In Jan. 15 EMS personnel from the Fire Department City of New York (FDNY) EMS deployed to Port au Prince, Haiti, as part of FEMA’s New York Task Force 1 (NYTF–1) team to assist with a 10-day search-and-rescue effort.
"I have a newfound respect for victims of disasters," says FDNY EMS Lieutenant Rafael "Ralph" Goyenechea, EMT-P, a FEMA medical specialist. "I have responded to many disasters—for example, Hurricane George in the Caribbean, the 9/11 attacks in New York City—but this involved an entire country. Haiti is a poor country, and their infrastructure was almost non-existent prior to the earthquake. This has left them with less than nothing, if that is possible."
Goyenechea and five other FDNY EMS providers traveled to Haiti as part of NYTF–1, whose mission was to rescue victims and render medical care.
"The most common medical issue we treated was dehydration—particularly in rescuers," explains Ian Swords, EMT-P, a lieutenant/EMS Haz Tac training officer, FDNY EMS, and FEMA medical specialist. "The oppressive heat and humidity took its toll on our members. Dehydration was also the primary issue with the patients we rescued. Other than that, we treated abrasions and minor soft-tissue injuries."
In Haiti, NYTF-1 separated into two operational teams—the red team and the blue team. "The medical breakdown was one physician medical manager and two medical specialists per team," says Swords. He was on the blue team, which operated primarily during the daytime. "We assembled for a briefing early in the morning, and we would respond to areas as requested by the United Nations’ command staff."
Seven days after the quake, Swords was on scene for the rescue of two children. "It was truly amazing, and it is hard to describe the feeling my teammates and I had. Here were two children who were trapped—pushed up against their dead siblings—only to be miraculously rescued with no apparent injuries. We treated them both for dehydration."
Goyenechea, who was on the red team, patrolled at night. On his first night in Haiti, the team was called to a grocery store. "It was more of a four-story supermarket that had collapsed in a nearly perfect pancake pattern. As victims were found—three total—they were quickly evaluated medically," he explains. "The two most memorable rescues I saw that night was the seven-year-old who was pulled out in what appeared to be in very good condition. The second was the last victim we pulled out: She had been trapped for about 96 hours and had pain to her lower extremities with no obvious deformities. This patient had been found in a sitting position, unable to move throughout the entire ordeal."
As they transported her to the U.N. hospital in an open, flatbed pick-up truck, Goyenechea and his colleagues administered fluids to the patient. "By then it was daylight, and it was my first time actually seeing the devastation in the sunlight," he explains. "What I saw I will never forget: a grateful patient holding my hand—she would not stop thanking us throughout the entire time, and the total devastation of everything. Not one building standing without damage. People living in the streets under makeshift shelters. Burning trash. Bodies covered in sheets along the sidewalks."
The team found medical supplies mostly abundant in Haiti. NYTF–1’s base of operation had a complete supply of medical equipment, including a full pharmacy, and airway equipment, including advanced trauma life support equipment. "We also had critical care equipment, such as ventilators, IV pumps," says Swords. While in the field, each medical specialist and physician carried a Stomp backpack containing a full ALS kit. In addition to this backpack, each person in the field had a fanny pack set up with basic bandaging supplies, IV start kits, and so on. They also had a mobile blood analyzer to assess blood lab values in order to treat crush syndrome appropriately and a cardiac monitor and oxygen at all times.
Of his deployment to Haiti, Swords says, "Humbling. That’s the best way to describe my Haiti experience. It helped me realize how good life here in the U.S. is." —Lisa Dionne
NREMT Investigates Allegations of Testing Irregularities
In April 2009, the training division of the District of Columbia Fire and Emergency Medical Services (DCFEMS) informed the National Registry of EMTs (NREMT) of cheating allegations during administration of exams. Such a breach could threaten the public’s trust in EMS care delivery.
DCFEMS and the District of Columbia Metropolitan Police Department initiated independent investigations and immediately notified NREMT, at which point they became involved. A report by NREMT staff obtained by JEMS outlines the extensive examination of the allegations by the fire department’s internal affairs division, the police department, Pearson VUE (the NREMT examination delivery contractor) and the testing venue.
The investigation concludes that no exams were compromised and no one passed the test through unfair advantage. To arrive at this conclusion, NREMT looked at the time each test taker took to answer each question. A long answer time could indicate the test taker used reference material to look up the answer. With one exception, all the DCFEMS EMT candidates fell within the national mean time for answering questions. One person took much longer during the first attempt to pass the test, but cheating is unlikely, because they failed the test. The candidate subsequently failed the exam two more times.
The computer adaptive testing (CAT) Pearson Vue administers for DCFEMS is generally resistant to cheating because of the large bank of test questions, which serves as the source for questions that make up an individual test. No two candidates’ tests are identical, so glancing over to see another computer screen is useless. Also, subsequent tests a candidate might take for certification will have no questions from previous tests the candidate has taken. Even if a candidate had access to the bank’s 1,500 test questions, it’s unlikely anyone could memorize all the questions and their answers.
"This is the first time this has come up since we moved to CAT in 2007," said NREMT Executive Director Bill Brown, Jr. He added that NREMT feels no need to make any changes in procedures. DCFEMS did not respond to requests for comments. Read the full report at jems.com/bonus.
‘Father of Atlanta EMS’ Dies
Judge Arthur M. Kaplan, also known as the "Father of Atlanta EMS," died on Jan. 1 at the age of 84. Kaplan was a municipal court judge by day, but he rode the streets of downtown Atlanta evenings, nights and weekends as Rescue 10—his own car, which was a fully equipped first responder unit. He was an honorary police major who devoted his life to training police, fire and EMS personnel, along with serving the citizens of Atlanta.
