Jump to content

Fla. mom awarded $10M in ambulance birth lawsuit


Recommended Posts

Of course malpractice suits often have more to do with outcome than actual malpractice.

Welcome to the House of God, JP.

Link to post
Share on other sites
  • Replies 44
  • Created
  • Last Reply

Top Posters In This Topic

Top Posters In This Topic

Popular Posts

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.

The baby was at a hospital which offered a more stable environment for the birth than the back of an ambulance even if the hospital staff were not comfortable with it. As a hospital, they are still r

Weezers and seizers was a term of endearment I learned from one of the NICU attendings at one of the hospital where I work. We have a 67 bed, Level III NICU that is the only one in western Michigan a

Serious question. What sort of expertise and equipment can be expected to be found at a community hospital that doesn't even offer OB services? While I have questions regarding destination and transport choices (for example, Medical Center of Daytona has NICU capabilities and is only 17 miles and a few turns away. I'd argue that any NICU is better than an emergency room at a hospital with zero L&D services past a physician whose last uncomplicated delivery was God knows when), I also have serious questions as to just how much better a community ED is especially if the possibility exists that the transport can be completed prior to delivery.

So you think the back of an ambulance is better for almost 70 or even 17 miles with virtually no specialty equipment or even something to keep the baby warm? Or how about NRP and intubation skills?

Almost every ED in this country, even the smallest, have a Braslow code cart, an infant warmer, infant ventilator and at least one person somewhere inhouse who has taken NRP. The Children's Hospitals sponsor NRP at these local little hospitals and invite their RRTs to their NICU to get some airway and ventilator management skills. It generally does not take long for one of these neo teams to reach that hospital once delivery is progressing and usually the outcome is good. At least the baby is intubated which it appears to not have been according to some of the information now being released.

The problem in this situation started with the sending physician attempted to arrange for a transport without knowing all the options. EVAC said they could handle it. By the time the sending facility realized they goofed in a big way by sending mother and a baby about to be born, EVAC was already trying to find a faciity to divert to. Now, it will be the rec'g hospital (higher level of care) that determines the appropriate crew.

As far as the verdict, all the jury needs to hear is "injured baby" and you get your checkbook out. There's a reason why OB/Gyn has enormous malpractice insurance premiums, and I refuse to believe that OB/Gyn is just filled with idiots who don't know how to practice. Of course malpractice suits often have more to do with outcome than actual malpractice.

The physicians and hospitals knew they screwed up and in the case of a child, they would only make themselves look worse if they tried to put the blame on the mother and child to relieve themselves of their share of the guilt. EVAC decided to make the trial about them which turned the jury off. It appears they are still doing this in the news articles they have been appearing in as they prep for the appeal. I'm actually very surprised the amount was only $8 million. If everyone else has said it was a bad call to transport and yet the least trained/educated providers are still holding themselves out to be the "only ones who could save the day" I would say your lawyer and company have failed to do their homework to see where they might have been part of the problem.

Also, as pointed out in the JEMS article:

In 2003, the mortality and morbidity rate for this type of birth was 50%.

That statistic was for 25 weekers born out of a controlled environment including at home and in an ambulance. The rate for those born in a hospital, including little generals that can call a neo specialty team, is greater than 70% and an 80% for those born near a higher level NICU.

Is it fair to write off the baby by saying it only had a 50/50 chance of survival to justify any shortcomings of the EMS crew? Should the 50% that do survive be left for dead or not worthy of any chance like at least intubation and warmth?

Would blame the baby for being born prematurely and not the crew who didn't have the proper equipment or training? Again, the hospital and physicians knew they screwed up. Most of Florida heard about this 7 years ago and again about EVAC in 2006 with the phenergan/artery incident which I believe is still to be settled. It also wasn't so much about the medical mistakes, since they can happen to even the most careful of providers, but rather the way they attempted to displace the blame elsewhere.

JP, as an EMT-B, would you accept a patient with multiple drips that needed ETI or would you politely tell the ED that is not appropriate for your training?

