Paramedics Assert They Followed Trauma System Procedures

The two Carlsbad paramedics who cared for a 14-year-old boy who was fatally injured in February while skateboarding said Thursday that they followed county trauma system procedures completely.

The paramedics said they contacted the proper hospitals as required under county emergency medical regulations, that they correctly determined that the victim could not be safely transported by helicopter, and that Tri-City Hospital in Oceanside was the proper facility to use in the case even though it is not a trauma center.

Their division chief, Jim Page, called the furor that developed this week over the handling of the accident politically motivated, saying he will not allow his paramedics “to be made scapegoats” in a dispute between doctors and hospitals.

In a related development Thursday, Tri-City spokesman Mark Havel told The Times that the hospital, effective immediately, is ending its effort through the county’s administrative process to be designated a trauma center. Havel said the decision was made by the hospital’s board of directors after the publicity on the Carlsbad incident.

Havel said that Tri-City would instead pursue its lawsuit against the county and try to gain its designation through the courts.

The Board of Supervisors on Wednesday ordered an investigation into the circumstances surrounding the actions of the paramedics in taking John William Dement to Tri-City by ground ambulance instead of calling the Life Flight medical evacuation helicopter to the scene to take the victim to Scripps Memorial Hospital in La Jolla.

Scripps is the designated trauma hospital for the north coast area under the county’s fledgling trauma system and has complained --along with four other hospitals now in the system--about Tri-City acting as a de facto trauma facility and handling severely injured patients. Tri-City has unsuccessfully requested trauma center designation from the county and was told it needs to correct deficiencies in its emergency medicine unit before the county will consider the request. That request will now be withdrawn by Tri-City.

The boy died at Tri-City on Feb. 23 of heart and lung failure resulting from head injuries sustained during the Feb. 8 skateboard accident. Supervisors acted Wednesday after a story in the San Diego Union raised questions about the boy’s death and the handling of his transportation.

But the paramedics Thursday complained bitterly about news accounts, which quoted Scripps hospital officials as saying they never received a call from the paramedics on the case. Under county regulations, the Carlsbad paramedics are required to contact Scripps, the nearest trauma center, for guidance when they handle an accident involving major trauma. Scripps officials said they were never called, implying that the paramedics consciously decided to take the patient to Tri-City in violation of procedures.

“We did call Scripps; I made the call,” said Carlsbad paramedic Sonny Hilliard, who along with partner Jim Torretto responded to the Dement accident. “We are supposed to call the nearest trauma base station, and I did so.”

Hilliard said that the intensive care nurse at Scripps who handles such calls told him that Scripps was overloaded with emergencies at the time and to call another

base station hospital. “That is proper procedure,” Hilliard said. “The nurse did not tell us to call Tri-City, as has been reported.”

A spokesman for Tri-City said Wednesday that the hospital had a tape of the paramedics saying that Scripps had told them to call another hospital.

Hilliard said that the only other base station that can be reached by radio from the La Costa area in Carlsbad, where the accident occurred, is Tri-City, even though it is not a trauma base station hospital. (A base station hospital is one that dispatches paramedics and other emergency vehicles.)

“So I acted properly in calling Tri-City,” Hilliard said. “That is the only other reliable base station we can communicate with other than Scripps.”

Although Hilliard initially requested that Life Flight respond to the accident, both he and Torretto decided that Dement was too combative to be transported safely by helicopter, fearing the boy could kick the pilot.

Torretto works part time as a Life Flight paramedic and said Wednesday that he used his experience on Life Flight to decide that Dement needed to be moved by ground ambulance. Life Flight landed at Tri-City to await Dement’s arrival by ambulance.

“I thought I had a good idea of what is combative,” Torretto said. “It would have been difficult, if not impossible, to take this patient by air rescue.”

Torretto said that Dement was vomiting, going into seizures and having a severe breathing problem.

“We stated this to Tri-City on the tape, and Sonny told them that the judgment was partially based on my Life Flight participation,” Torretto said. Torretto said that normally one paramedic drives and the second tends to the patient when a victim is transported by ambulance.

“In this case, both of us had to tend to the victim, and we recruited a firefighter (at the scene) to drive the ambulance,” Torretto said. “The boy had us all over the ambulance.”

Life Flight personnel, based at the UCSD Medical Center, have complained that the helicopter should have been allowed to land at the accident scene. They say that, too often in North County, Life Flight is told by paramedics to meet trauma patients at the helipad at Tri-City, and that often trauma patients are taken into the Tri-City emergency room, bypassing a waiting helicopter.

Torretto, however, said that the Dement case was the first among more than 20 in which he has participated that Life Flight was not asked to land at the scene. “I don’t see how anyone can second-guess us,” Torretto said.

Hilliard added, “This has been blown all out of proportion. We want Life Flight to land at the scene if at all possible, because it saves time for the patient and makes it easier for us.”

Dement was taken into the emergency room at Tri-City by the Life Flight doctor, who determined that the boy needed to have a breathing tube put down his throat. Once inside the emergency room, Tri-City doctors began working on Dement and he became the responsibility of Tri-City.

Tri-City officials have said they believe that Dement received the same level of care at Tri-City that he would have received at a designated trauma center such as Scripps. Dr. Randall Smith --president of the San Diego Academy of Neurosurgeons, a member of the county committee that oversees the trauma system and a doctor who helped treat Dement--said Wednesday that the boy received superb care. The deputy county coroner who reviewed the case after Dement’s death said he could not question the adequacy of the care.

Tri-City’s Havel said Thursday that the hospital “will continue to provide the highest quality emergency care” to trauma victims who must be taken to the hospital.

Life Flight director Dr. William Baxt of UCSD Medical Center said that he will ask county medical officials to tighten regulations to require the landing of Life Flight at accident scenes except in cases of mechanical failure or severe weather problems. In that way, Baxt said he believes, non-trauma centers such as Tri-City will have less chance to receive patients, because trauma victims will be helicoptered directly to designated hospitals from the field.

Baxt said that the Life Flight crew should determine whether a patient is able to be transported safely.