Last Monday, I posted my views on the story that came out of Prince George County, Maryland involving a child who was transported in the back of a fire truck who was in cardiac arrest. My opinion about the incident ruffled some feathers but it also sparked some terrific discussion not only on my blog, but it also helped fuel the topic at EMS12Lead, and on Facebook as well.
I stand behind my statement that I felt the decision made was reckless and absolutely wrong. While human emotion drives us, sometimes we need to fall back on our training. When we walk into a scene, we are there to bring order to chaos, not add to the craziness.
I have never had as many comments on a blog post as I did on this one, and while I replied to a few of them within the post itself, I thought I would take the time to share some of them here.
Tom Bouthilette from EMS 12 Lead wrote:
“It’s easy to second-guess the boots on the ground but unless you’re the one there watching a child die you can’t know what it was like. There is no “absolute.”
While I agree with Tom that there is no absolute, I do not think any of us would sit back and idly watch a child die. We have training, and we would let that training guide us in caring for this individual with the equipment we had on hand. Also, isn’t learning from mistakes made and dealing with the tough situations to improve care what we are here for? Isn’t that why we write, and retrospectively look at situations that have happened in the past, whether they are positive or negative?
Matthias Duschl asked:
“Why do you see a need for punishing this crew? I totally believe that we create better medics by analyzing what they do, measuring the outcome, and if something isn’t optimal, we should improve it by training not by suspending people who did something that saved a life but wasn’t according to their protocol.”
Without protocol, we are nothing more than cowboys running around the streets shooting from the hips. Policy and procedure is designed to give us a guideline to operate by. Punishment goes beyond suspension in a case like this. The paramedic, in my opinion, deserves some sort of remedial training on transport decision making.
Failure to take action in this instance creates a dangerous precedent should a situation similar to this one happen again. We must be careful of “how far outside the box” we let ourselves go. The Chief’s public actions increase that distance a bit more than I am comfortable with.
Again, I stand by my opinion that CPR and patient care saved this girl, not “rapid transport in the back of a fire truck.”
Fern the Fire-Rescue Newbie goes a different direction:
“Can you prove that ambulances are designed as a safe place for patient care and we can do CPR efficiently in the back? Look at most ambulances out there. Metal wall studs are your protection. CPR in the back of an ambulance can’t be done effectively without being seated, and even then if you’re transporting you can be thrown all over the place if you’re not holding onto something. (Which begs the questions, what’s the point of 1 handed CPR? There is none. So why transport?)
This was a point that I saw in a few different places: JEMSConnect, Facebook, and on a few blogs. The point was driven home by many that CPR effectiveness is not what it needs to be in the back of an ambulance. Wake County prides that as one of their successes for the high rate of ROSC their county has. MedStar in Fort Worth, TX does not transport patients in cardiac arrest with lights and sirens. Many states (unfortunately, not ours) advocate for on scene termination of cardiac arrest patients rather than working them into an ER.
So Fern, you’re right. We cannot to effective CPR in the back of an ambulance either. Again, there’s another argument for caring for the patient in the best way possible when the chance of survival is at its highest: on scene in the first few minutes.
Christopher and AngelaMulkerin sum up the point I was trying to drive home perfectly. Christopher writes:
“. . . I think I’d label this, “the wrong call, at the right time.” Probably doesn’t need to happen again and some work should be put into planning in their system such that it does not have to happen again.”
“I think people are so caught up in the emotion of a little girls life being saved that they’re not realistically seeing the problem here. I really think this was a case of panicking-which is totally understandable and happens to all of us on occasion, but it’s not about doing what you can with what you have. It’s about doing what is best for the patient. And in my opinion, even thinking of my 3 year old, the best thing is never shoddy CPR in an unsafe situation with no advanced airway. Even if they did happen to luck out this time.”
The system needs some work. More ambulances need to be made available. The personnel were there, but they did not have the right apparatus and amount of equipment to handle the emergency at hand. Finally, we are all human, and like I said, emotion is going to drive us sometimes, but as prehospital care providers, we need to work through that emotion and remember the training.
I could share more comments from my Facebook (there were about 20 of them) but they were posted on my personal one, which is private, so I will maintain the privacy of those comments, but they were just as polarized as the ones quoted above, and the comments featured elsewhere.
The last thing that I want to say about this is this is not a fire vs EMS issue. This is an equipment, training and resources issue. The patient could have just been as easily transported in a police car, an EMS SUV, or a family member’s private vehicle. The last one of those has happened more times than I can count. \My point is this: when a patient is put in the hands of an EMT or a paramedic, it is their responsibility to use their training to the best of their ability. We’ve all been in situations (mostly with kids) where everyone around us seems to be tapping their feet, not understanding why we are taking the extra time to put a patient on the monitor, or take a stationary blood pressure. I’ve heard “can we go?” or “why are you guys just sitting here?” more times than I can count, but I had to work through that because at that moment, an extra 60 seconds, or three minutes, was in the best interest of my patient.
Thanks to everyone who shared their views. I was quite surprised by the number of comments that i got, and some of the names attached to them. It is a testament in itself to how great the online EMS community really is. That is what I love about this medium: it gives us all a chance to have our voices heard. We are not all going to agree on everything, even though many of us have the same patches on our shoulders but that is how we improve. Sharing our ideas, whether we agree with each other or not, will always produce positive outcomes.
Stay safe out there!