Friday, May 6, 2011

KCFD EMS: More Questions Than Answers

The report last night by Dana Wright of KCTV5 raised a lot of questions and did not provide a lot of answers surrounding an incident that happened this past January. A patient died during a transfer trip from St. Luke's Northland to St. Luke's on the Plaza and the report raises questions about the quality of care that patient received during the trip from one hospital to another. Just a few quick impressions and thoughts.

A transfer from one hospital to another can be an emergency trip or not. Typically hospitals transfer patients they are unable to provide optimal care for, either because they simply do not have that ability to do that type of care or they are out of room. Transfers to specialities such as cardiac care, trauma or psychiatric care are common. Most transfers can be done non emergent. Some are "non-emergency without delay"--a wonderful phrase from the KCFD dispatch center that describes the middle zone. Of course, some are flat out emergencies. The transferring hospital will tell the EMS provider what is needed for the patient: an EKG monitor, oxygen, IV medication and/or fluids infusing, restraints or no equipment other than the cot. There is a concomitant elevation of monitoring--those more urgently ill will be placed on a heart monitor, with oxygen saturation measurements and perhaps BP checks.

During the report the phrase "just inches away" is used with reference to the medic "teching" or attending to the patient during the call. It could be inferred by this that the medic was not sitting in the back with the patient. During an interview on KMBZ radio this morning reporter Wright made it clear that the medic was sitting in the back with the patient. They were in the seat that is behind the patient's head--the seat looks at the back door of the ambulance, just as the patient does. I am not sure of the exact layout of the KCFD ambulances--exactly how far this seat is from the patient, or what kind of sight lines the medic had--some of that would be dependent on the medic's stature. A shorter person would have to likely shift position to get a really good look at a patient lying on the cot, especially if the head of the cot is elevated 30 degrees or greater. Yet in a way this is more troubling; if the medic was in the "box" with the patient, did he/she just miss the change in condition during the blizzard prolonged drive?

The second part is tonight, with the reporter talking to the medical director for the KCFD EMS. Now we get down to it--has there been a change in the expected standard of care since the city took over or is this event a sad outlier, a one-off, that with proper problem solving will not happen again?

Update: This comment I posted on Tony's Kansas City about sums it up. I haven't seen the second part of the report yet. We'll see what sort of stuff gets stirred after that airs.

The real question: Is this a one time event or an overall trend? How is the care given by the KCFD in terms of quality--better than MAST, the same as MAST, worse than MAST?

In the meantime, the fire department needs to man up and take responsibility and then do the things needed to make sure that this never happens again. Because this sure was a crappy unacceptable outcome.

5/6/11 3:22 PM


Bob G. said...

There seems to be a bit too much "odd" about this to NOT warrant several levels of investigation.
You make some fine points, however.

Personally, I don't think that ANYONE being transported in the back of the ambulance for ANY reason should ever be "alone"...even a cadaver.

But, I don't know the levels of protocol that are found in the "box" these days, and it may differ from one area to another.

Good post.
Can't wait to see the outcome.

Stay safe out there.

The Observer said...

Bob G:
Shit storm coming, no doubt about it. The entire structure may be rethought and the EMS separated from the fire department. Or not.

First mess for the new mayor, beyond the chronic messes that he has already encountered.

Now, it could disappear after this flurry--we'll have to see.

I'll have commentary but running out of internet time now.

Thanks for the visit.