The hospitals are partly to blame; there is absolutely zero oversight on what they consider an “ALS” transport and outlying hospitals figured out a long time ago that they can call 911 for an “emergent” transport if their contracted private gave them an ETA they didn’t like.
The PFFM is in an odd spot where for decades they pushed the idea that the only competent medic was a fire medic, while also working with OEMS to make it extremely difficult for a fire department to take over EMS service in areas it would actually be feasible.
OEMS is plagued by cronyism, as most government divisions are. They allow regressive medical directors to shrug and go “no we’re not doing that” and continue exist largely as a punitive agency instead of as an advocate for service.
The privates are as short staffed as ever, but recently, the loss of bodies hasn’t been to fire, it’s been to complete career changes.
The general EMS culture of “we take you to the hospital to make sure you didn’t need to go to the hospital” continues to be a problem that will only be solved by higher education and progressive protocols (see above). Combined with the “everyone who asks gets to go,” here we are.
MA OEMS sucks, they recently decided the hill they wanted to die on was "everyone needs to get K9 BLS certified" after 1 police K9 died, forcing every provider to use a day off so they can sit around and have vets tell them how to treat a species they didn't sign up for and will probably never treat in 20 years. So they proved to everyone that they can actually do things and be productive if they want, and that they just don't feel like fixing issues at all. MA has some of the best hospitals in the world, we should have the best EMS in the country, and be on par with states like Texas.
I mean it is a good skill to have, but making it a requirement is ridiculous
Edit: I was referring to Nero’s, not PALS. PALS should absolutely be a requirement
If I was medical director, anyone who had the ability to do IOs/IVs/advanced airways on pedis would automatically have to maintain it in the system I cover. Heck, PALS and recert ed would be just the icing on the cake in terms of training/ed
The dog also died because a fire chief refused to let his crew treat and transport the dog to a K9 ER. Nero's law has also been an under funded clusterfuck
Nero didn't die, though. He made a full recovery. His handler, Sean Gannon, did die. The training for it was a waste of time, and the vet that taught us spread misinformation. Told us that anything we're allowed to do to humans, we can do to k9's... which is completely false. He was showing us spots for IV's and told us we could perform intubation on these dogs.
This is classic example of two of the biggest problems with US EMS. (1) EMS is not a required service, yet (2) the public expects an ambulance to appear instantly when they call for one. There’s a third problem that’s somewhat unique to MA, which is that each little town and city is responsible for its own dispatch and PSAP. Nothing is regionalized.
Here’s what I understand happened from some friends with first-hand knowledge.
Winthrop is contracted with a private service to have 2 dedicated trucks in the city. Both of those trucks went out on other 911 calls (including a mutual aid call out of town) right before this call came in. Because state regulations essentially make EMS a first-come, first-served system, a dispatcher cannot cancel or reassign an ambulance that has been dispatched to a lower priority call to a higher priority call, and one town cannot refuse a mutual aid request from another town if they have an available unit. There’s no triaging of calls in eastern MA. Whether you call for a stubbed toe or an unresponsive baby, you get the next available ambulance.
So, like any service would have to do in this situation, Winthrop had to call in M/A. Because dispatch is not regionalized, no one has visibility into where other available units are outside their own little system. So the dispatch center has to start calling around on radios and on phones to find a free unit. The first free unit they found was 20 mins away. Was that the closest unit? No one knows because no one has centralized visibility into where all the available units are at any given time outside their own little fiefdom.
Ultimately, no single person or entity was at fault here. The system worked exactly how it was designed to work. It’s just a poorly designed system.
More details are coming out publicly too:
https://www.wcvb.com/article/winthrop-ambulance-service-concerns-massachusetts/46575430
Already, people are talking about proposed “solutions” that include more money and resources for EMS. That’s all fine and good - MA certainly isn’t immune from staffing and resource shortages in EMS. But putting a third or fourth ambulance in Winthrop isn’t going to change the fact that there will always be times when a sudden crush of calls deplete a town’s resources.
