2 Paramedics Face Inquiry Over Surgery In Emergency

[paramediclori]

I think an important aspect is being overlooked here.

The Doc ordering the medics to do a C-section in the field most probably knew the medics he was giving the orders to. No physician would be even a little unaware of how serious AND unusual such an order would be.

I can't imagine the medics blaring out "Want us to do a C-section, Doc?" either.

If an OB/GYN got on the horn to guide, beleive you me it never would happen unless the attending ER Doc felt confident in the INDIVIDUAL(s) handling the call.

My money's on this: here is a case where the complexity of the order was based on the known capabilities of the medics handling the call.

I've been asked to do outrageous stuff (i.e. intracardiac sticks) but only by Docs who knew durn well I was capable (and wouldn't snitch!).

Wouldn't snitch?? Isn't everything said over radio where any one can hear it, not to mention recorded line? Anywhoo, I agree that the medic probably didn't ask for the order. I also agree with the fact that is was probably personell that the Doc trusted, not some new green medic out of school with two weeks of expierence. I still think the worst part of this whole story is the fact that paramedics go over looked all the time. Credit is always given to firefighters and police (which don't get me wrong, we could not do our jobs with out) but we are out there supposed to do what ever we can to save lives. These people were given an order by thier med control to do something, and they did it, and saved a life. I think thier punishent is VERY extreme.

 

[Ridryder911]

Isn't everything said over radio where any one can hear it, not to mention recorded line? .

Not here... most do not have recorded devices, as well with the HIPAA scare, all of the hospitals have secluded the radios off as well a private scrabbled channels on the phone...

R/r 911

 

[paramediclori]

Wow, everything here is recorded and said over a med chanells here. It actually came in handy for a guy that I worked with. He was taking in a chest pain that he thought was border line priorty1 (which is lights and sirens here) or priority2. The ER doc told him to continue in priority2, and the guy died later, they tried to come back on him and couldn't, for once, a recorded line helped someone, lol.

 

[medicdan]

Question for those who live in NJ-- how far away was the scene from a hospital with ANYONE WITH HIGHER TRAINING. I can understand this happening in a rural community, but at least the way I see NJ-- you are never too far from a hospital (especially if in North Bergen, why couldn't they go to Palisades General?)
I certainly feel for the paramedics (and ER Doc), but see this as a bad set of choices on everone's part...

 

[Ridryder911]

Question for those who live in NJ-- how far away was the scene from a hospital with ANYONE WITH HIGHER TRAINING. I can understand this happening in a rural community, but at least the way I see NJ-- you are never too far from a hospital (especially if in North Bergen, why couldn't they go to Palisades General?)
I certainly feel for the paramedics (and ER Doc), but see this as a bad set of choices on everone's part...

Why was it a bad choice? Obviously, the outcome (for the infant) was good. As well, if they had decided to load and go and continue CPR or awaited for someone to respond, the child would be dead. Again, CPR in pregnant women to the fetus has very poor outcome.. You only have up to 4-8 minutes before affecting the fetus.

R/r 911

 

[medicdan]

Why was it a bad choice? Obviously, the outcome (for the infant) was good. As well, if they had decided to load and go and continue CPR or awaited for someone to respond, the child would be dead. Again, CPR in pregnant women to the fetus has very poor outcome.. You only have up to 4-8 minutes before affecting the fetus.

R/r 911

I am very happy things ended up the way they did-- the infant was born, and as of print time of the newspaper, was still alive. Maybe the choice was a good one...
What I was saying, based on my understanding of NJ geography, is that they could never be more then a few minutes away from a hospital, and instead of fooling around with trying to get an ER Doc (or OB/GYN resident) on the phone, find a scalpel, etc, they would have been better served treating with Diesel.
I completely understand this being done in a rural setting, but dont see how it was rationalized in a urban area.
I really dont know the statistics for CPR with a pregnant patient-- can you give me an idea how bleak the odds are?

DES

 

[Ridryder911]

The reason you understand Diesel medicine and have been taught so which is actually understandable is because of the lack of education in medicine. One only saves 2-5 minutes ever responding back "hot", which not only endangers the patient, the crew and other motorist.

Every O.B. kit, that I have worked with has a scalpel in them, other wise I don't know how you would cut the cord? As well, I can reach my medical control per cell, radio, etc. within a few minutes (<1-2) 24/7. So again, less time that "running hot".

Remember, one only has up to 8 minutes of performing an emergency C-section after cardiac arrest or the fetus mortality is almost a definite. I can assure you if they had not performed this procedure, the child would had been dead... period.

Sorry, we need to get the "diesel medicine" mentality removed from our thought process. Yes, there are definite times to expedite safely and yes while performing treatment enroute. Scene times should be closely monitored on certain types of call. As long as you have an educated, qualified, experienced provider in the back, there is not much difference performed in the back of the EMS unit and the first initial treatment in the ER. Again, definitely not the risks of getting killed while transporting.

R/r 911

 

[Arkymedic]

I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?

Yes on every single unit in AR and I would venture to say all OK units (we do but I don't know about all) as well

 

[medic8613]

I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?

