# Questions surround paramedics' response to head trauma victim



## VentMedic (Feb 9, 2009)

*Going along some of the themes lately with the Golden Hour, treat on scene and release or determining which patients need an ambulance, here is another situation that is being reviewed in public. The additional attachments and comments are rather interesting also.*

*http://www.islandpacket.com/trauma/story/749484.html*

*Questions surround paramedics' response to head trauma victim*

By RENEE DUDLEY



> At 9:31 p.m. the night before Halloween, a Beaufort County ambulance rolled up to a house in greater Bluffton. Two paramedics, responding to a 911 call about a severely beaten man with a head injury, got out.
> 
> Inside the house on the living room floor lay Brian Lanese, 33, bleeding profusely from the right side of his forehead, speaking incoherently and behaving combatively -- often signs of severe head trauma.
> 
> What happened in the next 20 minutes has raised questions -- not only about the two paramedics' actions, but also about how the county's Emergency Medical Services handles trauma cases:


 


> The paramedics brought no medical equipment inside with them -- no stretcher, backboard, cervical collar or oxygen, according to Tracy Lanese and the Hoffmans. The county's "EMS Standing Orders" for trauma patients recommend that "immobilization equipment and any necessary supplies should be taken to the patient on initial approach" so time isn't wasted if they're needed later.


 
http://www.islandpacket.com/trauma/story/749484.html


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## karaya (Feb 9, 2009)

Yeah, this is a little of bit of a PR firestorm for the EMS provider.  The comments are interesting and it would suggest this provider has an ongoing credibility issue in the eyes of the community it serves.

The outcome will certainly be interesting!


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## emtfarva (Feb 9, 2009)

That is just wrong. I would have taken c-spine precautions and I would never had that Pt cuffed. That's just wrong. Why was family carrying the Pt? Why was the cop yelling at him also? no backboard or c-spine. com'on.


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## Sasha (Feb 9, 2009)

What sad excuses for Paramedics.


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## karaya (Feb 9, 2009)

I'm going to suggest some caution here.

Although from the looks of the article it appears the medics have a lot of questions to answer, there may be additional information that may paint a differing version from the article. I have nothing to suggest that such information exists, but we should be cautious that articles may not contain all the facts.

I'll give you a for instance. Last year I did an investigative article about a Florida fire-chief / paramedic who was terminated over taking scene photos of a partially clad patient. The television media and news articles would lead one to believe the chief was some sort of pervert. But I did a three month investigation into the incident and came up with testimony and facts that were never brought to light.

Although my article concluded that mistakes were made, it clearly showed the chief was not what the media was making him out to be. Furthermore, we turned up witnesses and testimony from sources that were never contacted by the media or the city's own investigation.

http://www.jems.com/news_and_articles/articles/Anatomy_of_Florida_Photo_Controversy.html

Just a point to keep our minds open about speculative articles. All the facts have not been presented.


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## Doug (Feb 9, 2009)

I have walked head trauma pt's before.  Listen sometimes you have to choose between lesser of 2 evils...do you fight the comabtive pt and force him to the board where he continues to struggle, possibly injuring himself more and/or increaseing ICP?  Or do you try and calm him and let him feel as if he's in control and calmly walk him to the truck?  It's hardly ever black and white...just make sure you document!!


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## Sasha (Feb 9, 2009)

Doug said:


> I have walked head trauma pt's before.  Listen sometimes you have to choose between lesser of 2 evils...do you fight the comabtive pt and force him to the board where he continues to struggle, possibly injuring himself more and/or increaseing ICP?  Or do you try and calm him and let him feel as if he's in control and calmly walk him to the truck?  It's hardly ever black and white...just make sure you document!!



According to the report, while Ray is right and it could be slanted, the family and friends of the patient CARRIED him to the stretcher. You want to forgo the board because of the combativeness? That's all fine and good but there is no excuse for family members carrying the patient to the truck. If he couldn't be boarded or walked, the paramedics should have been the ones to carry him to the truck and put him on the stretcher. Family and bystanders and friends, off duty paramedic or not, shouldn't. 

And comments about the patient being drunk or using drugs? Did they miss the whole "AMS" portion of Paramedic class?


