More FAIL in Massachusetts

[Dustdevil]

I don't know for sure that the kid didn't exhibit dependent lividity and rigor mortis, and that the crew did not assess pulse, respirations, lung sounds, and pupils. But this admittedly incomplete story seems to indicate that they did not. If they did not, they've screwed the pooch and deserve the sack. But if they did, then it would appear that they're being railroaded by emotional politics. I'd sure like to see the PCR, as well as the incident report from the police officer and supervisor.

[FireMedic65]

"Arrived on scene to find a baby that looked like it was sleeping without movement, we didn't bother to check. We stood around, smoked a cigarette until the arrival of the supervisor. Upon his arrival, he did what we should have done, and did an assessment, and transported.. we smoked another cigarette."

sound about right?

[VentMedic]

I don't know for sure that the kid didn't exhibit dependent lividity and rigor mortis, and that the crew did not assess pulse, respirations, lung sounds, and pupils. But this admittedly incomplete story seems to indicate that they did not. If they did not, they've screwed the pooch and deserve the sack. But if they did, then it would appear that they're being railroaded by emotional politics. I'd sure like to see the PCR, as well as the incident report from the police officer and supervisor.

If they did indeed document:

Investigators found that the EMTs incident report after the fact said CPR was continued when it was not.

That would be back peddling and not consistent with their assumption of death unless they were just going with those who had already started CPR.

[DwayneEMTP]

Does "the baby later died" mean died in the hospital?

That tells me they should have worked the baby.

Nah, tells me that 'they', the family and newspaper, considered the baby alive as long as CPR was being performed, and dead when and where it ceased. hopefully that is not your feeling as well.

As far as working a "compassion Code", that was proven harmful to survivors about a gazillion years ago, wasn't it?

And I can imagine a scenario where their very poorly written PCR could be accurate. For instance story never states that CPR was discontinued by the cop before being taken over by the supervisor. Right?

I'm really not defending the crew, I simply hate giving the newspaper the benefit of the doubt.

Not enough information here to even argue about really...

Dwayne

Edited to add sentences 4-6 and a second time to explain my edit. DW

Edited June 4, 2009 by DwayneEMTP

[p3medic]

If they did indeed document:

That would be back peddling and not consistent with their assumption of death unless they were just going with those who had already started CPR.

Not really. It is very possible the scene went to hell, hysterical family, cop out of his comfort zone, so crew opted to scoop and screw and do CPR on the way, leaving the final call for the hospital. They may not have begun resus immediately due to the patient being non viable, however w/o a chart, its all speculation. Not saying that is the most professional approach, but at the time it may have been the safest and most politically appropriate, although it would seem leaving the kid (if in fact the kid was non-viable) would have been the best choice in hindsight. I would bet a weeks pay the complaint was generated by the cop, just a hunch. I've been in a similar situation, with different results.

[VentMedic]

Not really. It is very possible the scene went to hell, hysterical family, cop out of his comfort zone, so crew opted to scoop and screw and do CPR on the way, leaving the final call for the hospital.

Quote from the article:

Investigators from the Department of Public Health said Brody told them that he thought the baby was already dead.

To say you "thought" the baby was dead is not good enough. You either confirm death or you don't. It is not that difficult. If he couldn't "decide" which way to call it he could have called his medical control which is mentioned in the Cessation of Resuscitation section. I probably would have done that anyway since CPR had been initiated and it was a child just to cover the bases.

Here's another article:

http://www.southcoasttoday.com/apps/pbcs.d.../NEWS/906020336

NEW BEDFORD — The state Department of Public Health has recommended two New Bedford paramedics be suspended for 30 days for failing to perform cardiopulmonary resuscitation on a baby in cardiac arrest during an emergency call in December.

The two paramedics — Rosemary Nunes and Ivan Brody — also were cited for inaccurately recording the details of that December emergency call, according to a complaint investigation report issued by the public health department.

Mayor Scott W. Lang said Monday he intended to review the incident and would announce any actions within the next 48 hours.

The recommended suspensions stem from an incident in the early hours of Dec. 4, when Nunes and Brody responded to a 9-1-1 report of a baby who was not breathing, the report stated.

When the paramedics arrived, a New Bedford police officer was already there, performing CPR on the baby, according to the report.

Nunes and Brody immediately took the baby to the ambulance where, according to the trip report completed by Brody, CPR was continued.

However, when Thomas Pimental, then a supervisor with the department, arrived at the scene a couple of minutes later, he found the baby on a stretcher in the ambulance and neither paramedic delivering "medical care of any kind" to the infant, the report stated.

Pimental, who has been a paramedic since 1984, is also a registered nurse and a certified emergency nurse.

Pimental started CPR, and the baby was transported to St. Luke's Hospital, according to the report. The baby later died, Pimental said.

In Brody's written trip report, he did not include any information about the cessation of CPR.

The state investigation found that "the allegation of EMT-Paramedics Ivan Brody and Rosemary Nunes not performing CPR on an infant in cardiac arrest is valid ... there is no evidence that this patient met the criteria for EMTs to withhold or cease CPR efforts."

No number was available for Nunes, and Brody said he would prefer not to comment without talking to his attorney.

