Follow up on CALSTAR airway incident - page 2

This is a follow-up story on the CALSTAR flight nurse incident that occurred on February 2008. This is serious business, two nurses stand to loose their lively hood and perhaps much more if criminal... Read More

  1. by   GilaRRT
    Not a problem. If anything, your googlefu skillz provided us with additional infromation such as the glass and headache concepts.
  2. by   helicoptergal
    This is a sad story and tragic for all parties involved. I am just curious what airway attempts were made prior to the flight crew making pt contact. It depends if the helicopter landed @ scene and the Paramedics already had made pt contact, or if the EMS crew rendezvoused at an airport to meet the flight crew. Oftentimes a flight crew will utilize a different airway management approach if other means to control the airway were attempted and not successful. There is a possibility that EMS may have attempted to Intubate the pt, and the flight crew chose to proceed with a Crichothyrotomy after evaluating that further ET attempts would be unsuccessful. Crichothyrotomy is a last ditch airway management tool. Again what a sad and tragic story for everyone involved.
    Last edit by helicoptergal on May 23, '09 : Reason: spelling
  3. by   mwboswell
    Quote from ♪♫ in my ♥
    Wow, I had no idea.

    Sounds like flight nurses are underpaid given the professional risks that they have to take.
    Ahem (clearing throat) AND flight medics or ground medics for that matter!
  4. by   sjt9721
    I haven't read much from this EMS Network publication, but this statement from the above article just sounds odd:

    CALSTAR staff are trained in providing emergency medical aid; however, they are considered "nurses." The are not formally considered to be either "EMTs," or "paramedics."

    Considered? They either are or they aren't..it's a matter of licensure/certification. Not what they are "considered".

    Sorry to split hairs, but it just struck me as weird.
    Last edit by sjt9721 on May 23, '09 : Reason: correction
  5. by   nerdtonurse?
    Yeah, that's what I thought. You've got a license or you don't, whether nurse, EMT, paramedic, etc.

    Another thought. I've had enough happy little crack heads on my floor to know what it does to the heart, but I wonder what coke could do to the trachea. The pt was positive for coke at autopsy. Just like coke can kill your heart, I wonder if it can thin out the trachea or make it more likely to tear? You know, they make a small hole and the pt's trachea just unzips? Is it possible that the trachea wasn't midline, and d/t the pt's injuries what they thought was the middle was actually more to the side? The pt had glass in his neck, he'd been ejected out of a vehicle, you've probably got at least some displacement of structures in the neck, plus all the blood and debris from the ejection; not the best circumstances to try something, but if the guy wasn't breathing, you can't wait from an opinion from the corporate legal department on how to proceed...

    I have bad days, but at least I'm not trying to intubate somebody in a ditch....those of you who do that are my heroes.
  6. by   GilaRRT
    Quote from nerdtonurse?
    Yeah, that's what I thought. You've got a license or you don't, whether nurse, EMT, paramedic, etc.

    Another thought. I've had enough happy little crack heads on my floor to know what it does to the heart, but I wonder what coke could do to the trachea. The pt was positive for coke at autopsy. Just like coke can kill your heart, I wonder if it can thin out the trachea or make it more likely to tear? You know, they make a small hole and the pt's trachea just unzips? Is it possible that the trachea wasn't midline, and d/t the pt's injuries what they thought was the middle was actually more to the side? The pt had glass in his neck, he'd been ejected out of a vehicle, you've probably got at least some displacement of structures in the neck, plus all the blood and debris from the ejection; not the best circumstances to try something, but if the guy wasn't breathing, you can't wait from an opinion from the corporate legal department on how to proceed...

    I have bad days, but at least I'm not trying to intubate somebody in a ditch....those of you who do that are my heroes.
    In some states, EMT's are certified. Some places and people differentiate a license from a certification. I am unsure of the situation in California. While cocaine was found in the patient, cocaine was not found to be related to the patient's ultimate death.

    Regarding the glass and trachea, it is impossible to make an educated statement without additional information. However, the patient was breathing at some point and the patient was being bagged. Did he have effective ventilations? No one can say without additional information.