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## JPINFV (Feb 9, 2009)

I'm having trouble downloading the statement from Shayna Orsen right now, but it looks like a fuster cluck. I was able to read the statement from Jeff Knieling and his statement only delt with why they didn't call for HEMS. Ok, but he has to know that this incident goes well beyond activating/not activating HEMS. Why did he not respond to why they choose not to transport to the trauma center? Why did it take an order from OLMC after initiating transport? Why did they force the family to carry the patient? What about the difference in GCS and the assessment on the patient's ability to open his eyes? There's too many unanswered and unresponded to questions about this case.


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## Doug (Feb 9, 2009)

Sasha, I apoligize.  I commented before I was able to read the full article.  My browser had difficulty with it,  I was going only on the quotes pulled from the article in the first post.


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## JPINFV (Feb 9, 2009)

Ok, so I was finally able to open the statement by Shayna Orsen and it just opens up more questions? The reconized the need for immediate transport, but still spent 20 minutes on scene? By her own admission, the first set of V/S was taken just before transport. While yes, vital signs aren't necessarilly the first thing done on scene, I don't think it's too much to ask for a set after standing on scene for 20 minutes. The reason that they were originally going to transport to the smaller hospital was because he "may need stabilization." If you aren't sure if you should divert or not, why not ask OLMC prior to starting transport?


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## emtfarva (Feb 9, 2009)

Boarding a combative Pt can be hard but I have done it. I just had a sz Pt last week that fell and ended up with a head injury. We boarded her it wasn't easy. Did I mention she was combative. She kept trying rip off the C-collar and NRB. But we got it done. It helped that we had nursing home staff and another crew from another service to help us. we did restrain her though. But in this case the Pt should have been boarded and he should have not been carried by his family.


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## BossyCow (Feb 9, 2009)

We had one similar to this and fuster cluck is an understatement. It was an assault, and the pt had fxs to his skull, occipital bone, and most of the bones in his hands. 

We were called by law enforcement and had to stage while they subdued the guy who did the damage. Both men were severely intoxicated. 

The pt was the most combative pt I've ever seen. He was restrained by the cops with handcuffs to the gurney and was so violent he almost knocked the gurney over several times. We spent a lot of time on scene just waiting for the thrashing to stop long enough to get a restraint on one of his extremeties. He had multiple sheriffs 'assisting' him and would calm down for a minute or two only to amp it back up.

He was bleeding copiously and was flinging his bleeding head around spraying a large amount of blood from his hair. I ended up duct taping a towel around his head turban style in order to keep that semi under control. 

This patient could not be safely placed in our rig until he was fully restrained. He ended up restrained to our gurney in the ER for hours, while the staff tried to give him enough halodol to allow him to be safely moved from my gurney to the ER bed. 

This may have been the medics bad.. but I'm not going to pass judgement.


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## Sasha (Feb 9, 2009)

BossyCow said:


> We had one similar to this and fuster cluck is an understatement. It was an assault, and the pt had fxs to his skull, occipital bone, and most of the bones in his hands.
> 
> We were called by law enforcement and had to stage while they subdued the guy who did the damage. Both men were severely intoxicated.
> 
> ...



You were unable to get him to the stretcher. A family member and bystander didn't come by, pick him up, and carry him to your stretcher. There in lies the difference. If the paramedics COULDN'T do it, with the cop's assistance, that's different. However if his wife and his friend could pick him up and get him in the truck, why could the paramedics not do it?


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## ffemt8978 (Feb 9, 2009)

You're assuming the patient would have allowed the medics to do so...we've all had cases where the patient was more comfortable with family members than EMS, and we've all had cases where the patient didn't want anything to do with family.

We simply don't have enough information to pass judgment...all we can do is ask questions.


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## Ridryder911 (Feb 9, 2009)

emtfarva said:


> That is just wrong. I would have taken c-spine precautions and I would never had that Pt cuffed. That's just wrong. Why was family carrying the Pt? Why was the cop yelling at him also? no backboard or c-spine. com'on.






Sasha said:


> What sad excuses for Paramedics.



Spoken as inexperienced providers would say. 

I do* NOT *take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.

Wow! A whole whopping additional five minutes... that is not really bad considering. If an additional five minutes would matter, there is no hope for them anyway. 