According to the state's investigation report, Pimental filed a written report about the incident with James Trout, director of the city's Emergency Medical Services department, just a few hours after taking the baby to the hospital.

In a phone interview on Monday, Pimental said he told Trout in December that the incident needed to be reported to the Department of Public Health.

According to Lang, the city's EMS department did report the incident to the state within a few days of its occurrence.

However, according to the report issued recently, an investigation into the incident was not started until Feb. 15, a little less than a week after the state received a complaint about the incident.

The report stated that the city's EMS department addressed the incident on Feb. 5, through a "call review," and then required the two paramedics to go through remediation training, which was completed on March 3.

Lang said in a phone interview Monday night that he first learned of the December incident a few hours earlier in the day.

However, on March 24, Pimental wrote Lang a three-page letter outlining his concerns about the incident; also in that letter, Pimental argued that such incidents point to why EMS supervisors, such as himself, were a necessary part of the department.

Pimental and the city's other EMS supervisors were laid off by the city in February as a result of the mid-year cut to state aid the city had to absorb.

Pimental, who said he received no response to his initial letter, sent a second letter by certified mail to Lang on April 7.

William Burns, the mayor's chief of staff, responded to Pimental on April 9 in an e-mail, writing, "We received both of your letters, and have forwarded both of them to City Solicitor, Irene Schall."

On Monday, Lang said he had requested a full report on the incident from the city's EMS department by midday today.

"I want to look now at everything that they did and whether it was appropriate," he said.

Lang said the issue is not the supervisor system: "It's (not) something I'm looking at from a standpoint of whether the supervisor system was the answer to preventing this, because obviously the supervisor system was in place when this happened," he said.

"Irregardless of whether anyone made an anonymous complaint or not, I'm glad it's come forward, and we'll go from there."

During the course of investigating the December incident, the state discovered two additional incidents — one involving Nunes and one involving Brody — that raised concerns about patient care.

The first occurred on Nov. 19, when Nunes responded to a 911 report about a family of four suffering possible carbon monoxide poisoning; Nunes was accompanied on the call by an emergency medical technician-intermediate — a lower level of certification than a paramedic.

According to the report, Nunes canceled a second ambulance that was on its way and transported all four patients to St. Luke's in an ambulance designed to accommodate no more than two patients. Additionally, the patients were not given oxygen before or during the trip to the hospital, the report stated.

(Could the pulse ox have told Numes the patients' SpO2 was 100%?)

The second call, which involved Brody, occurred on Dec. 13.

Brody, along with his partner, also an EMT-intermediate, responded to a report of a child who had almost fainted.

According to the report, Brody and his partner agreed at the scene that the child did not require any advanced life support and, during the ride to the hospital, the partner did not give the child oxygen, nor did he start the an intravenous line on the child.

Dr. Jon Burstein, state medical director for the Office of Emergency Medical Services, reviewed all three calls and "found all of them to have clinical deficiencies of care" that did not meet the standard of care required by state protocols, the report stated.

The two EMT-intermediates were issued letters of clinical deficiencies.

Edited June 4, 2009 by VentMedic

[ERDoc]

With the obviously very limited info provided about the other "incidents," I'm not too concerned. I don't necessarily see anything wrong (again, I have almost no information) or anything that sounds too concerning in reguards to the other incidents. This CPR call sounds like they screwed up big time, based on this most recent info.

[Dustdevil]

Two New Bedford Paramedics to be Disciplined for not Continuing CPR

Chairs Anderson

SouthCoastToday.com

2009 Jun 4

NEW BEDFORD, Mass. -- Mayor Scott W. Lang said sanctions against two city paramedics will be announced sometime after a hearing for them is held Friday.

A state investigative report found the paramedics, Rosemary Nunes and Ivan Brody, violated state protocols during a December 2008 emergency call by failing to perform cardiopulmonary resuscitation on a baby in cardiac arrest and then inaccurately recording the details of the call.

Video courtesy WPRI CBS 12 Providence

The state has recommended a 30-day suspension of Nunes and Brody's emergency medical technician certifications.

"I do want to hear what they have to say," Lang said Wednesday afternoon. Lang said his focus on the December incident is how and why the paramedics made the decision not to perform CPR, which is an issue of not properly following state protocol.

"Everything I've heard everywhere ... (is) basically saying to me, 'This is not a case where we're alleging these individuals committed any kind of lack of medical care'" that would have led to a different result, Lang said.

Melissa Valliere and Richard Rock Jr. of New Bedford said they met with Lang on Wednesday and the city confirmed it was their baby who died in the December incident. Lang couldn't answer all of their questions, Valliere said, but said he would get back to them with more answers.

"He does believe that the paramedics did not have any contribution to having our son pass away," she said. "It kind of does make me feel a lot better."

Valliere said the couple recommended the paramedics be required to repeat the recertification process.

In December, the city immediately reported the CPR incident to its contact at the state Department of Public Health, Lang said.

At that time, the consensus between the city's Emergency Medical Services department, its medical director at St. Luke's Hospital and its contact at DPH was that the incident could be appropriately addressed through remediation training, according to Lang.

