FDNY EMTs do not let Private Medics help with choking child

[catie]

I know where I work that if someone is trying to get your attention by banging on the back doors they are going to give more than just two standard bangs on the back.

To tskstorm-

I am not really sure how you can be so certain they did not hear sirens or see lights? (unless maybe you were there?)You said they misunderstood the radio and yet they heard clear enough to know it would be a minute before ALS arrived? I seem to sense a defensive "tone". Could it be that you were one of these guys/girls and think you have to justify your actions? Thank you for the vast span of knowledge you have bestowed upon me, as I have only been in EMS for going on 10 years now, all of which has been 911.

But I do appreciate it. :wink:

I see your point. I would venture to say there are many arguments to this story. I was thinking in terms of a larger ball....say one you would get out of a quarter machine at wal-mart. If you provide compressions/chest thrust you would enable the ball to move up enough to at least provide some airflow.In turn, Using a BVM would push the ball back down and cause a seal so that no air would be able to get by.After all the kid ended up dying regardless of your "by the book CPR".

Yes, I know what the book says. Everyone who has been through school should know this.

Every Medic and EMT knows you can't always go "by the book". But, I do understand what you are saying. :-k

Ultimately.... All the shoulda,coulda, woulda's are in vain. These people made choices that affected the rest of their lives and others. Nothing can bring this child back and I am sure these guys lay in bed at night and wonder,What if ........

We have all been to those calls and each one has asked that same question a thousand times over. If you haven't yet, then give it time....if you stay in EMS long enough your time will come.

[tskstorm]

I know where I work that if someone is trying to get your attention by banging on the back doors they are going to give more than just two standard bangs on the back.

To tskstorm-

I am not really sure how you can be so certain they did not hear sirens or see lights? (unless maybe you were there?)You said they misunderstood the radio and yet they heard clear enough to know it would be a minute before ALS arrived? I seem to sense a defensive "tone". Could it be that you were one of these guys/girls and think you have to justify your actions? Thank you for the vast span of knowledge you have bestowed upon me, as I have only been in EMS for going on 10 years now, all of which has been 911.

But I do appreciate it. :wink:

I see your point. I would venture to say there are many arguments to this story. I was thinking in terms of a larger ball....say one you would get out of a quarter machine at wal-mart. If you provide compressions/chest thrust you would enable the ball to move up enough to at least provide some airflow.In turn, Using a BVM would push the ball back down and cause a seal so that no air would be able to get by.After all the kid ended up dying regardless of your "by the book CPR".

Yes, I know what the book says. Everyone who has been through school should know this.

Every Medic and EMT knows you can't always go "by the book". But, I do understand what you are saying. :-k

Ultimately.... All the shoulda,coulda, woulda's are in vain. These people made choices that affected the rest of their lives and others. Nothing can bring this child back and I am sure these guys lay in bed at night and wonder,What if ........

We have all been to those calls and each one has asked that same question a thousand times over. If you haven't yet, then give it time....if you stay in EMS long enough your time will come.

I work in the area, I know people involved, I don't work for FDNY or OLM however.

1. I have yet to have been to a call in the north Bronx where ALS pulls up with L&S where a bls crew is already there.

2. Just because the report says the dispatcher gave a 1 minute ETA doesn't state the crew heard or understood that.

3. Just because a newspaper crew who probably heard it over a scanner or who listened to the tape heard it doesn't say anything about the crew hearing it or understanding it.

Side note, I work for the privates. The crew everyone has rivalries with, and have no reason to back up any crew or have a defensive tone or justify myself. I know the reality of the system I work in as I am certain you know yours. Perhaps in your 10 years as ems you've turned rogue, but I rely on my protocols to cover my ass, as this crew did, because if they didn't do proper CPR "by the book" they would have their asses handed to them in court.

[catie]

tskstorm.... You are right to keep doing your job "by the book", as I don't really think you are ready for anything less right now. Its always better to CYA than to just go along.

In these situations you have to be capable of going to court to prove your actions worthy of keeping your patch.If your not then you don't need to even go in that direction.

There are risks to everything and I think there are some who can go outside the box and some who cannot. I am not putting you down or saying your not a good EMT. I am saying I think you are right in what you believe. So don't let anyone try to make you into someone your not.

So for now I will conceed to you,because I'm tired.

[FormerEMSLT297]

Richard B... To answer your question, this whole problem, incident could have been avoided and this is how:

1. If the LT were an ALS provider, s/he would have had a tube kit with him/her. Direct laryngoscopy, removal of FBAO, and done problem solved.

I do not know if they crew knew the meidcs were banging on the door, I dont know if they intentionally left the Pvt. medics in the dust. The point is it is better to have an Medic supervising a medic and not an emt supervising a medic.

How would you, or any EMT LT. know if my treatment as a medic was appropriate and within protocol, if you yourself was not an EMT-P.

I'm not saying you as an EMT could not be a station boss, but responding to calls, handling RMA/AMA's, during PRIDE reports and evals on MEDICs, is very difficult if you are only an EMT.

Sample law suit:

Atty: So, LT, X, you are an EMT not a paramedic correct ?

LT X: thats right.

Atty: So, you responded to 123... and was supervising medic A and B, when they misintubated my client and caused hypoxia that lead to brain damage.

LT X: I was on the scene thats correct.

Atty: and for the record the missed tube was not dicovered by either medic or you at teh scene correct?

LT X: it was discovered at the hospital.

Atty: But on your report you said the crew operted within EMS OGP and BLS/ALS protocol, how would you know that if you are not a REMAC Certified medic?

LT X: Well I read the protocols and saw them do them.

Atty: But, you failed to detect that the ET Tube was improperly placed, and my client was not getting any oxygen .

I could go on and on about this but you see what i'm getting at.

My basic question is how can you evaluate an employee at the ALS level, when you yourself can not and never have provided ALS.

I'm sure your union is going to fight the ALS LT thing, what is their take on it ????????

You have rights ,,, get Pat B on the case.

You get the idea.

[thiswillbenothingkid]

So, how easy is it to remove a rubber ball that would be round, wet and slippery from being wedged in an airway? I could see it as being a bit of a problem.

Would the ALS crews have been able to perform a crichothyroidotomy?

[tskstorm]

So, how easy is it to remove a rubber ball that would be round, wet and slippery from being wedged in an airway? I could see it as being a bit of a problem.

Would the ALS crews have been able to perform a crichothyroidotomy?

Best they could do is a needle Cric

[MICP_Rn2011]

lets put a red ball in their throats and see who they want help from.... :twisted:

[spenac]

Best they could do is a needle Cric

That is bad protocols. Needle cric does not get nearly enough air, better than none but not by much. If only doing needle how many actually place two needles so as to avoid pressure build up?

[p3medic]

The kid was 4, a large bore needle for the 10 minute ride would have been more than adequate. Attempting an open surgical cric on a 4 year old would have been a waste of time in my opinion.

[DwayneEMTP]

The kid was 4, a large bore needle for the 10 minute ride would have been more than adequate. Attempting an open surgical cric on a 4 year old would have been a waste of time in my opinion.

This has always confused me. You say he'd get plenty of air from a needle, but with the larynx blocked, thus no expiration, how is he going to get ANY ventilation? I've never been clear on why we were even taught this. I can see where protocols might indicate it, I just can't envision the situation where it would be indicated, yet allow positive ventilation.

As spenac mentioned. At the very least it would seem you would need two needles if you wanted any chance of avoiding the creation of a pneumo in this situation, yet I'm having a difficult time seeing where even a 10g would do much good.

Perhaps I just don't understand the physics involved...

Dwayne