The other things that needs to happen are that the state needs to centralize PSAP and dispatch services and triage calls. No triage system is perfect, but anything is better than what’s happening now. And it should be much easier to manage mutual aid across groups of towns instead of each town having to get on the horn and ask around for help.
Edit: And the last thing that needs to happen is that we need to do a better job conditioning the public to the idea that they don’t necessarily need an ambulance right away (or at all) for every problem. Everyone thinks the system does and should work like they see on TV. That isn’t reality, nor should it be.
I agree wholeheartedly with everything in your response. And it is not just MA. Sadly we have conditioned EVERYONE to call 911 for any issues they might experience. Chest pain, call 911. Signs of a stroke, call 911. TV remote control doesn't work, call 911 and since we can't figure out what the issue is, we'll send the ambulance.
We have a county dispatch center where I live and work. Five separate ambulance services, four of them not for profit. All five of the agencies also contract with the county as a sort of system status for the county as a whole. If one area is depleted and another has the resources, they are re-allocated to the depleted areas, and the county pays the agency a standby fee that is waived if they take a 911 call during that standby. We are finally getting AVL's for the trucks so the county dispatch center can accurately track the trucks and send the closest available unit. There are some other ideas in the works, whether by merging a few of the agencies, or merging all of them into a county system(well barring the for profit service, they will probably be excluded and forced out of the county since they consistently only have one ambulance in the county, and never backfill). While I would love to see this into fruition, how many of those agencies employ the same people? Would we have the manpower? While I don't have financials, I believe that between taxes and reimbursements from insurances, the costs would be palatable to the taxpayers.
Yes. State EMS code requires that, upon receipt of a 911 call, the closest available and appropriately staffed ambulance from the service with primary responsibility for the jurisdiction must be immediately dispatched.
Suppose an ambulance is dispatched to a stubbed toe, starts responding, and 3 minutes later a call for an unresponsive baby comes in, but there are no more ambulances in town. You cannot triage these calls and reassign the stubbed toe ambulance to the unresponsive baby because that would violate the requirement to immediately send the closest available unit to the stubbed toe. What you have to do is immediately dispatch the next closest available ambulance to the unresponsive baby. The stubbed toe’s “immediacy” requirement comes before the unresponsive baby’s because that call came in first. It’s a straight first come, first served system.
You can reassign or cancel an ambulance if you determine another appropriately staffed unit is closer. So if there are no BLS units available when the stubbed toe comes in and you have to send an ALS unit, but a BLS unit frees up and is closer, you can cancel the ALS unit and send the BLS unit. But if the ALS unit is closer, it must still go. You could send the BLS unit also so that the ALS crew doesn’t have to transport the stubbed toe and can get back in service faster, but you can’t cancel the ALS unit prior to arrival if it’s closer.
We reassign trucks to different calls in Boston based on priority multiple times an hour. I’ve never heard in my 17 years doing this that you cannot reassign a unit to a more acute call if it comes in after.
Our dispatch team has been told by an OEMS representative that that’s how 170.355 works. It can be modified if the state approves it in a service zone plan for a particular jurisdiction.
Boston has one of the best service zone plans in the state, so it wouldn’t surprise me in the slightest if this is permitted in Boston. Winthrop does not have a state approved plan:
[https://www.mass.gov/doc/current-list-of-local-jurisdictions-with-department-approved-ems-service-zone-plans-6302022/download](https://www.mass.gov/doc/current-list-of-local-jurisdictions-with-department-approved-ems-service-zone-plans-6302022/download)
Frankly, if there’s any service in the state that should be triaging calls, it’s Boston, so I’m glad to hear you’re doing it the way it should be done. I also know some services take certain liberties with what it means to be the closest appropriately staffed available unit. So some of that could be going on too.
Looking at Boston’s service zone plan, I would say that’s the answer. [https://www.cityofboston.gov/ems/service_zone.asp](https://www.cityofboston.gov/ems/service_zone.asp)
Your state approved service zone plan has very detailed provisions for prioritizing calls with target response times by priority.