As it reads.. patient was reported to be "combatitive" and even some of the bystanders described possible intoxication. 

Again .. propaganda from a disgruntled patient. Must have recieved their bill. 

R/r 911


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## medic417 (Feb 9, 2009)

ffemt8978 said:


> You're assuming the patient would have allowed the medics to do so...we've all had cases where the patient was more comfortable with family members than EMS, and we've all had cases where the patient didn't want anything to do with family.
> 
> We simply don't have enough information to pass judgment...all we can do is ask questions.




Thank you.  Finally a voice of reason.


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## medic417 (Feb 9, 2009)

Ridryder911 said:


> Spoken as inexperienced providers would say.
> 
> I do* NOT *take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.
> 
> ...



I agree.  With experience comes common sense, what do I need to take care of ABC.  I can send my partner back for anything else I need.  Based on the dispatch no way of knowing if you will need something so either carry the ABC equipment, in other words jump bag, and see what you got then decide what equipment is needed, otherwise every call would require you carry everything in the ambulance as it could be needed.  That would be just stupid.


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## Airwaygoddess (Feb 9, 2009)

True, we can ask questions, even if they are answered we can still wonder why.


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## emtfarva (Feb 9, 2009)

Ridryder911 said:


> Spoken as inexperienced providers would say.
> 
> I do* NOT *take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.
> 
> ...



I didn't say I would take the c-spine stuff with me, I said I would have taken the precautions. I tend to bring in only a jump kit. depending on the call. I like to do every thing on the truck. exculding c-spine if indicated


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## Sasha (Feb 9, 2009)

Ridryder911 said:


> Spoken as inexperienced providers would say.
> 
> I do* NOT *take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.
> 
> ...




My issue with the article was not about the lack of equipment or extra five minutes on scene. It was the described lack of action of the paramedics. Fifteen minutes on scene, fine. But fifteen minutes on scene with no vitals? Have family carry him to the truck? 

And as one medic was being described as saying "It's not that serious" and calling him drunk when family is telling them there are no drugs or alcohol. When in your right mind do you ever tell the family that? When did YOU go to Medical school where you can determine the definite severity of a person's head injury? Did they have a lab to do a BAL in their truck? Even basics are taught that head injuries and hypoglycemia often mimics being drunk and to never make a butt of yourself and put you in the position to be sued by calling a patient intoxicated.


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## medic417 (Feb 9, 2009)

Sasha said:


> My issue with the article was not about the lack of equipment or extra five minutes on scene. It was the described lack of action of the paramedics. Fifteen minutes on scene, fine. But fifteen minutes on scene with no vitals? Have family carry him to the truck?
> 
> And as one medic was being described as saying "It's not that serious" and calling him drunk when family is telling them there are no drugs or alcohol. When in your right mind do you ever tell the family that? When did YOU go to Medical school where you can determine the definite severity of a person's head injury? Did they have a lab to do a BAL in their truck? Even basics are taught that head injuries and hypoglycemia often mimics being drunk and to never make a butt of yourself and put you in the position to be sued by calling a patient intoxicated.



But is that actuall the way it happened or the way the family imagined it?


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## Sasha (Feb 9, 2009)

medic417 said:


> But is that actuall the way it happened or the way the family imagined it?



I'm sorry my computer is currently having trouble opening the article so I can't go look up the direct quote, didn't one of the Medics claim that the family had said he was drunk? Why would someone tell them that when they had been there for the attack? Or are they trying to CYA now?


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## Elliot (Feb 9, 2009)

i hate jumping to conclusions though i think these medics displayed  poor judgment relating to this specific call.


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## Aidey (Feb 10, 2009)

It really doesn't look good for the medics, and my guess is that there is at least some solid truths in the family's story, even if it isn't 100% accurate. 

As for on scene time, I have to wonder where they are getting it from. Does the on scene time include the time they were staged? I had dispatch do that to me once, they were super busy and they marked the time in staging as the time on scene, throwing our on scene time off by about 15 minutes.


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## RESQ_5_1 (Feb 10, 2009)

Our area doesn't have MCR's or FR's. It's just me and my partner. So, we bring the stretcher with us. Most times we leave it outside, but close enough to use. Depending on the call, we might bring the Zoll. I have been caught short without it a couple of times. Like our "Fall off the toilet" that coded in front of us as we were getting vitals. That was also the time we needed the backboard and the pt's son brought us the stair-chair. 

