Paramedic Didn't Check Wreck Victim's Pulse

[NJN]

"SAN ANTONIO -- A paramedic failed to check the pulse of a car-wreck victim who was presumed dead and left untreated before a medical examiner discovered she was breathing, officials said.

Erica N. Smith, 23, remained in the car's wreckage with a tarp over her body for more than an hour on Dec. 16 before she was taken to a San Antonio hospital. She died from her injuries the next day."

http://www.ksat.com/news/15010345/detail.html

 

[EMTMandy]

That's really scary.

 

[SC Bird]

Don't know how that happens....

-Matt

 

[VentMedic]

And this is what happens when you ***-U-ME.

From article:

"We were assuming (they had checked for her pulse)," Hood said Tuesday.

Texas paramedic didn't check pulse before declaring wreck victim dead

http://www.ems1.com/news/332810/]http://www.ems1.com/news/332810

Hood that day added he did not expect the paramedics to be disciplined.

He told the Express-News the next day that paramedics had sought Smith's pulse but could not find one.

Sculley added, "Because it is standard operating procedure to do that."

 

[JPINFV]

Three other paramedics involved in the incident, including two who arrived at the scene more than two hours after the wreck in a second wave, have been de-authorized for an indeterminate length of time and transferred to the firefighting division. They are: Michael Collins, 39, who arrived on the scene with Gardner and treated Ybarra; and William Bullock, 33, and Jeremy Huntsman, 30, both of whom responded to the scene after officials realized Smith was alive.

This is probably the scariest part of the entire article. It looks like the chief is on a witch hunt now and everyone involved with the incident that he has control over is getting screwed. I hope the second pair of paramedics have a good lawyer because it's lawsuit time.

 

[bstone]

Put on the monitor and check for asystole. I wouldn't dream of pronouncing someone unless I had the on the monitor and then called med control.

 

[Flight-LP]

Good 'ol fire department politics. Back your people until called out by Joe Q. Public. Sorry, but he is spineless. If you are going to put your neck out for your employees, you better be prepared to back your position up, instead of pu@*#ing out. Yes, the pulse should have been eventually checked and we may never know if they did, but if there are no spontaneous respirations after an attempt to manually open the airway, then they are dead. Move on to the next victim. Once everyone salvageable has been dealt with, then yes I would reconfirm the death by palpating for a pulse. A monitor is not needed and personally I would waste my time hooking them up to one.

While this is indeed sad for all involved, the family needs to realize that the "delay" is not what caused her death, it was the traumatic injury from being smacked head on. Even if immediately rushed to University or BAMC or Wilford Hall, that girl had no chance of survival. It is easy for family to place blame for losing a loved one, but someone should stand up for these medics, especially the ones who responded after the fact. Just my opinion,we could dissect this one all day long, but the truth lies only in higher powers that be. Us mortals will never know........................

 

[Ridryder911]

Put on the monitor and check for asystole. I wouldn't dream of pronouncing someone unless I had the on the monitor and then called med control.

Now, you connect the monitor and see a PEA IVR rhythm, now what are you going to do work them? ... Sure half the head is gone, but the medic cannot tell if they are dead without a monitor?

That is why our protocol is NOT to place the monitor on a DOA. If we are going to say they are dead, then we do NOT need a monitor, otherwise we should be resuscitating them, no matter what. If I called medical control every time I had a DOA, I would have to find another job.

I agree with Flight-LP. The problem is instead of educating the public about mortal wounds that people that have upper portion of the head missing or one's head is barely hanging on by threads of tissue and one can see the common internal carotids, but still has the brain stem attached and is still has perfusion is really dead.

I am sorry the medics got in trouble. They made a triage decision and did what most professional, busy medics do.. go to those that they can help. I read in another article that brain matter was exposed (thus severe injury) and considered the wound mortally or non-viable. Probably, the same thing I would do if I had another severe patient. Pulse or not, I would not had probably worked them either. Personally, I usually call and get a DNR if there is extrication required.

Remember, there is no saves from major trauma that causes traumatic arrest.. Death wins...the problem is the timing.

I have seen brain-stem patients live for hours, without a major portion of their cranium. Basically, you place them on a vent, and let nature takes its course.. like we should had allowed.

R/r 91

 

[SC Bird]

The first few reports I read were obviously not full accounts of what happened.....we talked about it in class yesterday. And my instructors shared similar sentiments, Rid...without being on scene and knowing the full extent of the scene, it's very likely that any paramedic could have made that triage decision.

It is very unfortunate, but I for one believe that if the paramedic made a black tag decision after checking the patient, then her survival was unlikely anyways.

Can someone tell me why the other paramedics have been stripped of their licenses??

-Matt

 

[bonedog]

[

I have seen brain-stem patients live for hours, without a major portion of their cranium. Basically, you place them on a vent, and let nature takes its course.. like we should had allowed.

R/r 91[/QUOTE]

Parts are parts, a good brainstem could equal how many transplants?

Thinking outside of the wreck....

 

[ffemt8978]

This is probably the scariest part of the entire article. It looks like the chief is on a witch hunt now and everyone involved with the incident that he has control over is getting screwed. I hope the second pair of paramedics have a good lawyer because it's lawsuit time.

Yeah, but I have to wonder what the department's justification for this is going to be.

 

[BossyCow]

Didn't an earlier poster state there was grey matter present on the scene? By my protocols, brain scraps constitutes Do Not Resuscitate. This would not have been an issue if the medics had at least let someone know that the pt was only 'mostly dead' and not 'completely dead' so that the amenities could be observed.

I agree with Rid, trauma codes don't survive! Unfortunately, everyone who has lost a loved one under these types of circumstances will go through the 'what if's'. These medics left a hole a lawyer could drive an Escalade through, not because of their decision not to work the code, but in their decision to leave the pt there as a body, before she actually became one. It's unfortunate that they will be hung out to dry, but that's an inherent risk in what we do.

