Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

City may discipline EMS workers – Public Safety Director Michael Huss

Pittsburgh is reported to be considering discipline for EMS workers for not being able to get to a patient due to a snow storm.

Most of the attention seems to be on the facts that the patient called 10 times over 30 hours and died. This is an outcome that is horrible.

Why did he (or his wife) call 10 times?

It started as abdominal pain, progressed to respiratory difficulty, and ended with respiratory and cardiac arrest. If EMS had been able to get to the residence, there would have been no need to keep calling.

Why couldn’t EMS get to the residence?

This is the important information.

The first two calls for ambulances were graded E-2, or less pressing, because Mr. Mitchell told call-takers he was suffering from stomach pains, a symptom deemed not life-threatening. The third call was an E-1, because he was short of breath, and the fourth call was an E-0 — the highest priority — because he was no longer breathing.[1]

The couple called 911 10 times starting early Saturday, Feb. 6, but impassable roads, poor communication and a high number of calls meant an ambulance did not arrive until the morning of Feb. 7, after Mr. Mitchell had died.[1]

Ambulances were dispatched three times on Feb. 6 to the house in the 5100 block of narrow Chaplain Way, but couldn’t get there because of the snow. Communication problems meant that each call was seen as a separate request for help, so dispatchers did not know details from the previous calls that were placed.[1]

Unfortunately, Pittsburgh’s dispatch does not appear to have any way of tracking calls. Suppose there is a shooting at one address. A 911 call is made for EMS to the same address, but the caller does not mention the shooting. If EMS arrives before police, then EMS may be the first responders to realize that things are not exactly as dispatched. Surprise!

I have called Philadelphia 911 dispatch to update them on an apparent drunk driver, who woke up and started to drive away before police arrived. I was told that dispatch has absolutely no way to update responding police to any change once I hang up. The dispatcher told me that a separate dispatch needed to be made, rather than update the responding unit(s). When the apparently drunk driver did stop, the first police officer on scene was just driving by. She had not been dispatched. The next 2 police officers on scene had also just been driving by. They had not been dispatched. When I left, about 10 minutes after the arrival of the second and third police officers, there was still no sign of any police actually dispatched to the call.

I hope that Pittsburgh 911 dispatch is run a bit more intelligently than in Philadelphia. From what is reported in this article, it does not seem that the administration has considered the possibility that any information not provided by the caller would be of any importance.

As part of the probe, Public Safety Director Michael Huss said he is reviewing calls to and from Allegheny County’s 911 center during the 30 hours that Curtis Mitchell, 50, and his longtime girlfriend waited for help to arrive.[1]

Mr. Huss said they should have walked to Mr. Mitchell’s home to retrieve him. “It’s that simple,” he said.[1]

If paramedics had left their ambulance in the middle of the street and climbed through the snow, how far would they have had to go to get to the residence? What equipment would they have needed? Would they have been criticized by Public Safety Director Michael Huss, if they had not had all of their equipment with them. Would they have been able to move Mr. Mitchell to the ambulance? What means would they have had to use? Were there stairs? Were the stairs covered with ice and/or snow?

More importantly – was any assistance sent to clear the road to get the ambulance to the scene and to help move the patient to the ambulance?

It seems that there is no plan in Pittsburgh for dealing with weather emergencies. That might be expected in a small town, but Pittsburgh is not a small town. Another thing that Pittsburgh is not is flat.


Picture credit – Ainulindale


Picture credit – Conk 9 (talk)

Pittsburgh occupies the slopes of the river valley on the opposite side of the Monongahela and the ridges beyond. Many of the city’s neighborhoods, particularly the city’s North Side and those areas south of the Bungalow, are steeply sloped.[2]

Sloped. Not slightly sloped, but many are steeply sloped.

Maybe these pictures are not representative of the neighborhood where Mr. Mitchell lived, but they are taken from within Pittsburgh. Clearly, this is a problem that has to be addressed when the roads are slippery. There needs to be a plan to deal with hills like this during heavy snow. According to Wikipedia, the average snowfall per year is over 40 inches. This is not the first time the city has seen snow.[3]

I would like to ask Public Safety Director Michael Huss what his emergency plan is for dealing with ambulances on steeply sloped roads in heavy snow.

It appears that the plan of Public Safety Director Michael Huss is to do nothing, then blame the EMS crew later.

Mr. Huss said they should have walked to Mr. Mitchell’s home to retrieve him. “It’s that simple,” he said.[1]

No.

It is not that simple.

How many EMS crews were involved over 30 hours and 10 calls? How many dispatchers? How many supervisors? None of them were able to come up with a way to get Mr. Mitchell to the ambulance? Perhaps Public Safety Director Michael Huss does not understand the word simple.

If the solution were as simple as Public Safety Director Michael Huss states, then Mr. Mitchell would have been transported on the first 911 call. Maybe he would have died anyway, but he would have been able to go to the hospital.

Public Safety Director Michael Huss,

What is your emergency plan for dealing with ambulances on steeply sloped roads in heavy snow?

Does anyone in Pittsburgh have any further information on what happened? Road conditions, emergency plan, dispatch, management, et cetera. If you do not want to post anything in the comments, you can email me directly at the email below.

roguemedicblog@gmail.com

Late addition 04:00 02/19/10 – A similar conclusion coming from different sources of information and a slightly different perspective at Too Old To Work, Too Young to Retire in Trouble Right Here In Three River City.

My other posts on the death of Curtis Mitchell –

City may discipline EMS workers – Public Safety Director Michael Huss – 02/18/10

Where Was Public Safety Director Michael Huss during the Death of Curtis Mitchell? – 02/20/10

Public Safety Director Michael Huss and Others Continue to Blame the Medics for the Snow – 02/22/10

The Need for Evidence Before Assessing Guilt – 02/24/10

Anonymous Comments on the Death of Curtis Mitchell – 03/02/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part I – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part II – 03/22/10

Podcasting, Critical Judgment, and the Death of Curtis Mitchell Part III – 03/22/10

What kind of punishment do you get for NOT disobeying dispatch? – 03/23/10

The Scapegoats Will Be Punished – 03/23/10

Pittsburgh – Punishment, not Planning – 03/24/10

Josie Dimon was the Scapegoat of Public Safety Director Michael Huss in the Death of Curtis Mitchell – 02/16/11

Michael Huss – Pittsburgh EMS Only Needs Someone Good With a Shovel – 02/16/11

Links updated 02/16/11.

Footnotes:

[1] City may discipline EMS workers – Man died at home despite repeated calls to 911 during snowstorm
Thursday, February 18, 2010
By Sadie Gurman,
Pittsburgh Post-Gazette
Article

[2] Pittsburgh
Wikipedia
Geography

[3] Pittsburgh
Wikipedia
Climate

.

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