Bodycam Footage of Utah "Miracle Baby" Rescue

[Carlos Danger]

What magical things does the ER have that an ALS ambulance does not bring to the table for initial stabilization of this patient?

Expertise / experience (Residency-trained ED MD vs. EMTP). Personnel. Imaging. Labs. Drugs. Resources. Specialists and subspecialists.

Granted, probably none of the treatment differs in the very early phases of resuscitation, but to pretend that an ambulance is the same as an ED is silly.

Everyone will sit here and say "cut her a break, it was a pediatric call and a really sick kid" but the expectation of paramedics is to able to handle a high stress situation no matter the age of the patient. That is why we get paid to go out and treat sick people, its the expectation that we are able to do that.

That's a much easier thing to talk about than to accomplish.

It just isn't true that just because someone has graduated a paramedic program that they are properly equipped to deal with these unusual and highly stressful situations. It should be that way - I think everyone agrees on that - but it isn't.

 

[NYBLS]

Expertise / experience (ED MD vs. EMTP). Personnel. Imaging. Labs. Drugs. Resources. Specialists and subspecialists.

Granted, probably none of the treatment differs in the very early phases of resuscitation, but to pretend that an ambulance is the same as an ED is silly.

This patient waited 14 hours for help. Do you think it would have been better for her to wait another 10 minutes to be treated by staff that probably has a lot more experience than the medic in the video, or to be treated on scene by someone who obviously wasn't capable of providing the care the patient needed?

I never stated that an ambulance is the same as an ED, there are many distinct differences. However, I think it is silly to work any arrest while moving. It takes away your partner (someone has to drive) , adds an increased risk (this patient was never secured) and shows a higher failure rate in procedures (IV, IO and intubation). Instead of screaming "Go!!" why not develop a quick plan? Okay Mr. Cop, we dont have a pulse, you do CPR while my partner (he's free to the back since we aren't flying down the road) can bag the patient. Great, lets place the monitor. Great, lets get access. Great, lets get a tape out and grab some meds and continue our resuscitation. The difference between 14 hours in a car and now being in the ambulance? Help is here.

 

[Angel]

You are seriously splitting hairs. Why would you wait 10 minutes on scene just to do abc then sit outside the ER for another 12 to do xyz?? (When it can be done en route, people can still start IVs while moving right?) Never once have I walked in with a code 3 and the ER not be ready (kind of the point of a radio report) and registration? Stat reg anyone? Pyxis? Not for what this kid needs right now resuscitation meds and airway equipment...even in traumas or OB emergencies so all that is invalid.

Learn from it or don't but I think everyone agrees she got tunnel vision and basically didn't even preform at a BLS level

 

[EpiEMS]

#1 priority here should be BLS measures (ABCs) -- looks like those were neglected until pretty late in the game. #2 is transport (to a physician). Anything in between can be done en-route -- that means the M.I.T. of V.O.M.I.T., no?

Also, if you need a second provider in the back, why not have the cop or FD drive...?

 

[DesertMedic66]

Also, if you need a second provider in the back, why not have the cop or FD drive...?

Not allowed in many systems

 

[Handsome Robb]

Those talking about performing interventions on a child in cardiac arrest during transport have very obviously never run one. I'm not saying that I'm God's gift to pedi arrests but in 3 years as a medic I've had 7 working plus more than a few obvious ones so it's not a totally foreign concept to me. Pediatric IOs are not as easy as adult IOs. You cannot go too deep with an adult IO but you very easily can with a pediatric one. Also, a little bit of blood from airway trauma in a little airway is a big problem.

This kid got lucky, lack of good BLS because of a frantic pair of providers does not bode well for PT outcome. Take a breath, calm yourself down, get what you need in place and when you have that done get going. I'm not advocating staying on scene for 45 minutes working, I am advocating spending an extra 5-10 minutes getting access, getting the monitor set up, getting a patent airway established whether it's BLS or ALS, measuring with the broselow and getting your ducks in a row as far as medication dosing. Also this child needed to be warmed, being in wet, freezing clothes isn't going to help you get ROSC. Get her naked, dry and crank the heat. If you've got a transwarmer get it going and place the child on top of it. to begin the reheating process.

