EMS FOUL-UP IN CONNECTION WITH ANOXIA CASE IN SWEDEN

Philip Kirschner philk at ix.netcom.com
Wed Jun 28 23:53:51 EST 1995


In <hce-2806952023030001 at pppnode8.bahnhof.se> hce at bahnhof.se (Hans
Christian Eidenert) writes: 
>
>Re: EMS FOUL-UP IN CONNECTION WITH ANOXIA CASE IN SWEDEN
>
>Further to the discussion whether the dispatchers in Sweden have the
>appropriate training to deal with emergency calls when a suicide
>attempt is suspected I wish to state the following questions.
>
>1. How come an ambulance is automatically dispatched with first
>priority to a location when an automatic alarm (such as a firealarm)
>is put into action when these alarms usually turn out to be false
>alarms?

In the United States, a typical responce is given by sending a fire
unit or paramedic unit before the actual ambulance is dispatched.
It's mostly typical in major cities that any 911 emergency call's
are dispatched via the police and then fowarded to an EMS dispatcher
for appropriate triage.

>Why should they not act on suspicions from relatives, friends, or
>neighbors where there is no reason why those suspicions should not be
>genuine?

Typically, a suicidal person will call themselves after the fact they
overdosed on some type of medication, or a relative finds them dead,
in respiratory arrest or some other type of extremis.

>Is there no other safe way in which crank calls and false alarms could
>be discounted?

Yes by sending a police unit first to determine the need for further
interventions.

>2. What is generally the educational and training requirement for
>ambulance personnel in other countries around the world especially in
>regard to dealing with cardiac arrests and subsequent breathing
>failure?

It depends on the level of training of the emergency personel. In the
united states we typically have four levels of training. Each level is
higher then the next.  


EMT-Basic Life Support 
EMT-Intermediate 
EMT-Advanced 
EMT-Paramedic

Basic level of training, CPR, Oxygen and transport using bag valve
masks,Emt-Defibulators set automaticly by medical control officers
in particular counties. Very basic overdose interventions if the
patients are contious and able to maintain a gag reflex then an emetic
can be given.

Intermediate- Emt's can start Intravenous lines via medical control 
officer which is a doctor. Can perform basic intubation techniques and
that level various from area to area. 

Advanced- Emt's can deliver drugs, intubation, cardioversion,
defribulation with medical control. 

Paramedics- Can provide all of the above without medical control and go
on standing orders, which are protocols set up by cities, counties and
or municipal governments. 

The typical Advanced Life support measures provided by drug overdoses
involving respiratory arrest are the same, IE Endeotracheal intubation,
hypoventaliation, IV meds such as the soup, antagonistic drugs that
challenege and or block the overdose. Some area give NARCAINE which is
a standard, anatagonist dextrose via bolis, calcuim channel blockers
are also now given in the field. This is just basic information I, am
providing of course.


>3. How should an ambulance be equipped to be able to deal with such
>situations? Are most or all ambulances equipped to be able to handle
>such emergencies?  

An ambulance should have depending on the level of training, suction
equipment, Lyrangascope for entubations, cardiac drugs, antagonists,
telemetry equipment. Again, this equipment varies with level of
training.

>These are just some of the questions that I would be interested in
>finding answers to in connection with my wife's case.

You will need to consult the local ems manuals and or medical
protocols.


>Here is a transcript of the fatal call number one to the 911
>dispatcher:
>
>911 dispatcher:   911.
>Caller: Yes, hello.
>911 dispatcher:   Hello.
>Caller: I have received a call from Norrlandsgatan 20 in Uppsala.
>911 dispatcher: Hmm.
>Caller:  And I believe someone is committing suicide.
>911 dispatcher: Hmm, I'll connect you to the Police, hold on.
>Caller: Thank you (can hardly be heard). 
>
>The Police arrives on location 21 minutes later.
>
>When the ambulance arrives according to witness reports they take a
>very long time to get the patient into the ambulance. One witness
>claims that this takes around 30 minutes. There is a delay of
>approximately three to four minutes during which timne the emergency
>personnel are looking for the patient's identification documents
>(despite the fact that two persons at the location know the patient
>well). None of those two follow the patient in the ambulance to the
>emergency ward.
>
>I am thankful for further comments via E-mail.
>

Christian,

         If the crew was above the level of EMT and IV lines were
established and medications were given to antagonise the overdose then
the crew did the right thing. If the crew was a basic unit, they should
have called for an advanced life support unit to back them up, or
scooped and run to the hospital providing respiratory life support
along with Cardiac support if she arrested.

Thank you,
Mr.Philip B. Kirschner
Former NYC paramedic
Disabled





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