Why should this be any different? Teams who are considered advanced will abort a transport if the patient is too unstable or is best served by remaining in the sending hospital until stabilized or even until they die. Why transport someone who is coding 2 hours by air transport? In this case, until the baby is born. No NICU and/or OB team would have suggested loading that patient in an ambulance if the contractions were close and could not be controlled. Some EMTs have a difficult time understanding why a neo team on transport because we may take hours of stabilizing the baby until we are ready to move. Diesel is not always the answer to every medical situation.

Edited by VentMedic
Link to post
Share on other sites

So you think the back of an ambulance is better for almost 70 or even 17 miles with virtually no specialty equipment or even something to keep the baby warm? Or how about NRP and intubation skills?

Almost every ED in this country, even the smallest, have a Braslow code cart, an infant warmer, infant ventilator and at least one person somewhere inhouse who has taken NRP. The Children's Hospitals sponsor NRP at these local little hospitals and invite their RRTs to their NICU to get some airway and ventilator management skills. It generally does not take long for one of these neo teams to reach that hospital once delivery is progressing and usually the outcome is good. At least the baby is intubated which it appears to not have been according to some of the information now being released.

I'd argue that this is a case where the hospital isn't going to be at a huge advantage. Do you not think that physicians suffer from skill atrophy also? Yes, a physician who has more education than a paramedic, but I wouldn't want to be the first patient that a surgeon operates on if he hasn't operated on anyone in years. You say it does not take long, but why would it take a significantly shorter amount of time for the hospital recovery team to be dispatched, assemble, and respond then the ambulance that ended up transporting? Furthermore, since when does completing a merit badge course mean that someone is competent to direct care? Thread after thread, the point has been made that just because someone is "ACLS certified" doesn't mean that they are the right person to run a resuscitation. Heck, even the American Academy of Pediatrics states on their website in regard to NRP, that it "is an educational program that introduces the concepts and basic skills of neonatal resuscitation. Completion of the program does not imply that an individual has the competence to perform neonatal resuscitation." Emphasis added.

The physicians and hospitals knew they screwed up and in the case of a child, they would only make themselves look worse if they tried to put the blame on the mother and child to relieve themselves of their share of the guilt. EVAC decided to make the trial about them which turned the jury off. It appears they are still doing this in the news articles they have been appearing in as they prep for the appeal. I'm actually very surprised the amount was only $8 million. If everyone else has said it was a bad call to transport and yet the least trained/educated providers are still holding themselves out to be the "only ones who could save the day" I would say your lawyer and company have failed to do their homework to see where they might have been part of the problem.

I would advance that an entity settling isn't an indication of guilt or innocence. I'd also argue that this is a case of damned if you do, damned if you don't. If the baby was born an hour later while waiting for the recovery team and suffered any complication at all, the lawsuit would be that the hospital didn't transport, knowing that they lack the proper capabilities to care for patients in labor and neonates, little less premature neonates. After all, only birth that occurs on a set schedule is that of Baby New Year. Furthermore, the ambulance company would still be named for refusing the transport. After all, I guarantee you that the jury doesn't care about what the paramedics can and can't do for a premature neonate. Adverse outcome, especially in children, means someone has to pay, and the more the better.

Additionally, if the cervix is "minimally dilated" according to the transfer physician, how long is it reasonable to believe that they have until the baby is delivered?

Furthermore, every emergency interfacility transport results in a decrease in the level of care available to that patient with the end goal of getting the patient to a higher and more appropriate level of care. Should trauma patients that end up at Medical Center of Podunk Nowhere be required to be escorted by the transferring physician because the paramedics lack the same ability to intervene as the hospital? What happens if there is no staff available to send away for 2 hours. After all, you can't shut down all or half of the ER because one of the one or two physicians on has to escort the patient. Furthermore, are paramedics in Florida allowed to intubate newborns? If so, then why is it inconceivable that the transferring physician expect that the paramedic can perform to his scope of practice?

Also, as pointed out in the JEMS article:

That statistic was for 25 weekers born out of a controlled environment including at home and in an ambulance. The rate for those born in a hospital, including little generals that can call a neo specialty team, is greater than 70% and an 80% for those born near a higher level NICU.

