SAN ANTONIO, Texas -- A San Antonio paramedic was complying with his training, and not the department's operating procedure, when he moved on to treat other victims at a head-on collision last month without checking the vital signs of a woman with critical head injuries, the president of the city's fire union said late Wednesday.
According to the city's current medical operating procedure, paramedics are required to check vital signs.
But Chris Steele, who heads the San Antonio Professional Firefighters' Association, said paramedics are taught in class that if victims have "massive brain injury or massive trauma, those patients have near zero survivability." In those instances, "you should not need to check their vitals. They are deceased."
"It's contrary to the written standard manual of operating procedures," he said. "But that is what our guys are taught."
Mike Gardner, a paramedic with five years of experience with the Fire Department, was barred from working as a paramedic in San Antonio this week after the Dec. 16 incident where he initially thought Erica Nicole Smith was dead. Two hours later, a medical examiner discovered the 23-year-old was still breathing, and she was taken to the hospital. She died there the next day.
Dr. Donald Gordon, the medical director for the city's Emergency Medical Services, who has authorized the department's operating procedures for the past two decades, could not immediately be reached for comment. Fire Chief Charles Hood also did not return messages left on his cell phone.
But on Tuesday, Hood said medical protocol was "definitely violated in this instance" and called Gardner's decision an "error in judgment." On the day after the accident, he told the Express-News that the paramedics had sought Smith's pulse but could not find one -- a statement he later characterized as an assumption because he said checking vital signs is standard operating procedure.
Gardner and his partner, Michael Collins, were the first to arrive at the Loop 410 accident scene at about 4 a.m., Steele said. Gardner checked on Smith, who was the front-seat passenger of the Accord, and "made the decision that she would be a black tag," or deceased. Steele said part of Smith's brain was on the dashboard.
"If people see what we saw, they will understand what we did," Steele said.
Also inside the car were Sabrina Shaner, the driver, and Amber Wilson, a backseat passenger, both 22. Jenny Ybarra had crashed into their Accord after veering into oncoming traffic; later, the 28-year-old was charged with intoxication manslaughter.
Because only two paramedics were on a scene with four patients, Gardner had to "black tag that and check on the other patients," Steele said. "When you have more patients, you treat the most treatable."
He said Gardner saw camera crews set up near the accident scene and decided to place a yellow blanket over Smith because "he didn't want the television to show the state she was in."
Another pair of paramedics, William Bullock and Jeremy Huntsman, soon joined him and Collins and they treated Shaner and Wilson, who were both taken to the hospital with minor injuries.
But Steele said, "We're not going to make any excuses. ... I just think it's necessary for everybody to understand that some of the responsibility for this needs to be borne by the medical director."
Specifically, he said the four paramedics erred and should have returned to Smith after the other patients were transported to ensure that she wasn't alive. Collins, Bullock and Huntsman were also deauthorized from practicing as paramedics, although not permanently.
"But that's why I think it should cause some concern," Steele said. "Nobody else checked the pulse either, because that's what they were trained to do."firstname.lastname@example.org