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

- Rogue Medic

Paramedic refused to carry dying girl over safety fears

There is a horrible story in the Telegraph on the inquest of a 14 year old girl. Here is the sub-title of the story –

Shannon Powell, a paramedic, refused to carry a dying 14-year-old girl from a cross-country race course because of health and safety fears for herself, a coroner heard.[1]

The biggest problem with the story might be that a paramedic refused to carry a patient, or refused to treat a patient.

The problem is that the story is so badly written that there is no way to tell what really happened. For example –

Shannon Powell is probably not the name of the paramedic. Other parts of the story claim that Shannon Powell is the name of the dead little girl. Which is it? We don’t know. Maybe they are both named Shannon Powell, but that kind of coincidence ought to have been mentioned by the reporter.

The life-saver declined to take part in the “chaotic” rescue mission to save Shannon Powell, saying she was worried about her own back, a witness told the inquest.[1]

That seems bad, but the names have changed. What was “chaotic” about the rescue mission? What kind of back problems does the life-saver have? What is it about this patient – apparently a 14 year old runner, probably not a big patient – that is a danger to the life-saver, that is not a danger on every other call. Won’t most of those calls be for much bigger patients?

Shannon had collapsed in the mud and was foaming at the mouth in a violent fit during a cross-country run but, due to a series of gaffes, life-savers only reached her almost an hour later, the coroner heard.[1]

Was the death of the little girl due to one person, out of many people on scene, not carrying the patient, but not due to a delay in care of almost an hour?

What was the cause of death?

We don’t know, but this is an inquest. One of the purposes of an inquest is to determine the cause of death.

Catherine Sheppard, a marshal, told the hearing that the response was so infuriating she almost attacked the rescue worker.[1]

This is someone who has her priorities so mixed up that she is considering attacking EMS. That would be a felony where I work. A lot of people become infuriated for a lot of reasons. Did Catherine Sheppard (assuming the reporter got the name right) not offer to help? Is it beneath her to help? Was there something unsafe about the scene that prevented the marshal from helping?

“I believe that I walked away at that point. I really was very close to being either verbally or physically abusive to the LAS attendant.[1]

The marshal has responsibility for the children participating in the race, but becomes so upset that she runs away from her responsibilities? Again, this depends on the accuracy of the reporting.

The helper, who is also a history teacher, told how she saw the teenage girl fall wide-eyed and rigid, to the floor.

However, rather than call 999 the assistant said she followed athletics’ club policy and told an organiser who sent a first-aider to the scene.[1]

A child having a possible seizure (a life threatening condition – she did die) and club policy is more important than the health life of the patient?

It was only on their arrival, five minutes later, that she said she called ambulance personnel trained to keep Shannon alive.

However, paramedics only arrived at 12.50pm, almost an hour after Shannon collapsed, she believed.

The inquest in Barnet heard how gates at the park were locked and organisers assumed paramedics would have the keys.[1]

They lock the gates, but assume that the paramedics have the keys.

Is there any good reason not to send someone to the gate to make sure that EMS gets to the right place?

Any reason at all?

Did they send GPS coordinates to the ambulance?

Why think that everyone else knows where you are, just because you know where you are?

There was also confusion about where the park was, which entrance they should use and where the teenager was lying freezing on the muddy track with Mrs Sheppard’s fleece over her, coroner Andrew Walker said.[1]

Mrs. Sheppard would not move the little girl off of the reportedly freezing ground, although she did put her fleece over her. An hour of freezing? Were they trying for therapeutic hypothermia?

Maps of the Middlesex Cross Country Championships’ course contained errors delaying medical help as it was rushed to the scene where the talented youngster collapsed in a fit in Trent Parl, Enfield, north London.[1]

Yet, the headline is about the paramedic refusing to carry the little girl.

Mrs Sheppard told how even as the two paramedics, one male one female, were led up to Shannon by another marshal they walked slowly behind the race assistant.[1]

EMS should never run, unless we are running away from something. Maybe Mrs. Sheppard should have called 999 earlier, if she thought time was important, and should have sent someone to guide EMS to their location, and should have moved the little girl off of the freezing ground. That is assuming that the information has been reported with any accuracy.

