PT Can't Breathe? Give Her to the FD.....

[PhillyRube]

OK. here's another situation...comment?

Philadelphia Fire Lieutenant being hung out to dry for transporting a critical asthma pt. in the Squad Company....No Medic Units available!!!! Watch the video.......And if you know the PFD and it's administration, you know why this happened......Thats all I have to say!

http://cbs3.com/video/?id=56087@kyw.dayport.com

[bstone]

Keep us posted as how this turns out.

[AZCEP43]

Amazing with the amount of negative press that PFD has gotten that something like this would happen again.

[emt161]

Amazing with the amount of negative press that PFD has gotten that something like this would happen again.

That's what happens when people's deaths aren't enough to turn the wheels of bureaucracy.

Foten, it's a death that gets things moving. When it doesn't, the citizens are REALLY screwed.

[EMS914]

Don't know a whole lot about that department and its so vague about the exact situation expect that she "couldn't breath". Which we all know could me 20 different things but bravo to him if his actions did save her life. My only opinion about the situation is ALS engines/squads with ALS drugs (subQ epi, steroid, albuterol) could have corrected this situation it sounds like if it was an asthma attack....that would have given ample time for the med unit to get there. There are rules for a reason and if every critically ill patient was transported by an engine before med unit arrival there would be a big problem in EMS.

[bossteen]

Yeah, I suppose that would be a problem. Perhaps more transport capable ambulances instead of ALS fire trucks? Just an idea.

[LasVegasEMS]

Yeah, I suppose that would be a problem. Perhaps more transport capable ambulances instead of ALS fire trucks? Just an idea.

Exactly what he said. Not only that, but this is a little different then the kid can't breath post, I think. Although, we don't know the exact time it took them to get her to a hospital so its unclear at this time.

[Fairyqueen]

What is the goal of EMS? To provide rapid transport of critical pt's to the hospital or to treat critical pt's onscene to improve the chance of survival?

I don't know what was meant by a ALS ambulance was not avalible in this situation. If one was truely not responding then it seems like the person made a good, if controversal, decision. But was it like this situation with the baby not breathing and the person just didn't want to wait. I don't want to be mean but I've seen good people make poor choices when they spin.

If that is the best way to get critical people to the hospital then we should just get rid of ambulances all together. Cities should just hire fast drivers with fast cars to drive like hell to the hospital.

[dr-exmedic]

If that is the best way to get critical people to the hospital then we should just get rid of ambulances all together. Cities should just hire fast drivers with fast cars to drive like hell to the hospital.
If we do that, can we bring back the hearses? :)

[EMS914]

More units with transport capabilities would of course be the best way to go but there are very few places that have enough personnel and enough units to staff what the area truly needs (there are other forums debating the use of ALS Engines, etc so i'll leave that to them) ...

My only thing about this situation and the baby is in most places the *average* response time of an ambulance is 8-10 minutes. Expecting them to get there any faster is just unrealistic and delays occur frequently (such as train, weather, traffic, etc.)

Please let me know if there is a place where an FD first response (BLS or ALS) has protocols stating that if an ambulance is more than X minutes away and this is a critical patient then put patient in fire truck and haul to the ER.

I believe 100% that this person was in the wrong and should be reprimanded for it. He was "on-duty" therefore he should have followed the protocols set by his medical director for the treatment of the patient exhibiting x symptoms until transport became available by a transporting unit. If the lady stopped breathing completely he should have done what he does for all patients not breathing --- and I don't think it was throw her in the fire truck or else he wouldn't be in hot water right now.

[ShuckingGome]

More units with transport capabilities would of course be the best way to go but there are very few places that have enough personnel and enough units to staff what the area truly needs (there are other forums debating the use of ALS Engines, etc so i'll leave that to them) ...

My only thing about this situation and the baby is in most places the *average* response time of an ambulance is 8-10 minutes. Expecting them to get there any faster is just unrealistic and delays occur frequently (such as train, weather, traffic, etc.)



If a city can staff enough firetrucks to respond to EMS calls with 2 or 3 minute response times, then they sure as hell can staff enough ambulances to do the same. A firetruck costs upwards of half a million dollars and it carries anywhere from 3 to 5 people. It's a very expensive proposition. An ambulance costs in the 70-100K range and it staffs 2 people. Ambulances cost less and staff less yet there are fewer ambulances in most cities then fire apparatus. That doesn't make any sense.

[DrParasite]

it might suck to say, and it is definately going to be unpopular, but the Lt was wrong. He deviated from the city's protocols. He transported the patient in a non-transport unit. and yes, he will need to deal with the consequences, and whatever repricussions they have.

sucks doesn't it?