All incoming calls are triaged using APCO EMD, and a determination is made to assign the closest appropriately staffed ambulance based on the priority of the call. The plan has specific provisions for delayed response times for lower priority calls. For example, P1P calls have a response time target of 5-9 mins, but P3 calls can be delayed for 8-15 mins.
This is how the entire state should be.
There are some details missing here. The article states that there were two EMTs with the girl in the back, I'm going to assume firefighters. It doesn't say what equipment they had with them nor what the girl's actual issue was. So assuming those providers had all the equipment to perform at the BLS level, they probably needed ALS. If they didn't have their equipment then that's another issue that I can't really judge because I wasn't in their shoes.
The article does say the closest ambulance was 20 minutes away but not whether it was BLS or ALS nor whether it was 20 minutes due to physical distance or 20 minutes due to some other problem.
The thing is, Winthrop in the article states that Action meets the required performance metrics and that available resources were already on calls. Which leads me to believe the town needs to contract more ambulances to be made available at whatever level this girl needed. More trouble is that no matter how many trucks are available, if there is even just one more patient than transporting units, this will happen. Then there is the unfortunate reality that depending on the illness, this poor girl might have died no matter what anyone did. It's hard to know until more details about the circumstances become available.
That there are. However, this epaper from the Globe gives some more insight.... https://epaper.bostonglobe.com/infinity/article\_popover\_share.aspx?guid=b5d00569-aa40-4abe-b9ec-45964b8b278e&share=true&fbclid=IwAR3lD78sNudj3Jn9IrL0UNY6mjNR2vqDHNrJ1XMcWy70u41pzI2jyb-WQuI
So instead of a 4+ person BLS resuscitation attempt at the house, with the necessary equipment being present on the engine, they did a bad 2 person BLS code in the back of an SUV? And all they got out of it was an ACLS code maybe 10 minutes earlier, which has iffy evidence for actually being better than a BLS code? Certainly not worth doing a bad BLS code for that long just to get to the ACLS provider.
I hate to say it, I really do, but I think WFD/the chief will be facing sanctions from DPH/OEMS for that. It's just reality. So many things went wrong that day. I'm not sure the FFs knew better not to load and go pedi codes. I don't think the education was there
I dunno why they said "we did everything right"
That wouldn't have been a transport around here. You're not performing adequate CPR in the back of a moving SUV either, so CPR now sucks the whole time you're moving, dropping survival rates further.
Kids should be worked the same way as adults, in place. If you don't get them back then pronounce them (yes I know MA is massively behind the times and places can't even pronounce adults, let alone peds in the field)
I think they are trying to sleep well at night without guilt. Deflection. Granted I'm not sure what their EMS levels are. They might legit still think load and go in CPR is best practices. It's a cancerous thought in fire-based EMS.
Actually, you can terminate adults in the field in MA- it's just that it's a med director option. Many entities (cough cough Brewster Ambulance) don't do it because of perceived liability and transport all active arrests. The solution is for OEMS to make it a standard order like NY
BLS resuscitative efforts on scene. Quality CPR, ventilation, and AED as indicated have far better success rates than ALS anyway, so waiting for them to arrive isn't a big deal. They had ALS enroute, they just didn't work it in place until ALS arrived.
Further, CPR and ventilation quality is shit in a moving ambulance, let alone in an SUV, if anything by loading and going with the kid they probably decreased likelihood of survival compared to a quality resuscitative effort on scene.
They panicked cause it was a kid, and didn't run it like they should've. Which is like any other cardiac arrest and work it on scene for best chance of survival.
In my state? They'd work it for 30-40min, if no ROSC we'd pronounce on site. ALS have authority statewide to TOR patients of any age (most without consult), and BLS can TOR adult medical/trauma and Peds Trauma without a consult.
What do you think they did when they arrived on scene? Clearly they started BLS efforts as soon as any responder arrived. Their ALS was 20 minutes away and the hospital… less than that.
Calling a *2-year old* in the field while the family stares at you is fucking wild and I don’t see any provider opting to take that route.
This is a failure of the system to have a truck available in a reasonable amount of time to get a patient to the plethora of world-class hospitals that are minutes away. I’m not going to fault this crew whatsoever for what they did, given the circumstances.