“The paramedic at the time was saying ‘we can’t carry her because its health and safety and we might fall over’.

“They didn’t come up with any solution at all. Because of the time we had been there I think I can say this for all of us – we all looked at each other as if to say ‘**** health and safety’.”[1]

That according to first-aider Robbie Proctor. Also –

He said: “One of the stewards made a comment and said ‘how come it took you so long?’

“The comment that came out was ‘this is a low priority call’ or ‘a green call’. That was the male paramedic.”[1]

If the call was dispatched as low priority, maybe that is because the information given to the 999 dispatcher downplayed the seriousness of the little dead girl’s medical condition.

The first-aider described how Shannon was being carried by six people from the course on a trolley bed when she sat bolt upright screaming.[1]

Carrying her required 6 people, but they expected the 2 paramedics to carry her by themselves. Was there more to the condition of the grounds than is being mentioned?

He said: “The last time I put the trolley bed down – and I’m being very honest with the parents here because it haunts me – Shannon sat up and screamed ‘let me go’.”[1]

How many times did these 6 people have to put the trolley bed down and rest? Yet, they expected the 2 paramedics to carry the stretcher?

He told how paramedics believed she was having a fit and gave her the painkiller diazepam when “everything seemed to go haywire.”[1]

Diazepam (Valium) is not a painkiller.

“everything seemed to go haywire.”

Is that supposed to mean that she was given the anti-seizure medicine diazepam because she was having a seizure? Or is it supposed to suggest that giving a seizure patient (fitting patient) anti-seizure medication is inappropriate according to the medical expertise of someone who leaves the patient on the freezing ground for an hour.

The first-aider, who owns the company, Spectrum, brought in to provide medical help at the event, said the paramedics questioned his qualifications and began asking bystanders if they knew how to provide lifesaving CPR.[1]

The owner of the company that was contracted to provide the wonderful medical care (as reported in the article) to the dead girl is trying to put the blame on someone else.

The race marshal appears to be doing the same thing.

Am I a bit jaded in doubting their objectivity?

Shannon was taken from Chase Farm Hospital, in Enfield, where she died of sudden death syndrome on January 18, this year.[1]

Was any CPR indicated at any time on scene or were the paramedics just giving Mr. Proctor a hard time? It is impossible to tell from the story.

The article finishes with –

The inquest continues.[1]

I would love to see the full transcript of the inquest. This is so badly reported that I have no idea how much of what is written in the article is true. The reporter does not appear to have a clue about how to report a story.

Footnotes:

[1] Paramedic refused to carry dying girl over safety fears
Telegraph
1:50PM GMT 08 Dec 2011
Article

.

Comments

  1. Wow.

    My head is spinning trying to understand her disjointed ramblings. Great dissection of some really shoddy writing.

    -Joffre

  2. Well, you have to remember the story by the press is only correct 99% of the time, that I have found on my calls. As far as contraindications for use of valium is not correct from what I just read. They are as follows:
    Known hypersensitivity
    Less than 6 months of age
    Myasthenia gravis
    Severe hepatic insufficiency
    Sleep apnea syndrone
    Acute narrow glaucoma
    Untreated open-angle glaucoma
    Pregnancy (due to eclampsia)
    Lactating mothers

    It is used for anxiety, seizures and acute,alcohol withdrawal

    My guess is if she had a “fit” it may have been what the medical field calls a postictal state. Patient’s will be confused and combative. It is actually very common.

    As for carrying her out, remember she was laying in muddy water. It normal conditions yea I can see them carrying out a child with 2 people. You have to remember she is covered in mud, it’s a cross country run so there’s probably some distance to get her out, if she is combative then it is a risk to carry her out to her (the patient) and the crew members. Safety first. If we get hurt it is more of a delay.

    Low priority call…….been there. If another call comes in that is a higher priority then the ambulance gets deverted. Which means another crew will get the call. It is bad on the part of the person calling 999/911 for not giving a better description of what was really going on. As it sounds not a good location. The crews only go where they are told so don’t be mad at them. Long runs need to be preplanned and have it mapped out and forwarded to emergency services. This helps greatly for EMS and the patient.