Is it fair to write off the baby by saying it only had a 50/50 chance of survival to justify any shortcomings of the EMS crew? Should the 50% that do survive be left for dead or not worthy of any chance like at least intubation and warmth?

Do you have a source for the actual statistic because the JEMS article does not specify which environment has the 50% survival rate, or if that's the overall survival rate.

Would blame the baby for being born prematurely and not the crew who didn't have the proper equipment or training? Again, the hospital and physicians knew they screwed up. Most of Florida heard about this 7 years ago and again about EVAC in 2006 with the phenergan/artery incident which I believe is still to be settled. It also wasn't so much about the medical mistakes, since they can happen to even the most careful of providers, but rather the way they attempted to displace the blame elsewhere.

Nice false dichotomy and appeal to emotion in that first sentence. So apparently the only two choices are to blame the crew or blame the baby. Can we play the same blame game when ever there's an adverse outcome? After all, who's fault is it when someone dies due to a MVC at a non-trauma hospital? The patient or the hospital that didn't have the proper equipment or training to do trauma surgery?

JP, as an EMT-B, would you accept a patient with multiple drips that needed ETI or would you politely tell the ED that is not appropriate for your training?

Why should this be any different? Teams who are considered advanced will abort a transport if the patient is too unstable or is best served by remaining in the sending hospital until stabilized or even until they die. Why transport someone who is coding 2 hours by air transport? In this case, until the baby is born. No NICU and/or OB team would have suggested loading that patient in an ambulance if the contractions were close and could not be controlled. Some EMTs have a difficult time understanding why a neo team on transport because we may take hours of stabilizing the baby until we are ready to move. Diesel is not always the answer to every medical situation.

No, but if I use this as precedent, then I shouldn't accept care of a patient at a SNF suffering from any life threatening emergency. Sure, the emergency room might be only 5 minutes away (and, thus, closer than a paramedic response), but the SNF should be able to handle the patient better than I can. Also, really? We're going to compare EMT-Bs to paramedics now? Similarly, if the patient needs any intervention that the SNF can supply that the paramedics can't, then the paramedics should refuse to transport as well. Especially if there's a respiratory emergency and the SNF has an RT on site. After all, we wouldn't want the paramedics to decrease the level of care available, even if the emergency department can offer significantly better care than the SNF.

Link to post
Share on other sites

So you think the back of an ambulance is better for almost 70 or even 17 miles with virtually no specialty equipment or even something to keep the baby warm? Or how about NRP and intubation skills?

Almost every ED in this country, even the smallest, have a Braslow code cart, an infant warmer, infant ventilator and at least one person somewhere inhouse who has taken NRP. The Children's Hospitals sponsor NRP at these local little hospitals and invite their RRTs to their NICU to get some airway and ventilator management skills. It generally does not take long for one of these neo teams to reach that hospital once delivery is progressing and usually the outcome is good. At least the baby is intubated which it appears to not have been according to some of the information now being released.

The problem in this situation started with the sending physician attempted to arrange for a transport without knowing all the options. EVAC said they could handle it. By the time the sending facility realized they goofed in a big way by sending mother and a baby about to be born, EVAC was already trying to find a faciity to divert to. Now, it will be the rec'g hospital (higher level of care) that determines the appropriate crew.

The physicians and hospitals knew they screwed up and in the case of a child, they would only make themselves look worse if they tried to put the blame on the mother and child to relieve themselves of their share of the guilt. EVAC decided to make the trial about them which turned the jury off. It appears they are still doing this in the news articles they have been appearing in as they prep for the appeal. I'm actually very surprised the amount was only $8 million. If everyone else has said it was a bad call to transport and yet the least trained/educated providers are still holding themselves out to be the "only ones who could save the day" I would say your lawyer and company have failed to do their homework to see where they might have been part of the problem.

Also, as pointed out in the JEMS article:

That statistic was for 25 weekers born out of a controlled environment including at home and in an ambulance. The rate for those born in a hospital, including little generals that can call a neo specialty team, is greater than 70% and an 80% for those born near a higher level NICU.