As far as domestics or assaults, that's why we stage until the scene is secure. 

I completely agree with the Medic's decision to not call in the bird. By the time it's up and on scene, they would have been at the hospital by ground for some time. I have stood down STARS a couple of times because it was faster for me to transport by ground to the best facility.


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## daedalus (Feb 10, 2009)

emtfarva said:


> That is just wrong. I would have taken c-spine precautions and I would never had that Pt cuffed. That's just wrong. Why was family carrying the Pt? Why was the cop yelling at him also? no backboard or c-spine. com'on.



It is not fair for you to arm chair quarterback the scene. First, the paramedics were not even there when the patient was cuffed, and you are not aware of police protocol in the locality. Second, back-boarding patients is subject to protocol, which you are unaware of in that locality. In my county, Ventura, we are actually barred from using C-spine equipment in cases that do not pass the selective c-spine score we use. 

I am willing to bet that Hoffman and the patients wife were disruptive, and that causes a delays in itself. We all know that we lose track of time on scene, and is it that hard to believe that a handcuffed and very combative trauma patient took 5 minutes longer to get inside the unit? I am going to take a wild guess that the paramedics were trying to move him when the neighbor off duty medic and the patients wife decided to take things into their own hands.


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## daedalus (Feb 10, 2009)

Ridryder911 said:


> Spoken as inexperienced providers would say.
> 
> I do* NOT *take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.
> 
> ...


I tend to agree with rid/ryder, see my post above


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## rescuepoppy (Feb 10, 2009)

Have to agree with Rid about what to actually carry in with you. As for what happened in this type of situation their are usually more than one story. I would like to see statements from everybody that was actually there before i make any sort of judgment on what happened. This is not giving support to either party tjis is just wanting to get the whole story before I say anything.


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## VentMedic (Feb 10, 2009)

Instead of looking at this news article as something to *judge* if "they" did everything right, why not use it as a training situation to discuss your own alternatives for a similar situation.  The reason some of us post these controversial news stories is to get some thinking so you too won't make headlines in a newspaper.   If mistakes were made by others, learn from them.  Also, learn why explanations to the family and patient are important so your actions are not perceived negatively.


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## triemal04 (Feb 10, 2009)

Did these paramedics screw up?  Very possibly.
Is the family misrepresenting what happened due to personal bias, stress, anger, lack of understanding or multiple other reasons?  Very possibly.
Are there multiple questions that need to be answered before any conclusion is reached?  Absolutely.
Is ANYONE who has either condemned OR condoned what these paramedics did wrong right now?  Yep.

Why is it that cases like this always get knee jerk reactions from people who where not there and have no info other than what is reported in a newspaper?  As paramedics and even EMT's we are supposed to be able to use critical thinking skills; why is it that that ability seems to go right out the window when something like this pops up?

Might want to consider the following questions:
They were on-scene for 20 minutes...why?  Did it take that long to restrain the pt?  Where they staged and really there for only 5-10 minutes?  Did it take that long for the family/neighbor to relay what had happened?
The neighbor reports that he restrained the pt after a deputy wasn't able to...and carried the pt outside.  Does this sound like someone who may have been a problem on-scene?
The neighbor reports that one medic went to get the stretcher and then he and the wife carried the pt outside...why?  Did they wait for the stretcher at all?  Would it have been difficult to get a stretcher inside?
What was the family AND neighbor's mental state?  Seeing a friend/loved one in extremis can cause ANYONE to lose it for a bit.
The pt was given a GCS of 6 by the neighbor...maybe a bit low for someone who is supposedly that combative.
What was the GCS and condition of the pt on arrival at the hospital?  And that means what was it really, not what the family reported.
What are the paramedics protocols for restraint?  Can they even assist, or do they have to wait until someone else does it for them?
What was the info given during dispatch?

These are just a couple of things (from one side...there's plenty more from the other) that need to be answered before anyone even thinks about giving a thumbs up or thumbs down to this.


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## JPINFV (Feb 10, 2009)

^
Hence why my questions were based mostly off of the written statements of the two paramedics that were published with the article.


