Recently, I wrote about a patient who was declared dead by EMS, but was found to be alive by the coroner.[1],[2] Some details have been released about the circumstances.
“I think my wife has died,” Tygart’s husband is heard telling a Bluegrass 911 dispatcher on an audio recording of his call. “She’s not responding. I just woke up about five minutes ago. She’s in the floor. I was hollering for her and she’s in the floor. And she’s cold and she’s not doing anything.”[3]
Not an unusual call, but nothing to discourage a full assessment.
“Do you want to try CPR on her?”
“I already have. I don’t know how long she’s been laying in the floor.”[3]
Unresponsive to CPR seems further evidence of death, but what do we know about anything that we hear over the radio/telephone?
Accuracy is not a strong point. Dispatchers have this problem, too. They are trying to obtain important information from a stressed called in as short a time as possible, then relay that information to EMS. It should be surprising when they get a lot of accurate information about an unstable event from someone who is not a repeat caller.
Do we base our treatment on the information from dispatch?
No. We should bring in extra equipment, but we should only use it if our assessment indicates that we should.
What about assessment?
We can certainly prioritize parts of our assessment based on information from dispatch, but we should probably not eliminate assessment based on what dispatch tells us.
After 3-4 minutes on scene, the medic calls for a coroner and cancel the ambulance.
Shortly after the deputy sheriff and Deputy Coroner Floro arrive on the scene, the deputy sheriff calls back to dispatch — about 30 minutes after Tygart’s husband first called — “We (inaudible) need a West Lincoln ambulance back on-scene ASAP at this time.”[3]
While the ambulance was en route, the dispatcher called Floro to find out what happened at the scene.
“What did you do? Go up there and lay healing hands on her or something?” the dispatcher asks on the recording.“No, she was breathing before I even touched her,” Floro says.
The dispatcher asks about “1200” (the medic) calling for a coroner.
“I know, but he didn’t have a truck and he didn’t have a monitor,” Floro says. “She had no pulse and she had extremely faint breath sounds and she was over in between a bed and a wall … I couldn’t tell she was alive until we pulled her out from the bed and I could see her and I heard breath sounds.[3]
No monitor, but he is a medic?
If I do not have a monitor, and the rest of my ALS equipment with me, I should not be identifying myself as a medic. I am only able to respond at the BLS level, or the AFA (Advanced First Aid) level. We are not our tools, but we are not able to even fully assess patients without a full set of tools.
Apparently, she was cold and did not have palpable pulses, but that does not mean that a person is dead.
Since the coroner determined that she died of a subdural hematoma, there may not have been anything that could have been done if she had been treated immediately, but hypoxia is not good for head injuries either.
Was there something that gave the impression of rigor mortis?
Until the Kentucky Board of EMS finishes its investigation, we will not have all of the information. Even after the investigation, KBEMS may not release all of the information.
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Footnotes:
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[1] She’s Not Quite Dead Yet
Fri, 25 Apr 2014
Rogue Medic
Article
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[2] WKYT Investigates: Can paramedics declare someone dead?
Sun, 27 Apr 2014
Rogue Medic
Article
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[3] Lincoln Paramedic Called For Coroner While Woman Was Still Alive
Posted: Tuesday, April 29, 2014 10:33 am
By Ben Kleppinger
Article
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Am I understanding correctly that the husband stated to a dispatcher that he had tried CPR? Sorry for my confusion this is the first I’ve read of the 911 transcript… Ty for any info.