Is it fair to write off the baby by saying it only had a 50/50 chance of survival to justify any shortcomings of the EMS crew? Should the 50% that do survive be left for dead or not worthy of any chance like at least intubation and warmth?

Would blame the baby for being born prematurely and not the crew who didn't have the proper equipment or training? Again, the hospital and physicians knew they screwed up. Most of Florida heard about this 7 years ago and again about EVAC in 2006 with the phenergan/artery incident which I believe is still to be settled. It also wasn't so much about the medical mistakes, since they can happen to even the most careful of providers, but rather the way they attempted to displace the blame elsewhere.

JP, as an EMT-B, would you accept a patient with multiple drips that needed ETI or would you politely tell the ED that is not appropriate for your training?

Why should this be any different? Teams who are considered advanced will abort a transport if the patient is too unstable or is best served by remaining in the sending hospital until stabilized or even until they die. Why transport someone who is coding 2 hours by air transport? In this case, until the baby is born. No NICU and/or OB team would have suggested loading that patient in an ambulance if the contractions were close and could not be controlled. Some EMTs have a difficult time understanding why a neo team on transport because we may take hours of stabilizing the baby until we are ready to move. Diesel is not always the answer to every medical situation.

As JP has pointed out, I'd be careful making some of these generalizations. One of the hospitals I work at is a smaller medium size community hospital with an ER census of 27,000. We have an OB service and a peds service (no PICU). We do not have any peds vents. If there is a peds pt that needs a vent they are being transferred and will be bagged until they leave. I don't think anyone, including myself, is currently NRP certified. I took PALS as a resident but we have been moving away from the alphabet soup in favor of education. I would also like to see the sources for the numbers that you give such as the 70 and 80%.

As for this case, it is hard to judge because there is a lot of information missing. We have no real idea of what transpired in the ER. I'm still confused as to who all of the players are. Who is the doctor from Halifax hospital and what happened to the transfer there? How far away is Halifax and what services do they have (I could look this up but it's just not worth it). How was she presenting in the ER in New Smyrna Beach? All we know is her contractions were 4 minutes apart. Primagravids can labor for hours with ctxs 4 min apart. As JP asked, what was the cervical exam like? I think it is a little hard to pass judgement without a lot more information.

  • Like 1
Link to post
Share on other sites

JP and ERDoc,

I already provided links to Volusia County and the court documents. Sorry but I am not going to spoon feed either one of you and you will have to click on the links yourselves.

ERDoc,

Are you comparing your education and training to a Paramedic with 6 months of training and very little baby or peds education? Even without NRP, as an ED physician, did you not do a rotation in the NICU or L&D? Did none of your training and education address this?

If you wanted a cardiac patient transferred out of your ED to a center of higher care and the Paramedic showed up without a cardiac monitor or O2 tank because the truck they were on didn't have the equipment for a 60 mile transport, would you be okay with this?

Completion of the program does not imply that an individual has the competence to perform neonatal resuscitation."
Furthermore, since when does completing a merit badge course mean that someone is competent to direct care?
JP: that is a silly argument and you know it. If they didn't take the course to begin with, you can't even begin to argue competence or no competence. Knowing the EMT and Paramedic courses are very weak in neo and peds, would you not want staff to at least make some attempt to get more information about these age groups? Or, do you believe the Paramedic program makes you more than qualified to do high risk delivery transport and neonates? Hell, even doctors must get some additional education even if it is not NRP to be proficient for working in areas they will come into contact with these patients. If they choose not to, they will have to explain their actions if something goes very bad. If they have some additional training, explaining the consequences might be a lot easier.

Why is it both of you are arguing it is okay to show up for a critical transport with little to no preparation as far as equipment and personnel? Why is this acceptable to you? ERDoc, if your patient required a Specialist OB consult, would you settle for a GP because the OB was busy? Would you feel you did right by your patient?

This area has access to at least 2 hospitals that have helicopters and specialty teams and that didn't include Halifax.

Contrary to what you are believing about the public, not everyone is out to screw over the poor EMT or Paramedic. However, there comes a time when they can not always hide behind the old way of just providing a fast trip to the hospital or that people will automatically think they did a great job because they are a Paramedic and as EVAC keeps stating, "must put up with suffering everyday". EVAC accepted a transport of almost 70 miles with very little resources. The hospital goofed by sending that patient out without a PROPER TRANSPORT team to provide for both the mother and baby.

