mad dies after calling 911 10 times

[46Young]

On the contrary. If this happened and it was a FD that was responding you guys would be allover the fact it was a FD. (but I will admit that is speculation on my part... but it has good standing with the track record of this forum).



I agree! And what was the problem... the roads had too much snow. So call the DOT for a plow. Heck break out the shovels and start digging if you feel you must. The FD is no more qualified to shovel snow that anyone else so why do they (in your opinion from what I am inferring) get the special job of shoveling snow?


Not sure what this is about... maybe something towards FD's. To rescue the Pt call a plow and while your waiting read a book. Start walking if you want to get to them sooner. But abandoning them is not an option.




I agree. Nothing is perfect.

I'm usually one of the first to tell everyone to get off of the FD stick when the FBEMS lynch mob gets going. You're probably correctin that it would have been ugly if it was the FD's doing. But, in this particular case, the earlier posts were pretty damning of the EMS system alone and it's crews in this incident.

There were a few weak attempts to somehow link the FD to this whole mess, but the fact of the matter is that they would need to be called to help. I'm sure they would have done their best if they were toned out for the assist with this one. If they're not called, how are they supposed to know there's a problem developing?

 

[46Young]

Where I work, in Northern VA, we maybe get a decent snowstorm every ten years or so. This region is certainly not facing such conditions every year as Pittsburgh does. The thing is, we had no issue in reaching pts during both of our snowstorms, which both dumped around two feet each.

All our units, ambulances and apparatus alike, have on spot chains, Z-cables, and heavy snow chains. We carry shovels on our pieces. We had 12 or so 4WD utility vehicles, each equipped with plows and also two FF's, to be johnny on the spot with any access issues. I've driven in many a NY snowstorm in mini mod's, with no chains or anything, and managed. Having chains made it a joke to get around. You need to know your first due, to have the foresight to know that you won't make it up a particular hill or bridge, and react accordingly. We had suppression units routinely doing ALS assessments (and tx if necessary) and bringing pts out to the ambulances, either by carrying or by ambulation if appropriate beyond doubt. Not bad for a dept that hardly ever gets even one storm, let alone two that were each around two feet. What's Pittsburgh's excuse? Maybe lack of available units, since restricted access resulted in repeated cancellations, rather than sending another unit from a different direction? FBEMS ALS first response really helps when conditions are poor, and also when units are scarce, which is the intention of having ALS first response in the first place. I've seen this firsthand through two storms, and things worked great. The concept works well if applied properly, with competent individuals. The alternative, of course, is working with the bare minimum, and getting jammed up on occasion, where sometimes preventable injury and death occur.

I'm willing to bet that there wasn't four feet of snow on the ground when the first 911 call was made in this incident. Since snowstorms in Pittsburgh are a given, the plows should have been out, and I can't see there being more than 6 inches or a foot down at the time, at least up to a block away from the residence, which is within walking distance. If you can't manage through even a foot of snow with a monitor and a couple of bags between two people, then you're physically incapable of working period. I've had to carry pts on a scoop or reeves a block or more to the rig with just my partner, as plowing from previous storms blocked any other egress (in NY). If I can carry someone a block or more in a foot of snow, you can't walk with just a couple of bags?

This particular situation makes a great case for ALS first response (I'm talking about fire based, of course). You get three or four physically capable individuals, ALS capable as well (how capable varies from dept to dept, but still), and additional resources if needed.

Speaking of additional resources, to get someone out of a house during a snowstorm it's real simple. You can use either a reeves or a stokes. Use 4-6 people to carry. Wrap the pt in blankets, and don't forget to cover the head. If a car ejects a pt down a steep enbankment (such as I-26 in North Charleston) a stokes and some ropes do wonders in getting a pt out. Imagine what a stokes will do on the horizontal? Get a utility truck with a plow if you need to. I find it hard to believe that the city of Pittsburgh has no such thing.

 

[EMSLaw]

I've been in this situation all too often lately. Recently, in one of our monster snowstorms of this month, the rig got stuck on the way to a fire call where we were told we had a patient. So, I told the driver to try and get the rig unstuck, I slung the jump bag over my shoulder, and I walked the three-quarters of a mile to the scene. Only to find out there was no patient, but that's really neither here nor there.

I refuse to accept that there was no way to get to the patient because there was a storm. Improvise, adapt, overcome. Tell your dispatcher to send a plow. Hit out the fire department for lifting assistance and carry the patient out on a Reeves, scoop, or folding stretcher if you have to. Whatever it takes. Response times will suck in a blizzard, but if someone calls an ambulance, I firmly believe said ambulance should (as soon as possible) show up.

