Firefighters Suspended for Taking Girl to Hospital

[WildBill]

I'll say first and foremost I am not an EMT, just a plain old FF with lots of other certs. I am currently enjoying the accommodations in college station to pick up my EMR which is only very slightly above useless in the grand scheme of things.
I can however, monday morning QB with the best of them.
IF the FF thought the girl had to be transported immediately and could in any way articulate it - then the simple and CORRECT solution would have been to throw the info up the chain.
Notify the services medical director that they needed to go above protocol and transport - I know for a fact we have done similar, although under different circumstances,
By passing it up you relocate the liability. If its a smooth transport - you were following orders. If the DOM says no, and will go on record assuming liability for delayed transport without seeing the patient (not gonna happen) he is liable.

I have no experience as a FF or EMT, but I have worked in the quality assurance field for over 25 years.
In our language this incident would be called a non-conformance.
Rather than trying to establish blame or punish someone we would perform a root cause analysis to examine the reasons the incident occurred.
Then we try to implement some corrective action(s) and look for opportunities for improvement.
That is how we strive for continuous improvement. This same process is used in many types of businesses and industries.
Off my soap box.

P.S, This process is much easier said than done.

[winters]

Maybe i missed something but why is a fire engine responding to someone having a seizure in the first place? Seems like a huge waste of money. Where i grew up they have a volunteer dept and have people responding in outfitted suburban and yukons and usually get there way before an ambulance does.

As for suspending people for doing there job. Thats why you have people standing around doing nothing because we punish people for doing the right thing.

People have been sued because of they got hurt by people trying to help when they were REQUIRED by law to stop and help. what a load of dung.

[Daddio-on-patio]

Jago668. First things first. Since you went out of your way to belittle and offend every paramedic with your admitted ignorance of emergency medicine let me assure you we have come a looooong way since Johnny, Roy, and phone calls to Rampart. Let's walk through an active seizure scenario in the field with a comparison to one in a hospital emergency department: (FYI: A Mobile Intensive Care Unit ambulance by definition is staffed with a certified paramedic.)
Patient is actively seizing. MICU establishes IV access and administers ativan or valium based on protocol. Intranasal route is also available if IV access unobtainable. During the procedure other potential causes are assessed (blood glucose level, poisoning, etc.). Hospital: Refer to MICU procedures.
Patient is in status-epilepticus: MICU provides initial treatment as noted. Provides versed drip and performs RSI (rapid sequence induction if you're interested in researching.). Hospital: Refer to MICU procedures.

It's unfortunate that paramedicine is so vastly taken for granted and absolutely under appreciated. It would be great if there was some way to educate the public of the capabilities that many EMS services provide.

[treadlightly]

Our family had a brush with seizure difficulties. I remember the first trip to the ER, not knowing what was happening to my son. A July Fourth car show had spilled over from the city park to the hospital parking lot and had barricaded one of the two entrances to the ER area without any authorization. When the car club tried to deny me entrance to the hospital, I still remember telling the jerk trying to keep me out it was his choice - over, around, or straight through him. I was getting my son to the ER.

A little while later, the car club folks heckled me for not caring about my son when I came back out to the parking lot. Only two at a time were allowed in with my son. I stepped outside to use my cell phone to start calling neurologists while other family members stayed with my son.

But, trying to let that fade into the past, I learned that every seizure involves some level of brain injury. There is no such thing as a non-threatening seizure, particularly idiopathic seizures - a doctor's way of saying they don't know what caused it.

The fact the patient had a second seizure right away is justification, in my lay opinion, to get help by whatever means as quickly as possible.

[Jago668]

Jago668. First things first. Since you went out of your way to belittle and offend every paramedic with your admitted ignorance of emergency medicine let me assure you we have come a looooong way since Johnny, Roy, and phone calls to Rampart. Let's walk through an active seizure scenario in the field with a comparison to one in a hospital emergency department: (FYI: A Mobile Intensive Care Unit ambulance by definition is staffed with a certified paramedic.)
Patient is actively seizing. MICU establishes IV access and administers ativan or valium based on protocol. Intranasal route is also available if IV access unobtainable. During the procedure other potential causes are assessed (blood glucose level, poisoning, etc.). Hospital: Refer to MICU procedures.
Patient is in status-epilepticus: MICU provides initial treatment as noted. Provides versed drip and performs RSI (rapid sequence induction if you're interested in researching.). Hospital: Refer to MICU procedures.

It's unfortunate that paramedicine is so vastly taken for granted and absolutely under appreciated. It would be great if there was some way to educate the public of the capabilities that many EMS services provide.