Not every child that suffers the effects of prematurity or will have a family that sues if it does. Usually the neonatalogist can explain the circumstances well enough to where they accept the fact EVERYTHING was done that could be done. However, even the best neonatalogist in THAT AREA of FLORIDA would have a difficult time explaining why an ambulance crew accepted a baby without proper preparation.

ERDoc, do you honestly believe the U.S. is not capable of saving 25 weekers? We've been saving 23 weekers since the 1980s. If you look at the literature you will find the stats run from 50% to 80% depending on the level of care closest to them. If the baby is born outside of the hospital or a hospital, the stats will be at the low end. In this situation, it was chosen to take a chance or accept the lower stats when the decision to put mother and child on an ambulance. Also, if you want more impressive stats, pull up the numbers from Canada and other countries of civilized medicine.

BTW, ERDoc, what do you do when a Paramedic brings you an ETT in the esophagus and then blames it on you when you try to explain how it could have happened or give him/her some pointers on assessment? Or, do you just ignor it or cover it up because the patient only had a 50/50 chance of survival? Would you allow a cardiac or any patient to have drips discontinued just to accomondate a crew with less training take your patient to an ICU in another hospital? Would you not expect to be scrutinized by your peers?

I've also wasted too much time trying to show where those in EMS may be held accountable for their actions and the "underdog" "they're picking on us" mentality will have to go away to be replaced by one that resembles a medical professional. Diesel medicine and just providing a real fast trick from point A to point B will have to be replaced with critical thinking, education and more training especially for the CCTs or ALS IFTs. Have either of you noticed the level of training/education required in other countries for a Paramedic to be on a truck for IFT critical care transport?

There are literally thousands of babies born in Florida each year. While there are lawsuits, compared to the volume of deliveries, including those that require a specialty team to get the baby at some little general, there truly are not that many. Most can be settled and do not drag into a jury trial. Yes, the risks are high especially in neonatalogy but there are still many health care professionals that assume the responsibilty to work with that population and know what it takes to be successful in that career.

However, this is why I am an advocate for taking a patient to the more appropriate facility to begin with if at all possible. As I have stated several times before, getting the proper IFT can be a pain and take hours. In some areas, a BLS truck may have to do and the patient will have to go without meds or a monitor to a higher level of care from a little general. That is a sad statement the U.S. but that does not mean we should settle for this as a profession every time or continue to make excuses.

Edited by VentMedic
  • Like 1
Link to post
Share on other sites

JP and ERDoc,

I already provided links to Volusia County and the court documents. Sorry but I am not going to spoon feed either one of you and you will have to click on the links yourselves.

I went through your public records page listed on the first page. No where does it list a study that says that in-hospital resuscitation rates for 25 week premature babies is 80% in the hospital and 50% elsewhere. You cited JEMS in your original post. The JEMS article does not make such a distinction. I'm not going to do your research for you.

JP: that is a silly argument and you know it. If they didn't take the course to begin with, you can't even begin to argue competence or no competence. Knowing the EMT and Paramedic courses are very weak in neo and peds, would you not want staff to at least make some attempt to get more information about these age groups? Or, do you believe the Paramedic program makes you more than qualified to do high risk delivery transport and neonates? Hell, even doctors must get some additional education even if it is not NRP to be proficient for working in areas they will come into contact with these patients. If they choose not to, they will have to explain their actions if something goes very bad. If they have some additional training, explaining the consequences might be a lot easier.

I'm not arguing about competence. I'm purely quoting from the AAP's website that you posted from, and I'm sure that the AAP can attest as to what their course does an does not do. Again, "Completion of the program does not imply that an individual has the competence to perform neonatal resuscitation. Each hospital is responsible for determining the level of competence and qualifications required for someone to assume clinical responsibility for neonatal resuscitation" is a direct quote from their website, and not something I just made up on the spot.

http://www.aap.org/nrp/about/about_coursedescrp.html

I enjoy how you talk about physicians coming into contact with these patients because EM physicians are not working in areas where they regularly come into contact with these patients.