And by the way, I also refuse to accept that the scene is unsafe because there's snow on the ground. I'm a fatty, and I managed to walk through the snow to calls. It's probably good for me. If I can do it, I think anyone can. If you get snow on your pants, suck it up.

 

[46Young]

I've been in this situation all too often lately. Recently, in one of our monster snowstorms of this month, the rig got stuck on the way to a fire call where we were told we had a patient. So, I told the driver to try and get the rig unstuck, I slung the jump bag over my shoulder, and I walked the three-quarters of a mile to the scene. Only to find out there was no patient, but that's really neither here nor there.

I refuse to accept that there was no way to get to the patient because there was a storm. Improvise, adapt, overcome. Tell your dispatcher to send a plow. Hit out the fire department for lifting assistance and carry the patient out on a Reeves, scoop, or folding stretcher if you have to. Whatever it takes. Response times will suck in a blizzard, but if someone calls an ambulance, I firmly believe said ambulance should (as soon as possible) show up.

And by the way, I also refuse to accept that the scene is unsafe because there's snow on the ground. I'm a fatty, and I managed to walk through the snow to calls. It's probably good for me. If I can do it, I think anyone can. If you get snow on your pants, suck it up.

Wearing two pairs of socks to help with the cold steel toes helps, as does changes of socks for wet feet.

Anyway, you're correct, as shifting the onus, shifting the blame, or CYA is necessary for longevity in EMS. Calling dispatch via a taped line or radio when any issues arise, as well as a well written PCR are two vital practices.

 

[DrParasite]

I would like to point out a few things:

1) the call was for abdominal pain, which in most systems (pitt included) is a low priority calls.

2) the earlier ambulance that went got stuck in the snow, and was unable to respond as well. so it was probably pretty bad.

3) NJ got hit with a major storm in the past week. the GSP, RT 1 and I287 were all plowed, yet they were all still snow covered. Some of the county roads were plowed. most side streets still weren't. So the response of "they should have plowed the streets" is kinda BS, because if the snow is still falling, there is often no way to catch up.

4) Pittsburg EMS has 2 heavy rescues, staffed with 2 paramedics. not sure why they weren't sent to assist, but they are an option if they were available.

5) this patient called 10 times. I don't care if they called 30 times. abdominal pain is still a low priority, unless something changes. if you have a chest pain, rollover, unconscious, and cardiac arrest who only call once, should the abd pain take precedence because they call many times? I am guessing the system is like mine, where we only have a finite amount of resources. you have to prioritize your calls, deal with the life threatening calls first, and then deal with the non-life threatening ones. it might sound harsh, but many urban cities only have so many units, and many don't use mutual aid for non-life threatening (BLS) calls. that, if if the city was hopping, how much you want to bet all your mutual aid companies were tied up as well?

That all being said, I find it completely unacceptable that a unit cancels a call because access is obstructed by snow. Asking the person to walk up the block wouldn't be something I would suggest, but canceling the call was a poor decision by the crew. They should have made every effort and found a way to get through the snow, even if it meant getting pulled by a winch out of the snow bank.

 

[46Young]

I would like to point out a few things:

1) the call was for abdominal pain, which in most systems (pitt included) is a low priority calls.

2) the earlier ambulance that went got stuck in the snow, and was unable to respond as well. so it was probably pretty bad.

3) NJ got hit with a major storm in the past week. the GSP, RT 1 and I287 were all plowed, yet they were all still snow covered. Some of the county roads were plowed. most side streets still weren't. So the response of "they should have plowed the streets" is kinda BS, because if the snow is still falling, there is often no way to catch up.

4) Pittsburg EMS has 2 heavy rescues, staffed with 2 paramedics. not sure why they weren't sent to assist, but they are an option if they were available.

5) this patient called 10 times. I don't care if they called 30 times. abdominal pain is still a low priority, unless something changes. if you have a chest pain, rollover, unconscious, and cardiac arrest who only call once, should the abd pain take precedence because they call many times? I am guessing the system is like mine, where we only have a finite amount of resources. you have to prioritize your calls, deal with the life threatening calls first, and then deal with the non-life threatening ones. it might sound harsh, but many urban cities only have so many units, and many don't use mutual aid for non-life threatening (BLS) calls. that, if if the city was hopping, how much you want to bet all your mutual aid companies were tied up as well?

