Fla. mom awarded $10M in ambulance birth lawsuit

[VentMedic]

It seems you and I were typing at the same time.

Weezers and seizers was a term of endearment I learned from one of the NICU attendings at one of the hospital where I work.

It is actually not a term of endearment but rather used by residents who hate NICU rotation or at least not in all parts of the country. It is sorta like the term GOMER but in neo land. If the neo attendings hear a resident using that term, the rest of their rotation will not be pleasant. In the past families have over heard less than thrilled residents talking about the babies and any disrespect to the babies or their families in the NICU will not be tolerated. What they do or say off campus is of course their own business.

We have a 67 bed, Level III NICU that is the only one in western Michigan and the upper penninsula so we do know a few things about premies. As for transport, we have our own helicopter service which is staffed by doctors and nurses. We do not have a ground transport service but have a private service such as AMR pick up the team.

So you do have a specialty team. You don't rely on EMTs and Paramedics to bring neonates or high risk mothers to your hospital?

I, personally, was never a paramedic, only an EMT and I admit I had a cowboy tendency when I was an EMT. It scares me now, knowing how much I didn't know.

That is my point I just made about NRP. If some only have the little info in a Paramedic textbook or confuse infant CPR with what is required to resuscitate a neonate, there will be confusion and they may actually have the information to make an argument or even decide what is appropriate for transport.

As for issue of providing links, when you post a statistic to further your argument, it is up to you to provide a source, regardless of how many people do or do not look at it. I agree that it is foolish to keep going back and forth on this, so let's agree to end it here. As for the JEMS link, I did not go to it. I, personally, do not look at much from JEMS. As for your other links in other posts, I have looked and them many times and have found them to be helpful and educational. Just because someone may not comment on a link you post does not mean they are not being looked at. Looking at your reputation, people obviously find your posts informative. I would encourage you to continue providing links. It only helps to prove that there may be hope for bringing education and not just training to EMS.

Thank you and apologies for some of my remarks. I now realize that neither you or JP have taken NRP to know some of the stats just as the AHA provides in CPR which are taken as somewhat reliable since like NRP, they provide the references.

The onus of the transport is on the sending physician. The receiving physician has not evaluated the pt and can only base their decisions on what the sending physician says. I think the Florida lawmakers response to this incident is an uninformed kneejerk response (would you expect anything less from politicians). There are times when waiting for a fully staffed, more equipped ambulance to arrive may be detrimental to the patient. These situations are judgement calls and should not be legislated. This is where the art of medicine comes from.

I totally disagree and this comes from doing specialty transport for over 20 years. The receiving physician can also say a patient is stable enough for ALS. That is done all the time with cath lab transfers. However, with a neonate you don't just swaddle a 25 weeker and place them in the back of a truck with those who may have a cowboy mentality and get caught up in an adrenaline rush. As you know not all ED physicians are the same and they should accept the advisement of the receiving physician. I also posted a lawsuit that was recently decided on.

Some times judgement is wrong, there is no way to avoid that, including trying to legislate it away. Sometimes, there is nothing you can do to change the outcome. Let's say this kid had a fully staffed NICU transport, would the outcome have been different? There is no way to say but it is very possible. As I said before, how do we know this kids was not oxygen deprived while mom was laboring in the hospital waiting for the transfer. Would waiting another hour for a fully staffed unit to come have made the situation worse?

This hospital has a warmer and a pedi cart for resuscitation. They have an infant ventilator. They had enough staff for baby and mother. That is much more than the ambulance had.

As a sending physician, when I call for an ambulance I expect that the paramedic that takes my pt has met the qualifications to be a paramedic (although I do keep in mind that the guy who graduates last in his class is still called a paramedic).

Unfortunately the Paramedic programs can meet only the minimum amout of hours of training required or they can have a 2 year degree if the Paramedic puts some effort into it. Michigan is also one of the states that does not want any part of accreditation for Paramedic programs. The training for intubation could have consisted of just tubing a manikin 5 time successfully. The class may only have consisted of the A&P and meds in a Paramedic text. The ambulance service may not have a decent monitoring system in place. More focus may also be on Adult resuscitation than the rare baby they run across.

Now in Florida, it is known that 50% of the Paramedic programs are medic mills that cater to the FDs. We are largely a Fire based EMS state and almost every FF is a Paramedic. That is an expectation at hire or within one year of hire. Some have held a Paramedic cert for several years while trying to get on with a FD and have worked in other professions like construction or Burger King. Until Paramedics can achieve some type of respectible standards for education and even experience two work lead on a truck, the state will have to at least protect the babies the best way they can.

Our Chidren's Hospitals also go out to teach NRP (and beyond) at the little hospitals they pick up from. They also invite the staff such as the RRTs to come to their hospitals for some experience. I would hope your transport teams and hospital do the same where you are.

