NYC Medics Limit CPR During Blizzard

[x635 4,066]

Heart-stopping! Medics limit CPR amid 911 backlog

By LARRY CELONA, SERGEY KADINSKY and LEONARD GREENE

Last Updated: 5:57 PM, December 28, 2010

The epic blizzard kept city medics so busy that -- for the first time ever -- they were given a time limit for performing CPR on patients, The Post has learned.

EMS workers normally call a doctor for advice after working on a patient for 20 minutes.

The doctor normally allows them to keep trying to revive the person, sometimes letting them continue for more than an hour.

But faced with an enormous backlog of 1,300 calls, the medics were told to quit after 20 minutes and move on to the next case.

CPR can last a long time and sometimes medics can work on patients for as long as an hour.

Read more: http://www.nypost.com/p/news/local/heart_stopping_medics_limit_cpr_7Ahv46Qfw6NXpYklWpMhiO

[ny10570 745]

The actual story is that after 20 minutes of CPR with no ROSC, no shocks delivered, and no EMS available CFRs were allowed to terminate resuscitation. Same rules applied to BLS crews that were unable to transport. ALS crews and all other arrests continued with standard protocols.

[M' Ave 1,466]

Engine companies were also permitted to leave a patient if they deemed that person to be stable. Normally this would be considered abandonment, but with such a backlog of EMS runs, engines needed to be available and couldn't be left waiting for hours for a bus.

Pretty lousy move on the part of the city. They should have had far more ambulances on the road and.....ever heard of tire chains? Why are ambulances left without chains?

[38ff 250]

My EMT card expired a while ago, but I dont remember there being an exception for weather emergencies that allowed you to abandon your patient. Some lawyer is going eat the city's lunch over that I bet.

[mikeinet 37]

i was going to say... that's great that SOP may say to leave a patient...but what does the law / NYS say about that? I don't remember ever being taught it's "ok" to leave a patient UNLESS you a personally in danger...

[efdcapt115 1,511]

i was going to say... that's great that SOP may say to leave a patient...but what does the law / NYS say about that? I don't remember ever being taught it's "ok" to leave a patient UNLESS you a personally in danger...

I thought they were either RMAing or pronouncing via telemtry/doctor...

[OoO 24]

I would think this falls somewhere under MCI / Triage protocol.

[FireMedic049 597]

My EMT card expired a while ago, but I dont remember there being an exception for weather emergencies that allowed you to abandon your patient. Some lawyer is going eat the city's lunch over that I bet.

I seriously doubt it. The court action would involve more than just showing that the Engine crew left the patient's house. The patient would pretty much have to have died or suffered some sort of irreparable damage from them leaving for it to go anywhere. How do you prove that you were "harmed" if all that happened was that somebody didn't wait with you for the ambulance to arrive during a blizzard and an extreme backlog of requests for service?

Given what the situation appears to be, there's a pretty good chance that a "state of emergency" was declared and that opens the door to doing some things that aren't permissible/acceptable under "normal" conditions. I know that under normal circumstances I can't start an IV on a patient and then send them to the hospital with a BLS crew. However, under (large) MCI conditions and limited ALS resources, I can do that.

[PFDRes47cue 653]

The actual story is that after 20 minutes of CPR with no ROSC, no shocks delivered, and no EMS available CFRs were allowed to terminate resuscitation. Same rules applied to BLS crews that were unable to transport. ALS crews and all other arrests continued with standard protocols.

Any idea how many situations like this occurred?

Engine companies were also permitted to leave a patient if they deemed that person to be stable. Normally this would be considered abandonment, but with such a backlog of EMS runs, engines needed to be available and couldn't be left waiting for hours for a bus.

Pretty lousy move on the part of the city. They should have had far more ambulances on the road and.....ever heard of tire chains? Why are ambulances left without chains?

Any idea on the number of buses that the city had out? Not out?

Edited December 29, 2010 by PFDRes47cue

[efdcapt115 1,511]

With Ambulances Stuck in Snow, City Resorted to Triage

A woman with stroke symptoms in Midwood, Brooklyn, waited for an ambulance for six hours, finally arriving at the hospital with telltale signs of advanced brain damage. In Forest Hills, Queens, bystanders waited for three hours next to a man lying unconscious in the snow before they were able to flag down help. And in Crown Heights, Brooklyn, a mother in labor who started calling 911 at 8:30 a.m. on Monday did not get an ambulance until 6 p.m., too late to save the baby.

http://www.nytimes.com/2010/12/29/nyregion/29hospitals.html?_r=1&hp

[RWC130 594]

enormous backlog of 1,300 calls

How much is too much? 100, 300, 500 backlog?

At what point does the City of New York reach out and say WE NEED HELP?

Does FDNY EMS have a Mutual Aid plan of any type with

Nassau, Suffolk, Westchester, Rockland, or parts of New Jersey?

I know a Task Force of NJ EMS was requested but at what point?

How far into the backlog? I heard 1,500

What can we learn from this?

