Left For Dead Update:

[Biggus Dikkus]

Union Official: Paramedic Was Following Training
Fire Chief: 'Medical Protocol Was Definitely Violated'


SAN ANTONIO -- A paramedic was acting according to his training when he moved on to help other victims of a car accident without checking vital signs of a woman who appeared dead but was actually alive, a San Antonio firefighters association official said Wednesday.

Mike Gardner, 35, was transferred to the San Antonio Fire Department's firefighting division and permanently restricted from working as a paramedic in San Antonio Tuesday after not checking the pulse of Erica N. Smith, 23. Smith remained in the car's wreckage with a tarp over her body for more than an hour Dec. 16 before a medical examiner discovered she was still breathing.


She died from her injuries the next day.

Protocol calls for paramedics to check vital signs regardless of a patient's injury.

Christopher Steele, president of the San Antonio Professional Firefighters Association, said paramedics are told in training that if there is "massive visual trauma," they can move on to other victims "in the initial stages" of an emergency operation.

Steele said Gardner observed "brain matter all over the place" when assessing Smith.

"Mike Gardner performed under current practice. ... I would venture to say that I can find 200 other paramedics that can say the same thing," Steele said. "We don't want to make excuses, because he really is emotional and he's sorry, but it's difficult from my perspective to let him solely take the fall when we know this is what we're trained to do."

But Donald Gordon, medical director for San Antonio Emergency Medical Services, said training for paramedics matches written policy.

"That's false. They're told always to check the vital signs," said Gordon, who has been in charge of medical training and medical direction for the San Antonio Fire Department for 21 years. "It's standard for every patient and it is done consistently for every patient."

Gordon said paramedics take a 40-hour refresher course every year, which every other year includes "pre-hospital trauma life support." He said Gardner attended at least two of the refresher courses.

"I have written policy that says determine" vital signs, Gordon said. "They're told the same thing in class."

"We're all very sorry for this incident," City Manager Sheryl Sculley said. "Our deepest sympathy and condolences to the family and friends of Erica Smith, it was a tragic and horrific accident."

Scully said training measures would have to be changed.

"We're going to improve and upgrade our training of the paramedics as a result of this incident, and also take a look at our dispatch," she said.

Steele said Gardner would not speak about the incident because of medical privacy laws, adding that Gardner is a member of the association.

"That was his patient, so he can't say anything about the case," Steele said. "Through me he is saying he's not allowed to comment."

A message left by The Associated Press for a Michael Gardner in San Antonio at a number from an online phone book listing was not immediately returned Wednesday.

Steele said Gardner arrived on the scene of the December accident with one other paramedic. Between the two cars in the accident, in which one crossed a highway median and slammed into the car in which Smith was the front passenger, there were four victims.

"Mike Gardner comes, he looks, he sees a female and ... he saw brain matter all over the place," Steele said. "He looked, he said, 'I can't do anything for her.' There's three more people."

"In any emergency there's a buildup" of personnel, Steele added. "People have the impression that there's an emergency and there's 10 firefighters there."

While Smith was left unattended, paramedics took the other two people in the car to the hospital with serious but non-life-threatening injuries.

The driver of the other vehicle, Jenny Ann Ybarra, 28, has been charged with intoxication manslaughter, police said.

Three other paramedics who responded to the accident have been demoted and stripped of their licenses to practice emergency care in the city, officials said.

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

[scribble]

ouch.

[sfdmedic69]

What happened to checking for a pulse?

[Cthippo]

I can see how it happened though. First in on a MCI and the first pt you come to has their brains splattered all over the roadway. Yeah, I can see someone assuming that was an obvious DOA and moving on. In this case theat was an incorrect judgement, not necessarily an irrational one.

[CombatMedic]

4 patients

One with exposed grey matter

one Unit on scene, two at best

even though the other injuries may not have seemed life threatening to some one at the hospital, we work the scene and treat the most good for the most people.

ask one hundred medics and they probably would have all passed the lady.

I am sorry. She would have got a Black tag. Two medics could have tried to save her, worked her to the hospital, and she still would have died. But if that happened, another would have probably died too, and the article would read, "Paramedics mis-triage, additional deaths caused"

[paramortis]

Docs just trying to cover his ***. Bad PR and all that.