That all being said, PFD's EMS system is understaffed, underequipped, and needs more ambulances to handle the call volume (like many other cities in the midatlantic/north east states, but i digress). And I don't doubt that no ambulance was available, or that every day citizens wait too long for a transport unit to arrive.

HOWEVER, the city has policies, the FD supression side has policies, and the FD EMS side has policies, which were drafted by upper management, and these rules need to be followed, regardless of what you think of them. And if you deviate them, you need to expect their to be consequences.

sucks to be the philly Lt, but he did the "crime," and now he needs to answer for his action. and as much as it pains me, the fact the Philly EMS is really screwed up and doesn't have enough ambulances in no way excuses his actions.

[redcrossemt]

Please let me know if there is a place where an FD first response (BLS or ALS) has protocols stating that if an ambulance is more than X minutes away and this is a critical patient then put patient in fire truck and haul to the ER.

I don't necessarily agree, but FYI, Michigan has a State Law (MCL 333.20939) allowing "spontaneous use of a vehicle under exceptional circumstances to provide, without charge or fee and as a humane service, transportation for the emergency patient" if an ambulance "is unable to respond to an emergency patient within a reasonable time".

[Born To Fly]

I don't necessarily agree, but FYI, Michigan has a State Law (MCL 333.20939) allowing "spontaneous use of a vehicle under exceptional circumstances to provide, without charge or fee and as a humane service, transportation for the emergency patient" if an ambulance "is unable to respond to an emergency patient within a reasonable time".

Wow that's nuts. I thought only cops had the ability to commandeer vehicles. Very interesting.

So what specifically is considered a reasonable time? And are the times different for different injuries/sicknesses? Or is it just a call made in the field (or a call to medical control)?

Depending on how that law is interpreted in court systems, it's either very powerful for understaffed systems or very dangerous for the licenses of your EMS personnel. Unfortunately, I would think that to some degree it would promote the underequipping of transport-capable rigs.

[MedicInLA]

Although a component of EMS is to get the patient to an appropriate facility in a timely manner it is also designed to start ALS treatment as soon as possible. In almost any setting even going hot to the hospital will only save you a minute or so if you are lucky. Therefore the patient does not really receive any benefit in this way. Where the patient gets there benefit is from the crew doing its job by correcting the problem as best as they can. In this situation if the FD had any ALS gear or even a way to administer oxygen they should have waited for an ALS unit. If one was not going to be available for some period of time I wonder if they could have intercepted with one. Now if it was a ridiculously long response time then the correct decision was made to transport the patient. The ultimate solution for this problem would be to most definetly staff additional ambulances if the number they have can't keep up with the call load.

[ownbeycfd]

Vegas you really hit the nail on the head. A big part of it was how long it took to get to the hospital . in philly probly not long. if it was out in the stacks I would have a diffrent opinon. no i dont think we need to get rid of ambulances but part of ems and fire is common sence and somtimes you have a choise to make. and when in doubt ask yourself what is in the pt best intrest:cool:

[RicanMedic78]

I commend the fire fighter's actions! Its a shame how rules, laws, and in our case, protocals can drump common sense! U know, protocals are like the bible! 99% of the time, most christians should follow it, but in the end, common sense comes first and there can never be an answer to every situation. We are a human beings, not robotic monkeys, despite the fact that organization keeps order this way. But when a man puts his job on the line to break from the rules to save a life with no ill intent on his part.... well, lets just say... EXCEPTIONS CAN AND SHOULD BE MADE! In life, acceptions should always be made for things... Life is not black and white and until we see that there is substantial gray, we'll always hear of crazy stories like this, if not in EMS, than in the law, or in politics, or anywhere else humans manage to get their hands on and mess up!

Lastly, the man was a paramedic and probably an experienced one considering his rank. So as for the details if what SOB really meant in this case and the distance to the hospital, I take the mans word for it for the decision that was made. Now... I'm not saying that we should be able to do anything whenever we want outside protocal, so I do welcome investigation... but at the end of the day, if she was docompensating, the hospital was far, and she truly benefited from the early unorthodox transport, then give then man a freakin MEDAL!!!!! I'd take him in my company in a second!!! Well... if I owned an ambulance company that is, lol

"why do they call it common sense if so many people are obviously lacking it" - I forget from who, but good quote!

[kghemtp]

Protocols & rules are simply guidelines to work from loosely, using knowledge & experience to deviate some as needed to get the patient or customer what he/she needs considering everyone's best interest. IF a paramedic lieutenant's choice put patient care first, then bending the rule should be no real problem. Modify the rules to leave additional judgment to the officer -- he's gonna have to justify choices, but making choices in the public's interest should not be hard to justify.