- The Washington Times - Saturday, September 1, 2001

D.C. fire department officials want to punish two paramedics who followed a doctor's instructions and revived a man because the routine procedure they used is not in the department's outdated medical protocols book.
All D.C. paramedics have been trained to perform the technique, called needle decompression, which is "standard procedure in surrounding jurisdictions," according to a letter of support for the medics signed by 10 physicians at George Washington University Hospital.
But needle decompression is not listed as "approved" in the department's medical protocols, which haven't been substantially revised since 1994.
Dr. Yolanda Haywood, an emergency room physician at the hospital, directed the medics to perform the procedure on the man even after they told her it was not in their protocols, according to a medical report from the incident and the letter of support.
The man's breathing and heartbeat had stopped after he was hit by a motorcycle at South Capitol and M streets SE on May 12, documents show. The man, listed as a "John Doe," suffered broken legs, a broken arm and massive internal injuries. His injuries were so bad that an air pocket had deflated one lung and was crushing his organs, including his other lung and his heart, according to a medical report.
The needle decompression relieved the pressure and revived him on the way to GWU Hospital's emergency department, documents show.
"Dr. Haywood believes that this patient would not have survived to the [emergency department] without this intervention," said the letter, which was sent Aug. 13.
Though he died of internal bleeding during an operation later that day, "the man lived eight more hours to see his family" because of the medics' action, said Kenneth Lyons, chairman of the department's medics union.
The department is weighing a 15-day suspension without pay for the medics, which is considered a "very severe" punishment, department sources said. A department official will consider the medics' response and decide the matter in the next few weeks.
Dr. Fernando Daniels, who is responsible for updating the medical protocols as the fire department's medical director, conceded that the protocols are "antiquated" and "confusing."
And he praised the medics for the job they did. But "rules and laws have to be enforced," he said.
"It's an unfortunate thing, but we have rules and regulations, and everybody has to abide by them," he said. The procedure "is not in their scope of practice."
The medics are identified in the documents as Brandon W. Graham and Michael W. Baker, both of whom are sergeants in the EMS division and work as evaluators. Mr. Graham said yesterday he is not allowed to comment on the matter, and Mr. Baker did not return a phone call.
A supervisor gave them disciplinary documents Aug. 13. Their violation is "performance of an invasive procedure on a patient which is currently not an approved clinical intervention listed in the District of Columbia's Fire and EMS Department's protocols," according to department documents.
The fire department has written the first new protocols since the mid-1990s and will send them out for review next week. Most agencies update their medical protocols every one or two years.
Dr. Daniels, who joined the department in 1999, said he has been trying to finish the protocols for a year and a half. He also said he hopes the protocols — which include needle decompression — will be approved by hospitals and the city's health department by the end of October.
All D.C. paramedics are trained to perform needle decompression when they receive certification from the National Registry of Emergency Medical Technicians.
The national guideline for emergency medical care — the U.S. Department of Transportation's National Standard Curriculum — also includes the procedure and calls for its use in situations in which an air pocket is crushing internal organs.
Department guidelines call for the medical director, Dr. Daniels, to take "corrective action," such as a refresher course, for medical mistakes. Officials in the EMS operations division are handling the case and have skipped directly to disciplinary acton.
Dr. Daniels said the proposed punishment is appropriate because what the medics did was a "major protocol violation."
Documents show that internal investigations of other incidents have yielded little or no punishments:
A paramedic burned a patient with a canister of liquid oxygen on the way to the hospital earlier this year, but she was not punished.
The same paramedic late last year refused to take a person suffering a diabetic emergency to the hospital. The medic was given an eight-hour refresher course.
In April, two medics did not take a man to the hospital and failed to show that he refused treatment, as they said. The man subsequently died, but they were not punished.


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