http://www.jems.com/video/news/maryland-firefighters-paramedics-hon...

Firefighters were recently given an award for tranporting a five-year-old girl on a fire truck.  She reportedly went into cardiac arrest during an asthma attack, and CPR was preformed during the transport.  The ambulance's ETA was 5 minutes from when they made the decision to transport.  The patient survived with no deficits. 

 

Is this a good idea?  Is this setting a precedent?

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Without knowing the specifics of what interventions were provided and when ROSC was obtained, I think it's entirely inappropriate to determine if transporting on a fire truck was appropriate or not. There's simply too many variables involved. I know locally there at least used to be a specific policy authorizing just about anyone to transport pediatric near drownings, but I can't find it right now. 

Are there times when it's appropriate for a fire engine to transport instead of waiting for an ambulance? Definitely, especially if there is a serious delay for the ambulance. Those times are, or at should be, few and far between. However, in those circumstances I don't want the police officer or fire fighters thinking too hard about the consequences of transporting in something other than an ambulance.

Freak occurrence.

The data clearly show that anything that interrupts compressions, including patient movement, results in worse outcomes.'

And I don't know about the local circumstances, but in our town there is NOTHING that can be done at the hospital that can't be done by paramedics right at the scene.  So, assuming equal paramedic capabilities, you work the patient where you find them until they either resuscitate or they don't.  Unless you aren't sure of that you are doing, then you resort to the old tried and true EMS treatment - diesel.

NO, not a good idea (in general) !

Though as Joe and many (in other forums) have pointed out, there are a number of variables that are not known that could tilt an opinion either way. It seems that the cab of a standard fire engine is not very conducive to proper safe positioning for compressions, or access to airway. Was there suction nearby? Does the FF/Medic have much experience with Peds, are they able to talk to the hospital via radio to give them a heads up to prepare? 

So these are some of the issues (playing advocatus diaboli) that I see that point me to saying that in general this was a bad idea. Though obviously the awarding of commendations means the department is probably not going to reprimand them for their actions, as they shouldn't.

 

A couple of years ago at EMS Expo one of the speakers mentioned some area protocols that allowed police to transport GSW patients in limited circumstances. If you allow this deviation, you encourage it, so how do you address it going forward?

Do you have a set protocol where alternate public safety transport is warranted? or ignore it, and treat each incident on a case-to-case basis?

Does anyone out there have any protocols like these?

 

From what I saw, and not being there, I don't think this was a good idea.  If the patient regained a pulse during transport, then she would have gained it on scene.  For the fire chief to imply that transporting on a fire truck saved this patient's life at a press conference is misleading.  

I am concerned that people in the huge DC viewing area will see this story and expect fire trucks to transport patients, because in this case it apparently worked. 

 

I've had problems with cops transporting seizing kids, lights and sirens, and unrestrained to the closest hospital instead of waiting an extra minute or two for us to get their.  The closest hospital doesn't see many kids, and a seizing one creates quite a frenzy and the need for a transfer to the children's hospital.  Had they waited for us, we can squirt some Versed up their nose and take a slow, secured ride directly to the Children's Hospital. 

There have been two studies done about Philadelphia PD transporting GSW patients instead of waiting for EMS.  One had improved mortality in the PD group and another showed no difference in survival.  The only hospitla studied was University of Pennsylvania, which is a Level 1 trauma center.  If PD transported to another hospital the outcomes would probably be different.   

Just a correction/clarification about the PD-transport vs. ambulance in Philly...

Study #1: Done by Temple University Hospital (sees the most penetrating trauma in the tri-state area) and only looked at patients who required ED thorocotomy (a very specific and small subset of penetrating trauma patients).  PD transported pts. had double the survival of ambulance transported pts.

Study #2: Done by the Hospital of the University of Pennsylvania.  I believe it looked at all penetrating trauma patients transported by PD or ambulance.  Their analysis showed no difference in outcomes after adjusting for injury severity.

I've seen PD bring in pedi patients (usually seizures) and a coworker of mine saw police bring in a traumatic arrest secondary to a motorcycle accident.  I'm not sure of the total fraction of penetrating trauma transported by PD, but it is probably 1/4-1/2 of all penetrating trauma.  Most officers in Philly know to go to a trauma center, but every now and then they go to a community hospital.  I'd guess it's usually newer officers that do that. 

Also, PFD has also transported pedi patients in engines in the past (made news a few years ago - child died).


