Re: The latest from San ....We call it Fallback and Regroup Trooper

[Guest guest]

Wes:

I am child of the VietNam era of medics and what they taught me,Chief among

them,my cousins and Mark. To me, there were plenty of medics around. I do

not feel it was and is fair to judge them since I was not there.There some

things which were forgotten. First,never give up on a patient. There instances

in VietNam when soldiers were barely breathing or moving among the dead. Next,

Caroline once said " A patient is not cold and dead,until they are proven

warm and dead. This means she should have been checked out especially when

bystanders pointed out this fact. I think tunnel vision prevailed here. I feel

that one of the four could have worked her. Now we have another question here.

If by gods grace she survived,what kind of quality of life would she hace had?

Would have been like Terry Schiavo or a normal life,that we cannot answer. Only

the Almighty Father can do this. I feel that we should have given her this

chance to do so. We must remember the protocols or standing orders are a

starting point and guideposts. We must treat what we see.We must also consult

online medical control. I try do what I can because I feel if the voice in my

head says do it and I don't It will bite me in the tuchus. May be we all need to

look at ourselves in the mirror and say " Did I do all that I could for my

patient,at the time? " If I say, Yes, then I did what I could do. I have been a

combat medic for many years now and it helps when I can review what I did and

learn. Here, in this case we are going to learn a terrible lesson. We have to

check each patient out and do what we can whether we succeed or fail

Respectfully,with High regards,

rabbiems,SSG Rick " Doc " Borenstein(retired)

hem sin

Re: The latest from San ....

So when I was taught EMS and learned to be an instructor nothing in that

informed me to disregard a patient if they were still breathing. Obvious signs

of injury mean there is no pulse, no B/P, no respiration's, a head is missing, a

hole is in the middle of the chest, or some other type of injury not consistent

with life. Severe head injury is not one of the criteria especially if the

patient is still breathing.

Perhaps someone should have thought to check a carotid pulse?

Another black eye for EMS across Texas and the Nation.

FYI: There was an article in the Amarillo Globe News about First Responders from

the Air Force Base in New Mexico that are not allowed to do Intubations due to 3

incidents in the last month for tearing the trachea.

Where are we going these days in EMS???????

Wes Ogilvie <ExLngHrn@... <mailto:ExLngHrn%40aol.com> > wrote:

More from the " oopsie " incident. Looks like the SAFD PR efforts are improving,

albeit slightly.

-Wes Ogilvie, MPA, JD, LP

-Austin, Texas

Â

Controversy over woman left for dead

Web Posted: 12/19/2007 01:02 AM CST

Chasnoff and Lomi Kriel

Express-News

The injury looked grave.

Part of the front-seat passenger's skull had caved in after a head-on collision

on Loop 410. McLaughlin, a truck driver who said he witnessed the wreck

and rushed to the aid of its victims, crouched beside the mangled Honda Accord

and talked to the injured woman, 23-year-old a , until a police officer

arrived.

had been moaning, McLaughlin said.

" I said, 'Sir, that girl in the front seat is messed up bad. She needs help,' "

he recalled.

Yet it was precisely that injury  coupled with an apparent lack of a

pulse  that led paramedics to abandon , believing her dead, and

instead rush two other victims with non-life-threatening injuries to Army

Medical Center, Fire Chief Hood said on Tuesday.

was actually alive  a detail discovered more than an hour later by

a medical examiner's investigator called to the scene to examine her body.

Paramedics again were called, and was taken to Army Medical Center,

on Sunday, more than two hours after the early morning wreck. She died at the

hospital Monday afternoon.

The paramedics' decision to abandon in the wreckage in near freezing

temperatures  compounded by Hood's refusal to apologize for the incident

at a news conference Monday  has stoked outrage among some. Tuesday, in

an interview with the Express-News editorial board, Hood said he regretted not

saying he was " sorry for the family. "

Although he conceded that Sunday's misdiagnosis " could possibly have been a

mistake, " Hood defended the judgment of the four paramedics who abandoned

after checking her pulse. Cold weather can mask vital signs, he said, and

victims can continue breathing after they are brain dead.

" The body is designed, basically, to function without a brain, " he said. " Bodies

make noises, bodies move, bodies will sit up on you.

Gordon, a professor of medicine at the University of Texas Health Science

Center at San , said up to 60 percent of patients who gasp are not alive.

Typically, he said, the gasp is the result of a spinal reflex.

Hood and Gordon, who has authorized the standard medical operating procedure for

the city's Fire Department for more than two decades, said medical privacy laws

constrained them from detailing what exactly led paramedics to believe was

dead.

But Gordon said national standards prevent medical providers from resuscitating

patients if they meet criteria classifying them as an " obvious death on

arrival. "

And on Tuesday, Hood said publicly for the first time that, " by all intents and

purposes, (the paramedics) thought () was dead. "

" She presented as deceased to them, " Hood said, adding that paramedics, " when

they checked, she had no pulse. "

According to the current operating procedure, which Gordon updated last year,

patients fall into the category of " obvious death on arrival " if they have " no

measurable vital signs, " such as a heart beat or pulse, and meet one of four

criteria: rigor mortis; when the blood pools to the lowest level of gravity;

decapitation, incineration or visual massive trauma; or if the body is

decomposed.

" Visual massive trauma " refers to injuries severe enough for a layperson to

think they might cause death, such as " part of a V-6 engine sitting in the

middle of your chest, " Gordon said.

According to McLaughlin, suffered a major head injury.

" I knew that if she didn't get help right away, she might not make it, " he said,

adding, " My opinion, I think they should have paid more attention to her. "

A police officer familiar with the incident said he told paramedics at least

twice that was still breathing.

" They kept telling everybody, 'No, she's not. ... She'll die in a few minutes,' "

said the officer, who requested anonymity because he is not authorized to speak

about the case.

If there's any question about whether a patient meets the required criteria for

resuscitation, paramedics are required to call their medical director for an

opinion. Gordon, who is the medical director for the city's Fire Department,

declined to say whether he was called in 's accident.

But typically, he offers such opinions on a daily basis, he said.

It is very rare for someone to be classified as an " obvious DOA " and then return

to life, he said, but it has happened. Over the past 20 years, San has

recorded two other such incidents, Hood said Tuesday.

The four paramedics involved in Sunday's incident have been with the department

for several years, with the least experienced having worked as a medic for

nearly six years. Officials declined to release their names on Tuesday, but said

the other three have served in their roles for six years, seven years and 12

years. None was disciplined for the incident and each is expected to return to

work this week, Hood said.

Still, the incident remains under investigation, he said, and will force the

department to review its policies.

" We need to figure out what to do to avoid this, " he said. " Customers in San

need to have faith in their department. "

was one of three people inside the Accord when a Pontiac G5 veered into an

oncoming lane on Loop 410, striking the Accordshortly before 4 a.m. The driver

of the Pontiac, Ann Ybarra, 28, was taken to a hospital after complaining

of back pain. She has been charged with intoxication manslaughter and her bond

set at $50,000. A jail official said she had posted bail, but was awaiting an

ankle monitor so that she could be released.

's friends  Shaner, 22, the Accord's driver, and back seat

passenger Amber , 22 suffered serious but non-life-threatening

injuries.

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