Friday, May 8, 2009

Protocol Variation

While working alongside my supervisor one evening, we caught a call for a motorcycle accident on one of the high speed intrastate highways going through our city. Dispatch gave no other information but did state they were receiving multiple calls on this accident. Now, when dispatch is advising multiple calls then you can pretty much assume that there is definitely some validity to the call and that things aren't going to be pretty when you arrive.

Pulling up on scene, I immediately noticed what used to be a crotch rocket type motorcycle that had disintegrated into many, many pieces strewn along the highway and a body lying face up on the edge of the highway next to and parallel to a guardrail. Approaching the patient, I saw that he was wearing all of his protective clothing along with a full face shield helmet. I also saw that the protective clothing had done him absolutely no good as there was major trauma that is incompatible with life to the patients thorax area. There was also blood spray going along the guardrail for what seemed like 50 feet.

A witness stated that the motorcyclist appeared to be racing another motorcyclist (that did not stop) and had passed her vehicle at an extremely high rate of speed and that when she rounded the curve there was just dust and debris flying through the air. This witness estimated the motorcyclist traveling at well over 100 mph.

Approximately 1 month prior to this event, we had one of our employees and a supervisor respond to a vehicle accident that involved "2" fatalities. On arrival, they found that a vehicle had stopped on the side of the road after going through a toll booth to adjust the tie down straps on his trailer and while doing this a DUI driver came through the toll booth and struck the rear of the trailer and the patient that was adjusting the straps on the trailer was cut in half and the top half of him was thrown through the windshield of the pickup truck that struck them containing the DUI driver. The Paramedic unit and Supervisor unit pulled up and one of the Paramedics walked over to the pick up truck, saw the DUI driver covered in blood and unconscious. He then noticed the other party next to her in the truck had been cut in half and was also unconscious and obviously deceased. The Paramedic then called Medical Control, advised them he had two fatalities, and received an official time of death. He then asked the engine crew to cover up the vehicle with a tarp so bystanders would not witness the grisly scene as they passed through the toll booth. He then placed his unit back in service and proceeded to the local hospital to get some supplies.

After arriving at the hospital, he gathered his supplies and was chatting with the nurses and physician on duty. Approximately an hour had elapsed since he received the official time of death from Med Control and he was dispatched back to the scene for a patient that was no longer deceased involved in the MVC. He arrived and was informed by the State Police Traffic Reconstruction Investigator that while he was marking the roadway he heard sounds coming from underneath the tarp. He lifted the tarp and the DUI driver looked at him and asked if he could help her get out of the vehicle. Now, I would of loved to see the look on the Troopers face when this occurred, it had to be priceless. The Trooper stated that when he arrived on scene he looked at the bodies and also determined they were dead as neither was breathing and because of the massive amount of blood present on both patients (not to mention one of them was cut in half). So the Paramedic proceeds to treat the now living patient and she was flown to a Trauma Center for treatment and eventually ended up making a full recovery. After she was released from the hospital, she sued for the false declaration of death and delay of treatment. Because of this incident, we now had a new protocol that stated we had to confirm all deaths via EKG (3 leads), regardless of circumstances.

Now back to my original story, I felt that background information was necessary before I continued.

So there I am looking at a patient whose insides were now on the outside and I was having trouble with deciding where to place the leads of the monitor so I could get a good Asystole rhythm and declare this patient DOA. I then decided to call Med Control and get a variance of our NEW policy and the conversation went like this:

(Med Unit) Med 302 to KGH ER
(ER) Med 302 go ahead
(Med Unit) I need Doc please for protocol variance orders
(ER) Doc 119 standing by
(Med Unit) Good evening Doc 119, I am on scene with an early 20's year old male that was involved in a high speed MVC while riding a motorcycle. Patient has injuries incompatible with life and is pulseless and apneic (not breathing at this time). I am requesting variance orders to not apply EKG at this time for confirmation of death as I can assure you patient is deceased and his heart is definitely not beating.
(ER) Med 302, how can you confirm this without an EKG?
(Med Unit) For starters, I see the patients heart laying in the roadway beside his right ankle and it doesn't appear to have any electrical or mechanical activity at this time.
(ER) *radio keyed up.....long pause.........variance granted!

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