911 call dispatch priority disputed

September 02, 2004|by ANDREW SCHOTZ

SMITHSBURG - A Smithsburg woman's seizure in March was dispatched as a high-priority call, two Washington County emergency services officials said this week, countering an allegation that dispatchers did not convey the situation's severity.

Danny Gibson called 911 on March 5 when his pregnant fiancé, Christina Hess, was seizing at their home on Maple Avenue in Smithsburg.

Hess, 20, and her unborn son died at Washington County Hospital that day.

Last month, through the Maryland Public Information Act, The Herald-Mail obtained a tape and transcript of emergency calls connected to the incident and published stories about what happened.


The ambulance squad, Smithsburg Emergency Medical Services, responded to the stories with two letters.

In one letter, published in Monday's Morning Herald and Daily Mail, the ambulance squad's membership wrote that county dispatchers did not relay to them the seriousness of the call.

"...[W]hen Gibson advised during his first 911 call that the patient was not breathing, no communication was forwarded to the ambulance company that the call had been upgraded to a 'code blue' cardiac arrest, as is standard procedure. This information is vital in alerting those responding that this is no longer a routine call and had been upgraded to our highest response priority."

Joe Kroboth, the county's emergency services director, said Monday that the ambulance squad is incorrect if it's suggesting that the call was not dispatched as advanced life support, which is a higher priority than basic life support.

Reviewing the tape and transcript, Kroboth said the fact that a dispatcher asked for "Medic 79" - a paramedic - shows it was sent out as an advanced life support call.

If it had been a basic life support call, the dispatcher would have asked for "Rescue 79," a general reference to the ambulance squad, Kroboth said.

Paramedics are trained to provide more care than emergency medical technicians (EMTs) and others. For example, paramedics may administer certain medications; EMTs may not.

911 timeline

When Gibson called 911 on the morning of March 5, a Washington County dispatcher - following protocol for emergency calls - asked him several questions about Hess' condition, according to Bardona Woods, the county's chief of 911/communications.

One minute and 58 seconds after Gibson's call came in to one dispatcher, a second dispatcher sent word of the emergency to Smithsburg's ambulance squad, the transcript shows.

Four minutes and 39 seconds after the call was dispatched, a paramedic reported that she was on her way, according to the transcript.

Then, 2 minutes and 16 seconds after the paramedic acknowledged the call, she was on the scene, the transcript shows.

Smithsburg Emergency Medical Services is about a block away from Gibson's and Hess' home.

The letter from the ambulance squad's membership says "any reasonable person would conclude that 2:16 is not appropriate" to get to the home. However, an odd, confusing house numbering system contributed to the delay, the letter says.

Members of the fire department, ambulance squad and a separate review committee each have said that the ambulance squad provided good care on the call.

Hess' mother, Tammy Reed, has said that Hess died of a condition similar to preeclampsia, which is associated with a sudden rise in a pregnant woman's blood pressure.

Woods said Hess' seizure, not her breathing, was the initial guiding factor in dispatching the call.

According to a book outlining the Medical Priority Dispatch System, a national guideline that Washington County follows, "When the initial Chief Complaint appears to be seizure," a dispatcher should go right to a series of caller seizure-related questions, "regardless of consciousness and breathing status."

Woods said the tape shows that Gibson initially told the dispatcher that Hess was not breathing, but the seizure took preference.

As the second dispatcher sent a paramedic to the scene, the first dispatcher asked Gibson more questions.

At one point, the dispatcher learns from Gibson that Hess was breathing again, Woods said.

The tape and transcript show that Gibson called three different times in a short time span. He told a dispatcher that his phone was cutting out.

Woods said the dispatcher repeated, for the responding paramedic, the basic nature of the call and added a few details - that the patient was 20 years old, had stopped seizing and was pregnant.

Changing conditions

Woods said the dispatcher might not have included an update on breathing because the patient's condition had fluctuated and because of problems keeping Gibson on the line.

At practically the same time Gibson's third call came in, the paramedic reported from the scene that the call was a "working code," or cardiac arrest, Woods said.

At that point, the fire department also was sent to the scene, which is the procedure for cardiac arrest calls, Woods said.

When a person is in cardiac arrest, her heart has stopped and she is not breathing.

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