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Sat Oct 13 16:20:22 BST 2007

Dr. Danks,
One, keep in mind that I was not only an EMS provider, I also happen to be a
respiratory therapist so I am probably a little better versed in the
pathophysiology side of things than most (still not a doctor, but a step
up).  My assessment skills for the thorax are probably a little better and
he had equal breath sounds, his trachea was midline and was easy to bag.

Two, "f--- you" part was brought up to my medical director (who is a
paramedic as well as an MD, so he tends to demand not only outstanding
knowledge from his providers, but also tends to defend us when someone
attacks us) by his deputy.  I was not party to the conversation directly but
from what the medical director told me he said was basically "Rick, I would
have told you the same exact thing if you had been in my way."  I could have
worded it a little nicer, but I was pressed for time.

Three, the mortality in this series (n=1) is 100% but it's also anecdotal
evidence and can not therefore be extrapolated.

Four, and actually until I hand over the patient to the doc in ED, the
responsibility rests with myself and with my medical director.  Our medical
director stated that he viewed this the same way as an emergent transfer
with direct admission since we had a staff physician waiting on the arrival
of the patient.  Therefore he considered the ED (where he was chief) to
simply be an hallway through which this patient would pass.  This case led
to a formal protocol being discussed for direct to OR transfers. I am not
certain as to whether it was ever put in force as I moved to Michigan
shortly after this to further my education.

-- 
Stephen L. Richey, CRT

"It is better to know some of the questions than all of the answers."- James
Thurber

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