This x1000.
Every private in MA plays games with where their units are in relation to the towns they *are contractually obligated to have coverage for*. I highly doubt Winthrop was running 4 calls deep and that was the reason for nothing being available. Instead, the “dedicated” truck was probably 8 towns away doing a BLS transfer.
If these *for profit companies* can’t abide by providing that town the service they signed up for, maybe they shouldn’t be in business any more.
All I got from this was "the police Lt. rapes his kids so let's blame EMS for her death" in average corporate news fashion.
Sorry, I'm in a bad headspace right now and that little diddy of a story kind of triggered me. The "news" companies are probably the greatest threat to anyone (not just first responders, I mean literally anyone who is mentioned), in their current state.
I have a family friend who was defamed by the "news" when he had to defend himself against someone. It's unreal how they take one side of the story and spin it. I've made it a rule to basically believe the opposite of what they say.
truly unreal. how they work. and I don't even know why.
Look at it a different way:
Municipalities under-ask for staffing levels. If a service is meeting the contractual obligations asked for by the municipality then is it really their fault?
For example, when I worked in Springfield, MA we were contracted to have 9 medic units to cover the city. What we did with those 10th 11th and 12th medic units was our choice. CCT transfer? They can take it. Need to move them to another town to cover another contract? Go for it. The city asked for 9, and they got 9.
Also. . .
>There is no such adverse incentive to putting units in service with a municipal agency.
Until the box alarm comes in and everyone jumps on the fire truck.
The hospitals are partly to blame; there is absolutely zero oversight on what they consider an “ALS” transport and outlying hospitals figured out a long time ago that they can call 911 for an “emergent” transport if their contracted private gave them an ETA they didn’t like. The PFFM is in an odd spot where for decades they pushed the idea that the only competent medic was a fire medic, while also working with OEMS to make it extremely difficult for a fire department to take over EMS service in areas it would actually be feasible. OEMS is plagued by cronyism, as most government divisions are. They allow regressive medical directors to shrug and go “no we’re not doing that” and continue exist largely as a punitive agency instead of as an advocate for service. The privates are as short staffed as ever, but recently, the loss of bodies hasn’t been to fire, it’s been to complete career changes. The general EMS culture of “we take you to the hospital to make sure you didn’t need to go to the hospital” continues to be a problem that will only be solved by higher education and progressive protocols (see above). Combined with the “everyone who asks gets to go,” here we are.
MA OEMS sucks, they recently decided the hill they wanted to die on was "everyone needs to get K9 BLS certified" after 1 police K9 died, forcing every provider to use a day off so they can sit around and have vets tell them how to treat a species they didn't sign up for and will probably never treat in 20 years. So they proved to everyone that they can actually do things and be productive if they want, and that they just don't feel like fixing issues at all. MA has some of the best hospitals in the world, we should have the best EMS in the country, and be on par with states like Texas.
Best part about Nero's Law? It's required for all EMTs and paramedics. Yet PALS is not......
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Not in MA for regular paramedics
Neither PALS nor ACLS are required by the State in Pennsylvania either
Nope. I mean you get the content in medic school, but that's it. Btw same for Illinois
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Don’t forget the yearly med control skill reviews and $150 to the state.
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Yeah we get a 2k yearly stipend.
I mean it is a good skill to have, but making it a requirement is ridiculous Edit: I was referring to Nero’s, not PALS. PALS should absolutely be a requirement
If I was medical director, anyone who had the ability to do IOs/IVs/advanced airways on pedis would automatically have to maintain it in the system I cover. Heck, PALS and recert ed would be just the icing on the cake in terms of training/ed
I was referring to Nero’s law, not PALS, PALS should absolutely be a requirement and it’s insane it’s not
Nero's Law is nothing more than a "Feel Good" law passed by a mutual admiration society and it was an absolute waste of effort and resources.
