What the rescue crew can't do to save you

October 11, 1992|By Jonathan Bor | Jonathan Bor,Staff Writer

Maryland's emergency medical system has relinquished it role as a leader in bringing the most advanced lifesaving skills to patients wherever they are injured, say some of the state's top trauma specialists.

Inside and outside Maryland, experts are astonished that many rescue companies do not practice a technique considered the "gold standard" of delivering oxygen to patients who have stopped breathing. The technique, called endotracheal intubation, brings air directly to the lungs via a plastic tube inserted into the windpipe.

Perhaps most disturbing of all, a survey of the 24 largest cities in the United States reveals Baltimore to be the only one where the state-of-the-art method is not practiced.

And while the term "paramedic" is used casually to refer to rescue personnel in Baltimore, the city does not employ paramedics except for six who are forbidden from using many of the lifesaving skills they are trained to perform -- including endotracheal intubation.

"When I tell people on the national scene that we do not intubate in Baltimore, the reaction is disbelief," said Dr. Kimball I. Maull, director of the Maryland Institute for Emergency Medical Services System.

"My reaction is embarrassment."

The system appears headed for an overhaul. Dr. Maull and his hand-picked director of emergency medical services, Dr. Richard Alcorta, plan a thorough -- and expensive -- revamping of the splintered system now delivering emergency care in Maryland.

They hope to prevent the confusion that compromised the treatment this summer of a Baltimore woman who lost consciousness in a choking accident.

City rescue crews were unable to restore her breathing because they couldn't intubate her. With her airway blocked, all other methods were useless. So a rescue worker radioed a dispatcher and arranged to rendezvous with a Baltimore County paramedic who could.

With precious minutes ticking away, the city crew sped toward Franklin Square Hospital. Along the way, city and county ambulances met, and pulled into the parking lot of a fast food restaurant.

A county paramedic hopped into the city ambulance, equipment in hand. She pumped oxygen into the patient's lungs, restoring a pink tone to the victim's cheeks. But the woman had gone without oxygen for at least 15 minutes -- about triple the time a patient can tolerate without suffering severe brain damage.

Once at Franklin Square, she was placed on a respirator. The next day she died.

It remains unclear whether the haphazard rescue was to blame. No one really knows how much time elapsed before her relatives discovered her. But, lacking the ability to bring oxygen to her lungs quickly, officials agree, city rescue workers couldn't give her a chance.

Many may be trained

Changes now being drafted call for the nearly 1,400 people working as cardiac-rescue technicians -- mid-level rescue workers in the hierarchy -- to be trained as paramedics. Along the way, they would learn to perform endotracheal intubation and begin to practice it before they receive their paramedic stripes. The process could take several years.

The plan comes at a time when Dr. Maull has drawn fire for shaking up the Maryland Shock Trauma Center and requesting an independent review that found the center to be inferior to many of the nation's leading trauma centers.

Now, Dr. Maull and his associates admit they face a difficult task. Although they hope to raise grant money to defray costs of what could be a multimillion-dollar task, they must persuade local fire chiefs and volunteers to crank up their own fund-raising to buy new equipment. Volunteers would have to donate more of their own time to get retrained.

"It's a matter of persuasion, peer pressure, ethics," said John Donohue, director of emergency medical services for Baltimore and the surrounding counties.

A look across Maryland reveals a patchwork approach to delivering emergency medical care to citizens.

People living in several counties, including Baltimore, Anne Arundel and Prince George's, are served by paramedics skilled in methods such as endotracheal intubation. Even there, paramedics are barred by state rules from using other lifesaving techniques that have caught on in states such as New Jersey.

In other many other counties, including Carroll and Harford, paramedics work in some communities but not in others. And in Howard and several Eastern Shore counties, citizens aren't served by any paramedics.

This means the best-trained personnel on most of the state's ambulance runs are cardiac rescue technicians -- dedicated people trained in some rescue techniques but not in many state-of-the-art methods such as intubation. Rather than intubating, they deliver air to the lungs with a technique regarded as less effective and sometimes dangerous.

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