Paramedic Didn't Check Wreck Victim's Pulse

[CFRBryan347768]

Fully

[

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

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

Thinking outside of the wreck....[/QUOTE]
agree, the one wreck i had was similar, and the end result was the same but atleast we tried.

 

[LE-EMT]

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?

quite possibly the most important thing said in this entire thread.... this is our job people.
more times then I would like to remember I have sat with a gun shot victim or a mva vic that is oh his/her way out and just talked to them held their hand whatever until they eventually expired. This is the real reason I am pursuing cross training in ems. I am sick of watching people die in my arms and not being able to do anything.

 

[MEDIC140]

What to do to make sure the trauma is DOA?

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.

I understand what you are saying, but think about this for a second. If you put on the monitor (essentially an ALS skill), then what do you do if you find a PEA, or V-Fib or even a realtively fast idioventricular rhythm in someone with obvious signs of morbidity?

Plenty of folks with half their brain gone will show something on the monitor, I do understand what you are saying and have verified trauma death in several leads myself in the past.

In the future, I think I am going to try to rely on BLS assessment. Check for a pulse in some good spots, listen apically for heart sounds and for lung sounds throughout all fields, check pupils, etc.

Just some suggestions from what other medics have suggested to me, I would hate to start working a trauma code who has PEA when they are apneic and have obvious signs of death.

I am new here, thanks for having me,

Respectfully,

Medic 140

 

[triemal04]

I understand what you are saying, but think about this for a second. If you put on the monitor (essentially an ALS skill), then what do you do if you find a PEA, or V-Fib or even a realtively fast idioventricular rhythm in someone with obvious signs of morbidity?

Plenty of folks with half their brain gone will show something on the monitor, I do understand what you are saying and have verified trauma death in several leads myself in the past.

In the future, I think I am going to try to rely on BLS assessment. Check for a pulse in some good spots, listen apically for heart sounds and for lung sounds throughout all fields, check pupils, etc.

Just some suggestions from what other medics have suggested to me, I would hate to start working a trauma code who has PEA when they are apneic and have obvious signs of death.

I am new here, thanks for having me,

Respectfully,

Medic 140

Dead is dead and a trauma code is a trauma code, regardless of rhythm. If they don't have a pulse due to a traumatic injury...they're dead.

 

[motownems]

I would hate to start working a trauma code who has PEA when they are apneic and have obvious signs of death.
Medic 140

other than a complete decapitation, decomp DB what would you consider a sign of "obvious death"?

 

[Ridryder911]

other than a complete decapitation, decomp DB what would you consider a sign of "obvious death"?

In a trauma case, no pulse. Dead trauma patients do not live. In medical cases it is different with each area having their own regulations. Ours is known cardiac arrest >15-20 minutes without CPR in progress, Aystole (in two consecutive leads), contributing factors.

R/r 911

 

[VentMedic]

Finally

http://www.woai.com/content/trouble...ntent_id=860b7169-486b-477e-87a1-fcb945b602f6

Left for Dead: Paramedics Get Six Month Suspension

September 23, 2008
Reported by: Brian Collister

SAN ANTONIO -- The state investigation into three San Antonio paramedics is now over. It is fallout from their failure to treat 23-year-old Erica Smith, who was left dying at an accident scene last December.

State investigators had initially proposed suspending the paramedics' certifications for a year, but they cut that time in half after a closed door hearing.

Now, paramedics Jeremy Huntsman, William Bullock and Mike Gardner will have their certifications suspended for six months.

They must also complete specialized training in four areas: Hypothermia, mass casualty and triage incidents, head injuries and protocols on pronouncing a patient dead on arrival.

After that, they will be on probation for six more months.

A spokesperson from the State Department of Health Services explained the reduction in suspension saying, "They had no previous disciplinary incidents. And, they understand their mistakes and are determined to learn from them".

 

[traumateam1]

I think 6 months is a good time to have their ticket pulled for. What do others think?

 

[BLSBoy]

Did anyone else read the other factors?
3 other patients?

You do a look and listen for 10 seconds after opening airway. Nope, not breathing.

Guess that that equals....

Triage here people!
You have a Black. Move on to the ones you know you can save. Not breathing and exposed brain matter means that there will NOT be a happy ending.

How quick some of you are to condemn your Brother and Sister EMS workers when all you have are newspaper reports to go on.

I can't wait until one of you makes a field judgement, so the rest of us have days, weeks, and months to pick it apart from the comfort and safety of our computers.

As for the punishment, they got the short end of the stick. The admin obviously had no balls to stick up for their troops under media scrutiny.

 

[ffemt8978]

Did anyone else read the other factors?
3 other patients?

You do a look and listen for 10 seconds after opening airway. Nope, not breathing.

Guess that that equals....

Triage here people!
You have a Black. Move on to the ones you know you can save. Not breathing and exposed brain matter means that there will NOT be a happy ending.

How quick some of you are to condemn your Brother and Sister EMS workers when all you have are newspaper reports to go on.

I can't wait until one of you makes a field judgement, so the rest of us have days, weeks, and months to pick it apart from the comfort and safety of our computers.

As for the punishment, they got the short end of the stick. The admin obviously had no balls to stick up for their troops under media scrutiny.