    My question is if the gates were locked why wasn’t someone sent to allow access. I have been denied access before and that is aggravating not being able to get it….which will also cause a delay.

    When a medical professional arrives that is off duty you better believe I will question them if I don’t know them. For an example I had a “doctor” doing CPR on someone that was not in cardiac arrest and he was doing it on the abdomen!!! Hello!!! Do NOT get offended if they do not know you and question you.

    In the cases of valium being contraindicated in hypothermia…..no. There are precautions to take but if you have a hypothermic patient having a seizure there is something going on to cause the seizure. Hypothermia induced medically is extremely beneficial. The body will do things on it’s own to try and protect itself. Hypothermia being one of them. As in the case listed the body is seizing for a reason. My question is the hypothermia due to her not dressed appropriately for the weather and been exposed for awhile or due to the time spent in the muddy water. Then I ask why didn’t she get pulled from the mud prior to EMS’ arrival. Stopping the seizure, whether it be on It’s own or with valium, is the goal here. When a patient has a grand mal seizure they do not breath which in return lowers their oxygen level in the blood. This hypoxemia is dangerous!!! No oxygen for a cell means death if not corrected. Not to mention hypothermic patients have to be handled with great care or you will cause the heart to go into v-fib. Then you have your hands full. So gentle care is a must.

    Everyone wants to put their 2 cents in. Ever heard the phrase too many chief’s and not enough indians….yea, that’s what you end up with. These medical personnel are tested and state licensed. You must allow them to do their job. If you want to help that’s fine if there are not enough hands there to do the job but ultimately the Paramedic is responsible if something goes wrong and a mistake is made. Don’t be mad they have good reason. Just remember, when we respond it does seem like a lifetime when it may have been a few minutes. Answer any questions that can help us, gather medications or a list if able and stand back and not get in the way. You must trust your EMS personnel to take care of emergencies. They do this because they care about people. What we do may not make sense to some but don’tjude if you don’t have the correct story. Remember the saying around the circle, by the time it gets back around it has nothing to do with what was first said.

    • Volparamedic,

      Well, you have to remember the story by the press is only correct 99% of the time, that I have found on my calls.

      In 20 years, I have never read an article in the news about any of my calls that was completely accurate.

      As far as contraindications for use of valium is not correct from what I just read. They are as follows:
      Known hypersensitivity
      Less than 6 months of age
      Myasthenia gravis
      Severe hepatic insufficiency
      Sleep apnea syndrone
      Acute narrow glaucoma
      Untreated open-angle glaucoma
      Pregnancy (due to eclampsia)
      Lactating mothers

      According to the diazepam (Valium) FDA label, that includes too many contraindications.

      Diazepam (diazepam) Injection
      [Baxter Healthcare Corporation]
      DailyMed
      FDA Label

      CONTRAINDICATIONS
      Diazepam Injection is contraindicated in patients with a known hypersensitivity to this drug; acute narrow angle glaucoma; and open angle glaucoma unless patients are receiving appropriate therapy.

      On the other hand, the following incorrect information is also listed on the FDA label.

      PRECAUTIONS
      Although seizures may be brought under control promptly, a significant proportion of patients experience a return to seizure activity, presumably due to the short-lived effect of diazepam after IV administration.

      Short-lived effect?

      From the dosage and administration section in the IV dosing for seizures –

      If necessary, therapy with diazepam may be repeated in 2 to 4 hours; however, residual active metabolites may persist, and readministration should be made with this consideration.

      I think it is much more likely that the seizure stopped spontaneously at some time after an inadequate dose of diazepam was given.

      Since the seizure was not stopped by the diazepam, the seizure did not start again due to magically accelerated metabolism of diazepam.

      I would prefer to use midazolam (Versed) because it is metabolized quickly A seizure patient will metabolize drugs more quickly, but not by hours.

      It is used for anxiety, seizures and acute,alcohol withdrawal

      My guess is if she had a “fit” it may have been what the medical field calls a postictal state. Patient’s will be confused and combative. It is actually very common.

      I believe that a fit, or fitting, is Queen’s English for a seizure, or seizing. Of course, the people being quoted do not appear to have a clue about medicine.