So... alphabet soup courses are all the same except when it comes to this one course? Even though the people running the course state otherwise?

Why is it both of you are arguing it is okay to show up for a critical transport with little to no preparation as far as equipment and personnel? Why is this acceptable to you? ERDoc, if your patient required a Specialist OB consult, would you settle for a GP because the OB was busy? Would you feel you did right by your patient?

The GP vs OB is a non-sequitar since there is no OB present. I checked Bert Fish's physician directory on their website. They don't even have an OB on staff. Hence it is an apples to oranges comparison. What I'm arguing is that the hospital isn't some sort of magical fairyland where every service is always offered, of procedure atrophy doesn't apply, and every piece of medical equipment ever made is readily available. I guess we could be making the argument that how dare that hospital not have a NICU and labor and delivery services. EMS loves saying, "Any port [ER] in a storm," but sometimes that means you are the Exxon Valdez in Valdez harbor. I'm also arguing that if the clinical assessment was that the patient would be able to make it through the transport without problems, then that's what you work off of.

Not every child that suffers the effects of prematurity or will have a family that sues if it does. Usually the neonatalogist can explain the circumstances well enough to where they accept the fact EVERYTHING was done that could be done.

Not everyone, but enough that OB services in many parts of the country are hampered because of a lack of OBs willing to practice there. Sure, it might not be 100%, but it doesn't have to be anywhere close to that.

I've also wasted too much time trying to show where those in EMS may be held accountable for their actions and the "underdog" "they're picking on us" mentality will have to go away to be replaced by one that resembles a medical professional. Diesel medicine and just providing a real fast trick from point A to point B will have to be replaced with critical thinking, education and more training especially for the CCTs or ALS IFTs. Have either of you noticed the level of training/education required in other countries for a Paramedic to be on a truck for IFT critical care transport?

Sigh... Yea... because I'm the great Defender of the EMS Faith who has never, NEVER criticized EMS education. Yep... that's me. :/

Edited by JPINFV
  • Like 1
Link to post
Share on other sites

I went through your public records page listed on the first page. No where does it list a study that says that in-hospital resuscitation rates for 25 week premature babies is 80% in the hospital and 50% elsewhere. You cited JEMS in your original post. The JEMS article does not make such a distinction. I'm not going to do your research for you.

For goodness sakes JP! Do you not know how to search for neonatal statistics? The stats quotes at 50% came from JEMS. It just took a few quick checks to see where he pulled that number from on the internet. I never made any direct statement as to where he got that information because JEMS was not part of the trial. Just look at the reputable neonatal websites and you can read all about neonatal stats. I also take NRP which is full of fascinating stats in the reference section that makes taking the course over and over again worthwhile as they are being updated as medicine evolves.

I'm not arguing about competence. I'm purely quoting from the AAP's website that you posted from, and I'm sure that the AAP can attest as to what their course does an does not do. Again, "Completion of the program does not imply that an individual has the competence to perform neonatal resuscitation. Each hospital is responsible for determining the level of competence and qualifications required for someone to assume clinical responsibility for neonatal resuscitation" is a direct quote from their website, and not something I just made up on the spot.

http://www.aap.org/nrp/about/about_coursedescrp.html

Like ACLS or any cert class on has to realize its limitations. However, if you do not put forth ANY effort to acquire at least the bare minimum of training, how can you even justify being capable of handling a neonatal transport. This baby did not get intubated during resuscitation. If a company wanted their employees to do neonatal IFTs, they should have seen that they got the training by whatever means. Bashing NRP still does not make it right. As least the NRP would show they put forth some effort if they can not come up with any other proof of competence. Also, when you do get the chance to take NRP you will find they make the same disclaimer as any other cert makes like ACLS or PALS. It does NOT replace proper education and training. If they had actually taken the NRP, they might have known this and realized their limitations.

I enjoy how you talk about physicians coming into contact with these patients because EM physicians are not working in areas where they regularly come into contact with these patients.