On a side note...

KUDOS TO FDNY EMS, FDNY FIRE FIGHTERS, NYPD POLICE OFFICERS,

AND 911 DISPATCHERS WHO GOT THE JOB DONE!

[38ff 250]

Since a "edict from above" was given that may change things a bit, but I dont think that is going to stop some lawyers. Good job to the troops in the field for doing what they had to do making the best of a bad situation, but those in the offices calling the shots might have some explaining to do..

1st question I would ask is "You didnt have any foresight to buy chains for your fleet???"

Edited December 29, 2010 by 38ff

[antiquefirelt 994]

Clearly there are times when the rules must be suspended within reason for the greater good of the masses. Most times MCI rules allow for different actions due to the overwhelming of immediate resources, I'd say this classically falls into this category unless someone can prove that NYC was negligent in not properly preparing and ramping up for the storm?

As for abandoning CPR after 20 minutes? We routinely stop working codes after 20 minutes upon consult with medical control. That's with full ALS being provided, nevermind being only at the BLS level. Very rarely does a code last beyond that unless the circumstances dictate, such as a hypothermic patient. Long gone are the days when we did CPR onscene and then during the 20 minute trip to the ED (where I started).

[NJMedic 96]

How much is too much? 100, 300, 500 backlog?

At what point does the City of New York reach out and say WE NEED HELP?

Does FDNY EMS have a Mutual Aid plan of any type with

Nassau, Suffolk, Westchester, Rockland, or parts of New Jersey?

I know a Task Force of NJ EMS was requested but at what point?

How far into the backlog? I heard 1,500

What can we learn from this?

On a side note...

KUDOS TO FDNY EMS, FDNY FIRE FIGHTERS, NYPD POLICE OFFICERS,

AND 911 DISPATCHERS WHO GOT THE JOB DONE!

NJ has a formal mutual adi agreement with NYC but I have no clue what the backlog was this week

[NWFDMedic 58]

1st question I would ask is "You didnt have any foresight to buy chains for your fleet???"

I've heard this argument more than once over the past couple of days. The answer to that question would be "how many storms in the past 30 years have caused such delays?" Sure we would like to have every resource for every situation every time but that's virtually impossible.

[38ff 250]

I dont think chains for the fleet are a crazy item to have to every vehicle for an eventuality such as this. According to another poster, there are 2 shovels per rig. Im not talking Onspots or the like, as they are expendsive. Normal tire chains will last a lifetime for the amount they will get used, and if you spec out the same size tire when you get new rigs, you can use the old chains on new vehicles.

[M' Ave 1,466]

I've heard this argument more than once over the past couple of days. The answer to that question would be "how many storms in the past 30 years have caused such delays?" Sure we would like to have every resource for every situation every time but that's virtually impossible.

We've had to put chains on both the engine and ladder in my firehouse more than once during the last few winters. If there have been times when 40-60,000 lb. rigs need chains, then there have been more examples of times when a lighter smaller unit like an ambulance could have used them. NYPD's RMPs have chains, why not ambulances. Having chains is not a resource for every situation, it's common sense.

[ny10570 745]

They were not abandoning the patients. They were triaging them out through telemetry. There 10 code for it, but I don't remember it.

No clue how many arrests were terminated without ALS. Hopefully it will come out in the investigation

No idea how many ambulances were running, however every available ambulance was running. The membership turned out and were committed to getting the job done. I did the first 6 hours of my shift no heat and had an EMT volunteer to ride third in a patient compartment with the AC stuck on high. We had crews waiting for broken trucks to get fixed and a thrid member on almost every ALS and in most command cars.

The Brooklyn delivery wasn't as simple as a woman in labor was left for so many hours. Initially it was a regular woman in labor, a low priority job. After repeated calls to check on the condition of the patient while awaiting an available ambulance went unanswered another caller reported eminent birth, upgrading the call to a higher priority. An hour later PD arrived reporting the unresponsive baby at which point it became an OB-out and an ALS was assigned. 12 minutes after that call EMS was on scene. Every call left in the system waiting for an ambulance gets regular calls to check on the patient.

The shovels were a joke. One plastic shovel that collapsed or broke on anything but light and fluffy powder and the other is an entrenching tool. Great for foxholes, useless for stuck ambulances.

Edited December 29, 2010 by ny10570

[M' Ave 1,466]

They were not abandoning the patients. They were triaging them out through telemetry. There 10 code for it, but I don't remember it.

No clue how many arrests were terminated without ALS. Hopefully it will come out in the investigation

No idea how many ambulances were running, however every available ambulance was running. The membership turned out and were committed to getting the job done. I did the first 6 hours of my shift no heat and had an EMT volunteer to ride third in a patient compartment with the AC stuck on high. We had crews waiting for broken trucks to get fixed and a thrid member on almost every ALS and in most command cars.

