JEMS.com -- There are some interesting stories and links related to the EMS response to Michael Jackson's cardiac emergency on Thursday.

TMZ is reporting that first arriving responders felt that Jackson was dead on arrival, but Jackson's personal doctor would not permit them to pronounce him dead.

The 911 called was released Friday afternoon with the caller reporting that Jackson was on a bed, not breathing and that a doctor was already attempting CPR. The caller says repeatedly Jackson was not responding to anything. "We have a gentlemen here, who needs help ... he's not breathing, we're trying to pump but ... he's not breathing." the caller says, not identifying Jackson by name. "He's unconscious."

"The LAFD received a 911 call for a 50 year old male who was not breathing and unresponsive. Engine 71 and paramedic rescue ambulance 71 responded and was on scene within a few minutes," Marc Eckstein, MD, MPH, FACEP, Medical Director of the Los Angeles Fire Department, told JEMS.com. "They found Mr. Jackson in full cardiac arrest with CPR in progress."

"LAFD members immediately took over CPR and intiated both basic and advanced life support interventions," Eckstein continued. "They aggressively attempted resuscitation on scene for approximately 30 minutes, and after consultation with on-line medical control at the UCLA base station, they continued resuscitative efforts during the short transport to the UCLA emergency department. There was no change in the patient's status during his prehospital course."

TMZ's report said there was evidence someone had been performing CPR for "quite some time" and possibly evidence of Lidocaine being administered. "He's pumping on his chest, but he's not responding to anything," the caller says as the 911 operator indicates help is on the way and instructs the caller to move Jackson from the bed to the floor.

Several videos and photos of the EMS units in action have been circulating online, including the video below of LAFD's Medic 71 and its Engine Company transporting the scene.


Oddly, at the end of the video, a bus full of tourists seeing star's homes drives by and is held up as the ambulance leaves the scene. Video shot by those tourists is posted on TMZ.com as well.

One of the most graphic photos showed up early on Entertainment Tonight's Web site, showing EMS crews working on an intubated Jackson in what appears to be the back of the paramedic unit. (Link Here -- Note this is a graphic photo OF a patient We are providing a link to this photo as it has appeared on major media for the last 24 hours). Based on other video, the photo was likely taken as the unit backed out of the driveway.

In the photo, medics can be seen doing compressions and ventilating Jackson. While this is an extreme case, it is always important to remember that cameras are everywhere now and while you may protect your patient's privacy, the public (and media) may not.

The Associated Press reported that medics tried to resuscitate Jackson for nearly three-quarters of an hour, then rushed him to the hospital, where doctors continued to work on him.

As for the doctor, he is being sought for questioning but is not a suspect in any wrongdoing at this point, according to multiple media reports. The Jackson family and others had been reported as being concerned about a possible overdose of prescription drugs. An autopsy was underway Friday.

Our friends at STATter911.com note that the pictures circulating of Medic 71 are making it the most famous ambulance in the world.

911 Call in Michael Jackson Death Released

By RAQUEL MARIA DILLON
Associated Press Writer

LOS ANGELES -- A 911 caller seeking help for Michael Jackson told an emergency operator that only a personal physician had seen what happened, and an ambulance was urgently needed because resuscitation efforts weren't working.

The Los Angeles Fire Department on Friday released a redacted audio recording of the call made Thursday by a person who only referred to Jackson as a 50-year-old man. It appeared that a mention of the phone number was deleted from the recording.

"I need an ambulance as soon as possible, sir," the caller said urgently but politely. "We have a gentlemen here that needs help and he's not breathing yet. He's not breathing and we need to _ we're trying to pump him, but he's not, he's not."

The caller reported that Jackson was on a bed and the emergency operator began to instruct him to do CPR, but stopped when the caller said that the personal physician was there.

"Oh, OK. We're on our way there. If your guy is doing CPR and you're instructed by a doctor, he's a higher authority than me. And he's on the scene," the 911 operator said.

The operator asked if anyone witnessed what happened.