Some physicians are better than others. Quite possibly if another physician has been on during this particular incident, the outcome might have been much better. I do many specialty transports from these little hospitals and I do find most doctors are not stupid. They also seek out advice from the higher facility and now for neonatal transports, the receiving doctor at the higher level of care will be deciding who and what is needed. This change came from the lesson learned from transport disasters like this. If you advocate for a system that continues to fail and just want to make excuses, other ambulance personnel will be put into the same position. Realize the mistakes and move on with proper education and communication with your medical director.

So... alphabet soup courses are all the same except when it comes to this one course? Even though the people running the course state otherwise?

See my previous comments about certs.

The GP vs OB is a non-sequitar since there is no OB present. I checked Bert Fish's physician directory on their website. They don't even have an OB on staff. Hence it is an apples to oranges comparison. What I'm arguing is that the hospital isn't some sort of magical fairyland where every service is always offered, of procedure atrophy doesn't apply, and every piece of medical equipment ever made is readily available. I guess we could be making the argument that how dare that hospital not have a NICU and labor and delivery services. EMS loves saying, "Any port [ER] in a storm," but sometimes that means you are the Exxon Valdez in Valdez harbor. I'm also arguing that if the clinical assessment was that the patient would be able to make it through the transport without problems, then that's what you work off of.

Not everyone, but enough that OB services in many parts of the country are hampered because of a lack of OBs willing to practice there. Sure, it might not be 100%, but it doesn't have to be anywhere close to that.

EMT-Bs deliver babies. Mothers deliver their own babies. However, the mother is just part of the equation and in no way is a preemie self sufficient unless someone can provide the minimum comfort. I am repeating myself but EDs in the U.S. have a pedi/neo code cart, warmer, infant ventilator and a variety of staff that can offer some level of expertise in their own specialty be it lab, nursing or respiratory. S.T.A.B.L.E. is also taught at the hospitals in that area and this is something that EMS providers generally are not aware of. And AGAIN, we do neonatal transports from these little hospitals with very few problems that can't be handled with doctor to doctor communication prior to our arrival. The babies will also do well provided there not other complications but I can tell you it is a very rare occasion we find a baby in an ED without an ETT and under a warmer. That is the bare minimum. Even when we go to less privileged areas both in and out of the U.S., certain minimums are done.

So, why do you feel it is safer for the baby, mother, EMS providers and the public to have an ambulance running L&S for almost 70 miles without someone who can intubate a baby to provide oxygen and provide adequate warmth? If the hospital stuck by a decision not to transport with the local ambulance because they were calling specialty teams, there is still a chance they would have been sued but by showing the ambulance was not capable of providing a safe transport alternative, their damages would have been less. The ambulance had good reasons not to accept.

Sigh... Yea... because I'm the great Defender of the EMS Faith who has never, NEVER criticized EMS education. Yep... that's me. :/

Then you should realize that defending mistakes made by the ambulance only justifies they have all the training they need and there is nothing more they should do to improve patient outcome.

Arrogance should not replace education and ignorance is not a good defense. The hospitals and physicians knew where they screwed up. This ambulance service should have realized their limitations and had their medical director be more proactive for them to prevent them from being placed in this situation. It is not like there were no other transport teams and those with access to helicopters that could have at least provided someone who could establish a neonatal airway. There is also a good chance if that mother delivered in that ED that someone would have been able to do ETI on a neonate and under a warmer. And again, if an advanced team felt it was unsafe to move the patient, they would have remained until stable or additional resources could arrive. Any other health care professional would be held accountable and if they accepted something they were not qualified for, they would have to answer for it and why they made the decision. Why should EMS be the exception?

So JP, when you become a doctor, are you going to pressure EMT-Bs and Paramedics to accept transports that put them outside of limitations? Are you still going to rely on L&S and a real fast ambulance ride to get critical patients from point A to point B?

No, but if I use this as precedent, then I shouldn't accept care of a patient at a SNF suffering from any life threatening emergency.

Do you also not have the ability as an EMT-B to call for ALS? Hasn't this been discussed over and over on these forums? Again, there is also a difference between some adult airways and that of a neonate. The adult can be managed by BVM. However, the 25 week neonate that is coding requires an ETT. You may not have enough education in this area to understand this which is also what happened in this situation.

