A Question of Life or Death
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SPOKESPERSON: This is a medicaid call.
LEE HOCHBERG: Seven to ten times a day, these Emergency Medical Technicians, or EMT’s in the Seattle suburb of Mercer Island, respond to calls from the emergency 911 line.
DISPATCHER: 17-year-old female –
LEE HOCHBERG: This call was to assist a teenager who couldn’t stop shaking. EMT’s can perform cardiopulmonary resuscitation, they can stop bleeding and strap a patient to a board for transport to a hospital, but what most people don’t realize is that the EMT’s cannot give any medication.
LEE HOCHBERG: Can you give her medicines?
EMT: There are no medicines I can give her, no, besides oxygen, that’s it. All we’re allowed to give is oxygen.
LEE HOCHBERG: Though they’re the first to respond to most 911 calls, EMT’s in Washington State and most other states are forbidden by law from carrying or administering medication, except in some cases the patient’s own medicine. Only paramedics, who have more training in medical diagnosis, are allowed to give medicines. This girl recovered on her own from her anxiety attack, but some doctors say the restriction on EMT’s may be preventing them from saving thousands of other lives.
DR. JOHN BRENNAN: I do think the system, the way it has been, is clearly getting in the way.
LEE HOCHBERG: Dr. John Brennan is the emergency medical system chair for the American College of Emergency Physicians.
DR. JOHN BRENNAN: I think there’s a need to change these laws. We’re looking at examples, saying this patient should have had or been allowed to have been given these medicines in order to get better. Presently that is not happening.
LEE HOCHBERG: Doctors like Brennan, the EMS Director at New Jersey’s St. Barnabas Health Care System, say the nation’s emergency response system has fallen out of date.
SPOKESMAN: Jacksonville is the safest place in the world to have a heart attack.
LEE HOCHBERG: The system was born 30 years ago, when ambulance drivers in Florida were trained in CPR and became the nation’s first EMT’s.
SPOKESMAN: Every Jacksonville fireman is required to know how to employ CPR.
LEE HOCHBERG: State law prohibited them from giving medications, other states trained EMT’s and passed similar laws. Since there aren’t enough paramedics to go around, most Americans today are served about EMT’s, who are still restricted by those same laws. That system tragically fell short for Mercer Island resident Nancy Kastner-Klinck and her friend, Brett Bever.
NANCY KASTNER-KLINCK: I miss her terribly.
LEE HOCHBERG: In November, Kastner-Klinck’s 12-year-old daughter Kristine, deathly allergic to peanuts, ingested peanut fragments in a cookie. Her throat constricted. The only treatment is an injection of epinephrine, from a device called an EpiPen. But Kastner-Klinck’s EpiPen malfunctioned. She called 911.
NANCY KASTNER-KLINCK: We have a little girl that’s having an allergic reaction to nuts, and her throat’s constricting.
DISPATCHER: Is she breathing normally?
NANCY KASTNER-KLINCK: No. And I don’t have an EpiPen.
LEE HOCHBERG: So you told her that you needed epinephrine.
NANCY KASTNER-KLINCK: Twice.
LEE HOCHBERG: Under Seattle’s system, EMT’s respond to most aid calls, with paramedics coming later. Two Mercer Island EMT crews were dispatched to the scene.
NANCY KASTNER-KLINCK: I just called, I was wondering — it’s getting harder for her to breathe — and I’m wondering if they’re close by.
DISPATCHER: Is she getting air at all?
NANCY KASTNER-KLINCK:A tiny bit.
LEE HOCHBERG: The first EMT arrived within five minutes, but without epinephrine.
NANCY KASTNER-KLINCK: I mean, when an ambulance pulls up in your driveway with their lights flashing, you expect they’re going to have what you need. And they did not.
LEE HOCHBERG: The second EMT car arrived two minutes later, again without medicine.
BRETT BEVER: I was up on the road waiting for the — hearing the sirens — waiting for them to arrive to wave them down to the house. As each one would come, I would say do you have EpiPen? Do you have it? They’d say no. I was dumbfounded when each time they came they had nothing for us. I could not believe it.
NANCY KASTNER-KLINCK: It was like a nightmare.
BRADD BEVER: It was surreal.
LEE HOCHBERG: The EMT’s radioed paramedics, who had epinephrine, but were still on their way from another town.
SPOKESMAN: We have a 12-year-old female in extreme respiratory distress. This is a sick patient.
BRETT BEVER: I said please, God, hurry up. And then finally a distant sound — I knew it was coming from I-90, I could hear it coming, and I also felt that it was maybe going to be too late — I hoped not, but it seemed like that took too long.
NANCY KASTNER-KLINCK: It did.
BRETT BEVER: And it did.
LEE HOCHBERG: Paramedics showed up eight minutes after the first EMT had arrived, but the girl’s heart had stopped. Her family believes those eight minutes cost her life. Mercer Island fire commander Al Provost says his EMT’s were hampered by the law.