Bob Sullivan said:

From what I saw, and not being there, I don't think this was a good idea.  If the patient regained a pulse during transport, then she would have gained it on scene.  For the fire chief to imply that transporting on a fire truck saved this patient's life at a press conference is misleading.  

I am concerned that people in the huge DC viewing area will see this story and expect fire trucks to transport patients, because in this case it apparently worked. 

 

I've had problems with cops transporting seizing kids, lights and sirens, and unrestrained to the closest hospital instead of waiting an extra minute or two for us to get their.  The closest hospital doesn't see many kids, and a seizing one creates quite a frenzy and the need for a transfer to the children's hospital.  Had they waited for us, we can squirt some Versed up their nose and take a slow, secured ride directly to the Children's Hospital. 

There have been two studies done about Philadelphia PD transporting GSW patients instead of waiting for EMS.  One had improved mortality in the PD group and another showed no difference in survival.  The only hospitla studied was University of Pennsylvania, which is a Level 1 trauma center.  If PD transported to another hospital the outcomes would probably be different.   

More details, from Prince George's County Fire and EMS Department PIO Mark Brady,

"Fire Fighter/Medic Scott was assigned to the engine crew that day.  He is a trained and experienced paramedic, yet, performing a firefighters duty for the day on the engine, he did not have any advanced life support equipment and medication available and knew that time was critically important."

 
"Fearing for the child’s welfare and realizing she needed immediate medical intervention at a hospital for any chance of survival, the crew made the decision to transport their patient to Southern Maryland Hospital on-board the engine, knowing they could be at the hospital before the medic unit arrived.

The firefighters continued CPR on-board the engine and responded to Southern Maryland Hospital which was just minutes away from the residence.  Before reaching the emergency room the child started to have spontaneous respiration's and a pulse."

Firefighters Awarded for Saving a Childs Life - Child and Family Me...

JEMS

So the child needed immediate medical care at the hospital, but somehow achieved ROSC prior to arrival? Something here isn't adding up from a clinical standpoint. After all, if the child desperately needed a hospital to be revived, how could the child be revived outside the hospital?

Also, if the child needed hospital intervention in order to survive, why no recognition for the hospital staff which, according to the paramedic, was needed to do the proverbial heavy lifting?

Its better to be lucky than good. Bad choice and very poor risk management/risk decision making regardless of the outcome (no, I am not a lawyer). 

 

I'm with Joe.  We don't know enough to make an informed judgement in this case.

 

Apparently the CPR quality was good enough to restore ROSC and a five-year-old patient survived.

 

This seems to be a case of "statistics are meaningless to the individual patient".  Statistically, "stay and play" will give most CPR patients their best chance of survival.  Then again, most CPR patients are not 5-year-olds in cardiac arrest secondary to asthma.

I witness as a child in the same county where this incident took place where a neighboring fire company of the Clinton Md fire dept, the Morningside VFD, used their heavy rescue truck to transported a patient in the back of their unit to the Andrews Air Force Base hospital emergency room back in the 60s. This was a cab over GMC with a compartment body with a crew compartment behind the cab of the truck and open area toward the rear for flood lights.

 The Morningside VFD never had a ambulance in their dept until the past few years until the county fire service provided a unit and a crew to run the unit. If they needed a ambulance it would come from the surrounding depts including Clinton which has a basic ambulance and a medic ambulance.

Now one thing in Prince George's County is the number of medicals that happen in a day and where units have to be dispatched from and the time and distance they have to travel from a station or the time it takes for a unit to clear hospitals and run calls. I have know some days to have multiple calls in two battallons which will cause the county to call mutual aid for ambulances from other counties to fill in.

Working fires will really messup a day and getting units to calls from other areas.

I helped on a pedestrian struck by a auto while in my POV near Andrews AFB one day. The pedestrain was not seriously hurt but the first unit was a fire engine who's crew treated the patient and blocked the lanes for a safety zone, but we waited for 10 minutes for a mutual aid ambulance from two counties south of our county which had been sent to fill in at a station. I guess we could have asked communications if Andrews AFB could have dispatched a ambulance but we all waited until the arrived and the patient was loaded and taken to the local hospital in Clinton.

Joe Paczkowski said:

Also, if the child needed hospital intervention in order to survive, why no recognition for the hospital staff which, according to the paramedic, was needed to do the proverbial heavy lifting?


Because we're just doing our jobs, whereas this was clearly heroic enough to deserve an award. You see, giving up your twenties to study then work 80 hours a week just isn't altruistic enough to deserve an award (though, frankly, there are other compensations, which suits me just fine).

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