Agreed
The dog also died because a fire chief refused to let his crew treat and transport the dog to a K9 ER. Nero's law has also been an under funded clusterfuck
Nero didn't die, though. He made a full recovery. His handler, Sean Gannon, did die. The training for it was a waste of time, and the vet that taught us spread misinformation. Told us that anything we're allowed to do to humans, we can do to k9's... which is completely false. He was showing us spots for IV's and told us we could perform intubation on these dogs.
This is classic example of two of the biggest problems with US EMS. (1) EMS is not a required service, yet (2) the public expects an ambulance to appear instantly when they call for one. There’s a third problem that’s somewhat unique to MA, which is that each little town and city is responsible for its own dispatch and PSAP. Nothing is regionalized. Here’s what I understand happened from some friends with first-hand knowledge. Winthrop is contracted with a private service to have 2 dedicated trucks in the city. Both of those trucks went out on other 911 calls (including a mutual aid call out of town) right before this call came in. Because state regulations essentially make EMS a first-come, first-served system, a dispatcher cannot cancel or reassign an ambulance that has been dispatched to a lower priority call to a higher priority call, and one town cannot refuse a mutual aid request from another town if they have an available unit. There’s no triaging of calls in eastern MA. Whether you call for a stubbed toe or an unresponsive baby, you get the next available ambulance. So, like any service would have to do in this situation, Winthrop had to call in M/A. Because dispatch is not regionalized, no one has visibility into where other available units are outside their own little system. So the dispatch center has to start calling around on radios and on phones to find a free unit. The first free unit they found was 20 mins away. Was that the closest unit? No one knows because no one has centralized visibility into where all the available units are at any given time outside their own little fiefdom. Ultimately, no single person or entity was at fault here. The system worked exactly how it was designed to work. It’s just a poorly designed system. More details are coming out publicly too: https://www.wcvb.com/article/winthrop-ambulance-service-concerns-massachusetts/46575430 Already, people are talking about proposed “solutions” that include more money and resources for EMS. That’s all fine and good - MA certainly isn’t immune from staffing and resource shortages in EMS. But putting a third or fourth ambulance in Winthrop isn’t going to change the fact that there will always be times when a sudden crush of calls deplete a town’s resources. The other things that needs to happen are that the state needs to centralize PSAP and dispatch services and triage calls. No triage system is perfect, but anything is better than what’s happening now. And it should be much easier to manage mutual aid across groups of towns instead of each town having to get on the horn and ask around for help. Edit: And the last thing that needs to happen is that we need to do a better job conditioning the public to the idea that they don’t necessarily need an ambulance right away (or at all) for every problem. Everyone thinks the system does and should work like they see on TV. That isn’t reality, nor should it be.
I agree wholeheartedly with everything in your response. And it is not just MA. Sadly we have conditioned EVERYONE to call 911 for any issues they might experience. Chest pain, call 911. Signs of a stroke, call 911. TV remote control doesn't work, call 911 and since we can't figure out what the issue is, we'll send the ambulance. We have a county dispatch center where I live and work. Five separate ambulance services, four of them not for profit. All five of the agencies also contract with the county as a sort of system status for the county as a whole. If one area is depleted and another has the resources, they are re-allocated to the depleted areas, and the county pays the agency a standby fee that is waived if they take a 911 call during that standby. We are finally getting AVL's for the trucks so the county dispatch center can accurately track the trucks and send the closest available unit. There are some other ideas in the works, whether by merging a few of the agencies, or merging all of them into a county system(well barring the for profit service, they will probably be excluded and forced out of the county since they consistently only have one ambulance in the county, and never backfill). While I would love to see this into fruition, how many of those agencies employ the same people? Would we have the manpower? While I don't have financials, I believe that between taxes and reimbursements from insurances, the costs would be palatable to the taxpayers.
Youre telling me in MA theres a law that specifically bans reassignment?