      As for carrying her out, remember she was laying in muddy water. It normal conditions yea I can see them carrying out a child with 2 people. You have to remember she is covered in mud, it’s a cross country run so there’s probably some distance to get her out, if she is combative then it is a risk to carry her out to her (the patient) and the crew members. Safety first. If we get hurt it is more of a delay.

      Another consideration is using a board to slide her out, rather than risk the chance of dropping her. After reading this, I looked at another article that stated they were on a muddy hill. This suggests that it would have been slippery even without carrying a patient. One of the medics is reported to have ridiculed the suggestion of carrying her down the slippery hill, but the sarcasm was probably lost on the first-aider and the marshal.

      Low priority call…….been there. If another call comes in that is a higher priority then the ambulance gets deverted. Which means another crew will get the call. It is bad on the part of the person calling 999/911 for not giving a better description of what was really going on. As it sounds not a good location. The crews only go where they are told so don’t be mad at them. Long runs need to be preplanned and have it mapped out and forwarded to emergency services. This helps greatly for EMS and the patient.

      They appear to confuse EMS with ESP. We are supposed to just know what they need, even when they try to pretend that everything is fine – but later are shocked to learn that their delays contributed to the death of the child.

      My question is if the gates were locked why wasn’t someone sent to allow access. I have been denied access before and that is aggravating not being able to get it….which will also cause a delay.

      Everybody knows that paramedics have the keys to all gates and the combinations to all combination locks/

      When a medical professional arrives that is off duty you better believe I will question them if I don’t know them. For an example I had a “doctor” doing CPR on someone that was not in cardiac arrest and he was doing it on the abdomen!!! Hello!!! Do NOT get offended if they do not know you and question you.

      I regularly stop and help until EMS arrives. I have no problem being questioned about everything I have done, or not done, or about my knowledge. But I don’t have anything to hide.

      In the cases of valium being contraindicated in hypothermia…..no. There are precautions to take but if you have a hypothermic patient having a seizure there is something going on to cause the seizure. Hypothermia induced medically is extremely beneficial. The body will do things on it’s own to try and protect itself. Hypothermia being one of them. As in the case listed the body is seizing for a reason. My question is the hypothermia due to her not dressed appropriately for the weather and been exposed for awhile or due to the time spent in the muddy water. Then I ask why didn’t she get pulled from the mud prior to EMS’ arrival. Stopping the seizure, whether it be on It’s own or with valium, is the goal here. When a patient has a grand mal seizure they do not breath which in return lowers their oxygen level in the blood. This hypoxemia is dangerous!!! No oxygen for a cell means death if not corrected. Not to mention hypothermic patients have to be handled with great care or you will cause the heart to go into v-fib. Then you have your hands full. So gentle care is a must.

      I have read conflicting information on whether they breathe during seizures. It may be that some patients do, others do not, and some may alternate.

      Benzodiazepines are used to prevent shivering for patients being treated with therapeutic hypothermia. Hypothermia may end up being a specific indication for diazepam.

      Everyone wants to put their 2 cents in. Ever heard the phrase too many chief’s and not enough indians….yea, that’s what you end up with. These medical personnel are tested and state licensed. You must allow them to do their job. If you want to help that’s fine if there are not enough hands there to do the job but ultimately the Paramedic is responsible if something goes wrong and a mistake is made. Don’t be mad they have good reason. Just remember, when we respond it does seem like a lifetime when it may have been a few minutes. Answer any questions that can help us, gather medications or a list if able and stand back and not get in the way. You must trust your EMS personnel to take care of emergencies. They do this because they care about people. What we do may not make sense to some but don’tjude if you don’t have the correct story. Remember the saying around the circle, by the time it gets back around it has nothing to do with what was first said.

      Yes.

      Sometimes the best way to help is to help carry something or to help carry somebody – not to run away throwing a hissy fit.

      I would love to read the transcript of the inquest and the internal investigation by LAS and see all sides of this very biased very badly reported story.

      .

  3. One of my calls was recently covered by all the network news shows here in Captial City.

    They were all 99% wrong. But at least I got to get on TV.

  4. I too have made the evening news on a couple of occasions. I was always fortunate enough to be aware of the camera and made sure they only caught my good side, or is that back side?

