Earthquake: The Long Road Back : Paramedics Praise Crisis Procedures

By the time paramedics arrived, the 65-year-old man lay lifeless on the floor of his Northridge home. He had been eating a bowl of cereal Friday morning when a 4.6 aftershock rattled his house and left him suffering from a severe heart attack. Breathless, with no pulse, the man seemed destined to become yet another quake-related fatality.

“He was blue in the face--basically he was not with us,” said the first emergency service worker on the scene, paramedic Ron Lingo of the Los Angeles Fire Department.

Working under an emergency order implemented after the earthquake, paramedics were able to treat the man differently from the way they typically treat heart attack victims: They were not required to call a hospital for instructions.

Lingo and his partner Mike Walker performed cardiopulmonary resuscitation, inserted an IV, defibrillated the man’s heart and then, relying on their training and years of experience instead of on hospital nurses, they administered medication.

“We got pulses back with him, and we got a good blood pressure,” Lingo said. “We saved his life.”

Just hours after the Northridge quake struck last week, paramedics with the city Fire Department began operating under what they call Communication Failure Protocols. The protocols, used primarily during a disaster, allow paramedics to treat certain types of patients without first calling a hospital for instructions--an adjustment that emergency officials say saves time without diminishing the level of care rendered to victims.

“The advantages are much quicker patient care,” said Alan R. Cowen, chief paramedic and commander of the city Fire Department’s Bureau of Emergency Medical Services. “It doesn’t make sense that when you have a cardiac arrest the first thing you need to do is run over and pick up a telephone. You should be treating the patient.”

Although the protocols were rescinded earlier this week as the demands on the emergency system declined, county Emergency Medical Services officials say it might not be long before the procedures become standard.

Prior to the quake, county EMS officials already were studying the idea of eliminating the mandatory call to base hospitals for some patients. For nearly a year the Long Beach and Burbank fire departments had been conducting a pilot program giving paramedics more autonomy.

“We saw that there was no change in the patient care,” said Dr. Samuel Stratton, medical director of the Los Angeles County Emergency Medical Services Agency.

The results of that study, which will be reviewed by the Emergency Medical Services Commission at its next meeting, possibly in February, along with the experiences of paramedics during the quake, demonstrate that contact with hospitals is not needed in most instances, he said.

“The earthquake was a devastating, terrible thing, but there’s a number of things we’re learning from it and this is one of those things: That we can function well under this type of system,” Stratton said.

After the quake, requests for Fire Department service--including many for paramedics--increased from an average 1,000 calls a day to 2,200 the first day, and 1,600 the next. While the demand on paramedics grew, their ability to contact hospitals declined. Several hospitals in the Valley were damaged and two of the three base stations were unable to accept calls from paramedics.

“Paramedics weren’t calling base stations because there were no base stations,” Cowen said.

Normally, paramedics are required to call a base hospital whenever they encounter patients experiencing chest pain, acute shortness of breath, symptoms related to hypertension and other ailments.

In such instances, the paramedic team will note the patient’s medical history, take vital signs and assess the patient. While one paramedic remains with the patient, the other relays the information by phone or radio to the base hospital. Typically, a registered nurse then orders a treatment.

In the case of the Northridge man, paramedics would--under normal circumstances--have called a hospital first before administering medication and then relayed the victim’s response to the nurse after each dose of medication, Lingo said.

But after undergoing intensive training and years of experience and continual updates, paramedics say that call is unnecessary.

“We know exactly what they’re going to say,” said Walker, a 12-year department veteran.

And sometimes it is more than a tedious formality, paramedics say.

“It’s a hindrance to patient care,” said paramedic Charles Barnett, who has been with the department 27 years.

Also, bad connections or street noise can make it difficult to hear nurses over the radio, paramedics say. And in instances where paramedics are inside a victim’s house, away from their radios, the task is even more difficult. The phone might be in a different room from the patient, or sometimes relatives in the house might be reluctant to release the line to paramedics.

“We can spend 20 minutes in the field talking back and forth to the base station,” paramedic Barnett said.

In the days since the quake, paramedics such as Lingo and Walker have answered calls ranging from the mundane to the extraordinary. They have patched cuts and bruises suffered in falls during the quake, resuscitated heart attack victims, and assisted Salvador Pena, a janitor who was trapped for more than seven hours in the rubble of the Northridge Fashion Center’s parking structure.

“When you’re dealing with a life-or-death situation, your No. 1 enemy is time,” said Lingo, a 20-year department veteran.

And during times of disaster, when the flow of calls is seemingly endless, less time spent with one patient can mean the difference between life and death for another.

“If you can treat, transport and clear, then you’re available for the next call during a disaster like this earthquake,” Capt. Steve Johnson said.

No longer tied to the phone, doctors and nurses in base hospitals also are able to spend more time with patients in the emergency room, Stratton said.

James Cott, director of education for the Long Beach Fire Department, said the paramedics in his department have adapted well to the procedural change.

“Much of pre-hospital medicine is pretty standard, and these are experienced medics who have been doing this for a long time,” Cott said. “It’s been morale-boosting for them.”

Even so, base hospitals would not be completely eliminated under the proposal. In some cases paramedics still would call hospitals for instructions.

“There’s always going to be that 10% that are complicated or not clear, where one needs to get a second opinion,” Stratton said.

If the change is approved, Los Angeles County, the largest emergency medical service agency in the world, will join numerous other municipalities that already have moved away from base hospitals.

Since the quake, it is uncertain when the change actually would be implemented because it would cost money, and the quake has and will continue to drain funds.

“The earthquake showed us that it will work, but it may have slowed us down because of problems with resources,” Stratton said.