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## triemal04 (Feb 10, 2009)

JPINFV said:


> ^
> Hence why my questions were based mostly off of the written statements of the two paramedics that were published with the article.


Sure, don't get me wrong, there is a lot of info that they also need to come up with, and it may turn out that they were in the wrong.  What bothers me is the reaction that a lot of people have when something like this happens.  Not from the general public; I expect that and it doesn't really bother me.  But when people who are supposedly trained and educated to work in this field start jumping to conclusions when there are glaring problems with the story...makes my blood pressure get a bit high.


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## Ridryder911 (Feb 11, 2009)

As one that handles complaints, I can assure the perception and truth is not always the same. For example, one complaint is that it took an EMS unit to respond 25 minutes, when in reality they had < than 3 minutes. Now, what I can describe is due to poor communication 911 system it was probably delayed for a little while crossing multiple dispatchers. Yet, the response time itself should not be questioned. 

Again, perception is something to consider. 

What does concern me evfen more so is the repsonse from the seasoned Paramedic. Not much in detail to CYA. As well, how did the press obtain such. Incident and variance reports should *NEVER* be allowed to public and especially to the media. Appears to me there is more problems internally that needs to be cleared up. 

R/r 911


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## emtfarva (Feb 11, 2009)

I guess there is three sides to every story, yours, mine, and the truth. Your are right about jumping to conclusions.


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## karaya (Feb 11, 2009)

Ridryder911 said:


> As well, how did the press obtain such. Incident and variance reports should *NEVER* be allowed to public and especially to the media. Appears to me there is more problems internally that needs to be cleared up.
> 
> R/r 911


 
How did they (the press) obtain info from the patient report? Easy! The patient went and requested a copy of his PCR on file from the EMS provider and then shared the information with the press.

Furthermore, many states have open record laws concerning investigations. Florida, for instance, has some of the most liberal (man, I hate that word!) open record laws in the country. I was amazed at the volumes of information concerning the investigation of a paramedic that was provided to me for an article that I writing.


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## rumedic (Mar 29, 2009)

The Paramedics on scene were found to be wrong for attitude tword family. 

They were told that they should have carried all c spine eq in to call:wacko:

and that they should not have stated that lifestar could not fly combative pt. The paramedic should have stated that the flight would be delayed due to pt needing rsi before flight.

The Paramedic were in scene trying to get pt to stop hitting everyone. the police were trying to handcuff him to protect all on scene. He was out of control. and the paramedic that was on scene before ems arrival was freaking out screaming at everyone and he himself was on the verg of arrest. the ems paramedic finally went to truck to get c spine eq and that when the "friend paramedic" and the pt wife carried the pt instead of waiting for imm eq. Then she (wife) got on top of stretcher and stated she was going to ride to hospital holding him down  needless to say the scene was crazy. they loaded the pt and called er and gave report and asked if they, the ER agreeded to transport direct to level 1 trauma center, the ambulance then left the scene (it did not get turned around) the pt was transported on a approx 35 min transport. from the time of attack to arrival at er less that 1 hr. he is back at work doing fine..
  the media in Hilton Head is still trying to bury these two medics.


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## reaper (Mar 30, 2009)

rumedic said:


> The Paramedics on scene were found to be wrong for attitude tword family.
> 
> They were told that they should have carried all c spine eq in to call:wacko:
> 
> ...



So you were one of the two medics that was on this call? If not, it is all rumors and no new information was added to the story!


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## triemal04 (Mar 30, 2009)

reaper said:


> So you were one of the two medics that was on this call? If not, it is all rumors and no new information was added to the story!


Sort of...there are things said in that post that haven't been in any news story (which never contain all the facts as most people know).  Whether or not they are accurate is open to speculation given the anonymity of online forums.  But, if only half of that was true, hopefully it makes people think twice before they attempt to judge someone on the basis of a single newspaper article without having all the facts in hand.


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## VentMedic (Mar 30, 2009)

reaper said:


> So you were one of the two medics that was on this call? If not, it is all rumors and no new information was added to the story!


 

This is probably someone who is just trying to discredit some issues or has a beef with the paramedic. If this is one of the medics on this call, I don't believe their attorney(s) will be too happy if they find out that one of the EMS medics is on the internet talking trash when there may still be legal action pending.


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