2 Paramedics Face Inquiry Over Surgery In Emergency

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New Jersey health officials are investigating the actions of two paramedics who performed an emergency Caesarean section on Thursday to deliver the baby of a woman in North Bergen who was in cardiac arrest and could not be revived.
The paramedics acted while consulting by radio with emergency room doctors at Jersey City Medical Center, officials said, but state health regulations forbid paramedics to perform surgical operations. The emergency workers said they believed that the procedure was their only hope of saving the baby.
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2 Paramedics Face Inquiry Over Surgery In Emergency
 
OMG I didn't even notice that!
 
yes, this an old story that keeps coming up in my medic class. It comes up because my program teaches both NY and NJ students. Several medic students currently work in Jersey City. Some instructors know the medics instructors and students know them. Its my understanding they lost their NJ certs but not their NY or national registry certs. Don't know if they work in NY now which is a short commute.
 
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okay Then...

would You Do It? Why? Why Not?
 
Wow, that's crazy. I know in class (I'm not a paramedic -- but still [even though it's quiet different]) we were told ~10 times that a caesarean section was WAY out of our scope of practice (which, yes I agree -- but apparantly it's the same for medics?).

Even though they are not allowed by regulations to perform such an intervention, and action -- they were (I suppose) operating under direct medical direction of the hospital doctors and staff they were communicating with, therefore wouldn't that make the level of care by intervention's ability to be higher possible? Since they are performing remote actions based on direction of the highly-trained doctors?

Also, "they believed that the procedure was their only hope of saving the baby"; not sure how this would end up --- I can see a mistake in a way, and in another way I can't.

But hey, I'm not medic -- I'm just some crazy ant-sized basic looking up at the medic seeing what I see.
 
I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?
 
seanm028 said:
I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?
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No. When I worked on the post-op floor in the hospital, we didn't even keep scalpels on the floor. You had to go get one from the ER or sterile supply. They are definitely not kept on our ALS ambulances.
 
seanm028 said:
I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?
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Yes, on every one of our units. We carry one in the OB kit and one for the Trach kit.

I have mixed feelings about this one. There are too many variables in place to make a yes or no decision, but if I would think that the importance would be to provide as much oxygenation and circulation as possible for mom until appropriate intervention could be made to save the baby. Would I do it if I knew there was no other alternative, yes without hesitation, but would that decision be weighed against every conceivable thought of alternative, definately!

You would also need to take into account why a female of child bearing age is in cardiac arrest. More than likely, it will not be a primary cause. So even if you did attempt it, the baby born to its crackhead mother will probably not do well. Just things to think about. Personally, I think these two were playing hero and got in over their head. They should have known that Jersey EMS was not going to support this radical of a decision. You gotta know your politics in this biz.................

However the chances of that ever occuring are next to none.
 
Flight-LP said:
Yes, on every one of our units. We carry one in the OB kit and one for the Trach kit.

I have mixed feelings about this one. There are too many variables in place to make a yes or no decision, but if I would think that the importance would be to provide as much oxygenation and circulation as possible for mom until appropriate intervention could be made to save the baby. Would I do it if I knew there was no other alternative, yes without hesitation, but would that decision be weighed against every conceivable thought of alternative, definately!

You would also need to take into account why a female of child bearing age is in cardiac arrest. More than likely, it will not be a primary cause. So even if you did attempt it, the baby born to its crackhead mother will probably not do well. Just things to think about. Personally, I think these two were playing hero and got in over their head. They should have known that Jersey EMS was not going to support this radical of a decision. You gotta know your politics in this biz.................

However the chances of that ever occuring are next to none.
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Hmm...I didn't think of the OB kit or the trach kit. There may be a scalpel in one of those. They're sealed, so we don't check the contents every day, just that we have one. I'm pretty sure the OB kit has a small pair of scissors for cutting the cord. The trach kit comes from sterile supply and I'm not entirely sure what's in that. Something I need to investigate next shift. Would make sense that there would be one there.

Personally, I think I would do everything I could to support the mother's circulation during transport and get to the hospital ASAP and let them do the c-section. As quoted above, you have to consider WHY the mother is in cardiac arrest. It's not normal for a 37 year old woman to have a sudden cardiac arrest like that. Surely there was something else going on in that situation. Instead of spending time consulting medical control, those paramedics could have transported quickly and let the hospital deal with the surgical aspect of this case. I agree that these two were in over their heads. I know it's easy for us to sit back and make judgements, but you have to know your limitations. Surgery is definitely out of MY scope of practice, any way you want to look at it. I'm just not trained to do surgery, you know?
 
I would like some follow up on what became of the paramedics. Did the state sanction or punish them?

I'm all for getting to the hospital as quickly as we can, but a lot of things may have made the trip futile. How far away is the hospital? What kind of extrication did they have?
 
The medic lost their NJ certification. I do not believe they lost their NR or NYS registration. As I said, Jersey City is 5 minute commute into NYC.
 
seanm028 said:
I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?
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We have two ambulances, each ambulance has an OB kit which is sealed. Each OB kit has a scalpel. The only thing thing that designates us a BLS or an ALS unit is whether we have a paramedic on board or not. Both ambulances carry ALS equipment.
 
seanm028 said:
I didn't think paramedics even carried scalpels. Are those something you typically have on an ALS stocked ambulance?
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I personally rather cut them with a scalpel than gnawing the cord into.... :D

The old debate of Paramedics being able to perform such a procedure is sill going on. Personally, if that was the last ditch and the fetus/infant is viable so be it. Reading the article, even the state EMS medical director did not see any difficulties... ironically, it did not mention if there were any actions against the M.D. ... sorry, sounds like typical Jersey problems.