Not every paramedic, just the ones that were belittling and offending people already, the ones wanting peoples careers ended for them (the firefighters) making the best call they could at the time with the information they had. I appreciate you explaining what should actually happen though, no sarcasm I really do. You have been the only person to actually explain anything. All that would have been great if there had been one of those there. At the time the firefighters made their decision there wasn't one of those, there wasn't one of those on the way, there was no eta on when one of those would get there. So once again I ask, do you stand there and do nothing or do you try to get the girl to the hospital?

[Bashful]

So once again I ask, do you stand there and do nothing or do you try to get the girl to the hospital?

You do what you're trained to do. Provide BLS care and support, assuring that the patient's airway is patent, provide supplemental oxygen, and any other care that you're authorized to do. I won't 'what if', but I will say that it's almost impossible to provide any care in the cab of a fire truck. There are no places to safely secure the patient, safely secure the caregiver, and you CANNOT adequately monitor and provide care to the patient. In short, it's DANGEROUS and potentially life threatening to the patient and the fire crew.

Were this to happen where I worked, the employees would be suspended to non-patient care roles until an investigation was complete. The EMS Medical Director would review for violations in Standards of Care and/or Delegated Standing Orders (Protocols). Since there is a potential regulatory violation, the incident would be turned over to the State for their investigation, and we would hope that they didn't take disciplinary action against the department or providers.

The article would be totally different if the patient would have had a bad outcome.

Oh.. For the record.. Currently an EMT, downgraded from a Paramedic in 2015. Initial EMT certification in 1975, Paramedic and other merit badges in 1978. Retired EMS Coordinator for the City of Baytown, where I implemented their MICU program in 1986.

http://www.yourhoustonnews.com/archives ... 29039.html

[JP171]

the website is wrong and is your cert active, so what your sayin is that I am lying. and what site lists work history? As per the texas department of health certificate I have I was certified in September 0f 1991 so your out of luck. oh ok I see, wonder when they started doing that. I don't work in EMS it doesn't pay I make about 3 times what paramedic pay is, I stopped working in ems in 1995 or so and went into industrial refrigeration. as far as the website listing my date as 2/2 2007 I will call and talk to Brett or Fernando about it

I never said you were lying so don't accuse me of it. I am reporting what is on the website based on your challenge. My status is expired/active. I was certified in 1988, with one renewal and expired in 1996 as I recall. I worked in a refinery and got certified when I did a turn in Health, Safety and Environmental as part of the manager development program , so it shows me as a volunteer and there is no agency listing. By your posts and comments I assumed you worked in EMS Texas and I thanked you for it.

I have been a Paramedic in Texas for over 25 years,

texas department of health certificate I have I was certified in September 0f 1991

I stopped working in ems in 1995 or so and went into industrial refrigeration

Since by your own admission you stopped working in 1995 and worked in industrial refrigeration. That could be the reason you have no history on the website. You also said you were certified in 1991 and quit in 1995 that's only 4 years. All a little confusing. You may have documents confirming all you say you have done, but in the state of Texas' eyes you were licensed February 2, 2007. I'll check from time to time to see if Brett and Fernando get the website repaired and your info updated. Apparently it's a site you don't know about.

and what site lists work history?

I haven't and will not post the link to your info on Texas DSHS out of respect and for privacy, though it's public information and any one can find it on the website. I wish you all the best.

According to Fernando Posada the reason all my information has been removed is that I went to an inactive status in 2004, everything previous to that has been removed or was never entered when they went to the instant verification system, I went back to active in 2007, records indicate that I was still a volunteer with Channelview fire Dept in 2003 but isn't on the website. Also the military doesn't need to have a state cert but the TXSG does like it you have it, so I have kept it current and active and will continue to do so, Brett and I used to work together at Navarre Diamond together. Also told me that Texas doesn't keep track of other states certifications. Nor does it keep any records of Military unless it is used in reciprocity to gain texas certification. My wifes information is just an expiration date with no history and no cert date, for years hers said her cert date was 1/1/ 1900 and it shows no history either, my Sisters doesn't even show a level, just a expiry date, my Brother in law shows null and void with only an expiry date

[WildBill]

Here's a short video where reporters talk with Capt James Kelly.

Capt. Kelley said that as soon as he saw the girl, he turned and looked at his driver.

“She was completely limp and flaccid,” he told Fox 5 DC. “Without any hesitation, I said, ‘we’re going to the hospital.’”

http://insider.foxnews.com/2016/03/06/v ... l-hospital

[JP171]

Bill, post ictal is usually flaccid/limp with sluggish response to stimuli, again a COMMON response to working your tail off harder than you have ever worked in your life. so again NO emergency

[WildBill]

Bill, post ictal is usually flaccid/limp with sluggish response to stimuli, again a COMMON response to working your tail off harder than you have ever worked in your life. so again NO emergency

I am just reporting what the captain said. Are you saying an 18 month old child was working her tail off?

