"medics didn't check v/s"

[Hayduke]

possibly 4 victims, one truck
"severe head injury"
mass casualty w/a DRT? or did the pooch get scrooed?


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

---

Members don't see this ad.

 

[Flopotomist]

possibly 4 victims, one truck
"severe head injury"
mass casualty w/a DRT? or did the pooch get scrooed?


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

DRTs don't have pulses.

 

[greytmedic]

The pooch got screwed. First off, I wouldn't describe four pts as a mass casualty incident. It would be a "multiple victim incident." A mass casualty incident would have to overwhelm the resources of the primary responding agency and take more than 20-25 minutes for additional manpower/equipment to arrive at scene. I have driven in San Antonio and although I think the roads are screwy with all the "Texas Turn-arounds," it shouldn't have taken that long for enough resources to arrive on scene from the San Antonio FD. So, in a multiple victim incident a full assessment is still performed on all pts and full radio reports and written reports are completed.

Even if someone did consider this a mass casualty incident and went into a rapid triage operation you still check airway and breathing before tagging someone black. If the girl was breathing an hour after the accident I bet she was probably breathing when the paramedic was assessing her and she should have been tagged red.

Of course I wasn't there and this is all just arm chair quarterbacking.

 

[igcgnerd]

I just wonder what about the pt made the responders consider her DOA. I mean unless she looked like she was decapitated or incinerated, why did they not assess the pt?

 

[edinOH]

Looks like scapegoating to me.

Two paramedics, multiple patients.

He sees "brain matter all over the place" and then moves on to the other patients who presumably have not been triaged.

So suppose he checks a pulse as they say he should have, then what?

Does he take away resources from the other patients to establish and maintain an airway and cspine control? This is likely a soon to be dead patient even in the best of circumstances.

 

[Hayduke]

Looks like scapegoating to me.

Two paramedics, multiple patients.

He sees "brain matter all over the place" and then moves on to the other patients who presumably have not been triaged.

So suppose he checks a pulse as they say he should have, then what?

Does he take away resources from the other patients to establish and maintain an airway and cspine control? This is likely a soon to be dead patient even in the best of circumstances.

This was my take.

As described in the posts above, this doesn't sound like enough to overwhelm a dept., but it was misdispatched. Maybe I missed how many people were on scene with the crew, but I was picturing two medics working a 2 vehicle MVC.
More than two folks needing immediate care is enough to absorb all the resources of a single responding truck. In my distant EMS experience, 2 medics on an engine equalled "a crew". We would have eyeballed a person with a smashed melon, possibly opened an airway then moved on to the next victim.

The disturbing piece for me in the article was the apparent expectation of the county attorney and dept. that the street standard should mirror that of a fully staffed ED.

 

[Febrifuge]

From the article:

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.

So there were, at some point, four medics for four patients. They may not have all been there at the same moment, and surely some arrived after the young lady had been "tagged black" by the first medic.

But yeah -- I'm of two minds. I agree it's not a "mass incident" and think it's dumb to act like the street is the ED. On the other hand, what happens if these crews respond to a real MCI? Yikes. At the end of the day, I think even in the best case, this grieving family would have probably gathered around in the ICU a week later and said goodbye.

It just sucks that they now have to play the "what if?" game in, if it's possible, a worse way. I feel for the medics as well as the family. The medical director, a little less so; he didn't have to throw the street team to the wolves like that.

 

[docB]

I think that the presence of a pulse on the initial assessment wouldn't have mattered. If there was "brain matter all over the place" then the vitals would have been irrelevent to the "black tag" on that patient. In my opinion based on what I know (I read the article) it was appropriate to move on (regardless of pulse) and extricate and transport the other patients. I agree this was not a mass casualty incident. It was a multicasuatly incident with more patients than providers initially. The error was made when sufficient providers arrived and did not then reassess. I understand that you can argue it's not standard practice to reassess black tags but in this situation, a low number MCI with prompt arrival of enough responders to treat the victims a reassess would have been a good idea. Once sufficient resources were available they should have transported the black tag. By leaving her for the coroner to discover breathing it put themselves in an untenable situation.

Clearly everyone will get screwed and sued even though none of it would have changed the outcome. In EMS as in medicine perception is often as or more important than outcome.

 

[blotto geltaco]

Friends, let me offer a view different from most of those above from someone who spent many years on the meatwagon. These medics are clowns and there ain't no two ways about it. Any medic worth his salt can at a BARE MINIMUM at least check to see that someone is alive. You are nothing more than an ammalance driver (if that) if you can't even figure out if someone is DRT or not. Making a pt. a "black tag" doesn't mean eyeballing them from afar for a split second and then going on. The tag needs to be retrieved from the musty stack that is likely in the glove box or buried in the center console, torn and placed on the person. At least check for a pulse and/or open the airway. It wasn't as if this person was obstructed and not breathing either. Any fool can tell if someone is breathing or not except for these clowns.