That all being said, I find it completely unacceptable that a unit cancels a call because access is obstructed by snow. Asking the person to walk up the block wouldn't be something I would suggest, but canceling the call was a poor decision by the crew. They should have made every effort and found a way to get through the snow, even if it meant getting pulled by a winch out of the snow bank.

Yes, self cancelling a call is a major faux pas, and is a quick and easy way to get fired.

As medics, we're taught to consider all differentials for any complaint. The differentials with abd pain are numerous. It's unknown if Pittsburgh's dispatchers are only hired with prior field EMS experience, or if they are lay people who determine call type by flipping through the EMD cookbook. Experienced EMS field providers ought to be able to ask more focused questions to get a better picture of the pts situation, and then place a more accurate call type. Otherwise, you get the 35 y/o female with a H/A getting priority over the dizzy 74 y/o with an extensive medical Hx.

 

[firecoins]

Yes, self cancelling a call is a major faux pas, and is a quick and easy way to get fired.

As medics, we're taught to consider all differentials for any complaint. The differentials with abd pain are numerous. It's unknown if Pittsburgh's dispatchers are only hired with prior field EMS experience, or if they are lay people who determine call type by flipping through the EMD cookbook. Experienced EMS field providers ought to be able to ask more focused questions to get a better picture of the pts situation, and then place a more accurate call type. Otherwise, you get the 35 y/o female with a H/A getting priority over the dizzy 74 y/o with an extensive medical Hx.

in this case, an MD apparently called and cancelled the call at one point.

Of course, making it too the house and seeing the patient would have made a big difference. If the crew can get close enought o have the patient walk to them, than they can go walk to the patient.

How did they get to the patient once he became a high priority on the 10th call?

 

[Foxbat]

I would like to point out a few things:

^ What he said.
On that day, Western PA, including Pittsburgh, was hit with a blizzard. Yes, Pittsburgh sees snow every once in a while, but it was, if I recall correctly, the worst one since 1993. We went from no snow at all to about 2 feet of snow in less than a day. State of emergency was declared, and many, if not most city streets were not drivable.
On that particular Saturday, Pittsburgh EMS was overloaded with calls. On Saturday evening city had a few dozens of priority calls pending. Abdominal pain in Allegheny county dispatch system is coded as an E-2 (ALS, but low-priority), and, if I am not mistaken, Pittsburgh Fire Bureau is not dispatched to these.
From what I have been told by dispatchers working the county 911, they have very strict policies to adhere to, and there's very little left to dispatchers' discretion.

 

[fortsmithman]

The medics should have gotten out of their rig and walked up to the residence and went in and did an assessment. One of the calls I was on a year ago involved my and my team going in to bget the pt by hiking approx 1.5k (roughly a mile) We had to wlk down a river bank across a frozen river then up the other bank both of which were steep then the rest of the way through a wooded area to a trappers cabin. After we arrived we were able to secure a snow machine to transport our pt to the rig. The team leader rode back with the pt myself and the other member of the team had to walk back. My town is primarily rural the nearest town is about 2.5 hrs highway speed from us.

 

[rescue99]

The medics should have gotten out of their rig and walked up to the residence and went in and did an assessment. One of the calls I was on a year ago involved my and my team going in to bget the pt by hiking approx 1.5k (roughly a mile) We had to wlk down a river bank across a frozen river then up the other bank both of which were steep then the rest of the way through a wooded area to a trappers cabin. After we arrived we were able to secure a snow machine to transport our pt to the rig. The team leader rode back with the pt myself and the other member of the team had to walk back. My town is primarily rural the nearest town is about 2.5 hrs highway speed from us.

YEP!

Even the GF has to take some responsibility for this man's needless death. However, the GF had no training to give her strong clues nor, was there a duty to act on her part.

The answer was so easy a caveman could do it. No one, not even the GF could manage to....call the dog-gone fire department!! A fire department will pluck ducklings out of storm sewers and dogs out of frozen ponds. They would not hesitate to get one sickly man across a snow covered bridge. In order to do that, they have to be called, eh?

 

[EMSLaw]

The answer was so easy a caveman could do it. No one, not even the GF could manage to....call the dog-gone fire department!! A fire department will pluck ducklings out of storm sewers and dogs out of frozen ponds. They would not hesitate to get one sickly man across a snow covered bridge. In order to do that, they have to be called, eh?

They live for that stuff, and sending an old guy across a rope bridge in a stokes basket makes a good "No sh**, there I was..." story.

 

[nomofica]

in this case, an MD apparently called and cancelled the call at one point.