Again, right or right Captain Kelly made a conscious decision to go directly to the hospital.
I appreciate some of the forum members adding their knowledge, experience and training to the discussion.

My major problem with this thread is people calling for their heads.
There isn't a doctor, nurse, EMT or medic who hasn't made mistakes when treating patients.
If all of them were stripped of their license and fired there wouldn't be any one around to treat sick people.
Both of the fire fighters were suspended. We will have to see the final outcome, but to call for them to be fired is premature.

[nyj]

Bill, post ictal is usually flaccid/limp with sluggish response to stimuli, again a COMMON response to working your tail off harder than you have ever worked in your life. so again NO emergency

For someone who has 25 years experience, to say all seizures are common and are not an emergency, then I certainly bring to question some things...

Yes, seizures are very common in children, especially this time of year (febrile), but to write off a seizure as nothing is just negligent. Airway compromise, status, and more serious ailments can certainly be the culprit of a seizure.

[JP171]

Bill, post ictal is usually flaccid/limp with sluggish response to stimuli, again a COMMON response to working your tail off harder than you have ever worked in your life. so again NO emergency

I am just reporting what the captain said. Are you saying an 18 month old child was working her tail off?

Again, right or right Captain Kelly made a conscious decision to go directly to the hospital.
I appreciate some of the forum members adding their knowledge, experience and training to the discussion.

My major problem with this thread is people calling for their heads.
There isn't a doctor, nurse, EMT or medic who hasn't made mistakes when treating patients.
If all of them were stripped of their license and fired there wouldn't be any one around to treat sick people.
Both of the fire fighters were suspended. We will have to see the final outcome, but to call for them to be fired is premature.

Actually Bill yes she was, Tonic Clonic activity uses a great deal of energy, one of the treatments besides the post above such as securing a patent airway and keeping the seizure individual from hurting themselves is to start an IV(largest possible) and give D-50 to counter possible hypoglycemia. there are in fact a lot of variables in this from a medical POV, we have all made mistakes when treating patients, we try to minimize that with 3 things, institutional knowledge, Protocols and standing orders and the FF on the rig violated all 3 so there was NO right it was ALL wrong, all "feelings" aside the potential for harm was multiplied because of refusal(conscious decision) to adhere to established, published guidelines. there isn't much more to say and I'm not sayin it anymore, from what I am seeing we have the libtard mentality" we gotz to do sumthin its fer the chillins"

[Bashful]

I am just reporting what the captain said. Are you saying an 18 month old child was working her tail off?

In a Grand Mal seizure, all of the muscle groups are firing, creating the seizure activity resulting in a massive energy expenditure. In addition, the patient is unable to breathe during the seizure and the patient will become cyanotic. Once the seizure stops, the normal response is for the patient to be lethargic, confused and/or non responsive. They will be breathing, with enough tidal volume to reverse the hypoxia induced by the seizure activity.

At this point, the patient should be transported to a medical facility, but it does not warrant an 'emergency' transport with lights/siren. Supportive care with airway maintenance, supplemental oxygen, and if an ALS provider, IV fluid access or saline lock to provide a medication route if the need arises.

A 'true' emergency exists for patients who are status epilipticus... which is described as continuous seizure activity, or multiple seizures without a post ictal state. The immediate issue that has to be resolved is the lack of respiratory drive during the seizure activity. The increased hypoxia (lack of oxygen) will certainly cause damage to vital organs, including the brain if not corrected by aggressive airway management and care.

[JP171]

I am just reporting what the captain said. Are you saying an 18 month old child was working her tail off?

In a Grand Mal seizure, all of the muscle groups are firing, creating the seizure activity resulting in a massive energy expenditure. In addition, the patient is unable to breathe during the seizure and the patient will become cyanotic. Once the seizure stops, the normal response is for the patient to be lethargic, confused and/or non responsive. They will be breathing, with enough tidal volume to reverse the hypoxia induced by the seizure activity.

At this point, the patient should be transported to a medical facility, but it does not warrant an 'emergency' transport with lights/siren. Supportive care with airway maintenance, supplemental oxygen, and if an ALS provider, IV fluid access or saline lock to provide a medication route if the need arises.

A 'true' emergency exists for patients who are status epilipticus... which is described as continuous seizure activity, or multiple seizures without a post ictal state. The immediate issue that has to be resolved is the lack of respiratory drive during the seizure activity. The increased hypoxia (lack of oxygen) will certainly cause damage to vital organs, including the brain if not corrected by aggressive airway management and care.

very good Bahsful stop quoting the book LOL

[Bashful]

very good Bahsful stop quoting the book LOL

Sorry... I put my EMS Educator hat on...