Mass. health department recommends 2 EMTs be suspended

[boingo]

Your missing my point, In the article posted from south coast it states the child was taking to the ambulance and when the supervisor arrived there was nothing being done.

My question is if they determined the child was not viable or in their words "dead" why was the child moved to the ambulance for transport? If he was in fact not viable he should have never been moved, the child should have been left there and med control/medical examiner called.

Again, speculation on my part, but I have been to many a call like this were a FF or cop comes flying out of the house with the dead kid in his arms, not much you can do at that point but load it in the truck. I have called kids like that, notified the hospital and not attempt to resuscitate. It may have been the plan until the supervisor showed up and decided to work it. I would love to see their chart, I can only assume it was poorly written, otherwise this wouldn't be news. For these medics not to work the kid I'd like to believe this was obviously non-viable, however I don't know the facts.

 

[VentMedic]

No one said it was BS, I'm just not convinced it was a transport of 4 critically ill patients. You worked EMS in a poor, urban area yourself, how many of these calls have you done? Thousands probably. All deserve a thorough hx and exam, however at the end of all that, sometimes minor illness is just that, minor. A ride to the hospital, a seat out at triage, and an eventual work up will be done. You are the expert on oxygen therapy here, and I'm sure you don't subscribe to the theory that everyone needs high flow o2. What makes these patient any different, other than a cook book that suggests everyone should get it? Either there is room for critical thinking or not. I have no idea how those complaint got filed, was it the disgruntled supervisor, problem w/nursing staff, or someone else. What was done for those patients at the hospital? Were they tx with o2? What were the results of any tests run? I don't think we can crucify these two based on what we have seen here, although I guess it can be a good lesson in why we need to write a thorough chart.

At what percentage, adult or child, does your facility dive the patient? How many clock hours for the half life does your facilty treat with O2? What was the PPM and length of exposure? See charts below which are from any standard medical manual for CO poisoning.

Your definition of critical is different than mine. If a patient has the proper treatment initiated for CO poisoning, they may not need an ICU.

I could also go into my lecture about what "high flow" O2 is and the difference between "high flow" and "high FiO2" but I have already done that many times on this forum. It is a shame too few get this basic education about O2 therapy in school to not know the capabilities of their O2 devices.

There are 5 things that we are very aggressive with O2:
1. CO poisoning
2. Sepsis with lactate > 4 mmol/L
3. PPHN of the newborn
4. DCS
5. ARDS until the treatment with adequate PEEP, pressors, buffering and monitoring are in place. Pulmonary HTN may also run on this protocol until NO or one of the other pulmonary vasodilators is in place.

There is one thing we will try to hold off with aggressive O2 therapy, at least until the Prostaglandin is started, and that is ductal dependant cyanotic heart disease. We may even go to 16% O2 for them.

Many times EMS does not realize how sick the patients they transport actually are. The same for those that do IFT on the elderly patient with a fever. This is not just me talking as there have also be studies to show that. Lab values and other diagnostics are not available in the field nor is the education about various disease processes.

Back to MA, some agencies want their Paramedics to follow their protocols. Your protocols may not be the same as theirs and they may have missed a few steps to determine death which may include contacting a physician for a child. So, you are judging just from your own recipe book.

Its not like we haven't heard of a Paramedic failing to see if a patient is really dead lately.

Symptoms Associated with a Given Concentration of COHb
COHb Symptoms and Medical Consequences
10% No symptoms. Heavy smokers can have as much as 9% COHb.

15% Mild headache.

25% Nausea and serious headache. Fairly quick recovery after treatment with oxygen and/or fresh air.

30% Symptoms intensify. Potential for long term effects especially in the case of infants, children, the elderly, victims of heart disease and pregnant women.

45% Unconsciousness

50+% Death

Symptoms Associated with a Given Concentration of CO Over Time
PPM CO Time Symptoms
35 8 hours Maximum exposure allowed by OSHA in the workplace over an eight hour period.

200 2-3 hours Mild headache, fatigue, nausea and dizziness.

400 1-2 hoursSerious headache-other symptoms intensify. Life threatening after 3 hours.

800 45 minutes Dizziness, nausea and convulsions. Unconscious within 2 hours. Death within 2-3 hours.

1600 20 minutesHeadache, dizziness and nausea. Death within 1 hour.

3200 5-10 minutesHeadache, dizziness and nausea. Death within 1 hour.

6400 1-2 minutesHeadache, dizziness and nausea. Death within 25-30 minutes.

12,800 1-3 minutesDeath

 

[boingo]

I'm not judging at all, I'm argueing there could be a rational reason for witholding CPR, perhaps the documentation of those reasons are in question. The fact that a recently layed-off supervisor blows the whistle in 2 letters to the Mayor, as opposed to the physician medical director makes me question the validity of his claims, despite the fact that the DPH seems to agree. Poor documentation is likely, however this is likely a poor attempt at justifying the supervisors job. I would love to hear the medical directors take on all of this, I know if it were me, my medical director would be directly involved as I assume would yours. Perhaps they are guilty as charged, time will tell. But until we have access to the chart, the ED chart and the post, I think I'll leave my torch and pitchfork at home.

 

[emtfarva]

there might be another side to this story that no one has heard. both of the medics are union leaders. the supervisior was not.

 

[SauceyEMT]

The fact that a recently layed-off supervisor blows the whistle in 2 letters to the Mayor, as opposed to the physician medical director makes me question the validity of his claims, despite the fact that the DPH seems to agree.

It seems, to me anyway, that the physician medical director probably only had the run sheet/report to go on, thus not reporting anything. The report says they continued CPR and transported. The problem comes in when the on-scene supervisor is contradicting the run sheet by saying that he saw that CPR was NOT being performed as indicated on the run sheet. Now there are questions as to the ACTUAL care that was given, thus the investigation.

 

[emtfarva]

one more thing is that the mayor didn't know about the case until OEMS pulbished their report. and the whistle blower brought it to the attention of OEMS.

 

[Hal9000]

I wonder if there were enough seat restraints on the ambulance for four patients and two medical providers.

 

[vquintessence]

I wonder if there were enough seat restraints on the ambulance for four patients and two medical providers.

Yep.

At least two pair of seatbelts on the bench seat (typically three pairs). Then there's the tech seat, and then the stretcher. That's four or five right there alone. Then there could also be a CPR seat. Then the two seats in the cabin up front.

You haven't the pleasure of a clown car experience yet? Not a lot of Italians in your area? jk, jk

 

[Hal9000]

Good to know. I'm not familiar with ambulances in that area. I've worked on Type I, II, and IIIs and I have seen some services put way too many people in IIs.