Thoughts? Need to read whole article.

[ventana]

From cnn

 

https://www.cnn.com/2023/01/13/us/illinois-paramedics-charged-patient-dies/index.html

 

 

[ventana]

Going to be a tough case to prove it was not CVA. Seizure.  

[kettle]

He was positioned prone and restrained. Died of positional asphyxiation. They're guilty. No one gets restrained prone or "hobbled" due to this. I was a medic and did over 10 years on the rig. They don't have a defense 

[ohiovolffemtp]

With all the appropriate caveats that a news media report has almost no important facts about what occurred:

• it will be easy to make the medics look bad because of the quotes, totally independent of the quality of care
• murder seems a deliberately inflated charge vs negligent homicide or manslaughter.  That may be driven by a combination of Illinois law and the prosecution trying to scare the accused into a plea bargain.
• the story states the police on scene helped put the patient on the cot, but there's no mention of charges against them
• as kettle said, as a medic I don't think I ever transported a patient prone except when there was an usual situation, like an impaled object.  Patients were usually supine or sitting, occasionally on their sides.  Access to airway had to be available.
• a key question for me is what kind of patient monitoring failed to occur if the patient died.  Who's ever in the back with the patient should be at least watching the patient to see if they're crashing.
• expect the agencies involved to throw everyone who's charged in any way under the bus for "not following proper procedures"

[EMEDPA]

16 hours ago, kettle said:

He was positioned prone and restrained. Died of positional asphyxiation. They're guilty. No one gets restrained prone or "hobbled" due to this. I was a medic and did over 10 years on the rig. They don't have a defense 

you never made a PCP sandwich apparently. Pt sedated and restrained between 2 backboards so they wouldn't kill anyone. Granted, the medic needs to manage the airway. and a PCP sandwich is supine with the head turned to one side. 

Sounds like their behavior in this case was inappropriate. They will probably end up with something like criminally negligent manslaughter. 

 

[ventana]

What about this 

w/d seizure caused his death 

Unpreventable death?

[rev ronin]

Not just murder but first degree murder? Prosecutor needs to be censured for that one unless there's a whole lot showing premeditation on top of intent to kill. They might get depraved indifference unless the defendants have good expert witness testimony showing that the vast majority of paramedics hate their jobs and coming to work with a bad attitude is standard of care.

As far as seizure? Coroner threw them under the bus by calling out their "care" as the proximate cause of death.

Never have I ever transported anyone prone, although I did ride extra in the back of a medic unit where the Ccollared/LBB patient was positioned on his side with me running suction in his dependent cheek so he wouldn't aspirate his own blood. That was a ~60 yo bicyclist who had caught one rock and faceplanted into another rock at speed and given himself a Le Fort III fracture in the process. Oozing everywhere, looked terrible... but came back to the station a month later with his jaw wired shut and a cake saying "Thanks for saving my life".  Much better outcome for an odd transport position than this story.

[iconic]

I am not going to comment on the merits of the case as it is outside of my area of expertise; however this trend of charging healthcare workers with murder is very concerning and is going to result in even more health care providers quitting or trying to limit their liability in every way possible including by trying to avoid treating complex/high-risk patients. As usual you can rely on attorneys to ruin it for everyone. I can attest that in my own field of psychiatry almost no one wants to touch or accepts medicaid/medicare patients as they are perceived higher risk due to the combinations of medications they are often on, among other issues 

Edited January 14, 2023 by iconic

[ohiovolffemtp]

8 hours ago, EMEDPA said:

you never made a PCP sandwich apparently. Pt sedated and restrained between 2 backboards so they wouldn't kill anyone. Granted, the medic needs to manage the airway. and a PCP sandwich is supine with the head turned to one side. 

Did something similar with a Reeves stretcher, but that made it easy to rotate the patient on their side.  Many years ago I had a restrained and sedated patient die during/after transport.  To highlight the differences and similarities in the cases:

• my patient was a combative psyche patient with polydrug overdose
• we gave the patient a B52 in the house and restrained him a Reeves stretcher.  He was supine.
• patient was transported on a cardiac monitor and likely (I don't remember) on O2 via NC
• I had another medic in the back with me
• we called ahead to hospital and told them what we were bringing them and what we'd done.  Like was usual with this hospital, they paid no attention (i.e. radio report never went past the tech to an RN or doc).
• we called ahead to let them know the patient was bradying down - same response.
• patient arrested as we pulled under the apron.  I ran in and told them the patient we'd called about had arrested.  That did get their attention.  My crew plus another crew from another dept started  coding the patient as we brought him in.
• ROSC in the resuscitation bay after multiple ACLS drugs.  I believe bicarb was the key, so TCA OD was possible.  I never heard anything about lab results on the patient.
• patient died in the ICU 2-3 days later.
• I spoke to the county coroner, who was an ED doc at that hospital.  He said he had no problem with what happened and that was it.  I believe the cause of death was listed as drug OD.

My opinion: our crew showed good patient monitoring & response to him crashing.  So, despite his death, we weren't blamed for the outcome.  This was probably 20ish years ago.

[EMEDPA]

14 minutes ago, ohiovolffemtp said:

Did something similar with a Reeves stretcher, but that made it easy to rotate the patient on their side.  Many years ago I had a restrained and sedated patient die during/after transport.  To highlight the differences and similarities in the cases:

• my patient was a combative psyche patient with polydrug overdose
• we gave the patient a B52 in the house and restrained him a Reeves stretcher.  He was supine.
• patient was transported on a cardiac monitor and likely (I don't remember) on O2 via NC
• I had another medic in the back with me
• we called ahead to hospital and told them what we were bringing them and what we'd done.  Like was usual with this hospital, they paid no attention (i.e. radio report never went past the tech to an RN or doc).
• we called ahead to let them know the patient was bradying down - same response.
• patient arrested as we pulled under the apron.  I ran in and told them the patient we'd called about had arrested.  That did get their attention.  My crew plus another crew from another dept started  coding the patient as we brought him in.
• ROSC in the resuscitation bay after multiple ACLS drugs.  I believe bicarb was the key, so TCA OD was possible.  I never heard anything about lab results on the patient.
• patient died in the ICU 2-3 days later.
• I spoke to the county coroner, who was an ED doc at that hospital.  He said he had no problem with what happened and that was it.  I believe the cause of death was listed as drug OD.

My opinion: our crew showed good patient monitoring & response to him crashing.  So, despite his death, we weren't blamed for the outcome.  This was probably 20ish years ago.

That sounds very much like a TCA overdose. I had a very similar patient as a medic in the mid 90s. His PH in the ED after coding (VFIB) several times and multiple amps of bicarb was 6.8.