[Philly Medic]

Simular situation happened here on New Years Eve. Engine on scene with a 500lb+ female difficulty breathing for 45 min. No medic units available. She became a code and about 30 minutes later a BLS unit shows up and after loading her the squad breaks down. This lady was getting CPR for almost 1 1/2 hr when the ALS finally shows up. As they are they are transferring her to the ALS the strecher breaks and they now need a man-sack to move her. She has been asystole the whole time so he pronounced her. This made all the news channels here embarrassing the Dept. for not having enough units to handle the run volume that night or any night for that matter. To cover there asses the higher ups are trying to jam up the medic for not contacting base command to pronounce since it is in the protocols when CPR and a witnessed arrest occur. I have brought extremely overweight pts to the ER and the docs have said with a person this size CPR is totally ineffective.

News link http://cbs3.com/topstories/EMS.Respo....2.622035.html

[Medic101Charlie]

4 patients

One with exposed grey matter

one Unit on scene, two at best

even though the other injuries may not have seemed life threatening to some one at the hospital, we work the scene and treat the most good for the most people.

ask one hundred medics and they probably would have all passed the lady.

I am sorry. She would have got a Black tag. Two medics could have tried to save her, worked her to the hospital, and she still would have died. But if that happened, another would have probably died too, and the article would read, "Paramedics mis-triage, additional deaths caused"

Not to be critical, or be a butt head, but you would have black tagged her without checking for a pulse?

I'm not sure what the situation or the fulls facts were, as you don't either, but it sounds like he didn't even check for a pulse. If that is the case, then the medic was in the wrong. In Medic School and BTLS, we're taught tri-age but not visual. We're taught 30 second assessment, including checking a pulse, before moving on.

I've taught BTLS and ACLS for almost eight years now and we train to ALWAYS check a pulse during tri-age.

Now if he checked a pulse and a carotid pulse was not present (meaning systolic BP below 60), then ok, he is being made a scape goat.

But I'll reserve judgment until the full facts come out.

Bottom line, a visual check is NOT good enough, even in an MCI. That's my opinion anyway.

How do you know two medics could have worked her and she still would have died? We're Paramedics, not God. We work under our physicians license and according to his rules, not ours. If the protocols state: check VS, then by God if you want to work in that system, you check VS. Period. End of story.

Even as a remote/independent duty medic, I work under a physician's guidance/med control. If comms are down I can go completely offline protocols, but I am still responsible to him. Period.

I'm not saying what he did was wrong, or that a lot of others would not have done the same thing. But I AM saying that it would be a training opportunity. Taking away his license to practice does sound like a witch hunt to me though.

OK, rant over.


S/F

Jim

[strwblue]

medic101charlie....I completely agree...well stated

[JenVTemt]

I've taught BTLS and ACLS for almost eight years now and we train to ALWAYS check a pulse during tri-age.

Now if he checked a pulse and a carotid pulse was not present (meaning systolic BP below 60), then ok, he is being made a scape goat.

But I'll reserve judgment until the full facts come out.

Bottom line, a visual check is NOT good enough, even in an MCI. That's my opinion anyway.

It mentioned in the article that protocols state you must check for a pulse on every person. He didn't follow protocols, bottom line. Even during an MCI, unless there is obvious death (like brain matter) you have to do a minimal assessment to triage. I am sure many medics would have done the same, but that just says most of us probably need to brush up on MCI patient assessment.


A similar event happened that I know of. A one car accident. FD on scene first. Three victims, some ejected, some not. One pt in the vehicle presumed dead. FD checked for a pulse, found none. Ambulance arrived with medics. One went over to verify the death of the presumed patient and found him to be breathing shallow with a pulse present. The person was transported to the nearest hospital and then to a larger trauma center. I do not know the end outcome, but the patient did not die while in EMS care or at the first facility. It can happen to anyone. Never hurts to take an extra 30 seconds and make sure. I know I couldn't live with myself if I missed something like that. I would always wonder if it was my fault or God's will if the person didn't make it.