Seven-year-old Aaron Pointer spoke his last words from the back of an ambulance.
“I . . . am . . . tired . . . of . . . breathing,” the asthmatic boy gasped, taking breaths between each word, according to a nurse’s report.
This is certainly a tragic story, and a terrible way to do die. It’s also a very important lesson for us EMS folks that regularly do inter-facility transfers. Incidents like this are why it’s important to determine if a patient is stable for transport and stand your ground if you don’t feel comfortable. While I don’t know any details outside of the media’s report (and you know how much I trust the media), I do know a situation like this would have probably required a specialized transport team, or better yet, air transport. This is of course assuming that said resources were available at the time. Once again, information that the media fails to provide.
When investigating cases like this, we always have the luxury of spending all the time we need to gather the facts and determine if the treatment was appropriate. It’s an unfair advantage that lawyers and administrative folks have, but that’s life. And that’s why we do the job that we do. We train to be able to make these decisions within minutes, if not seconds. Unfortunately, like this article points out, things don’t always go the way we want them to and we find ourselves in this position.
By no means am I criticizing the work of the paramedics on this call. I have been there, and I would be lying if I told you that I have never taken a chance with transports like this. Sometimes your only choices are to take the patient, or let them die at the facility they are at. It’s a bad position that none of us want to be in. As the article mentioned, the hospitals both transported the patient out because the treatment they had available wasn’t enough for his condition. I think the real questions we need to ask are: Why 3 hospitals? Did the kid present better at the first hospital, not necessarily raising any flags that warranted a 45-minute trip? Was there a specialty transport team available? What interventions did the hospitals and EMS attempt before the kid deteriorated?
Like I said before, it’s important to evaluate these cases carefully before initiating long transports. In a situation where the hospital simply can’t provide the treatment the patient needs, then “standing your ground” might mean to demand that a nurse or RT accompany you. If the patient is that bad, talk to the doctor about placing an advanced airway prior to leaving the hospital. These are all things that might have have been done, but we will probably never know for sure.
“Intubating a 7-year-old is difficult in the best of circumstances, much less in an ambulance,” during a long ride, said the family’s lawyer, Joseph Miroballi. “It’s a disaster waiting to happen. It’s a formula for death.”
This is where I typically start getting irritated when reading stories like this. Lawyers acting as medical experts. If intubating a 7-year-old is really “difficult at best”, then I must be the king of pediatric airways. Then again, a lawyer attempting to intubate a child WOULD be very difficult, so maybe his statement had some truth to it.
“They send him even though he’s not stable,” he said. “Why they didn’t put a doctor in that ambulance with him, or an anesthesioloist or someone who would manage his condition during that long transfer, we don’t know.”
I don’t even know where to begin with this one. Has anyone ever had a doctor, much less, an anestesiologist ride in with you during a transport? Yes, it sounds like the level of care available on the ambulance wasn’t sufficient, but sometimes I think the expectations placed on us are a bit unreasonable. Many ER’s, especially rural ones, only have 1 physician. So what do we do? Close down the ER so the doc can ride in?
There are so many factors not addressed in this story that it’s pretty much impossible to determine if anyone really did anything wrong. But hey, why let facts get in the way of a good story?