This also gives the attendings/medical directors of the receiving hospital an idea about who and what they are dealing with when they made decisions about transport. Unfortunately, many Paramedic students no longer have access to L&D and NICU in some areas after some very bad incidents and it is unfortunate it had to affect even the serious students. The experience they do have available is generally observational with no hands on. NRP or many of the classes offered by hospitals that could provide excellent information are not popular unless it is required. Some Paramedics show no interest in NRP because they do not meet the requirements to become an instructor and for those collecting titles or patches, that is a big deal.

Again, apologies for some of my offensive remarks but I have spent a lot of time trying to direct those who want more information to the sources. For this, the 50% used in JEMS was less of a "stat" but more of an argument about justifying outcomes to distract from the real issues.

Edited April 13, 2010 by VentMedic

[akflightmedic]

It is depressing that your life is so devoid of humor that even after my explanation you fail to see that it was neither an attack nor an agreement. I was appreciating his humor of a bogus statistic...kind of made me think of the quote that 85% of all statistics are made up on the spot and 2 out of 3 people constitute 75% of the population. In literature, this is a fine technique which lightens the mood during an emotional or dark scene...something you are in desperate need of (my assumption, since it is ok to make those).

No, I do not need a thanks for complimenting you, you deserved it as you often do. You complained about people not reading your posts...obviously if I take the time to post great job...then I have read what you wrote. I simply had nothing to add but continued to monitor (and learn).

You are the one who always gets so defensive. I am not here to stroke your ego but the whole whining post about no one reading what you write created a visual of a child stamping their foot and pouting. You do have some serious knowledge to share, there are few people who's posts I will always read when I see the name and you fall in that group. It is a shame however that you take exception to any challenge and your delivery format becomes severely antagonistic at times and very defensive.

We have had this discussion before, you will not change...but the winner is not the one who shouts the loudest, yet you always try.

Again to recap because you are probably formulating your response by this point...I did not attack, nor did I agree. See that part? Cause you mentioned it again even after I said it was not so earlier...**** <--------

I now return you to the scheduled debate already in progress (the one on topic). (Smiley face for the sarcastic and humor challenged)

[VentMedic]

It is depressing that your life is so devoid of humor that even after my explanation you fail to see that it was neither an attack nor an agreement.

I do not find humor in what happened to this baby or what the transport crew had to go through. Their company did fail.

You are the one who always gets so defensive. I am not here to stroke your ego but the whole whining post about no one reading what you write created a visual of a child stamping their foot and pouting. You do have some serious knowledge to share, there are few people who's posts I will always read when I see the name and you fall in that group. It is a shame however that you take exception to any challenge and your delivery format becomes severely antagonistic at times and very defensive.

I get defensive because I do posts links to support my arguments and give examples. I repeat myself over and over as well as post more links but yet some keep coming back with the same blastings over and over just as what JP did. That is frustrating as I waste time arguing a point already made to someone who can not support their own statements.

We have had this discussion before, you will not change...but the winner is not the one who shouts the loudest, yet you always try.

Again to recap because you are probably formulating your response by this point...I did not attack, nor did I agree. See that part? Cause you mentioned it again even after I said it was not so earlier...**** <--------

I now return you to the scheduled debate already in progress (the one on topic). (Smiley face for the sarcastic and humor challenged)

I realize, again, I only wsste my time on this forum and seriously could be using this time to teach those who do want to hear about medicine and how to be better prepared for those difficult tranports. I was finished with this forum but it was Ruff who sent me a PM that reached me by email which got me posting again. I realize now that was a mistake. I will not change my tone when posting about the life, disability and death of a child to one that is silly and laughing at someone whose outcome could have been better. I can laugh and joke outside of this forum since this forum is NOT my life which some here seem to confuse an anonymous forum with one's own personal life. If appropriate I can make a joke and have even done so on this forum but do not expect me to joke about the proper care of a baby when it causes that child to suffer.

Some do get into EMS for the wrong reasons. They believe the medicine part is a joke and worship the cowboy crap on TV. Some may be forced to become a Paramedic such as with the FD. However, for whatever reason, some need to be grounded to the fact that their actions or inaction can affect someone's life to the point of even being the cause of disability or death. And, regardless of why you got the patch, you do hold a license/certification and can be held accountable for your actions or inaction.

Edited April 13, 2010 by VentMedic

[akflightmedic]

Well it was nice seeing you again...

I hope one day you realize how high and mighty you make yourself seem and I do not mean in the educational or professional sense. Your comments in bold are yet another stab at trying to make yourself seem "above it all". A good bye statement to all the little people...charming.

[CBEMT]

If Vent wasn't on a call, whatever the crew did was stupid, dangerous, and contraindicated. If Vent wasn't in the hospital, it's mere luck that the patient somehow managed to survive to discharge.

One of these days, you guys will come to the realization that Vent is always right, about everything, and always has been. Your lives will be so much less frustrating once you stop trying to have an opinion in any thread she is involved with, because you can't. It's not allowed.

And she'll spend 6 pages telling you so.