LITTLE ROCK — While admitting responsibility for twice mistakenly declaring dead a lightly dressed, unconscious woman who overdosed on pain pills, top Metropolitan Emergency Medical Services officials said Tuesday that a coroner’s report released last week unfairly criticized the agency and its employees.
Speaking at a meeting of the MEMS board in Little Rock, Executive Director Jon Swanson and Medical Director Chuck Mason said that once two separate crews of paramedics believed that 52-year-old Pamela Harper was dead on a 40-degree morning in March, they followed the correct protocols and made decisions accordingly.
Swanson and Mason also said Pulaski County Coroner Garland Camper’s assertion in his report that paramedics should have followed a hypothermia protocol was incorrect. Instead, Swanson said, paramedics should have followed another protocol, “Pulseless Electrical Activity,” had they known Harper was alive.
“I don’t know where he got his medical training,” Mason, a physician and specialist in emergency medicine, said of Camper. “But it wasn’t medical school.”
Swanson also said the coroner was misinformed when he criticized a student emergency medical technician who performed chest compressions on Harper. Camper said the student was a minor and that it was inappropriate to have her try to resuscitate Harper. Swanson said the student was 18 years old and part of student training is to work in the field alongside more experienced emergency medical technicians and paramedics. To qualify to ride in an ambulance, Swanson said, a student must already have CPR certification.
Camper’s report also criticized what he called a reluctance to share certain information during his inquiry. But Swanson said his notes from those interviews show that Camper got answers and full cooperation from MEMS employees.
Swanson said as well that his agency has revised protocols as MEMS attempts to learn from the case. He was careful to say MEMS did not take responsibility for Harper’s death, only for not recognizing that she was still alive. A state Crime Laboratory report released last week with Camper’s report said Harper would likely have died even if the first paramedic had taken her immediately to a hospital.
“This is nothing to be proud of,” Swanson said. “We have done a thorough, honest and self-criticizing assessment of our performance. The responsibility is ours for the mistakes we made.”
Camper said he was confident in his report’s accuracy.
“It is what it is,” the coroner said. “It’s as right as I could get it. I gave them the benefit of everything we address in the report.”
Harper’s family did not reply to a phone message seeking comment.
MEMS board members asked few questions at the Tuesday morning meeting, focusing mostly on whether the agency responded openly to Camper’s inquiry.
Michael Keck, a nonvoting board member as liaison from the Little Rock Board of Directors, praised Swanson and MEMS employees for their professionalism and dedication.
“You have made it a source to improve on what is already a very good system,” Keck said.
Harper was found unconscious and lying face down, clothed only in a thin gown, light underwear and socks about 6:30 a.m. March 26 in an alley behind her brotherin-law’s house at 1322 Hunters Cove Drive.
The first MEMS ambulance crew believed she was dead, misdiagnosing rigor mortis, and left. A Little Rock police detective saw her breathe as he was on the phone to the coroner’s office. A second MEMS ambulance crew also decided Harper was dead, asking a doctor over the radio to declare her officially dead.
About 3 1 /2 hours after she was first found, as she lay under a thin white sheet in the 40-degree chill, a deputy coroner saw Harper breathe again.
She died two days later at Baptist Health Medical Center in Little Rock. Her death was ruled a suicide as a result of an intentional overdose of the narcotic painkiller Darvocet and alcohol. Hypothermia was a contributing factor in her demise.
The case is the first of its kind in MEMS’ 26-year history, Swanson said.
He acknowledged that he ordered paramedic Brandi Johnson to complete training courses because of mistakes she made as part of the second ambulance crew. She failed to adequately recognize hypothermia and the possibility of a drug-induced coma as elements that could make Harper appear dead. And she also missed brief activity on an electrocardiogram because she was looking at Harper and not at the device’s readout.
Though MEMS policies and protocols are constantly under review, Swanson said, the agency has already revised Protocol 803 - “Withholding/Withdrawal of Life Support.”
The new policy adds four criteria for determining whether a person is, in the agency’s terminology, “obviously dead”: No breathing through an open airway for 30 seconds, no pulse for 30 seconds, no heart sounds for 60 seconds and fixed and dilated pupils with “no neurological response to painful stimuli,”such as a pinch of the skin.
The new policy also includes a note in bold, italicized letters.
“Caution: Signs of death may be misleading,” the note begins.
The note mentions that a burn victim, for example, may look dead and poor hygiene can appear to be decomposition.
The note also addresses hypothermia. The low body temperature “may simulate death, and resuscitation should be attempted if time of exposure to cold environment or water has been less than one hour or is unknown,” the note reads.
Swanson said MEMS is retraining its employees under the new protocol. The agency gets more than 6,000 calls a month, transporting 4,000 people to hospitals.
“Maybe only 1 or 2 or 3 percent of our calls are truly to render lifesaving service, to perform in life-threatening situations,” Swanson said. “We know we don’t get a second chance.”
Told that it would seem that ambulance crews got a second and then a third chance in Harper’s case, Swanson sighed deeply and thought about what to say next.
“We acknowledge the duty that we have to do the best we can with each patient every time,” he said after a pause. “This is an outcome that we regret. Which is why it is so important for us to learn what we can from it, to use it to better offer treatment and care to the people we will serve in the future.”
Front Section, Pages 1 on 06/23/2010