SAN ANTONIO -- In the nine years he's spent at the University of Texas Health Science Center training people to become paramedics, Geof Smith has received plenty of calls from emergency responders seeking guidance from the field.
One such call Dec. 16 at first seemed routine -- an allegedly intoxicated driver traveling the wrong way on Loop 410 had collided head-on with a Honda Accord. The paramedic had a question about the injuries of the wrong-way driver.
Ten minutes later, Smith, who was on-call that night to respond to paramedics' concerns, got another call that transformed the incident into a shockingly personal one. Some injured people inside the Accord were insisting that they knew him.
"When that happened, I just about lost my mind," Smith said.
He rushed to Brooke Army Medical Center, where his goddaughter, Sabrina Shaner, 23, and her friend, Amber Wilson, 22, were being treated for minor injuries. Erica Smith, 23, another passenger in the Accord, arrived later with a severe head injury and died the next day.
Geof Smith, 40, said he had known all three women since they'd attended elementary school and had even been their youth pastor. An experienced paramedic, he'd also helped to train the four paramedics who responded to the crash. But the scope of the tragedy that unfolded when Jenny Ybarra, 28 -- who has since been charged with intoxication manslaughter -- allegedly veered across the highway had only just begun to reveal itself.
A cloud of controversy has since risen from the scene of the collision, enveloping the paramedics who violated protocol when they failed to check Erica Smith's pulse, leaving her unattended for more than two hours; Fire Chief Charles Hood, whose initial reporting of the incident to the media proved inflammatory and false; and Shaner, the Accord driver, who was charged Friday with driving while intoxicated.
Also swept into the controversy are fire union President Chris Steele, who has asserted that paramedics here are trained in certain instances that they don't initially need to check for patients' vital signs; and Donald Gordon, the Fire Department's medical director, who refuted Steele's claim.
Written protocol requires paramedics always to check for vital signs regardless of the severity of patients' injuries.
But Steele said paramedics have been taught that they can bypass that step in instances in which a patient appears dead and other patients require treatment. He said Erica Smith had suffered obvious, devastating head injuries, causing the paramedics to believe she was dead and move on to treat the other three victims in the collision.
Geof Smith on Sunday conceded that obviously fatal injuries could preclude checking for vital signs, especially in instances in which paramedics are overwhelmed. But he noted that four paramedics and four emergency medical technicians were on the scene of the collision and should have been able to assess Erica Smith, who suffered the massive head injury despite wearing a seatbelt and the deployment of the Accord's airbag.
The 20-year paramedic also insisted that he and other instructors at the health science center teach would-be paramedics to thoroughly assess all patients and that severe head injuries can be survivable.
"You never know," he said. "So we always preach and teach: You always have to be thorough, it's better safe than sorry, and we always err on the side of the patient. The guidelines are there for a reason. It's just easier to take the two minutes and go check."
Instead, Erica Smith was left unattended for more than an hour at the scene after paramedics mistakenly presumed she was dead. A medical examiner's investigator later determined that she wasn't, and the Texas State University senior was rushed to a hospital. She died the next day.
Steele has acknowledged that the paramedics erred when they failed to ensure that Erica Smith wasn't alive. The paramedics -- Mike Gardner, 35; Michael Collins, 39; William Bullock, 33; and Jeremy Huntsman, 30 -- were in the 21st hour of a 24-hour shift that began at 7 a.m. the previous day.
Gardner has been permanently barred from working as a paramedic in the city and transferred to the firefighting division. Collins, Bullock and Huntsman have been barred indefinitely and also transferred to the firefighting division.
Hood, Gordon and other city officials have professed bewilderment at the paramedics' decision not to treat Erica Smith.
For Geof Smith, as his own family grapples with the devastating effects of the wreck, he returns again and again to the same question: Why did four of his former students make such a big mistake?
"It was in the end of a 24-hour shift, it was 29 degrees and Erica had that horrible injury," Geof Smith said, only to falter at any understanding.
"Maybe I was on call that night for a very good reason. I just don't know what that reason was yet."firstname.lastname@example.org