But as more resources became available, every patient should have been reassessed and worked if appropriate. The triage tool applies when you don't have enough resources for the number of patients that you have. If you have enough resources, then you treat each patient individually.

 

[EMT-P633]

I have mixed opinions on this, and not alot of actuall credible evidence only news reports (and we all know they are always 100% accurate:wacko.

however, We have all had MCI training, and with BLSBOY's MCI triage flow chart I would have to agree with the "initial responding" medics decission. It seams once he got on scene he did call for additional assistance. It also seams that he did his job at triage, he did the most good for the good of the most. He had 3 other patients to attend to all with injuries. I believe one of the articals said the other 3 patients had severe but not life threatening. was his partner a basic? was there any other provider there who could adequately treat these injuries? that is one of my questions.

Once the other medics arrived on scene and (3 i believe). in which atleast 2 have assessed the ponounced patient. Why did they not work her? Yes she had a fatal wound but she was still breathing, yes it was most likely aganal respirations which are controlled by the brain stem (the area that controls the bodies vital functions). There are 2 conflicting articals one says they never checked for a pulse, and the other says they did but were unable to find one.

What pulse did they check?

Radial? If her BP was less then 80 systolic then there may not have been a pulse. But she could have still had one.

Femoral? or even coradid? This is what we do not know. Depending on what pulses were or were not present could have determined what could have been done for her. Just how hemodynamically stable or unstable was she?

After the additional resources were on scene, one would think that they would have noticed the respirations. This brings up another question, Why did they stop there? the presence of grey matter? How many of us have worked a GSW with exposed grey matter who has lived? How many have heard stories or even read reports of patients with such injuries surviving and end up living successfull lives after the incident? All of the above doesnt even take into account the possibility for organ transplant. We dont even know if she was a donor OR if her family would want to donate if she wasnt.

My biggest question is one that has yet to be asked. Why did the medical examiner make the discovery that she was still breathing? One would think that if the additional responding resources actually assessed the patient they would have reported the presence or absence of respirations to the ME prior to his arrival.

I think there are just too many unanswered questions, without a reliable information source to to give an objective opinion.

 

[BLSBoy]

It is quotes like this that really irk me.
Not only can the poster not spell or use correct grammar, but they are attacking a fellow EMS provider without the whole story.

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

 

[So. IL Medic]

Illustration from the real world:

Last night, I had to respond to a multi-vehicle MVC on the interstate. A semi failing to stop for stalled traffic plowed through quite a few cars. Initial call in gave 8-10 serious injuries and maybe a dozen minor. Initial assets available were one helicopter lifting off 30 mins away and two ALS trucks, fire department for extrication assist and first responders.

Our unit was first one scene with one FD engine. We were informed that two other agencies were sending other ambulances, unknown how many as it was a busy Friday night for everybody.

Initial triage - Car 1, three walking wounded with minor lacerations, neck pain, etc. Car 2, two with c/o back/neck pain, refusing transport. Car 3, one unresponsive, head injury, poss fx of tib/fib Car 4, one unresponsive, apneic, head injury, bilat tib/fib fx, obvious chest deformity, one altered loc, chest pain with cardiac hx, deformity right shoulder, DIB, upper abd pain with distension, one with L upper arm deformity, poss L femur fx with shortening. Car 5, one who "maybe blacked out" c/o chest and abd pain. Car 6, two c/o neck/back pain minor abrasions from shattered windshield.

Triage Black 1 Red 3 Yellow 1 Green 7

Car 4 had the worst damage. The apneic patient remained apneic with open airway. Left him (Black). Called for extrication and immediate transport of the other pts car 4 and car 3 (red). Car 5 next (yellow). The others when transport available. Began prepping Car 4 and 3 for transport.

The second ALS and an ILS Advanced unit arrived, asked a medic to hop on the ILS truck - they transported the 'red and yellow tags' of cars 3,4,5. As they loaded, third ALS unit arrived. Asked them to check the assumed DOA - three BLS trucks were arriving soon.

Got ready to load walking wounded on BLS tucks when they were ready to go. Informed that the "DOA" had a weak pulse but now was in PEA and the 3rd ALS crew were going to work him.

With initially limited ALS resources, the apneic pt was left so that four other potentially serious pts could be immediately tranported ALS. Two of whom were flown to higher level trauma centers from the ER. When the third ALS unit showed up, wanted to work the 'black tag' pt. I figured fine as the others could go BLS.

The black tag didn't make it, heard that he had "a couple" cervical fx's, subdural bleed, multiple ribs fx, punctured lung, assorted fx in pelvis and legs - the cardiac hx pt had a lacerated liver, hemothorax, and made it to surgery, haven't heard the outcome. All others reported stable.

Lesson to me was the basic lesson of triage.

 

[BossyCow]

The error here was not in the triage, but in the after-care. When asked about the still breathing pt. they informed law enforcement that she was dead or would be soon. They also failed to inform the personnel who responded later that there was a dying pt on scene.

This girl's parents and loved ones will live forever with the knowledge that their daughter's final moments were spent under a tarp on the side of the highway while people ignored her. Had these medics simply told someone that she had not yet expired, they would be blameless here.