    However, when we look at all this stuff, a point must be emphasized. The enemy of good is better. In that, I mean if things are working ok for the moment, taking aggressive measures to make things better can be met with disastrous consequences. My skin crawls when I hear people make casual comments about airway management. "It's ok, I can always cric him." This situation clearly demonstrates that not every person can be successfully crice'd. Food for thought when we are out there making these kinds of decisions.
  7. by   helicoptergal
    In Calif. EMT's are certified, EMT-P licensed.
  8. by   herring_RN
    The BRN only holds disciplinary hearings involving registered nurses.
    ...The Board of Registered Nursing is accusing two air ambulance nurses of incompetence and gross negligence in the death of 48-year-old Quintin Jones, a Woodland bus driver who crashed his vehicle and died while being tended to by emergency personnel in February 2008.
    The board filed separate complaints against CALSTAR nurses Bradley Michael Sidwell, of Sacramento, and Thomas Edward Zoltanski, of Ohio, who treated Jones at the scene of the accident on Feb. 25, 2008.
    Their nursing licenses could be suspended or revoked....

    http://www.dailydemocrat.com/ci_12367670
    BRN site - http://www.rn.ca.gov/
  9. by   GilaRRT
    Quote from herring_RN
    The BRN only holds disciplinary hearings involving registered nurses.

    BRN site - http://www.rn.ca.gov/

    I think we understand that they are RN's; however, I suspect the article was attempting to emphasize this point. It sounds like they tried to say these guys are out performing interventions traditionally performed by paramedics; however, the flight nurses are still in fact employed and licensed as nurses and not EMT's or paramedics.
  10. by   lamazeteacher
    Quote from icyounurse
    Really sad, but thats what I was thinking. Again without knowing the whole story I can only speculate, but I get the impression the patient was probably doomed no matter what the nurses did or did not do.
    Are you thining that when the patient grabbed his head before the crash, it was due to severe pain associated with a massive CVA? If that was so, the pathologist would have noted it in the later autopsy report, which isn't contained in the description of the incident, as brain dissection takes weeks to do......

    However the hemorrhaging from the incision made by the nurse did result in copious blood being found in the bus driver's lungs on the initial report. If death had occurred before that, there wouldn't have been such a forceful hemorrhage, without the heart's ventricular pressure.

    It sounds like wrong place, wrong time, for the nurses involved; and perhaps some peace can be found in thinking it was the patient's time to go........
  11. by   lamazeteacher
    Quote from morte
    I wonder if the coroner even checked for a brain bleed?
    By now, the pathology department that dissected the brain would have that report, and we don't have it, despite the exquisite description of the incident given by Gila RN. It takes weeks to do a thorough job on that, and pathologists aren't likely to call a press conference about their findings. Those will come up in the trial(s), which is bound to happen.

    I sure hope those nurses hire an expert lawyer, with considerable medical knowledge. Even though testimony will be given by doctors, often the words chosen by them don't give enough information for a jury to decide accurately if malpractise occurred.
    Last edit by lamazeteacher on May 25, '09 : Reason: placement of author's name
  12. by   GilaRRT
    Quote from lamazeteacher
    By now, the pathology department that dissected the brain would have that report, and we don't have it, despite the exquisite description of the incident given by Gila RN. It takes weeks to do a thorough job on that, and pathologists aren't likely to call a press conference about their findings. Those will come up in the trial(s), which is bound to happen.

    I sure hope those nurses hire an expert lawyer, with considerable medical knowledge. Even though testimony will be given by doctors, often the words chosen by them don't give enough information for a jury to decide accurately if malpractise occurred.
    Any description I gave was and is purely speculation. I have consistently stated we cannot make any definitive conclusions until everything comes out. However, medical information has been released from the coroner's office. In fact, the cause of death that I placed in quotation marks was the exact quote from the report in the article. Absolutely nothing was or has been said about the presence of an intracranial hemorrhage, yet.
  13. by   helicoptergal
    In some states, EMT's are certified. Some places and people differentiate a license from a certification. I am unsure of the situation in California.

    In Calif. EMT's are certified, EMT-P licensed.

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