I also find it absurd that I am being criticized for explaining changing that have evolved from mistakes made or that I am suggesting some should know their limitations while establishing a line of communication with their medical director. I also find it unsettling that some would just let their emotions out weigh their common sense on an IFT to run with anything just because they think it sounds good without really understanding what they are getting into and the minimum that should be expected.

Edited by VentMedic
  • Like 1
Link to post
Share on other sites

So JP, when you become a doctor, are you going to pressure EMT-Bs and Paramedics to accept transports that put them outside of limitations? Are you still going to rely on L&S and a real fast ambulance ride to get critical patients from point A to point B?

Come on guys, let's keep this civil?

Take care,

chbare.

Link to post
Share on other sites
So JP, when you become a doctor, are you going to pressure EMT-Bs and Paramedics to accept transports that put them outside of limitations? Are you still going to rely on L&S and a real fast ambulance ride to get critical patients from point A to point B?

Come on guys, let's keep this civil?

Take care,

chbare.

Do you not think that is a valid question since JP may be in that position some day?

I have worked several areas in healthcare. I have moonlighted in those little EDs when a mother comes in ready to bring out a preemie into the world. I have been in a major medical center where ambulance crews have ran in with L&S where they are limited to even fixing an occluded IV line. The pumps were also set up by an RN who is trusting the patient will arrive safely or he/she may be drug into a bad mess. Truly not a good situation for all involved. I have seen an ICU attendings and ED doctors throw out a CCT team that failed to bring in their cardiac monitor or even O2 and continue care until a more appropriate team can be found or staff to send. I have been questioned without mercy about my qualifications by doctors before they have allowed me to transport a critically ill patient and I am not in the least offended. Many times RNs and RRTs as well as the MDs have asked for some guidance from the statutes and lawyers as to where we stand if care is released to a crew that is not properly trained or equipped. How many times have we "made do" with what is right there rather than make special arrangements? How many times have you known on a transport you will not have a chance in the court room with any defense if something happens during that transport? How many times have you been pressured by a physician to do something that is out of your scope of practice? The Medical Director of an ED just recently caught one of his doctors allowing an EMT-B student to intubate. That physician will be reprimanded and the school that the EMT-B attends may be on probation. In the doctor's defense the EMT-B student did not make it clear what type of student he was and what his skills consisted of. However, the doctor also did not make it a point to check. Two wrongs do not make a right.

If a physician gives you an order for a medication dose that could be lethal, do you blindly follow orders? What do you do if the doctor orders or pressures you into doing something you know is not correct?

Will JP realize since he is arguing there is nothing wrong with an unqualified team taking a mother and neonate? He may also have done this himself so would he expect the same from other EMT(P)s when he is a doctor? I do believe that is a valid question.

Furthermore, are paramedics in Florida allowed to intubate newborns? If so, then why is it inconceivable that the transferring physician expect that the paramedic can perform to his scope of practice?

This comment by JP is probably the most misunderstood by many and it is frightening. I believe I may have also mentioned it earlier as well and am again repeating myself.

Because it is allowed in your scope of practice does not necessary mean you have been properly trained or educated to do so. RSI might be allowed by your state but does that mean every Paramedic is competent to do RSI. Just having it as part of your state scope does not make you competent. Some Paramedics many never do or even see a live intubation on any age before they graduate from Paramedic school. The Paramedic should know their limitations. One should take professional responsibility for skills and knowledge expected of you. It would also be in the best interest of the patient to inform those trusting you of your limitations will not enable the physician to make a more informed decision about the proper transport.

I saw this on another forum. There's some good info here especially about thermoregulation.

http://www.babyfirst.com/

Edited by VentMedic
Link to post
Share on other sites

It's going to be a long while before JP is independently making those decisions. You always contribute so much and I appreciate your involvement and discussions, but JP will have many years and a whole lot of experience before making these decisions, so it's kind of a cheap shot throwing out that question.

Take care,

chbare.

Link to post
Share on other sites
Guest
This topic is now closed to further replies.

×
×
  • Create New...