I worked from Sunday afternoon until Monday evening, so I was on duty throughout. Just to clarify, I don't believe that any more could be asked of those on the street. Cops, EMS workers, firemen and others were doing the best that we could. I think what's important here is that the city do a better job of preparing citizens prior to the arrival of the storm. More media coverage to encourage people NOT TO DRIVE and stay out of the way of public safety and sanitation workers. More resources should have been available in terms of an increased number of buses on the road and all ambulances should have been staffed with 3. Every engine in the city was given a 5th man for the 24 and beyond, with good reason.

More resources should have been stacked up and ready pending the storm's arrival. There is no reason that 1,300 calls should be back-logged, no matter how minor the emergency is.

This tough, and in some cases fatal, occurrence aught to end any discussions regarding Fire, EMS, Police of Sanitation budget cuts. Clearly we need all of the resources we have and in some cases, more.

[FireMedic049 597]

How much is too much? 100, 300, 500 backlog?

At what point does the City of New York reach out and say WE NEED HELP?

Does FDNY EMS have a Mutual Aid plan of any type with

Nassau, Suffolk, Westchester, Rockland, or parts of New Jersey?

I know a Task Force of NJ EMS was requested but at what point?

How far into the backlog? I heard 1,500

What can we learn from this?

Well, to me an obvious thing to learn from this is that you can't use an "everyday" approach to a "once in a decade" event that you have advanced notice of.

As for at what point does NYC reach out for help...........

Call it a Devil's Advocate thing if you will, but considering the scope of a storm like this, simply calling in Mutual Aid may not be much of an actual solution for a variety of reasons. It's quite possible that the communities being called for assistance may be experiencing an increased call load also and you may be creating a situation where you're "robbing Peter to pay Paul". Additionally, considering the volume of NYC ambulances getting stuck and having problems getting around on the snow covered roads and around the abandoned vehicles, would adding more units from out of town help the situation or compound the problem since it's likely that some of them will have the same problems?

[antiquefirelt 994]

As for at what point does NYC reach out for help...........

For what it's worth, it appears that some EMS units from NJ did get called in and responded to NYC: http://www.firehouse.com/news/top-headlines/nj-ambulance-crews-assist-snowbound-fdny

Oops! If I'd seen the other thread I'd know that it's very evident that multiple areas sent EMS crews to assist NYC, so it's appears that is not in question.

Edited December 29, 2010 by antiquefirelt

[Bnechis 3,961]

Engine companies were also permitted to leave a patient if they deemed that person to be stable. Normally this would be considered abandonment, but with such a backlog of EMS runs, engines needed to be available and couldn't be left waiting for hours for a bus.

I dont remember there being an exception for weather emergencies that allowed you to abandon your patient.

NYS does not have a "weather exception"

I would think this falls somewhere under MCI / Triage protocol.

Not normally, unless the SEMAC (NYS DOH Medical Advisory Committee) aproved it.

Given what the situation appears to be, there's a pretty good chance that a "state of emergency" was declared and that opens the door to doing some things that aren't permissible/acceptable under "normal" conditions. I know that under normal circumstances I can't start an IV on a patient and then send them to the hospital with a BLS crew. However, under (large) MCI conditions and limited ALS resources, I can do that.

Dont know if its true, but many reports were that a "state of Emergency" was not declared. IV's during MCI's & Tx by BLS hs been outlawed in NYS as of 2004

http://www.nyhealth.gov/nysdoh/ems/policy/04-02.htm

In a state of emergency, normal rules usually don't apply so responders can do whatever is best due to the conditions. But some lawyer probably will try to feast on this one.

1) It was not state of emergency (But it should have been) 2) What law allows this?

They were not abandoning the patients. They were triaging them out through telemetry.

This makes sense if allowed. But its not clear if this is whhat was happening.

[PEMO3 523]

Back in the early 1990's the NYS DOH created a section specifically for NYC that stated that "in a city with a population over one million" that the EMS crew could triage out the patient on scene with the approval of medical control (telemetry). The disposition code "10-95: Triaged out at scene, patient not transported was created. It was rarely used when it first came on line due to the fact that it was quicker to transport then to "10-95" a patient. That is probably how they left patients without the risk of abandonment. I need to look around for the original section that it was created under but it covered both BLS and ALS units that were part of the Municipal system only.

Edited December 30, 2010 by PEMO3

[M' Ave 1,466]

Back in the early 1990's the NYS DOH created a section specifically for NYC that stated that "in a city with a population over one million" that the EMS crew could triage out the patient on scene with the approval of medical control (telemetry). The disposition code "10-95: Triaged out at scene, patient not transported was created. It was rarely used when it first can on line due to the fact that it was quicker to transport then to "10-95" a patient. That is probably how they left patients without the risk of abandonment. I need to look around for the original section that it was created under but it covered both BLS and ALS units that were part of the Municipal system only.

Interesting info. Thanks for the clarification, because during the following day-tour, we (CFRs) were most certainly told to leave stable patients before the arrival of a bus. Calling telemetry was "suggested".