Paramedic quit shortly after teen player's death

[Wackerdan]

CHAPEL HILL -- The paramedic who treated Atlas Fraley on the day he died resigned 15 days later.

When paramedic James Griffin couldn't reach Fraley's parents at work, he had the 17-year-old sign his own discharge statement, according to a patient care report released Friday by Donald Strickland, the Fraley family's attorney.

Griffin had worked for Orange County for nine years. He responded to Fraley's home about 1:50 p.m. Aug. 12 after the Chapel Hill High School football player called 911 complaining of full-body cramps

Fraley "specifically asked for an 'IV' to make the cramps stop," Griffin wrote in the patient care report. "[The patient] was continuously walking around the house and wouldn't stand still for more than a few seconds. [He] wouldn't sit down at all. ... [He] kept asking how long before the cramps would subside."

Fraley stood while Griffin took his blood pressure.

Griffin reported that he found Fraley's pulse to be strong and his breathing normal. He noticed several empty bottles of water on the kitchen counter, advised Fraley about dehydration and told him "to continue what he was already doing when I arrived. [He] had plenty of water and Gatorade in the house."

Griffin did not give Fraley intravenous fluids, and he did not conduct an echocardiogram -- an ultrasonic heart examination -- "due to the [patient] not standing or sitting in one place for any length of time."

County protocol requires an ECG if the patient has suffered heart trouble, fainting, an antidepressant overdose, difficulty breathing or electrical shock. None were among Fraley's complaints to a 911 dispatcher or appeared in the paramedic's report.

"After being unable to reach either of the [patient's] parents I decided to let the [patient] sign the declination form with instructions to continue drinking water and Gatorade and continue to work out his cramps," Griffin wrote.

The county's 165-page EMS protocol guide does not address how old a patient has to be to make his own decision on whether to decline hospital transport or under what circumstances a paramedic should administer IV treatment.

An autopsy report released earlier this week suggested Fraley's dehydration and cramping may have led to a fatal heart attack, though the autopsy could provide no definite explanation for Fraley's death.

Orange County officials have not said whether Griffin followed county protocol when responding to Fraley's call. A statement this week cites personnel and medical privacy laws in declining to comment on whether EMS personnel handled the case appropriately.

"Those types of questions are either falling under ... medical or personnel privacy," said county spokesman David Hunt.

In their statement, county officials said their investigation included a review of the paramedic's actions by a peer committee and by the county medical director. They are also reviewing their procedures to determine whether any changes in protocol need to be made.

Jim Jones, a spokesman for the state EMS office, said Orange County EMS officials will present their findings to the N.C. EMS Disciplinary Committee as early as April 2, part of due process for potential employee discipline.

Jones said counties, not the state, determined whether paramedics could discharge minors without their parents' permission.

Fraley had collapsed from dehydration a year earlier. After that, at the advice of a paramedic, he started drinking a few bottles of water or Gatorade before football practices and games to avoid another incident. But a morning scrimmage on Aug. 12 didn't leave as much time for this hydration routine, his father, David Fraley, has said.

State medical examiner Dr. John Butts reported that multiple causes might have included dehydration or a genetic disorder that caused a breakdown in Fraley's muscles.

Such a disorder would have released toxins into his vital organs, according to UNC-Chapel Hill sports-medicine expert Dr. Mario Ciocca.

http://www.newsobserver.com/news/story/1452060.html

-What is your take on this. I know what I would have done even though I am an EMT, but what is your protocal and how would you have handles this??

I would like to know...Thanks.

[CBEMT]

Medic would most likely be safe here, from a civil and licensure standpoint. 16 and over can make their own medical decisions; says so right in our very first protocol. He signs the refusal, it's on him.

A service might still offload him to avoid the bad press, but they'd be handing him a wrongful termination suit.

[Spock]

We don't allow minors to sign a refusal and make every attempt to contact the parents. We also require command consult for refusals. If we can't contact the parents the minor goes to the hospital.

If I remember correctly there were several high school football players that died from heat illness in North Carolina last year and a football coach has been charged in the death of one player.

Live long and prosper.

Spock

[Canadian Caesar]

Griffin did not give Fraley intravenous fluids, and he did not conduct an echocardiogram -- an ultrasonic heart examination -- "due to the [patient] not standing or sitting in one place for any length of time."

County protocol requires an ECG if the patient has suffered heart trouble, fainting, an antidepressant overdose, difficulty breathing or electrical shock. None were among Fraley's complaints to a 911 dispatcher or appeared in the paramedic's report.

Uuuuuh. I'm confused? Is this a typo or do they really do echocardiograms there?

I think the reported wrote ECG in his notebook when he was gathering info and then looked up the wrong term?

[itku2er]

Tough call here if he followed protcols then he is in the clear. But the article never said why he quit was it personal or was it business. I am not sure if I in his place what I might have done or not done. But I don't personally know any medic that would just start an IV on a patient just because they wanted them too. But then again on the other had if the kid had passed out before from the same signs and symptoms he might have known what was going on. But either way he signed the refusal and at 17 they understand the concept of death and if you dont get medical attention you could die.

[rat115]

Our protocal for a minor is that anyone under 18 is transported if we don't have parental consent to not transport.

The fact that this boy was agitated would have had me pushing and calling for a doctor to back me up to get him in for evaluation. I would have done everything that I could have to get him into the ER within reason.

[HERBIE1]

I'm not sure why they are so vague on the concept of a "minor" in their system. I've had minors sign refusals with the direction and approval of the base station. (A/oxs3, understand risks, consequences, no drugs, alcohol, head injury, etc.) It's rare but it does happen. It does not say whether or not he contacted medical control. As for us- 17 is still a minor.

In this case, I would suggest this patient might have been dealing with rhabdomyolosis. Very serious issue that can cause renal and liver failure, shock and death. Probably impossible to distinguish between this and simple heat exhaustion in the early stages. If this happened to an adult and not a minor, we wouldn't be having this discussion- they can legally refuse.

[Kiwiology]

An autopsy report released earlier this week suggested Fraley's dehydration and cramping may have led to a fatal heart attack

So what this kid had some MASSIVE electrolyte imbalance which caused a cardiac arrest hmm ..... ok sure I've heard of that happening but it's pretty gosh darn rare. I'd expect anybody THAT dehydrated to have some symptoms and ECG changes.

In this case, I would suggest this patient might have been dealing with rhabdomyolosis

I was originally going to post a sarchastic question asking if a building fell on him or something because I've known this as "crush syndrome" but I looked in the journals, and sure enuf excessive muscule use (esp if dehydrated) can cause it. See here for the article

I can't say what I'd have done here but I sure as hell wouldn't get vascular access on this kid because he wanted it. If he couldnt sit still for more than a few seconds and was bitching about cramps I wouldn't leave him at home that's for sure!

Edited April 12, 2009 by kiwimedic

[brentoli]

Seventeen and under, I am talking to a parent. I have done SOR by telephone, but we are getting an officer or non-service affiliated 3rd party to talk to them on the phone and witness the SOR as well. It is in our system protocols, and possibly in the state rules, however I can't say that for sure.

[Richard B the EMT]

I am unaware of the local protocols involved where this call took place.

Under the NYS DoH and FDNY protocols, to sign an RMA (Refused Medical Assistance), the patient would have had to be 18, or be a legally emancipated person.

Paramedics do EKGs in the field, but in my area, I never heard of anyone doing an Echo-cardiogram, or a Sonogram, in the field.