Unsurvivavable head injury left in the field

[Teillard]

State board cites 7 Kan. responders for failing to transport patient to hospital

Though injury was deemed "incompatible with survival," bodycam footage and records show patient was alive for hours before transport to hospice

www.ems1.com

Weird story...just an online publication, but would be interested in any insight someone might have.

---

Members don't see this ad.

 

[Birdstrike]

People can blow off an amazingly large part of their head and still breath and have a pulse.

The Headless Trauma

 

[Dr Mantis Toboggan]

State board cites 7 Kan. responders for failing to transport patient to hospital

Though injury was deemed "incompatible with survival," bodycam footage and records show patient was alive for hours before transport to hospice

www.ems1.com

Weird story...just an online publication, but would be interested in any insight someone might have.

Stuff like this always amazes me. Just bring the patient into the ED. They can always be an organ donor if nothing else.

 

[DrDrummer]

Yeah. Super weird case. There have to be some details that are left out of the news story, otherwise it's a very "WTF were you thinking" type of scenario. I feel like the medical director probably should be bearing the responsibility in this case rather than the medics, but again, details are scant.

 

[dadaddadaBATMAN]

Yeah. Super weird case. There have to be some details that are left out of the news story, otherwise it's a very "WTF were you thinking" type of scenario. I feel like the medical director probably should be bearing the responsibility in this case rather than the medics, but again, details are scant.

It also doesn’t seem clear to me that any effort was made to contact family or other contacts. Agree that his organs could still have been salvaged even if rest of him could not.

 

[Vandalia]

Very strange.

The phrase penny-wise, pound-foolish comes to mind. If I understood correctly, to "save" transporting a potentially dead patient to the ED they kept multiple EMS on scene for five hours. What is the math on that?

The only thing I can conclude is that they determined he needed "just a few more minutes" to die. The problem, of course, is such patients can keep breathing for hours. That isn't even some dark EM secret, there was an entire MASH episode on this theme.

For the sake of argument, no medical intervention would have changed the ultimate outcome, but based solely on what was presented in the article, it seems to be very poor EMS (system) management. Even in a mass-casualty/natural-disaster scenario you are not going to have (apparently several) EMS crews babysitting a patient for hours.

As I said, I am certain they thought he needed "just a few more minutes" and then reached the point they didn't have a graceful way out. To paraphrase the financial saying to EM, "don't throw good time after bad." The fact you realize that you should have done something 30 minutes ago shouldn't stop you from doing it now.

 

[GeneralVeers]

I'm sure this will be a lawsuit cuz this is 'Merica. Not sure what damages they could claim.

 

[DeadCactus]

There are outcomes other than living or dying. They left someone to suffer and languish on the floor for 5 hours with some half-assed attempt at palliative care in between trying to dump the patient on police until hospice arrived 5 hours later. They did a round of CPR and got a pulse and then just stayed there. I don't see CPR to hospice over a 5 hour period to be a reasonable disposition from an EMS crew.

 

[Dr Mantis Toboggan]

There are outcomes other than living or dying. They left someone to suffer and languish on the floor for 5 hours with some half-assed attempt at palliative care in between trying to dump the patient on police until hospice arrived 5 hours later. They did a round of CPR and got a pulse and then just stayed there. I don't see CPR to hospice over a 5 hour period to be a reasonable disposition from an EMS crew.

I can’t even get stuff to hospice that should be in hospice sometimes! What hospice takes someone who was just shot in the head?!?

 

[RustedFox]

I can’t even get stuff to hospice that should be in hospice sometimes! What hospice takes someone who was just shot in the head?!?

I remember hospice sending patients to me in the ER for nonsensical things all the time, often seemingly in direct opposition to the goals of hospice.

 

[southerndoc]

I do not know all the details, but from what is portrayed in the media, it seems this patient had a non-survivable injury but endured more suffering than was necessary.

 

[Apollyon]

I do not know all the details, but from what is portrayed in the media, it seems this patient had a non-survivable injury but endured more suffering than was necessary.

If they had to treat him twice with 500mg Vitamin K (slang) for pain, that looks like more suffering, indeed.

 

[AlmostAnMD]

How do I get this EMS staff to my area

Maybe at least they can come do some lectures to our EMS that transport say, for example, knee pain every single day at noon from the same guy for years and never once refusing to transport.

Or that time they brought me a 60 year old guy that had CPR in progress for over 90 minutes and got mad when I checked heart with US and immediately called it

I have the total 100% opposite problem here

 

[dchristismi]

I would have taken him to my hospice house, no question. (Inpatient level care, freestanding, with ability to manage complex ICU-type patients.)

The logistics of making it happen are the problem, and it's a LOT easier from the ED. Still, I probably would have had to pull strings to make it happen even with my connections.

FWIW, I have had people I thought were imminent linger for a week, and people I thought were going to hang on pass quickly. It's an art, and even though I'm pretty good at it, I wouldn't expect precision in the field. Heck, it's hard to expect precision in the hospital.

Also, when you as a medical director get multiple calls, that means your people aren't comfortable with something and you should listen to them or go see for yourself. Or there was some sort of MCI going on at the hospital and all ambulance traffic was diverted, or something crazy like that.

 

[Siggy]

Also, when you as a medical director get multiply like rabbits calls, that means your people aren't comfortable with something and you should listen to them or go see for yourself. Or there was some sort of MCI going on at the hospital and all ambulance traffic was diverted, or something crazy like that.

The medical director did show up on scene...

 

[Buckeye1992]

Hard to comment on this without more details. But pretty terrible to just let the person suffer for that long.
Did have an EMS call in somewhat recently for a code that had been down less than 10 minutes with family CPR that they wanted to call because the person was a hoarder and they thought it would be hard to get them out.

 

[alpinism]

Definitely a sad case but the medics should have absolutely transported him to a hospital.

 

[docB]

It's safe to say there were a lot of factors involved here. Some are evident from the article and I'm sure there are other things that we didn't hear. Clearly there was a decision early on not to transport and then there was reluctance to change direction and transport once it became apparent death would not happen quickly. I've reviewed enough of these kinds of calls, including calls about non-transport of trauma victims, to speculate a bit. Often there is some recent case that has caused the pendulum in an agency to swing one way or the other. Perhaps a patient was transported that was clearly dead resulting in a complaint from a hospital. EMS agencies and providers are very reactionary. A medic who is told they were wrong will often not do that thing again, ever, even when it's indicated. Similarly there are almost always big egos involved in these cases. There is the stress of EMS interacting with law enforcement. I've seen arguments about who is in charge of a scene, what interventions are allowed on a crime scene and how it all affects evidence turn into major league pissing matches.
These cases are uncommon but not unheard of. Everyone involved is going to get screwed. And the pendulum will swing back. At least until the next complaint about a patient with rigor mortis being transported.