    I hate these types of articles. They raise more questions than they answer. Along those same lines, it is very nearly impossible to Monday Morning Quarterback any call, especially this one. The underwhelming lack of facts, chaotic story telling (with emphasis on story), and the apparent bias towards EMS in general provides the reader with nothing upon which to build a semi-sensible recreation of what happened.

    I’m curious now though, and will see what, if anything, I can dig up on this story. And yes, a fit is a seizure in the Queen’s English.

    Pip pip, cheerio

    • Dewayne,

      I too have made the evening news on a couple of occasions. I was always fortunate enough to be aware of the camera and made sure they only caught my good side, or is that back side?

      I just keep my back to cameras (they might sue me for damage to the cameras) and try to keep between the patient and any cameras.

      I hate these types of articles. They raise more questions than they answer. Along those same lines, it is very nearly impossible to Monday Morning Quarterback any call, especially this one. The underwhelming lack of facts, chaotic story telling (with emphasis on story), and the apparent bias towards EMS in general provides the reader with nothing upon which to build a semi-sensible recreation of what happened.

      That is one of the reasons I criticize the use of chart review as oversight. The chart is written from the point of view of the person being evaluated. How does this help the person pretending to provide oversight through chart review to understand what happened?

      How many IV attempts/intubation attempts/doses of medications/times of treatments are documented accurately?

      Too many of us are taught to make patients fit the protocols. Why don’t we realize that the chart is often written to make the treatment fit the protocol.

      How can chart review be oversight, when the chart is written to tell the reviewer what the reviewer wants to read?

      Chart review will result in punishment for the honest and for the obviously clueless, but not those who know how to work the system, even though they do not know how to treat patients.

      The marshal and the first-aider present examples of the kind of oversight we have in EMS. It is more about appearances, than about patient care.

      1. No immediate emergency call for an athlete having a seizure. 2. No attempt to make sure that EMS comes to the right location on a long distance race course. 3. More attention on the feelings of the person complaining, than on the care of the patient. 4. The information given to emergency dispatch resulted in a low priority call.

      I’m curious now though, and will see what, if anything, I can dig up on this story. And yes, a fit is a seizure in the Queen’s English.

      Pip pip, cheerio

      A Google News search under the name of the patient should produce a few dozen other articles. I scanned through one after writing this.

      Apparently, the coroner determined that the cause of death was the delay in care. The patient had an unusual cardiac condition that might have been responsive to treatment if she had arrived at the hospital sooner. Even though seizures are described, there is the possibility that the second seizure was an arrhythmia. Yes, arrhythmias can cause seizures, but anti-seizure medication will not help. Did the press point this out? Not from what I’ve seen.

      .

  5. This job happened on my patch and I know the crews involved. This park is a nightmare for access, and as for running, I heard the crew were going to take all the kit they took to the job into the inquest just to ask them how they would have run with it all over 2 miles of muddy terrain. Obviously my deepest sympathies go out to the family, but we need to learn from this and not try and play the blame game.

    • anon,

      This job happened on my patch and I know the crews involved.

      Thank you for providing some information on the particulars.

      This park is a nightmare for access, and as for running, I heard the crew were going to take all the kit they took to the job into the inquest just to ask them how they would have run with it all over 2 miles of muddy terrain.

      Hiking 2 miles with a bunch of ALS gear is not a good idea – unless there is some specific knowledge of what will be needed. It does not appear that the information provided was in any way helpful in preparing the crew for what they found.

      If we bring a lot of gear in to the patient, we then have to bring a lot of gear and the patient back out over the same muddy hills.

      The obvious solution is to send someone to meet the ambulance and guide them as close as possible to the patient, so that carrying the patient is minimized. This is best for the safety of EMS, the patient, and of anyone assisting EMS. Also, this will allow the patient to be transported most quickly; will decrease the amount of time the patient spends in a cold environment; and will even allow the event staff to get back to their event sooner. Getting EMS through a locked gate is only one small benefit of event staff planning ahead.

      Obviously my deepest sympathies go out to the family, but we need to learn from this and not try and play the blame game.

      Amen.

      .

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