"No, just the doctor, sir, the doctor was the only one there," the caller said.

"Did he see what happened?" the operator asked.

"Doctor, did you see what happened, sir?" the caller asked someone in the room. Only an urgent mumbling can be heard on the recording.

"We're on our way. It's less than a mile away from Cedars," the operator said, referring to Cedars-Sinai Medical Center.

Paramedics, however, took Jackson to Ronald Reagan UCLA Medical Center, where he was later pronounced dead.

Tags: 911 call, michael jackson

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Anna, we have linked (and clarified that the photos are graphic) to a photo that is already very widely posted across the internet. This site is for EMS professionals, not the general public ... and the takeaway should be that the public is always watching (and taking photos) ... in this case through a closed ambulance door/window. There are lessons to be learned for all. There is value in understanding that even when crews think they are not being watched, recorded, etc. even on the most routine call, in these times they should expect that anything can end up online.

(Note: User appears to have removed original comment about link to the photo taken inside Medic 71)
Please don't be so naive.

Anna Bonner said:
I am really quite saddened that this forum of professionals would contribute to the distribution of photos of a patient. If this were to happen to any of our own patients, we would be outraged. Really JEMS? I thought you were better than this.
You do realize I removed that because it has my name on it. Thanks for reposting though. I just think it is wholly unprofessional and unethical. Just because others are posting it, doesn't mean you need to. You can make your point that people are always watching without providing access to the pictures.
Let's all remember that if I posted a photo similar to this anywhere online I would be fired and sued. This is unprofessional by the photographer and the media who choose to show it. I think having a link to it in this forum is simply hitching the cart to the publicity show.

I personally think moving a patient of this stature out of the home and into a more secure location, like the hospital, was a scene safety decision, and a good one.

But links to something like this on JEMS connect I think brings the forum down a notch. Will it also be the cover photo for the next JEMS magazine?

My 2 cents
Happy Medic
Sadly there are cameras everywhere now. People use them for all types of reasons. Which means we all need to be vigilant while working not only for our own protection but that of our patient. I don't agree that it was unprofessional for JEMS to post a link to the picture that is wide spread on the net. We would have found it anyway. If it was unprofessional then you could make the argument that all pictures of patients both critical and non were unprofessional to publish. I don't think that this was published with malicious intent but in an effort to educate which is what JEMS is in the business of doing.

I am more curious about the doctor on scene and some reports that the doctor "made" the paramedics continue to work him even though they wished to pronounce him deceased on the scene. I have the authority to pronounce patients on scene without a doctor consult. And a doctor on scene doesn't have the ability to dictate my care unless I work under his direction. But I am on the other side of the country. Are the laws in CA very different? Did the medics on scene have an obligation to work as the physician on scene dictated or was it more of a decision to reduce friction on scene?
Happy do you really think moving the body of a person of that stature is a really good idea? I would think that it would be more secure behind the gates of his home, inside and away from a bus load of tourists and paprazzi. Who as we have seen will go to any lengths to get a picture or clip. He could have been moved the ME's office on a gurney and covered. then all they would have gotten was pictures of the body bag and not the indignity of having CPR preformed for all the world to see. They weren't getting past those gates or those guards. The average ER is not very secure at all. No matter what they do to try and lock it down. The moving just allows for more picture taking. Hmm You have me thinking this will make a good blog post!

the Happy Medic said:
Let's all remember that if I posted a photo similar to this anywhere online I would be fired and sued. This is unprofessional by the photographer and the media who choose to show it. I think having a link to it in this forum is simply hitching the cart to the publicity show.

I personally think moving a patient of this stature out of the home and into a more secure location, like the hospital, was a scene safety decision, and a good one.

But links to something like this on JEMS connect I think brings the forum down a notch. Will it also be the cover photo for the next JEMS magazine?

My 2 cents
Happy Medic
We've added some additional information in the story from LAFD's medical director.