It's proven that adults have a better chance at survival when worked where they are found, the same goes for pediatrics. With that said no one is saying work the entire arrest on scene since it is easier to do good CPR on a small child in a moving ambulance compared to an adult.

I'm not trying to single anyone out but it really irks me when people get sick children and their immediate answer is scoop and run like hell. This might come out as brash but if that's your mindset then maybe the child is better off with you (again a general you, not directed at anyone) taking them to someone who can separate themselves from the situation and act calmly and competently.

 

[NomadicMedic]

This is the best line in this whole thread:

What I take away from this isn't "that medic didn't know what she was doing", but rather "that medic should have been better trained in reacting to a pediatric emergency and in dealing with the stress that can accompany those situations".

 

[Angel]

Like I said....different strokes. Everyone has the right to run their scene the way they see fit, but this person's performance is lackluster at best

 

[Handsome Robb]

I'm not disagreeing with you Angel. What I am disagreeing with is when the decisions on how to run that scene have a poor effect on patient care. There are multiple different ways to get from A to B, doesn't matter how you get there as long as you do it without getting lost.

 

[NYBLS]

You are seriously splitting hairs. Why would you wait 10 minutes on scene just to do abc then sit outside the ER for another 12 to do xyz?? (When it can be done en route, people can still start IVs while moving right?) Never once have I walked in with a code 3 and the ER not be ready (kind of the point of a radio report) and registration? Stat reg anyone? Pyxis? Not for what this kid needs right now resuscitation meds and airway equipment...even in traumas or OB emergencies so all that is invalid.

Learn from it or don't but I think everyone agrees she got tunnel vision and basically didn't even preform at a BLS level

What is the hospital going to do differently than EMS within the first 10-15 minutes of this arrest? Specific examples.

 

[Angel]

What is the hospital going to do differently than EMS within the first 10-15 minutes of this arrest? Specific examples.

You still don't get it. I've repeated myself at least twice now, bring yourself up to speed then maybe we can have a meaningful conversation.

@Handsome Robb, we agree on that. At the end of the day I think (hope) good patient care is what we all want.

 

[NYBLS]

Double post, my bad.

 

[NYBLS]

Stay and play why? The kid was in the river 14 hours already right? Again, everyone runs calls different, but I've never been the one to say...sit outside the ER and do things so the ER doesn't get upset I don't have an IV or advanced airway.

They will be upset because its basic care that you are able to provide but ran to the hospital out of fear instead of doing.

That's why you do it in en route....

What is your peds IV success rate? How about in a moving ambulance? How about on a hypothermic pediatric patient? We can discuss intubation later.

You are seriously splitting hairs. Why would you wait 10 minutes on scene just to do abc then sit outside the ER for another 12 to do xyz?? (When it can be done en route, people can still start IVs while moving right?) Never once have I walked in with a code 3 and the ER not be ready (kind of the point of a radio report) and registration? Stat reg anyone? Pyxis? Not for what this kid needs right now resuscitation meds and airway equipment...even in traumas or OB emergencies so all that is invalid.

Learn from it or don't but I think everyone agrees she got tunnel vision and basically didn't even preform at a BLS level

I'm not "waiting" on scene, I'm stabilizing my patient prior to transport as it is much safer and more effective while I'm not flying down the road.

Like I said....different strokes. Everyone has the right to run their scene the way they see fit, but this person's performance is lackluster at best

At least we agree on something.

You still don't get it. I've repeated myself at least twice now, bring yourself up to speed then maybe we can have a meaningful conversation.

@Handsome Robb, we agree on that. At the end of the day I think (hope) good patient care is what we all want.

I've read your posts several times.

 

[Angel]

Great. Anything else? I'm not arguing. We disagree, period.