San Antonio Official Says Vital Check is Taught - @

San Antonio Official Says Vital Check is Taught


Lomi Kriel | | Monday, January 14, 2008

SAN ANTONIO -- Contradicting the fire union chief, the medical director who oversees San Antonio s paramedics said Friday they are expressly taught to check the breathing and pulse of every patient, even if they suffer massive visual injuries and might already be dead.

Dr. Donald Gordon said that protocol was ignored in the case of Erica Nicole Smith, a 23-year-old crash victim with critical head injuries who went unattended by paramedics in December. Because of her state, they assumed she was dead and moved on to treat the other three patients in the wreck.

In his first public statements about the matter, Gordon called it an "unfortunate mistake," and said, "I don't have any logical explanation" for what occurred. "It shouldn't have happened."

Gordon's statements starkly contradicted the assertions of fire union President Chris Steele, who said earlier this week that Mike Gardner, the paramedic who first responded to the head-on collision, acted according to his training, and not the department's operating procedure, when he failed to check Smith's pulse after deeming her injuries at or near death.

Two hours later, a medical examiner discovered Smith was still breathing. She died at the hospital the next day. Gardner and three other paramedics at the scene who also failed to check her pulse were deauthorized as paramedics this week.

"It just astounds me that they abandoned all the principles of paramedicine and then say they're not taught that," said Gordon, who has authorized the department's operating procedures for the past two decades and oversees paramedics' training. "That's the protocol for all situations and it's something basic."

According to state-mandated protocols, Gordon said, paramedics trying to determine whether a patient is dead must first check respiration and circulation "before you look for major trauma as a reason not to work someone."

"I personally taught that myself," he said, adding he also met with all 13 training instructors recently and "none of them have ever trained anybody to do shortcuts. We train exactly what the protocols are."

He characterized the statements from Steele as a "personal attack," and likened it to "the batter striking out and saying, 'I struck out because I didn't see the ball.'"

But Steele ardently stuck by his statements Friday, saying he had received calls from at least 13 paramedics who said, "This is what we are taught. We heard it from (Gordon's) own mouth."

On Wednesday, Steele said despite written protocol stating otherwise, paramedics are taught not to initially check a person's vital signs in an emergency situation if the patient suffers extreme visual trauma or brain injuries. That person has "zero survivability," Steele said, and is essentially already dead. Paramedics are supposed to return to the patient after others with higher chances of survival have been treated.

In the Dec. 16 incident, Steele said Gardner and his partner arrived first and found Smith in the front seat of an Accord with large-scale injuries, including brain matter on the dashboard. Gardner and his partner tended to the other two victims in the car before the second pair of paramedics arrived.

One assisted them, while the other treated the driver of the car who had veered into oncoming traffic on Loop 410 and crashed into the Accord. Jenny Ybarra, 28, was later charged with intoxication manslaughter.

But Gordon said the scene wasn't a triage situation, where there are more injured persons than available paramedics. Aside from Gardner and his partner, Gordon said initial responders also included at least three firefighters who are trained in basic EMT skills and could have checked Smith's pulse.

Even in triage situations, Gordon said paramedics are required to check for breathing and circulation, "way before you hang a black-tag on somebody," or declared them deceased based on their visual injuries.

Steele countered that none of the seven emergency responders thought to check Smith's pulse.

"That nobody did, should be indicative of a systemic issue," he said.

Because a fire/EMS dispatcher miscoded the accident, no supervisor arrived at the scene. Neither did any of the paramedics or firefighters involved notify his superiors or the on-call medical director a development that should have occurred.

Also on Friday, police charged Smith's friend and the driver of the Accord with driving while intoxicated. Sabrina Shaner, 23, was jailed on a $12,000 bond.

Through a grand jury subpoena, detectives requested Shaner's medical records from Brooke Army Medical Center, where she was treated after the wreck and where her blood was drawn as part of standard procedure. Her blood alcohol level was 0.13, nearly twice the legal limit, according to an arrest affidavit.

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Related Topics: Industry News, Legal and Ethical, Medical Emergencies, Patient Management, Training

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