much of this is hear-say.. but you've got to wonder, why would anyone make this up?


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## mycrofft (May 12, 2011)

*Union be darned. Do your due diligence and roll some heads.*

Start with Training and shift supervisors.
Even with a contract, gross negligence is usually a ground for dismissal. If not, then report them to the state and get their ticket yanked.


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