 

[VentMedic]

Unfortunately no everything when it comes to TBIs is so easy to call. It all depends on how much and what part of the brain is injured. I have seen too many TBIs in the ED and ICUs that with the exposed gray matter would have been left for dead in the field by some. I am even quietly writing them off or getting ready to put the organ harvest protocols in place. But, they made to the ED with a pulse and were intubated. After a CT scan, the neursurgeons did their magic and many of these individuals make it to rehab. Some had severe neuro deficits and some returned to work. The brain is truly an amazing organ. If the medics and physicians in Iraq had the same "leave them for dead attitude", there would be a lot less soldiers coming home. The severe brain trauma that our soldiers are suffering is beyond belief. Yet, we have made advancements in survivability and regaining function in that area. I would urge some people here to visit a TBI rehab center. I'm sure many here have transported pts to and from these centers. Anybody look through the chart at the surgical info and/or pictures?

If a person still has a pulse and some recognizable respiratory effort even if it is agonal, they are not a "trauma code". Someone found at scene in cardiopulmonary arrest are the ones who have very little probability of surviving. Even after withdrawing life support on someone, I have seen patients survive for hours and occasionally days with a HR and agonal respirations before nature takes its course.

And, of course, most of you have read my position for organ donation. Many times the families of the deceased do find closure if they know their loved one can give someone else life. Sometimes that doesn't always happen but it is so good to see a 16 y/o CF pt make if to his/her prom with new lungs. I also would encourage those new to the medical profession to talk to a heart or lung recipient.

Even after death a body should be respected. If a person is near death, they should be offered some comfort even if one doesn't know what or if the pt is feeling anything. Why should someone die alone? Have we become a society where we just walk away and leave our near dead like some dying road kill?

 

[Ridryder911]

I agree, again it is down to a judgement call. That unfortuntely is not black & white.

I can acclaim my biggest f**k up in the field, I wanted to flag a yuong female with loops of brain exposed. My partner was the type that would work a decompsing opossum if possible laying beside the roadway.

To make a long story short, she is alive, graduated from college and has a family... even though she walks with limp.. .. I learned a valuable lesson.

That is why anatomy is so important as well as good education, and yes experience! No, I don't flag every TBI or major trauma that is still alive, but there are certain conditions that one has to realize that there is no + outcome.

I agree with Vent one should consider organ donor, I unfortunately no longer think of such since my regional retrieval system appears to prefer only in house arrest. They much rather retrieve "other organs, tissue, bone" at the M.E. The time delay of them arriving is usually several hours, although we are only 20-30 miles away from the team. Fortunately, not all systems are alike!

As well, many of the D.O.A's are now considered a "crime scene" even in MVA's, although it will never change your treatment modality.

Again, a hot topic and ethical debate = no right answer....
R/r 911

 

[VentMedic]

... one should consider organ donor, I unfortunately no longer think of such since my regional retrieval system appears to prefer only in house arrest. They much rather retrieve "other organs, tissue, bone" at the M.E. The time delay of them arriving is usually several hours, although we are only 20-30 miles away from the team. Fortunately, not all systems are alike!

R/r 911

My city is one that fortunately/unfortunately(?) provides us with many young donors by way of the ER. It is a challenge to keep the organs viable and the pt "alive" for almost 24 hours which is about how long it takes to test for compatibility and quality. But one young trauma patient can donate to several pts. Skin, corneas, heart, lungs, 2 kidneys; lots of people can benefit.

Sometimes I am quite frank with youngsters that I see multiple times for gunshots or stab wounds. I just tell them not to put too many harmful drugs into their body or smoke heavily so that someday they can be a good organ donor.

Life is precious and there are people who appreciate it while others waste it.

 

[griz1974]

thats bull

that paramedic should be completely gone not just lost his privilages you never just look at a patient wow he just lost some pay and pride what about her his decision ended took any chances of survival away

 

[MSDeltaFlt]

When I find a DOA on scene on ground EMS, I'll contact Med Control to inform him/her what I have and what I'm doing, and tell them why. They always agree. I do this because it is not MY license I'm working under. It's theirs. Even if it wasn't in our protocols; which it is.

Also, I only use the monitor for documentation assistance. No carotid pulse, no brachial, radial, or femoral pulse, no apical pulse. No spontaneous respirations. Blunt trauma with significant mechanism of injury, and, oh yes, Asystole x 3 leads.

That just etches that chart in stone.

 

[paramedix]

Always remember the basics. Never assume and if in doubt ask for a second opinion.

A colleague will never look down on another if he or she asks for assistance or help.

Even in the basic OSCE station if you omit any of the ABC's you get failed. So there is no excuse for not checking vitals.

 

[firetender]

I can acclaim my biggest f**k up in the field, I wanted to flag a yuong female with loops of brain exposed. My partner was the type that would work a decompsing opossum if possible laying beside the roadway.

To make a long story short, she is alive, graduated from college and has a family... even though she walks with limp.. .. I learned a valuable lesson.

R/r 911

We're just one link in a chain of responses and circumstances that come together to either keep someone alive, or usher them into the beyond.

If we hold up our end, we can give all the other factors room to conspire in the patient's behalf.

Thanks for sharing that lesson, Rid. It has probably made a difference in a lot of lives since and now is doing its service with everyone who reads this.

 

[emtwacker710]

wow:blink: they should be disiplined for that, from what I've heard about procedure and protocols and from different people in the field, before you consider anyone dead, even an obvious death, you run a strip on them, or at least hook them up to the monitor to see if they are alive and if not then run the strip, hell around here Basics can do 4-leads, at least see if they are alive!!