What Would YOU Do?

Have you ever tried to walk through a foot and a half of snow - while the sky kept dumping more snow on you?

That's what Pittsburgh public safety director Michael Huss says paramedics on three different crews should have done on February 6. With the worst blizzard in recent memory howling outside, Sharon Edge called 911 at approximately 0200. Her fiancee, Curtis Mitchell, was complaining of abdominal pain that even his oxycodone wasn't helping much. At different times during the early hours of the morning, three different ALS crews were dispatched to the address.

The trouble was twofold. First, their neighborhood sat overlooking a river and was accessible only by a narrow bridge. With snow piled high by then, the ambulances couldn't pass over the bridge. The first two crews had 911 dispatchers call back and ask Mitchell to walk to them, but he was both too cold and his pain too intense to make it. At one point, a neighbor offered to drive him to the hospital but the snow was so thick that he couldn't shovel his car out of the mess.

The calls spanned the day of February 6 and into the night. Around 0800 on February 7, Edge called 911 one last time - to tell them that Mitchell was dead. Paramedics finally reached them and called it. He was 50 years old.

Every soul in the EMS field can Monday quarterback this situation to death. There are parts - albeit small - in Arizona where they do get snow, but it's rarely as horrid as the snow storms on the East Coast, far less often than Pittsburgh. Some of my colleagues in Northern Arizona have weighed in on this particular incident and none of them have been very nice about it. What are the facts, though?

Medic Trommashere brought up a couple of good points, but I'll start with the most obvious: walking through over a foot of snow for nearly a mile is not easy. EMS crews are not typically equipped for extreme weather rescues and, in this case, the city was ill-prepared for the deluge of calls that befell them when the blizzard dumped nearly two feet of snow and knocked out power. Cities like Pittsburgh were not necessarily built with ease of maneuverability in mind; a lot of big East Coast cities are old enough that modern EMS wasn't in mind when the cities began to grow exponentially. Naturally, there are areas that can be tough to reach in the best of conditions - much less during a bad blizzard. I'm not an Arizona native. I've lived in parts of the country that normally get a foot or more of snow annually. I can tell you that it is not easy to trudge through that much snow in near white-out conditions even when your hands are empty.

When the rig couldn't make it and they were expected to walk, what should they have done? Even if they put their jump bags and heart monitors on the stretcher, would the stretcher have made it? Under all that snow was guaranteed to be ice, and if they'd lost control of the stretcher, they would have lost it and would have had no safe mode of transportation (not to mention they'd have lost all the gear piled on it, that stuff isn't exactly made of air).

Huss then said, "you get out of the damn truck and you walk in...we coulda carried him out!"

Now there's a fantastic option. What about protocol? If it's not safe for me, I'm not going to do it. What if I do walk in there and find a man twice my size and weight? You still expect me to heave him over my shoulder and carry him for a mile through ice and snow? If we're in a fire, it's a distinct possibility. At least there won't be a mile of distance to cover and I won't be dancing on a sheet of ice. What would be worse would be to try to carry him out and drop him. Then the crew gets sued for acting outside their scope of practice (without special rescue skills, they would be), taking an unnecessary risk, and causing further injury to the patient, with pain and suffering besides. How much do you think that settlement will balance out to? A few million? If Mitchell had survived we'd be sitting here bitching about how he was abused by medics who should have found another way to get him out or maybe even waited.

In our culture, we tend to be very reactionary. When something bad happens, we all sit back and go, "coulda, shoulda, woulda" until we're blue in the face. When the outcome of an incident isn't what we wanted, we aim for someone's hide and promise that somebody, anybody, will pay. When that's the case they're never fair. I saw three good corrections officers lose their jobs because more seasoned officers weren't doing their jobs when something bad happened, and someone's head had to roll. How fair is that?

In this case, paramedic Josie Dimon was fired. Three others were suspended. Many laypeople who don't have a working knowledge of the EMS system have all but called for blood over this incident. What most news stories haven't told you was that Mitchell had actually been in pain for a week and had, until that day, refused to go to the hospital. He had a history of pancreatic inflammation and had recently been hospitalized. You didn't hear in the news about the report that said members of all three teams did get out of their rigs to try to find a way and - this is the clincher - they were canceled by dispatchers.

Did you catch that? When you're dispatched to a call, who do you depend on - the caller or your dispatcher? If you tell your dispatcher you're having a hard time getting to the patient, your rig won't make it, there are near whiteout conditions outside...it's then up to the dispatcher and their supervisor to determine the best course of action. It wasn't the medics that refused. It was the dispatchers, who were on the phone with Sharon Edge and Curtis Mitchell, who would have tried to come up with solutions.

Could things have been done differently? Yes. I can think of a few calls I've been on where I wish things had been done differently. Hindsight is 20/20. Before you pass judgment, though, try and think of how your agency would have handled it. You can't look at the incident with the end result in mind, either. You have to consider what you would have done if you were standing on ice, facing a wall of snow, your only route to your patient's house completely blocked, and your dispatcher telling you to disregard and go to another call where you actually CAN reach the patient.

Still think you'd have done what needed to be done?