UPDATE: Paramedics Suspended Over CPR Incident (Massachusetts)

[CBEMT]

Targeted paramedics' attorney speaks out

NEW BEDFORD — An attorney for two city paramedics accused of violating state protocols said his clients' primary concern is — and always has been — for the welfare of the parents of the baby who died.

"Even going through all this that they're going through now, their careers on the line and everything, the first thing they did when they met with me was express their concern for the parents," said Anthony Savastano, a New Bedford attorney.

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Editorial: Review City EMS

The two paramedics suspended in New Bedford are living a nightmare, partly of their own making and partly political.

We would not presume to make a medical judgment about their actions in the early hours of Dec. 4, when they responded to a call about a baby who had stopped breathing.

But we do know a state investigation concluded that the paramedics, Rosemary Nunes and Ivan Brody, should have administered cardiopulmonary resuscitation to the baby, and that by failing to do so, they violated state protocols. The state report said the baby did not meet the criteria for ending CPR; the paramedics believed the baby was dead.

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Pair slapped in CPR flap

NEW BEDFORD — Two city paramedics have been suspended from their jobs without pay for, in part, their actions during a December 2008 emergency call.

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

Nunes has been suspended by the city for 45 calendar days, while Brody's suspension is 70 days.

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[nremtp]

Autonomy vs Protocols, Education vs Training this is what happens when you man the equipment instead of equipping the man!

[Dustdevil]

Autonomy vs Protocols, Education vs Training this is what happens when you man the equipment instead of equipping the man!

While I agree with that theory, I don't believe it applies to this situation. These guys didn't follow training, education, or protocols, or even utilise their equipment. They just unilaterally made up some shyte as then went along. They took autonomy where there was none authorised. I really cannot figure out WTF they were doing or why. There was no rhyme or reason to it. I can only think of two explanations: They're either lazy or sociopathic.

If they have jobs to come back to... well, I was going to say I'd be shocked. Then I remembered we were talking about Massachusetts.

[p3medic]

While I agree with that theory, I don't believe it applies to this situation. These guys didn't follow training, education, or protocols, or even utilise their equipment. They just unilaterally made up some shyte as then went along. They took autonomy where there was none authorised. I really cannot figure out WTF they were doing or why. There was no rhyme or reason to it. I can only think of two explanations: They're either lazy or sociopathic.

If they have jobs to come back to... well, I was going to say I'd be shocked. Then I remembered we were talking about Massachusetts.

Really? They found a non viable kid, with dependant lividity, and some supervisor ordered them to abuse a corpse. I don't see where they were making anything up....

[VentMedic]

Really? They found a non viable kid, with dependant lividity, and some supervisor ordered them to abuse a corpse. I don't see where they were making anything up....

Where did you get the information about having dependant lividity?

We had already discussed their protocols and they were posted on an earlier thread. As with any situation, if one is going to declare death and especially with a child, one should document well enough to cover their butts as well as contacting the med control as listed in their protocols. It really shouldn't have been difficult for them to do that instead of sitting in a truck with a dead baby. If they were going to declare death, they could have allowed the parents a chance to hold the child and comfort the parents as well. Instead they allowed everyone else (parents, LEO, supervisor) to run the show and didn't document well enough to back up their actions, inactions or declaration of death.

[Lone Star]

Really? They found a non viable kid, with dependant lividity, and some supervisor ordered them to abuse a corpse. I don't see where they were making anything up....

Where was any description of the child (other than 'not breathing')? I've read every word of each post and the attached story and found no mention of 'dependant lividity'.....

[Dustdevil]

I don't necessarily disagree with their assessment. We haven't been given enough information to agree or disagree. But their course of action was clearly outside of their scope of practice. That -- and their falsified documentation -- is what I disagree with.

Screwing up protocols is an offence for which re-training is appropriate. Dishonesty is not. Firing is the only option for these two.

[ncmedic309]

I would really like to take the information we have now and compare it with the PCR from this incident. It seems that the biggest issue here is turning towards false and/or inaccurate documentation. It sounds like the decision was made to not attempt resusciation based on the finding that the patient was obviously deceased. I'm completely fine with that in pediatric patients but unless it's been declared a crime scene, it's usually best to at least transport the patient. I agree that we shouldn't be transporting dead bodies to the hospital, but in the case of a young child the circumstances are a little different.

I've had similar calls in the past and made the call to go ahead and transport the child to the closest facility even after determination of death. I always call the receiving facility and speak with the attending in the ER and inform him/her of the same. They have always been very receptive to this and I've never once caught any grief from anyone for doing so. If the crew had done this, I imagine we would have never heard of the incident. I'm not citing the crew for the decision they made but calling medical control and documenting this call accurately based on their standing orders probably would have kept them out of hot water.

[p3medic]

Where did you get the information about having dependant lividity?

We had already discussed their protocols and they were posted on an earlier thread. As with any situation, if one is going to declare death and especially with a child, one should document well enough to cover their butts as well as contacting the med control as listed in their protocols. It really shouldn't have been difficult for them to do that instead of sitting in a truck with a dead baby. If they were going to declare death, they could have allowed the parents a chance to hold the child and comfort the parents as well. Instead they allowed everyone else (parents, LEO, supervisor) to run the show and didn't document well enough to back up their actions, inactions or declaration of death.

First article, 10th paragraph down.

I don't disagree that a better documented chart would have made this all go away, but I can't help but think this is all blown out of proportion by a layed off supervisor. Just my opinion, no facts to back any of it up, I'd love to see their chart as well as the ED's. Until then, I will give them the benefit of the doubt.

[VentMedic]

The paramedics noticed obvious lividity, a pooling of blood that occurs in dead bodies, and cold extremeties, according to Savastano

.

I've also seen babies covered in petechia and cold extremities from sepsis that could look like they have lividity and are dead. I've also seen babies with bradycardia and with extended periods of apnea or even agonal breathing that look like they could be left for dead. However, with the proper care, they may have a chance to turn around.

What was the cause of death?

Was the patient fully covered or just wearing a diaper? Outside temperature?

How much pedi experience did these two have?

There are too many unanswered questions that the media didn't provide or wasn't released. But then this would not have gotten this far if they has provided documentation of a proper assessment to show signs of death. If the ME placed the time of death long before the call, then there should not have been any problem. I would also give the benefit of the doubt to the ME, ER doctor and Medical Director as well as those in the State EMS office that they did their homework. Surely somebody in that state knows the definition of dead. I can't believe all of the MDs involved in this situation are missing the point or are out to get these two EMT(P)s.

This also happened before the supervisor was laid off since he was at the scene in that capacity.

Edited June 21, 2009 by VentMedic