AL PROVOST: We’re not giving the best care we can give to these individuals that need it in a true emergency.
DR. JOHN BRENNAN: It is unconscionable that a patient died when we have the technology and the medicines to take care of those kind of patients.
LEE HOCHBERG: Emergency physician Brennan says EMT’s should be trained and allowed to give several medicines, like epinephrine for life-threatening allergies, inhalers for asthma, nitroglycerin for heart conditions.
SPOKESMAN: Third shock to 360.
LEE HOCHBERG: And he says if EMT’s knew how to use automatic external defibrillators, or AED’s, thousands of people suffering irregular heartbeat before heart attack could be better treated.
SPOKESMAN: This shock on board.
SPOKESMAN: Clear, stand clear.
LEE HOCHBERG: Although flight attendants use them on airplanes, in many states EMT’s cannot use them. Mercer Island EMT’s are training on them with special permission from the county medical director.
DR. JOHN BRENNAN: With the AED, out of those 350,000 people that die of sudden death, certainly between 10 and 20 percent could be saved.
LEE HOCHBERG: But the creators of emergency response systems say there are reasons why EMT’s roles are limited. Dr. Lothar Pinkers helped design Washington State’s program.
DR. LOTHAR PINKERS: So it’s easy to say, yeah, sure give them these drug, they’ll do great things. But in reality, give them drugs and they have the opportunity for committing just as much mayhem as they do benefit.
LEE HOCHBERG: Pinkers, a trauma surgeon, recently retired from his practice, says EMT’s don’t have the know-how to make complex clinical decisions in the field. EMT training is only 120 hours, compared to 1,000 hours or more for paramedics. Some paramedics agree.
MICHAEL MANN: The classroom is completely different. Our classroom tends to be the hospital. The EMT’s classroom tends to be a fire station.
LEE HOCHBERG: On an off-day from his job, Seattle paramedic Michael Mann said EMT’s can misread patient’s symptoms. What appears to be an allergic reaction, for example, in an older patient can actually be congestive heart failure. That’s an ailment epinephrine could aggravate.
MICHAEL MANN: I’m concerned that an EMT in rural communities or even in urban settings is going to have that familiarity, to be able to look at someone and say, yes, this person is in anaphylactic shock, yes, it would be appropriate to give an EpiPen to.
LEE HOCHBERG: Still, in many school districts around the country, teachers are being trained to use EpiPens for students with allergies similar to that suffered by Kristine Kastner. But EMT’s on Mercer Island, who were unable to save Kastner, say they, too, would like the chance to help. Captain Chris Tubbs.
CAPTAIN CHRIS TUBBS: Schoolteachers, parents can administer that, and why is there a contra — or why is there a difference between that and EMT’s? I don’t know the answer to that, it doesn’t seem logical to me.
LEE HOCHBERG: Washington State is training some EMT’s in rural areas where there are few paramedics about EpiPens, inhalers and nitroglycerin. And the EMS agenda of the future, put out by the National Traffic Highway Safety Administration calls for EMT’s to get additional training. But Dr. Pinkers says health dollars could be better spent elsewhere.
DR. LOTHAR PINKERS: Putting some of those training modules into place doesn’t make societal sense. It will be an expenditure where we will do less good for a larger number of people than if we put our energies and efforts and our money somewhere else. We cannot accommodate every citizen in every state in every place in the world, it just doesn’t work.
NANCY KASTNER-KLINCK: All of the EMT’s were there, lined up, and you could tell in their faces, you know, if they would have had it, it could have saved her.
LEE HOCHBERG: Nancy Kastner-Klinck testified recently for a bill to allow Washington State EMT’s to carry epinephrine. Four states have passed similar laws. Sponsor Ida Ballasiotes argued the medication could have been used in 300 Seattle area cases last year. But she met strong opposition from physicians, who she says don’t want others to treat patients.
IDA BALLASIOTES, State Representative: If I have to be perfectly blunt, I think a lot of it is just turf, okay? And I don’t think people’s lives should mix with turf.
LEE HOCHBERG: Recently, the legislature agreed to a two-year trial, beginning next year, in which EMT’s will be allowed to give epinephrine to patients under age 18, or to those with a prescription. Dr. Nancy Auer, immediate past President of the American College of Emergency Physicians, says such a piecemeal approach is unwise, though she agrees laws restricting EMT’s should be changed.
DR. NANCY AUER, Emergency Physician: You’re doing a band-aid approach. Epinephrine is a good thing to give, so let’s make this law specific to epinephrine, and I don’t want to see that. What I want to see is the flexibility of laws so that as technology changes and treatments change, that the system can adapt to that without having to go back to the legislature for everything you need.
LEE HOCHBERG: In New Jersey, Dr. Brennan recently convinced his state legislature to join more than 30 that allow EMT’s to at least give patients their own prescribed medicine, but they still can’t carry it to the scene.