Not always going to be a bloody mess?

[mercop]

Just wanted to recount something that happened to us last week for some professional thought.

I started riding an ambo when I was about 13 (my Mom was a volly EMS Lt) in a small town. Then all the normal crap in the Army. The first responder with the PD and some private study under my Ju Jitsu instructor who was an 18D in the Army. I have always had a huge interest in trauma. Anyway here it goes.

A good example of how people that should know better don't.

The other day I got a call from school that my son had a seizure in gym class and was being transported to the hospital by EMS. He had no history.

During gym class they were cleaning up when the gym teacher turned around and saw Frank on the floor in a "full body seizure". He called a medical emergency and the principle and nurse came. He was unresponsive and nobody saw him fall. EMS transported him. Several mistakes were made.

First of all nobody timed the seizure or had a good description of the seizure activity. This is very important especially for someone with no history. Apparently nobody saw him fall, so either he seized and fell, or fell and seized. Either way he should have been placed on a backboard with a cervical collar and he was not. During a medical emergency the nurse should have pulled his information card and seen that he had no history of seizure activity. In my opinion this would have screamed possible closed head injury to a juvenile and required Advanced Life Support and not Basic Life Support that was dispatched.

Further investigation revealed that he seized, fell to the floor and struck his head, luckily only causing a small bump. Long story longer he is now considered to be epileptic (anyone who has had more than one non trauma induced seizure in their life) he has now had three and is on antiseizure meds. He scared the crap out of us but is no worse for the wear.

Just like with everything else, knowledge and training over tools. People screwed up and it still all worked out. I will be having some discussions with certain individuals next week


Again guys I am not a medical professional, check me where I am wrong.- George

.- George

[ST911]

You have every right to ask questions about the care you and yours received, and I encourage you to ask them of every level and participant in the process. Good call review and QA is important.

That being said, best QA for this call would require a lot more information. Especially the information that each participant had as the call progressed.

ALS is always nice. Your BLS unit may have been appropriate and sufficient, depending on their capabilities, transport times, protocols, patient presentation, etc. Was an ALS intercept requested, and just had not yet arrived? Were they dispatched and cancelled? Were they on-line with the BLS crew? And when you say BLS, what level? Some states, systems, and med directors have some very capable, special-skills BLS providers.

The lack of C-spine precautions isn't necessarily a problem. Is there a field clearance protocol? What additional information did they develop as they were in the decision process to apply or not to apply? Thinking about a closed head injury is logical. Did they gather data at the scene that ruled that out? I've c-spined some seizure patients, and not others, even with a ground level fall or certain unknowns. Short: It depends.

Timing the seizure is nice to do, but an approximation of length is usually sufficient. Are you certain that it was untimed altogether? Timed, but not disclosed to you? Who did, or didn't time it? There did appear to be a description of the seizure activity, "full body" I think you said. When was that known? By who? Passed on?

The school not pulling a data card may not be a problem either. How do you know that it didn't occur? What's the size of the school? Is it possible that the nurse already knew that he had no history? Our school nurse can give me a complete brief from memory of known concerns with kids in her building. Yours too, perhaps?

Have those conversations, and ask those questions. More food for thought:

Parents can be tough customers. Parents in fire/EMS/medicine/public safety are the toughest. They have knowledge and experience, their own methods and preferences, and lack the professional detachment in the process of care and QA afterward. Consider how that might be impacting your view. (Yes, I've BTDT, and it's tough.)

I'd be interested to hear what you find out. Best wishes to you guys.

[Vic303]

Hope your boy is ok, and they find the right meds to control the seizures. Also hope they find the root cause--be it epilepsy or something else.

[NinjaMedic]

Most kiddos that age with no prior medical history who experience a witnessed seizure in my community with a resultant fall from standing height would not be placed in spinal motion restriction. I would second Skintop911's view of things, and you also have every right (and many would argue a responsibility) as the parent of the child to ask questions. A couple of quick points however.

1 - The nurse has nothing to do with the response level. In your community they probably assign resources based on a computer algorithm known as Medical Priority Dispatching. Based on the answers to the set questions that the dispatchers ask the incident is assigned a priority level and the specific set of resources for that incident dispatched based on the priority. Your community may or may not have multiple ALS units. (Although in many communities any seizure is an ALS call)

2 - Just a guess but I bet the crew onscene were given an ADEQUATE description of the seizure activity and duration. While we always prefer more info we usually get what we need (ie he was convulsing all over or his eyes rolled up and to the right etc, and the seizure was maybe 30 seconds or maybe 3-4 minutes or maybe the seizure was like 10 minutes it ended right before you walked in etc)

3 - It would be extremely unusual for a kiddo to sustain a closed head injury from a fall from standing height even on concrete.

Just my thoughts, good luck to yall!

[mercop]

Thanks guys. I guess I was just pissed that with all the second hand information nobody could even tell me if his seizure was less or longer than 10 minutes. We did not have a clear description of the seizure. They also did not bother asking any of the kids what happened and we found out latter from one of his friends that Frank seized, fell into is buddy and then to the floor bumping his head. I was the one that noticed the bump on his head in the ER.

The two EMT's on the ambo just did not inspire confidence. I was judging them against the EMS they had where I was a police. Even though they were Volly's many were full time paramedics other places or just real into what they are doing. Of course we had more serious stuff out their like GSWs and cuttings. Judging from past experiences there if this happened hew would have likely been flown, right, wrong, or indifferent.

Thanks for all the grounding guys. I am going to check on the EMS protocol as well as talking to the nurse and principle since their is a chance they will have to deal with him or someone else in the future. - George

[NinjaMedic]

Also consider that in medicine you really do get what you pay for and while there are some great volunteer EMS services out there it is ver very difficult to preform effective QA/QI and education in a volunteer service. Stay Safe!