# Illinois Boy Dies in Ambulance during Hospital Transfers



## rhan101277 (Sep 28, 2011)

This is a good read.  Always be careful, sometimes people are to sick to fix.

http://www.jems.com/article/news/illinois-boy-dies-ambulance-during-hospit


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## ah2388 (Sep 28, 2011)

It will be interesting to follow this case, to see where the failures were along the way.

Regardless, a tragic case for all involved.


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## EMTswag (Oct 25, 2011)

Did he really get a BLS non emergent transfer? Shouldn't he have been sent SCTU emergent? That would have meant he had pedi MICNs or even a resp therapist with him, or even just tube him before he left?


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## fast65 (Oct 25, 2011)

EMTswag said:


> *Did he really get a BLS non emergent transfer? *Shouldn't he have been sent SCTU emergent? That would have meant he had pedi MICNs or even a resp therapist with him, or even just tube him before he left?



Where are you seeing that? They attempted to RSI him in the back...


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## EMTswag (Oct 25, 2011)

fast65 said:


> Where are you seeing that? They attempted to RSI him in the back...



whoops i chalk that one up to having shift changes at 4am... all i read was emergency medical technicians and assumed they sent him BLS. My fault lol


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## usalsfyre (Oct 25, 2011)

Pediatric asthma can be a nightmare. Without seeing the chart it's pretty well impossible to intelligently comment on the case. However, I'm struck by this comment:


> Why they didn't put a doctor in that ambulance with him, or an anesthesioloist or someone who would manage his condition during that long transfer, we don't know


Folks, this complaint should have been right in a paramedics "wheelhouse" so to speak. We're supposed to be experts on the ABCs. If there's any doubt this was handled appropriately from the paramedic end of it than there's been a serious system failure.


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## fast65 (Oct 25, 2011)

EMTswag said:


> whoops i chalk that one up to having shift changes at 4am... all i read was emergency medical technicians and assumed they sent him BLS. My fault lol


  Eh, we've all been there lol


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## WTEngel (Oct 25, 2011)

Not being familiar with this case, I can only speculate, but here is my hypothesis.

If the details of the story are accurate (unlikely) then the initial transfer to a facility of equal care was likely due to bed space. I have a sneaking suspicion that he was sent to the hospital 45 minutes away due to Medicaid status. The closer hospital may very well not accept Medicaid.

The second transfer occurred because of his deterioration. He was clearly not a regular peds floor patient, especially in a hospital that does not specialize in peds. So the second transfer was to a higher level of care. 

In the story it describes his last words s being charted in the nursing notes. I am not sure if they mean he was transferred with an RN (CCT) or if that was charted at the hospital prior to transfer.

In any case, this is an example where we would have used our helicopter. Due to the instability of the patient, prolonged transfer time due to distance and traffic, rotor wing transport is appropriate in this situation, although I have very little doubt that a pedi critical care team most likely could have managed this patient without adverse effect.

They way we operate is that a memorandum of transfer has to be filled out describing the need for transfer (typically higher level of care) and detailing the diagnosis, referring physician, and accepting physician. There has to be a physician to physician report, and at that point our attending determines whether the patient is stable to be transferred by a private service, or if they need our critical care team. Then, based on mileage, traffic status, patient acuity, referral request, etc we determine mode of transport. 

Like I said, I am not in the know on this particular case, but being a pediatric transport medic, I can already identify a few areas where the process is likely to have broken down.

A truly sad story all around. I hope the family finds peace, and the medical professionals involved learn from the series of tragic errors.


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