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

- Rogue Medic

Paramedic struck off for failing to perform full life support on girl, 7

I first wondered what they meant by failing to perform full life support.

Although papers from the case do not mention Izabelle Easen by name, they show he failed to perform Advanced Life Support on a seven-year-old girl and pronounced her dead after only performing Basic Life Support.[1]

I have pronounced patients dead based entirely on BLS assessment. That is not wrong.

A technician on a second ambulance wanted to take the girl to hospital, which he said would have “given the family some support” but was overruled by Mr McKenna.

Experts did say that the chances Izabelle would have survived if she had been taken to hospital were slim.[1]

“given the family some support”?

This is often claimed as a reason for continuing CPR in futile cases, but nobody appears to have done anything other than pretend that they know what others would want. Based on what? How do we know that parents want to be given false hope? Why do we presume that parents want large hospital bills just to be given false hope?

Why are we so insistent on misleading family members?

ALS (Advanced Life Support) has not been demonstrated to improve outcomes in cardiac arrest.

This is what I was thinking. While I do not know what went on in this case, there is much more detail on some other cases where ex-paramedic James McKenna appears to have really misbehaved, and not just a little bit.

During your employment as a Paramedic with Yorkshire Ambulance Service NHS Trust:
1. on 31 December 2007, you attended a male patient who had suffered five epileptic seizures and you:
(a) did not check the patient’s pulse;
(b) informed the ambulance crew that they were not required to take the patient to hospital;
(c) obtained a signature from the patient, on a form stating that he refused transport to hospital or treatment, whilst he did not have the capacity to make an informed decision;

This raises some questions about whether the Health Professions Council is more concerned with procedure than with patient care.

They provide some more details about their decisions on these complaints.

8. Mr McKenna admitted that he attended this 25 year old male patient who had a history of epilepsy. Shortly before 9:00pm he had suffered a cluster of five seizures. The Panel does not find particular 1a to be proved. The “Refusal of transportation” document records “P100” which is fairly to be construed as a recording of a pulse rate of 100. Given the ease and speed with which a pulse might be taken, the Panel does not find that the HPC has proved this particular. Particular 1b is proved, the same being admitted by Mr McKenna and in any event supported by the Patient Report Form (“PRF”) completed by the ambulance crew who attended the scene as it records that they were “stood down” at 9:08pm as they were “not required” as a result of Mr McKenna’s call to the Despatch Centre. Particular 1c is disputed by Mr McKenna but the Panel finds it proved. The “Refusal of transportation document” patient signature on this document is illegible and shaky and there is no printed name as required by the form. Furthermore, there is no supporting signature of a witness despite the fact that a number of persons, including Patient D’s girlfriend, were present.[1]

Why do so many paramedics work so hard to refuse to transport patients?

Why do medical directors ignore the refusal forms that are not extensively documented?

Why do medical directors not perform 100% review of refusals?

The same questions apply to the QA/QI/CYA committees that are supposed to be concerned about patient care.

This kind of problem with patient care seems to be the end point of a series of bad decisions made to avoid patient care. How did QA/QI/CYA let it get that bad.

But wait, there’s more –

The patient had more seizures and ex-paramedic McKenna returned to provide more of the lack of care he delivered the first time.

2. on 31 December 2007, you later attended the same male patient who had suffered a further three epileptic seizures and was also suffering from a leg injury and you:
(a) informed a second ambulance crew that they were not required to take the patient to hospital;
(b) argued with the patient’s mother about whether or not he should be transported to hospital;
(c) agreed to transport the patient to his mother’s home and so dragged him to your car using his trouser belt;
(d) muttered “this is ridiculous” in a manner suggesting that the patient was being uncooperative;
(e) failed to assess and/or treat the patient’s knee injury;
(f) transported the patient to the hospital in your car with no additional support if the patient had further seizures;
(g) did not inform the patient’s family that you were taking him to hospital instead of his mother’s home; and
(h) behaved without compassion, feeling or tact towards the patient and his family;

All of these appear to have been admitted by ex-paramedic McKenna or supported by other evidence.

At some point, he may have been a good medic, but he does not seem to care what happens to patients. There does seem to be undue attention to procedure over patient care, but I don’t see that as the cause of the undertreatment.

There is something else to consider. How many of us work with someone like this?


[1] Paramedic struck off for failing to perform full life support on girl, 7
A paramedic has been struck off after failing to perform advanced life-saving techniques on a seven-year-old girl who then died.
By Stephen Adams, Medical Correspondent
5:14PM BST 11 Oct 2011
The Telegraph

[2] James McKenna
Health Professions Council
Hearings and Decisions
Allegation Number: FTP02654 and FTP02093