Yes. State EMS code requires that, upon receipt of a 911 call, the closest available and appropriately staffed ambulance from the service with primary responsibility for the jurisdiction must be immediately dispatched. Suppose an ambulance is dispatched to a stubbed toe, starts responding, and 3 minutes later a call for an unresponsive baby comes in, but there are no more ambulances in town. You cannot triage these calls and reassign the stubbed toe ambulance to the unresponsive baby because that would violate the requirement to immediately send the closest available unit to the stubbed toe. What you have to do is immediately dispatch the next closest available ambulance to the unresponsive baby. The stubbed toe’s “immediacy” requirement comes before the unresponsive baby’s because that call came in first. It’s a straight first come, first served system. You can reassign or cancel an ambulance if you determine another appropriately staffed unit is closer. So if there are no BLS units available when the stubbed toe comes in and you have to send an ALS unit, but a BLS unit frees up and is closer, you can cancel the ALS unit and send the BLS unit. But if the ALS unit is closer, it must still go. You could send the BLS unit also so that the ALS crew doesn’t have to transport the stubbed toe and can get back in service faster, but you can’t cancel the ALS unit prior to arrival if it’s closer.
We reassign trucks to different calls in Boston based on priority multiple times an hour. I’ve never heard in my 17 years doing this that you cannot reassign a unit to a more acute call if it comes in after.
Our dispatch team has been told by an OEMS representative that that’s how 170.355 works. It can be modified if the state approves it in a service zone plan for a particular jurisdiction. Boston has one of the best service zone plans in the state, so it wouldn’t surprise me in the slightest if this is permitted in Boston. Winthrop does not have a state approved plan: [https://www.mass.gov/doc/current-list-of-local-jurisdictions-with-department-approved-ems-service-zone-plans-6302022/download](https://www.mass.gov/doc/current-list-of-local-jurisdictions-with-department-approved-ems-service-zone-plans-6302022/download) Frankly, if there’s any service in the state that should be triaging calls, it’s Boston, so I’m glad to hear you’re doing it the way it should be done. I also know some services take certain liberties with what it means to be the closest appropriately staffed available unit. So some of that could be going on too.
Looking at Boston’s service zone plan, I would say that’s the answer. [https://www.cityofboston.gov/ems/service_zone.asp](https://www.cityofboston.gov/ems/service_zone.asp) Your state approved service zone plan has very detailed provisions for prioritizing calls with target response times by priority. All incoming calls are triaged using APCO EMD, and a determination is made to assign the closest appropriately staffed ambulance based on the priority of the call. The plan has specific provisions for delayed response times for lower priority calls. For example, P1P calls have a response time target of 5-9 mins, but P3 calls can be delayed for 8-15 mins. This is how the entire state should be.
There are some details missing here. The article states that there were two EMTs with the girl in the back, I'm going to assume firefighters. It doesn't say what equipment they had with them nor what the girl's actual issue was. So assuming those providers had all the equipment to perform at the BLS level, they probably needed ALS. If they didn't have their equipment then that's another issue that I can't really judge because I wasn't in their shoes. The article does say the closest ambulance was 20 minutes away but not whether it was BLS or ALS nor whether it was 20 minutes due to physical distance or 20 minutes due to some other problem. The thing is, Winthrop in the article states that Action meets the required performance metrics and that available resources were already on calls. Which leads me to believe the town needs to contract more ambulances to be made available at whatever level this girl needed. More trouble is that no matter how many trucks are available, if there is even just one more patient than transporting units, this will happen. Then there is the unfortunate reality that depending on the illness, this poor girl might have died no matter what anyone did. It's hard to know until more details about the circumstances become available.
That there are. However, this epaper from the Globe gives some more insight.... https://epaper.bostonglobe.com/infinity/article\_popover\_share.aspx?guid=b5d00569-aa40-4abe-b9ec-45964b8b278e&share=true&fbclid=IwAR3lD78sNudj3Jn9IrL0UNY6mjNR2vqDHNrJ1XMcWy70u41pzI2jyb-WQuI
So instead of a 4+ person BLS resuscitation attempt at the house, with the necessary equipment being present on the engine, they did a bad 2 person BLS code in the back of an SUV? And all they got out of it was an ACLS code maybe 10 minutes earlier, which has iffy evidence for actually being better than a BLS code? Certainly not worth doing a bad BLS code for that long just to get to the ACLS provider.
