Dying patient left on apartment floor

[NomadicMedic]

State board cites 7 Kan. responders for failing to transport patient to hospital

Though injury was deemed "incompatible with survival," bodycam footage and records show patient was alive for hours before transport to hospice

www.ems1.com

thoughts?

 

[DrParasite]

I read this last night.... Couple thoughts:
1) this is BAAAAAAD. The optics are horrible. But just because it looks bad, and people's emotional response is highly negative, doesn't mean it was an incorrect clinical decision.
2) "[Sedgwick County EMS Medical Director Dr. John Gallagher] went to the man's downtown Wichita apartment and decided he was "unsalvageable" and should be left to die."
3) "The Medical Society's EMS Physicians Advisory Committee reviewed the case shortly after this tragic incident occurred," Brownlee said. "The committee of emergency medicine physicians unanimously concluded the EMS providers delivered appropriate care."
4) "Two months after the call, Sedgwick County consolidated its EMS services and the Office of the Medical Director, placing Gallagher, a physician, as the top official in the county's EMS system."
5) The EMS supervisor was on scene and directly contacted the medical director. So the field paramedics were utilizing their chain of command and follow their direction. multiple times.

Some other thoughts
1) All paramedics work under the license of the medical director. The medical director made a call, so if a paramedic overruled or disregarded the medical director, they would be practicing medicine without a license
2) With GSW to the head, maybe brain matter was showing... does anyone seriously think the patient was going to live? and if the MD says the patient is not viable, isn't it their prerogative to make that decision?

the Kansas Board of Emergency Medical Services has no authority over the medical director, which is why they are going after the field crews. , but I do agree with them on one thing: there should be an investigation into Dr. John Gallagher's actions. Even if the Medical Society's EMS Physicians Advisory's committee review wasn't good enough. And if the investigation confirms that Dr. Gallagher's actions were appropriate, then the Kansas EMS board should drop all charges against the EMS providers involved in the calls, and offer them formal apologies for their erroneous judgments against them.

 

[mgr22]

Here are two paragraphs that stood out to me:

"Charges include falsifying information, disregard for patient well-being and dignity, failing to provide patient care, unprofessional conduct and not following protocol.

"Gallagher (an MD) supervised the call that day along with Sedgwick County paramedic Timothy Popp. Gallagher is not facing disciplinary action."

Among those charges, "falsifying information" and "not following protocol" should be specific and the easiest to sustain or refute. And if Dr. Gallagher was providing medical control online and later on-scene, I think that's where the ultimate responsibility should lie.

 

[GMCmedic]

We had a very similar situation locally and I can tell you that nobody wins in this.


I don't believe that body cam footage is adequate enough to determine punishment for fire. It's very plausible that the patient was clamped down so tight they didn't have palpable pulses, and labored breathing doesn't really say much beyond respirations were present.


That said, I'm not familiar with Kansas rules and regs.

In my opinion absent falsified information, the medical director is responsible.

 

[E tank]

From the accusations, seems to me that there was no provision in the local protocol to allow for "end of life care" determination by the doc. Really odd story...given the exact same injury in an accidental discharge or a robbery, would they have made the same decision?

Kind of an aside, but suicide/euthanasia have been making their way into main stream thinking and a very particular narrative about them is gaining favor in medical (physician) training and governmental settings.

Is this kind of thing a thing? Kind of breathtaking...

 

[Peak]

Not to sound like a vulture but that’s a heart, two lungs, liver, two kidneys, and gut that were slowed to die in vain instead of potentially being harvested.

 

[CCCSD]

One quick BLS ride and this never would have been an issue...

 

[Jim37F]

So the patient had injuries incompatible with life, yet they found a pulse after doing a round of CPR? Why did they even start CPR in the first place?

But with a pulse, with our without CPR, this whole mess would have been avoided by simply transporting.

But otherwise it sounds like the field crews did follow their Supervisor and Medical Director instructions. And not like offline protocols or online instructions via phone/radio, but by the Doc being there in person, they were following their chain of command so if you wanna be upset with the Doc or Supervisor do so, but not the crews.

Now the other charges are concerning. They talk about charging people with falsifying records or acting inappropriately with the patient, etc. Def some serious stuff right there.... and the article makes no effort whatsoever to support those charges. It sounds more like someone just fired a shotgun blast of charges just to see if something would stick, not because they had any evidence to support those charges in the first place.

THAT is concerning to me. I didn't get any sense that anyone was trying to hide or falsify anything, just that it was a bad call with a bad outcome.
Sounds like it should be more of a case of "EMS apologizing and clarifying procedures that yes he was gravely injured, and no trauma team would change that, be he wasn't dead just yet, so it would have been better to transport" versus dragging the Medics names thru the mud and throwing career ending charges at them...