 

[southerndoc]

Friends, let me offer a view different from most of those above from someone who spent many years on the meatwagon. These medics are clowns and there ain't no two ways about it. Any medic worth his salt can at a BARE MINIMUM at least check to see that someone is alive. You are nothing more than an ammalance driver (if that) if you can't even figure out if someone is DRT or not. Making a pt. a "black tag" doesn't mean eyeballing them from afar for a split second and then going on. The tag needs to be retrieved from the musty stack that is likely in the glove box or buried in the center console, torn and placed on the person. At least check for a pulse and/or open the airway. It wasn't as if this person was obstructed and not breathing either. Any fool can tell if someone is breathing or not except for these clowns.

Blotto, just for the record, many of the EM physicians on this forum, including those posting in this thread, are former paramedics.

 

[Wackie]

The medic is kind of screwed since the written protocol from his director was to check v/s despite the injury.

The outcome would have been the same (IMO) but we all know that doesn't matter.

 

[Arch Guillotti]

Blotto, just for the record, many of the EM physicians on this forum, including those posting in this thread, are former paramedics.

How long can it really take to check a pulse?

 

[ditch doctor]

Former medic for 8yrs here. So, let's say this was a mass casualty; the START triage says to check for breathing, reposition and check again. If no breathing then black tag. The coroner found this person alive because she was breathing. Problem solved. Who cares about pulses.

I can say there has been more than one occasion where I have gotten on scene and said, "Oh, ****, there's no way that injury is compatible with life!!" and then find myself running hot to the hospital 5 minutes later. Contrary to popular belief, exposed brain matter is not instant death criteria.


On top of all that, I worked in 6 different systems in 2 different states all of them had protocols that had us run a strip of asystole on *all* black tags (once backup arrived in a mass casualty), dnr's and drt's. Even decaps and hemicorpiectomies. Problem solved again.

And definitely, when back-up finally arrived they should have re-assessed the patient, not just leave it for the coroner. Problem solved a third time.

Like someone said earlier, it's easy to be an armchair quarterback, and I can't really pass judgment because I wasn't there, but it seems like some checks and balances were not there.

 

[ditch doctor]

How long can it really take to check a pulse?

5 to 10 seconds?

 

[southerndoc]

How long can it really take to check a pulse?

That's not the point. The point of all this seems to be either the paramedic got tunnel vision or became spastic and was easily overwhelmed with patients.

Being overwhelmed is not dependent on the number of personnel as much as it is the feeling of those personnel to handle the situation. I've seen a single resident manage 18 patients without batting an eye, and I've seen residents get spastic when they get more than 3 patients. The same happens with paramedics, and in fact, I've seen it myself when backing up other ambulance crews.

Despite this, this should not lead to the paramedic getting fired or suspended. For all we know, the guy may be the best paramedic in existence when dealing with patients one on one.

 

[docB]

Monday morning quarterbacking will always be with us in medicine and EMS. I am reluctant to just say these guys screwed the pooch. It sounds like the scene was bad and evolving quickly. I will say that I think a reassessment after more people arrived would have been wise and prevented the contraversy but not the outcome.

I've been doing this stuff since '90. I have a very high bar set for saying that someone screwed up. I have a "there but for the grace of God go I" kind of attitude. I frequently see badness happen and I file it under "I wouldn't have done that but I might have (and actually have) done other thing equally stupid."

I think that the take home message for this is for everyone to look at the situation and learn a few things:
-If you have time and resources to go back and reasses do it.
-Know your protocols and when in doubt follow them to the letter. The med director can't back you up if you're off the protocol.
-You are on your own in many situations. These guys are getting fed to the wolves. Watch and remember.

 

[EM2BE]

Monday morning quarterbacking will always be with us in medicine and EMS. I am reluctant to just say these guys screwed the pooch. It sounds like the scene was bad and evolving quickly. I will say that I think a reassessment after more people arrived would have been wise and prevented the contraversy but not the outcome.

I've been doing this stuff since '90. I have a very high bar set for saying that someone screwed up. I have a "there but for the grace of God go I" kind of attitude. I frequently see badness happen and I file it under "I wouldn't have done that but I might have (and actually have) done other thing equally stupid."

I think that the take home message for this is for everyone to look at the situation and learn a few things:
-If you have time and resources to go back and reasses do it.
-Know your protocols and when in doubt follow them to the letter. The med director can't back you up if you're off the protocol.
-You are on your own in many situations. These guys are getting fed to the wolves. Watch and remember.

My brother is a paramedic and said in the same situation, he would have done the same. If brain matter is all over, he would go check on the others. He didn't say if he would have gone back to reassess (it was a short conversation), but he did make one good statement: it only takes one move to get a bad name, no matter how many good moves you make, even at the same call.