Jennifer Manley, a spokeswoman for DPH, said Tuesday the city, which was obligated to report the December incident, has never filed a formal written report with the state.

After the state received a complaint in February about the incident, it launched an investigation, which resulted in the recommended suspensions.

"I think it's far more complicated than simply the city didn't notify DPH, or DPH didn't act, didn't make the right decision on one level and then made it on another," Lang said. "What exactly broke down here?"

Lang said he has also talked with the EMS department about when it needs to notify the mayor's office and the city solicitor's office about such incidents.

"For some reason, the December incident was not regarded as an incident that would lead to action by me, the solicitor or DPH for that matter, including by DPH," he said. "That's the disconnect I want to find out about."

Lang, on Wednesday, said again that he first learned of the December incident and the ensuing investigation on Monday.

He received a letter from Tom Pimental, an EMS field supervisor laid off by the city in February, sometime after the layoffs, Lang said, but he said he did not read it closely.

Pimental's letter, which he sent first on March 24 and then again on April 7, discussed the December incident and the state investigation.

Pimental first filed a written report of the incident with EMS Director James Trout the day it occurred.

"I looked at it and put it down, sent it down to solicitor's office," Lang said of the letter. "I didn't spend a minute on that letter, do not know what that letter indicates one way or the other."

[CBEMT]

From what I'm getting via various means, when the supervisor showed up and ordered CPR and transport, the crew was in the truck with the patient, and were in the process of getting medical control clearance for cessation of efforts- but not actually performing CPR. So it would seem to me at first glance that the supervisor walked into a situation he knew nothing about and changed everything.

Should they have been doing CPR while calling the doc? Probably. Would have changed ANYTHING? Nope:

"Everything I've heard everywhere ... (is) basically saying to me, 'This is not a case where we're alleging these individuals committed any kind of lack of medical care'" that would have led to a different result, Lang said.

I'm also wondering why the supervisor writing the letter didn't consider this an issue of deficient care until he got laid off. Maybe it proves his point, maybe it doesn't. But the timing is interesting.

The only person who gave the family false hope was the cop who started CPR and the supervisor who forced the transport of a dead body. Further, newspapers always say that the patient "died at the hospital," because they like the lay public have this idea that transport (even with CPR in progress) must mean the patient was still alive. Happens all the time with shootings, stabbings, and car crashes in my area where I know for a fact the patient was a trauma code from the moment of EMS arrival, but the media always reports that "the victim was transported to an area hospital, where s/he later died." "Later" being the ER pronouncement about 5 minutes after arriving.

As for "Why did they need a supervisor," it's common practice in many systems with field supervisors for the supervisors to respond to potentially serious calls and assist. I'd say a dispatch for "baby not breathing" would qualify, wouldn't you?

Edited June 6, 2009 by CBEMT

[VentMedic]

What exactly does EMS want or expect?

We complain when systems and states allow minimally trained and questionably competent EMT(P)s to remain without fear of being held responsible for their actions. We complain about Medical Directors who do lax oversight. We complain about field supervisors who look the other way. We complain that those who screw up are not retrained and educated. We complain that about the media who reports an issue although for CA I think that was a good thing although very little will be done about it.

But, when a medical director and the state finally step in to investigate, retrain and reprimand 2 EMT-Ps and hold them accountable for their actions and charting, we complain about that also.

So, what is it that EMS wants? To be left alone and not have to explain our actions or charting? Or, to become like the other professions and be held accountable as well as being able to explain or chart well enough for our actions to hold up in court? Do those in EMS want to be considered as professionals and held to a higher standard or at least be able to explain their actions?

If anything, others should be reviewing their own P&Ps and charting proficiency to see if there is anything that could come back to bite them in the arse in a similiar incident. Making excuses and thinking all is perfect just doesn't advance the profession. Speculation that they "probably meant" to do this is just that, speculation. It also gives those who continue to mess up hope that their futures are secure because others have the same view for work ethics as they do. There is no need to explain anything in your charting because your peers are behind you and that just makes you fit in with the herd.

Some on the forums have also said EMS is just getting picked on. Except for the people in immediate areas, only those in EMS see most of these headlines pulled from an EMS newswire. If you go to a nursing or RT site, you will see the headlines for those professions. However, for these professions, the state is often quick to yank the license before much media damage can be done.

This is just one incident that happened to make headlines. Luckily, many medical directors try to correct the problems before they make headlines. There will also be those that will constantly complain that these companies are "not fun" to work because they have a atrong QA/QI program in place that "monitors everything". These are also the same employees who complain if their medical director doesn't feel they are up doing advanced procedures like RSI or even ETI. However, those that welcome medical oversight and quality assurance programs usually get the benefits of protocols structured more like guidelines and trust from their medical director to do advanced procedures when warranted.

Now, for these two Paramedics, they should have known the call might be scrutinized because of the actions of their supervisor and the LEO present. They should have charted their butts off as well as made a separate report for their medical director and maybe even some face time with him. However, if they have been accustomed to just getting a gentle slap on the wrist, they probably thought this dead baby incident would be no big deal either.

Edited June 6, 2009 by VentMedic