R/r 911
 
Ridryder911 said:
I personally rather cut them with a scalpel than gnawing the cord into.... :D

The old debate of Paramedics being able to perform such a procedure is sill going on. Personally, if that was the last ditch and the fetus/infant is viable so be it. Reading the article, even the state EMS medical director did not see any difficulties... ironically, it did not mention if there were any actions against the M.D. ... sorry, sounds like typical Jersey problems.


R/r 911
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We have the scapled in our OB kits too. If they were doing this under med controls authority, then that Dr was taking responsibility for every one, I agree, and nothing happend to them. Besides, they saved the infant, has that gone over looked?:ph34r:
 
Ridryder911 said:
I personally rather cut them with a scalpel than gnawing the cord into.... :D

The old debate of Paramedics being able to perform such a procedure is sill going on. Personally, if that was the last ditch and the fetus/infant is viable so be it. Reading the article, even the state EMS medical director did not see any difficulties... ironically, it did not mention if there were any actions against the M.D. ... sorry, sounds like typical Jersey problems.


R/r 911
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We have the scapled in our OB kits too. If they were doing this under med controls authority, then that Dr was taking responsibility for every one, I agree, and nothing happend to them. Besides, they saved the infant, has that gone over looked?:ph34r:
 
paramediclori said:
We have the scapled in our OB kits too. If they were doing this under med controls authority, then that Dr was taking responsibility for every one, I agree, and nothing happend to them. Besides, they saved the infant, has that gone over looked?:ph34r:
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I don't necessarily agree with you here. We have a responsibility to inform our docs if they ask us to do something blatantly outside our protocol or scope of practice. How many residents do we get on the phone/radio who are just beginning their ED time and they give us orders for meds that are outside our protocols? It's happen to me a bunch of time and it's our duty to inform them that violates protocol.

That being said, I still think if delivering that baby was my absolute only choice in saving it, that I would always err on the side of life. These guys are hero's and I was saddened to hear someone on here say that they lost their state certs for it. That was a bit extreme...maybe a suspension, but not a removal. Of course, how would they have been talked up or down if the C-section would have turned out differently and the baby didn't live. They'd likely have been reviled instead of heroes.
 
Asclepius said:
I don't necessarily agree with you here. We have a responsibility to inform our docs if they ask us to do something blatantly outside our protocol or scope of practice. How many residents do we get on the phone/radio who are just beginning their ED time and they give us orders for meds that are outside our protocols? It's happen to me a bunch of time and it's our duty to inform them that violates protocol.
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That is a "systems" problem. If residents are giving orders then your EMS Director is not acting responsible for allowing them to do so. They again, are acting under his/her control as chief medical director, acting as a liaison.

If there were not "advances" we still would have to call for IV's... in which I remember the "mother may I"days" of calling for all IV's, medications, etc. Especially such far radical procedures such as chest decompression, all now considered standard procedures. Yes, C-sections is radical, but so were crichs, even intubations at one time.


Asclepius said:
That being said, I still think if delivering that baby was my absolute only choice in saving it, that I would always err on the side of life. These guys are hero's and I was saddened to hear someone on here say that they lost their state certs for it. That was a bit extreme...maybe a suspension, but not a removal. Of course, how would they have been talked up or down if the C-section would have turned out differently and the baby didn't live. They'd likely have been reviled instead of heroes.
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I agree, it took big gonads or big ovum's to perform such:D.. Something, truthfully, I do not know I would attempt. During the bombing event, I had a pregnant female firefighters wanted me to attempt to perform a C-section on. I refused, due to the time delay, severity of injuries to the mother.

One only has up to 8 minutes to perform a C-section without damage to the fetus. If the mother was dead, she is now only a corpse.. studies have shown drastically poor outcomes with CPR to fetus. I have assisted physicians in emergency cesarean in traumatic codes, not a pretty site.

Hopefully, the child will survive. My hypothesis would be that the mother might have had a cerebral aneurysm. Unfortunately, this is not a uncommon event. I have seen one rupture during bearing down, and was a tragic site, as we had to manually compress the child out again not a site I want to see or do again.

Again, my hat is off to those medics that actually went above and beyond. I am sure they are receiving both praises and criticism from peers.

R/r 911
 
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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!).
 
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I am sure you are correct, since ALS is offered through hospital based EMS only in N.J. One of the advantages of being hospital based services, getting to know your medical director and vice versa.

I worked with a hospital base EMS for several years, and yes we performed ALS procedures that most did not..(i.e hang blood, central lines, RSI, etc) in the early 80's. Again, like Firetender described the physician probably knew their limitations. I thought I recalled reading they were seasoned medics, which I am sure which made a difference. As well, most new medics hopefully would not even consider such a thing.

Fortunately, this has a somewhat happy ending. I recall many, many years ago in which a "hot shot" Paramedic wanted to perform a C-section on a traumatic arrested female. Medical control denied and fortunately for both they did. It turns out the female patient was not pregnant, rather just fat!
Apparently, he did not actually hear FHR. Of course, he never was trusted again...

R/r 911
 
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