They are in our OB kits and trach kits as well. We also have a few floating around the ambulance...found one on the floor while transporting a violent psych patient...long story.

But anyway,

Good for them. They did their job, which last time I checked is to save lives. The woman was in cardiac arrest, and apparently couldn't be resuscitated, so they couldn't cause her any harm. The worst outcome would be the death of the baby, which would probably have happened if they had not done the
procedure. It couldn't have gotten any worse for their patients. On top of that the procedure was done under medical direction. This is not the first time a medic has strayed from protocol under medcom, and it won't be the last.

In my opinion these two medics are an example of heroism, and represent what a medic should be. They knowingly risked their careers and freedom (practicing medicine without a license can carry jail time) to save a child's life. In the same situation I would like to say that I would do the same thing, but, unless it happens, I will never know.

 

[medic8613]

The reason you understand Diesel medicine and have been taught so which is actually understandable is because of the lack of education in medicine. One only saves 2-5 minutes ever responding back "hot", which not only endangers the patient, the crew and other motorist.

Every O.B. kit, that I have worked with has a scalpel in them, other wise I don't know how you would cut the cord? As well, I can reach my medical control per cell, radio, etc. within a few minutes (<1-2) 24/7. So again, less time that "running hot".

Remember, one only has up to 8 minutes of performing an emergency C-section after cardiac arrest or the fetus mortality is almost a definite. I can assure you if they had not performed this procedure, the child would had been dead... period.

Sorry, we need to get the "diesel medicine" mentality removed from our thought process. Yes, there are definite times to expedite safely and yes while performing treatment enroute. Scene times should be closely monitored on certain types of call. As long as you have an educated, qualified, experienced provider in the back, there is not much difference performed in the back of the EMS unit and the first initial treatment in the ER. Again, definitely not the risks of getting killed while transporting.

R/r 911

I agree with this. Yes, redballing it to the ED is fun, and I'm sure if our lights and sirens were taken away, some of us would look for a better paying job, but going code 3 is not only one of the most dangerous things we do as EMS responders, but it really doesn't save much time. I don't have any statistics or research on this, but just from experience, it will turn a 10 minute trip into an 8 or 9 minute trip (also from my experience, those 2 minutes you get are often used on scene to get lines and tubes in.)

When a woman is pregnant the body prioritizes need. Mom comes first, baby comes second. If mom is hemodynamicly unstable (dead falls into this category) then the mom takes priority, so the baby needs to be delivered as soon as possible, urban or rural environment.

 

[medicdan]

I dont think I have made my point clearly... I am not arguing just for diesel medicine (and its true, with my "advanced first aid" certification, as you mention so often, the treatment was stressed in my Basic training), but transfer to higher medical capacity stressed to a higher degree. Why, in an urban area, when you are never too far from a hospital, are you playing around with a c-section? Why were two highly trained paramedics sitting in the back of a stationary ambulance trying to do a procedure I doubt either had even seen before? Guided by an ER doc on the radio who has no idea what they are seeing. Why didn't the paramedics try to get a driver to start their movement towards the ER (not even Code 3, but movement towards higher medical capacity)?

Is there any data/research that speaks to staying on-scene performing a procedure far out of one's scope of practice, as opposed to travelling to a nearby Emergency Room, where they are properly equipped and trained to treat the patient(s)?

In reality, what would we say had this all not been successful? What if the baby did not make it? While the outcome was favorable this time, what can we learn from the case? What could have been done differently?

I know I am new to this-- and as my username signifies, I hope to never stop learning... so please excuse my insistence that this case could have been handled differently.

Thank you for your help, and hearing me out,

DES

 

[kiwimedic]

Our clinical flip book says:

CARDIAC ARREST AND PREGNANCY:
In advanced pregnancy the uterus impded venous return thruough the inferior vena cava in the supine position. Dislace the uterus to the patients left to alleviate this.

If you do not get a quick ROSC and you are within 10 minutes of a hospital capable of performing an emergency caeserian section consider transporting the mother with CPR enroute (focousing on chest compressions).

 

[emtwacker710]

I know this is a dated thread, but I saw posts where people are saying we don't have access to scalpels on ambulances...well you do have an OB kit correct? which is accessable to both BLS and ALS EMT's...well if you look in that kit there is a scalpel for cutting the umbilical cord...think about that..

 

[JPINFV]

^
I'll venture an answer to that. I do remember from my EMT-B class that we were told that some OB kits use sterile scissors instead of a scalpel.

 

[SMC]

Well.

My old timer (partner) said this happened to him with a 18 YO. he spent a long time on scene getting every thing done and yada yada yada. Any ways once they arrived at the ER a OB doc was waiting with scapel in hand. he said they did the C-section on the EMS stretcher in under a minute. Baby didnt make it.

Doc told my partner that if this were to ever happen again to call the hospital and get medical direction to perform C-section over the phone.

----------------------------------
This is so rare that i doubt it will ever be apart of EMS training. But who knows. I could be performing a C-section in 10 years with with a doc on a speaker and him watching my every move on a video screen.

SCARY !