While teaching nursing students first aid at Grady Memorial Hospital, he realized there was no organized entity of first responders within the city. He then began to train Atlanta’s police in EMS along with members of the FBI, Secret Service, Atlanta Fire Rescue and numerous others in government and private organizations. It’s estimated he taught more than 15,000 people and responded to more than 30,000 calls. Kaplan received countless awards, including one for saving a DeKalb County (Ga.) police officer who had been shot.
"He was bigger than life as a judge, EMS leader first responder, educator and role model," said JEMS Editorial Board Member Corey Slovis. All of us should try to live up to his standards."
Who’s in charge here?
This month’s column addresses the age-old "who’s in charge" question. If an ambulance crew is comprised of an EMT and a paramedic, is the paramedic always legally responsible for all patient care issues? And, if so, is this true for strictly BLS calls?
In medicine, many states follow the so-called "captain of the ship" doctrine, a common-law rule that holds a surgeon responsible for any and all negligent acts or omissions that occur inside the operating room, even if they were someone else’s fault. However, we’re unaware of any cases that have expressly applied this same doctrine to a paramedic in the ambulance. Therefore, a court properly applying principles of negligence law would be compelled to judge each member of the crew, and the ambulance service, by the standard of care applicable to them. That is, the paramedic and EMT must each act as would a reasonably prudent paramedic or EMT, respectively.
Although it’s generally considered to be within the standard of care for a paramedic to perform an assessment and then transfer the care of a patient to a BLS provider for transport after determining no additional monitoring or ALS interventions are necessary (even Medicare has adopted this rule in its ambulance reimbursement policies), that doesn’t mean the paramedic is off the hook for all legal responsibility. First, the paramedic can be legally liable if their decision to transfer care to the EMT was negligently made and the patient suffers harm as a result.
On the other hand, if the paramedic acted reasonably in transferring care to the EMT, and the EMT becomes the primary caregiver, then the EMT is responsible for upholding the standard of care applicable to an EMT. If the paramedic is driving the ambulance and the EMT is providing care in the patient compartment, the paramedic wouldn’t ordinarily be responsible for the EMT’s negligent acts or omissions, unless the paramedic knew or had reason to know of them and took no action to prevent harm to the patient.
All of this means that when an EMT is acting as the primary patient caregiver, he is "in charge" of patient care. When a paramedic is the primary caregiver, then they are "in charge." If an EMT and paramedic are jointly providing care, then ordinarily the paramedic is "in charge," although either or both would be answerable in court if they violated their applicable standards of care. And remember, we’re addressing who’s in charge of patient care. Follow your local or state policies or protocols regarding overall incident command when it comes to your emergency operations. Of course, these are general legal principles, and how the law might be applied in any particular case can’t always be predicted. Paramedics and EMTs can best prevent legal liability by ensuring that they always work together as a team in the best interests of patient care.
Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth ofPage,Wolfberg & Wirth LLC, national EMS-industry law firm. Visit the firm’s Web site at www.pwwemslaw.com for more EMS law information.
San Diego Seeks to Set CPR Record
Between 50 and 100 San Diego Fire-Rescue Department uniformed personnel will participate in what’s expected to be the world’s largest public CPR training program in December. The program will be conducted in connection with ECCU (Emergency Cardiovascular Care Update) 2010 in San Diego.
Maureen O’Connor, public access defibrillation project manager for San Diego Project Heart Beat, says half-hour training sessions on hands-only CPR and an introduction to AEDs will be conducted in Balboa Park on December 10–12. Training will also be conducted on the flight deck of the USS Midway Museum. O’Connor expects as many as 5,000 citizens will attend the Midway training.
To commemorate CPR’s golden anniversary, ECCU plans to train as many as 10,000 people and surpass the 4,626 people trained in Arlington, Texas, in November 2009, as well as make it into the Guinness Book of Records.
‘Chronicles of EMS’ Debuts
O’Connor says the event will be family-focused. "A five-year-old can learn to operate an AED." Although a child that young may not have the strength to achieve good compressions, creating a memory of CPR at that age may make them more likely to administer CPR once they’re big enough to do it effectively.When U.K. paramedic Mark Glencorse(pictured at left) met California paramedic Justin Schorr(at right) via their EMS blogs, they decided to take things offline—to the streets of San Francisco and the U.K. They embarked on a cultural exchange, in which Medic 999 (Glencorse) learned about EMS American style at Schorr’s (Happy Medic) San Francisco Fire Department. When documentary filmmaker and Thaddeus Setla, NREMT-P, and Chris Montera, NREMT-P, who owns and hosts the popular weekly EMS Garage podcast, got into the mix, "Chronicles of EMS" (CoEMS) was born. BBC was originally set to film the reality series, but when they backed out, Setla Film Productions took on the project. The result debuted Feb. 12 at the Hotel Frank in San Francisco to an enthusiastic audience. CoEMS was always intended to be a highly interactive vehicle, and the group plans to keep the level of interest by soliciting feedback on episodes from viewers via Facebook and Twitter. The premiere episode finds Glencorse confronting language barriers, which are less common in the U.K., and patient concern over the cost of care, a non-issue in his home country, where medicine is socialized. Watch it and other episodes, and provide your feedback at www.chroniclesofems.com. Also, read Happy Medic’s blog at http://happymedic.com and Medic 999’s at http://999medic.com .
New AHA pediatric emergency cardiovascular care courses: http://americanheart.org/cpr
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