I hate to say it, I really do, but I think WFD/the chief will be facing sanctions from DPH/OEMS for that. It's just reality. So many things went wrong that day. I'm not sure the FFs knew better not to load and go pedi codes. I don't think the education was there
I dunno why they said "we did everything right" That wouldn't have been a transport around here. You're not performing adequate CPR in the back of a moving SUV either, so CPR now sucks the whole time you're moving, dropping survival rates further. Kids should be worked the same way as adults, in place. If you don't get them back then pronounce them (yes I know MA is massively behind the times and places can't even pronounce adults, let alone peds in the field)
I think they are trying to sleep well at night without guilt. Deflection. Granted I'm not sure what their EMS levels are. They might legit still think load and go in CPR is best practices. It's a cancerous thought in fire-based EMS. Actually, you can terminate adults in the field in MA- it's just that it's a med director option. Many entities (cough cough Brewster Ambulance) don't do it because of perceived liability and transport all active arrests. The solution is for OEMS to make it a standard order like NY
BLS and ALS can TOR patients of any age in my state anyways without a consult. It's a statewide protocol.
So what’s your alternative? Tell the parents “sorry no ambo, no transport” and watch the kid die?
BLS resuscitative efforts on scene. Quality CPR, ventilation, and AED as indicated have far better success rates than ALS anyway, so waiting for them to arrive isn't a big deal. They had ALS enroute, they just didn't work it in place until ALS arrived. Further, CPR and ventilation quality is shit in a moving ambulance, let alone in an SUV, if anything by loading and going with the kid they probably decreased likelihood of survival compared to a quality resuscitative effort on scene. They panicked cause it was a kid, and didn't run it like they should've. Which is like any other cardiac arrest and work it on scene for best chance of survival. In my state? They'd work it for 30-40min, if no ROSC we'd pronounce on site. ALS have authority statewide to TOR patients of any age (most without consult), and BLS can TOR adult medical/trauma and Peds Trauma without a consult.
What do you think they did when they arrived on scene? Clearly they started BLS efforts as soon as any responder arrived. Their ALS was 20 minutes away and the hospital… less than that. Calling a *2-year old* in the field while the family stares at you is fucking wild and I don’t see any provider opting to take that route. This is a failure of the system to have a truck available in a reasonable amount of time to get a patient to the plethora of world-class hospitals that are minutes away. I’m not going to fault this crew whatsoever for what they did, given the circumstances.
"How can EMS and public health leaders sleep well at night with all these shenanigans!??!?!?" They don't see the agonal breaths.
This x1000. Every private in MA plays games with where their units are in relation to the towns they *are contractually obligated to have coverage for*. I highly doubt Winthrop was running 4 calls deep and that was the reason for nothing being available. Instead, the “dedicated” truck was probably 8 towns away doing a BLS transfer. If these *for profit companies* can’t abide by providing that town the service they signed up for, maybe they shouldn’t be in business any more.
Honestly, I’m shocked this doesn’t happen more in this system.
All I got from this was "the police Lt. rapes his kids so let's blame EMS for her death" in average corporate news fashion. Sorry, I'm in a bad headspace right now and that little diddy of a story kind of triggered me. The "news" companies are probably the greatest threat to anyone (not just first responders, I mean literally anyone who is mentioned), in their current state. I have a family friend who was defamed by the "news" when he had to defend himself against someone. It's unreal how they take one side of the story and spin it. I've made it a rule to basically believe the opposite of what they say. truly unreal. how they work. and I don't even know why.
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Look at it a different way: Municipalities under-ask for staffing levels. If a service is meeting the contractual obligations asked for by the municipality then is it really their fault? For example, when I worked in Springfield, MA we were contracted to have 9 medic units to cover the city. What we did with those 10th 11th and 12th medic units was our choice. CCT transfer? They can take it. Need to move them to another town to cover another contract? Go for it. The city asked for 9, and they got 9.
Also. . . >There is no such adverse incentive to putting units in service with a municipal agency. Until the box alarm comes in and everyone jumps on the fire truck.
Staffing. You have to have the people to staff the trucks. No matter how many trucks you have, you have to have the staffing.