 

[CCCSD]

When in doubt, transport.

 

[E tank]

Not to sound like a vulture but that’s a heart, two lungs, liver, two kidneys, and gut that were slowed to die in vain instead of potentially being harvested.

Not necessarily...if he doesn't show brain death criteria, he can't be harvested. Intubated he could last indefinitely. Tissue harvesting after death, sure, but not vital organs...

 

[Tigger]

This is uh....wild all around. “Hey doc I don’t think he’s dead yet, cool if I give some v high dose ketamine in the meantime?”

 

[EpiEMS]

Unreal. Wow. I'd be curious to read the autopsy report, assuming one was performed.

I'm not convinced that following the Medical Director's orders necessarily protects from liability...particularly if they are in contravention to good judgement. That said, perhaps the issue here is a subjectivity in determination as to what a "lethal injury" is?

 

[E tank]

This is uh....wild all around. “Hey doc I don’t think he’s dead yet, cool if I give some v high dose ketamine in the meantime?”

Yes...missed that among all the other jaw droppers...my opinion, but this thinking is a direct consequence of physician assisted suicide/euthanasia campaigns that are taking some states by storm. Someone on a scene offers to snuff a patient? Unreal.

 

[Tigger]

Yes...missed that among all the other jaw droppers...my opinion, but this thinking is a direct consequence of physician assisted suicide/euthanasia campaigns that are taking some states by storm. Someone on a scene offers to snuff a patient? Unreal.

Who knows what the route cause is here, but 500mg (x2) is not really a comfort dose. Not much of a euthanasia med either. The whole thing just seems like it just spiraled out of control. Involved medical direction is important but it seems like in this case that some excessive decisions by the physician played a role here. Still very unclear as to why the control doc would leave the hospital to mitigate this, what is the best case scenario he was looking for?

 

[CCCSD]

Ego.

 

[Peak]

Not necessarily...if he doesn't show brain death criteria, he can't be harvested. Intubated he could last indefinitely. Tissue harvesting after death, sure, but not vital organs...

We can harvest and reperfuse many organs after cardiac death. Kidneys, livers, and pancreas are pretty straightforward and most OPOs can do this. In some cases we can get the heart and lungs, but these are far more challenging.

 

[DrParasite]

Involved medical direction is important but it seems like in this case that some excessive decisions by the physician played a role here. Still very unclear as to why the control doc would leave the hospital to mitigate this, what is the best case scenario he was looking for?

Some systems (including my own) have an EMS medical director who frequently responds to the scene, in a marked vehicle. the medical director is different than medical control, and is typically a full time employee of the EMS agency. The county medical director of my county (and his two deputies) both have take home cars, as did the former medical director of the agency when I worked in NJ, and it's not uncommon for him to show up on a scene. esp weird or unusual ones in the city limits

I don't know if I agree with your assessment of "excessive decisions by the physician" especially when the field crews contacted the doc for advice/orders/guidance. But giving ketamine because he's not quite dead yet... I mean, I understand why (alleviate suffering, not contradict the medical director, etc), but ooo boy...

 

[Tigger]

Some systems (including my own) have an EMS medical director who frequently responds to the scene, in a marked vehicle. the medical director is different than medical control, and is typically a full time employee of the EMS agency. The county medical director of my county (and his two deputies) both have take home cars, as did the former medical director of the agency when I worked in NJ, and it's not uncommon for him to show up on a scene. esp weird or unusual ones in the city limits

I don't know if I agree with your assessment of "excessive decisions by the physician" especially when the field crews contacted the doc for advice/orders/guidance. But giving ketamine because he's not quite dead yet... I mean, I understand why (alleviate suffering, not contradict the medical director, etc), but ooo boy...

I too work in such a system. Ketamine is not long acting nor is 500mg a pain dose. I ask again what outcome the doctor was seeking here by responding to the scene. This was not a complex call.

 

[Carlos Danger]

I too work in such a system. Ketamine is not long acting nor is 500mg a pain dose. I ask again what outcome the doctor was seeking here by responding to the scene. This was not a complex call.

500mg isn’t a pain dose but it’s the dose you would want given to you in a similar scenario, that is assuming one of the many more appropriate drugs are unavailable.

Super weird situation.

 

[DesertMedic66]

What on earth is going on in that system? Why are there so many inconsistencies with their report? Why would you not transport this patient to a hospital that is 5 minutes away? Why would you have a medical director respond to a scene that is less than 5 minutes away from an ED?

So instead of transporting the patient, who is still alive, to the ED where they have established palliative care process, they spend over 5 hours on scene just watching this guy cough/vomit/move his extremities.

Makes you wonder what other extremely shady things have occurred without being investigated.