Of course, making it too the house and seeing the patient would have made a big difference. If the crew can get close enought o have the patient walk to them, than they can go walk to the patient.

How did they get to the patient once he became a high priority on the 10th call?

If you read the article, the MD canceled the call because he assumed the patient took his prescription drugs and went to sleep.

You never assume that somebody just took their meds and went for a nap, especially when an ambulance has been called out numerous times in the past day or two. And you never cancel a call because you assumed as much without an actual patient assessment.

 

[Veneficus]

If you read the article, the MD canceled the call because he assumed the patient took his prescription drugs and went to sleep.

You never assume that somebody just took their meds and went for a nap, especially when an ambulance has been called out numerous times in the past day or two. And you never cancel a call because you assumed as much without an actual patient assessment.

my favorite part was the guy with abd pain couldn't walk across the bridge to the ambulance. Take a look at my earlier link for how big that bridge is.

 

[nomofica]

my favorite part was the guy with abd pain couldn't walk across the bridge to the ambulance. Take a look at my earlier link for how big that bridge is.

They expected a patient with severe abdominal pain to hike across THAT bridge?:wacko:

 

[Foxbat]

The answer was so easy a caveman could do it. No one, not even the GF could manage to....call the dog-gone fire department!! A fire department will pluck ducklings out of storm sewers and dogs out of frozen ponds. They would not hesitate to get one sickly man across a snow covered bridge. In order to do that, they have to be called, eh?

All 911 calls are handled by same dispatchers anyway... Her call would still be handled the same, and unless medics would request FD to respond, which they probably should have done, there would be no different outcome.

 

[phildo]

Ok, I have a question. Forgive me if I have not heard all the news on this. What was the cause of death, or has that not been determined? Abdominal pain can be anything. Could be a AAA, an atypical MI, pancreatitis, necrotic bowel. How is this a low priority dispatch? I can't imagine not taking extraordinary measures to make contact. If they were so busy, they'd know as soon as they went in service, they'd get launched out on another call. So why the (perceived) apathy on the part of the crews? Its not like the Superbowl was on at the station.

 

[firecoins]

If you read the article, the MD canceled the call because he assumed the patient took his prescription drugs and went to sleep.

You never assume that somebody just took their meds and went for a nap, especially when an ambulance has been called out numerous times in the past day or two. And you never cancel a call because you assumed as much without an actual patient assessment.

you mentioned the dispatchers not asking the right questions and I replied by mentioning the MD spoke to the patient. I am unaware of any system where a doctor can cancel a call prior to EMS arriving unless he speaks to the pt. If the MD canceleed the job without even speaking to the patient, his license may need to be taken.

 

[DrParasite]

Abdominal pain can be anything. Could be a AAA, an atypical MI, pancreatitis, necrotic bowel. How is this a low priority dispatch?

and toe pain for the last 3 days on a diabetic can sign an atypical MI. does that mean every toe pain should be a high priority dispatch?

like it or not, dispatching is based on odd, history, and playing the percentages. most abdominal pains are non-life threatening. most unresponsive calls have the potential to be life threatening. so if you have one ambulance, who are you going to send to first?

also like it or not, every EMS system has a finite amount of resources. so they have to prioritize their calls, and do the best they can. I am willing to bet that the majority of people on here have not worked as dispatchers in a busy 911 system. If you did, you would know that trying to manage resources on a busy system when all your units are busy and you still have 5-10-20 jobs holding can be more emotionally draining than a shift on the streets. They do the best they can, with the rules and regulations and protocols that they are given. remember, a field unit may deal with 18 incidents on a busy shift 12 hour. a dispatcher/call taker has to deal with maybe 60-100 incidents during a 12 hour shift.

If you guys think you can do better, apply to Pittsburgh EMS 911 Dispatch division. I'm sure once you get there, they would be more than welcome to see you do their job better than they could ever do. or more likely, see you fall on your face and say "damn, this job is a lot harder than I thought it was..."

 

[rescue99]

All 911 calls are handled by same dispatchers anyway... Her call would still be handled the same, and unless medics would request FD to respond, which they probably should have done, there would be no different outcome.

I know the non emergent number to the local area FD's. They're listed. But, yer right. Dispatch should have made the call.

 

[Foxbat]

This is the QA review of that event by city EMS's medical director, released by city's public safety director. Recommended read for all interested.
http://www.scribd.com/doc/26960692/Medical-Call-Review-for-5161-Chaplain-Way
Accessed via http://roguemedic.blogspot.com/