Good point on both sides of the photo debate. The entire situation is what is great -- and bad -- about the Web.
Is it me? Or does the 911 operator's professionalism needs a little tweeking? Not the best operator I've ever heard.
Dawn Burrows said:
If it was unprofessional then you could make the argument that all pictures of patients both critical and non were unprofessional to publish. I don't think that this was published with malicious intent but in an effort to educate which is what JEMS is in the business of doing.

Sure. I'll make the argument that publishing pictures of patients outside of educational materials is unethical without written consent. Just because it's widely available doesn't mean it should be published. In riot situations, if everyone is else is looting and the like, does that all of a sudden make it ok? When programs like TLC's Trauma or Paramedics tape patients, consent is given before those video are published.
What educational material is being passed on by the video of an ambulance backing out of a driveway or linking to a picture of Jackson being ventilated via ETT?
I am more curious about the doctor on scene and some reports that the doctor "made" the paramedics continue to work him even though they wished to pronounce him deceased on the scene. I have the authority to pronounce patients on scene without a doctor consult. And a doctor on scene doesn't have the ability to dictate my care unless I work under his direction. But I am on the other side of the country. Are the laws in CA very different? Did the medics on scene have an obligation to work as the physician on scene dictated or was it more of a decision to reduce friction on scene?

LA County EMS protocols:

Cardiac arrest:

(step 13 under asystole/PEA and step 21 for V-fib/Pulseless V-tac) If resuscitative efforts are unsuccessful, consider base contact for pronouncement.
http://ems.dhs.lacounty.gov/ManualsProtocols/SFTP/SFTP-CA.pdf

Physician on scene protocol:
http://ems.dhs.lacounty.gov/policies/Ref800/816.pdf
Heaven help our profession! The level of whining and hypercriticality in this post take it to a new level.

Unless you have evidence to the contrary, how about assuming (before you express your outrage) that:

1. The medics involved are professionals and did the best they could under the circumstances.

2. Circumstances, including celebrity, make things difficult.

3. When a person puts themselves in the public domain, they have a lesser expectation of privacy anyway.

4. Somebody took a picture - probably not an EMS person.

5. Once the picture is in the public domain, it's there. You can't un-ring the bell.

6. JEMS is here to educate us, about whatever goes on in our industry.

Yowzer! We are like a pack of jackals with a crippled wildebeast! Tear 'em to shreds without knowing all the facts.

Let's learn instead......
Hey Joe Thanks for posting those links. I always appreciate the ability to learn what it is like somewhere else. I stand by my position that it was not unprofessional to post that link. With the intent to educate us on how easy it can be for some people to violate the inside of our trucks, I think JEMS was within their rights and we should take it as lesson learned.

Skip,
I am not sure if you are referring to my posts or not. If so I never intended for the impression that I was critizing the medics. We all make difficult decisions while in the course of our jobs. I don't fault them for any of the decisions that were made. I may have made some of the same ones if put in their place. I was more curious about the role that an on scene doctor can play in the decision making processes and what the rules in CA were. Joe was nice enough to clear those up for me.

Skip Kirkwood said:
Heaven help our profession! The level of whining and hypercriticality in this post take it to a new level.

Unless you have evidence to the contrary, how about assuming (before you express your outrage) that:

1. The medics involved are professionals and did the best they could under the circumstances.

2. Circumstances, including celebrity, make things difficult.

3. When a person puts themselves in the public domain, they have a lesser expectation of privacy anyway.

4. Somebody took a picture - probably not an EMS person.

5. Once the picture is in the public domain, it's there. You can't un-ring the bell.

6. JEMS is here to educate us, about whatever goes on in our industry.

Yowzer! We are like a pack of jackals with a crippled wildebeast! Tear 'em to shreds without knowing all the facts.

Let's learn instead......
I took a class at an EMS Today conference (in San Diego and there were 65 attendees!). One of the presenters was an attorney by the name of Jack Ayers from Dallas(?). He made the point that when the feces strikes the oscillating device, rule one is "Speak first, Speak Fast, it is the only thing EVERYBODY (his emphasis) will remember." He added," Know what you are talking about."

Even in this topic seems like good advice to me. . .

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