Ambulance satnav not to blame for asthma attack boy's death

Re: It's very sad...

No I wouldn't like my ambulance to be "late", but there are any number of things that can make an ambulance "late": Heavy traffic, road works, breakdowns, distance (suppose the crew's last shout had been two miles further away), etc.

Maybe the satnav sent them the wrong way a little bit, but you may as well blame the manufacturer of the ambulance itself for not making it faster in the first place. If they'd been using a map, they might have arrived even later.

@Grease Monkey

First, this is anonymous for reasons which will become apparent.

"Well that's true. A defibrillator wouldn't do anything to save you from cardiac arrest."

That's a very absolute statement. That would depend on *WHY* you arrested. Look it up, if you're interested to find out why that statement of yours is, in fact, wrong, and backed by evidence contrariwise.

"The point here is that the family and the ambulance service needed to know whether that 150 second delay would have made a difference."

This is true.

The most likely cause of death here would have been a cardiac arrest precipitated by hypoxia following respiratory arrest (from the bronchoconstriction). This is assuming this is a pure asthma issue - anaphylaxis is another possibility, given the stated "sudden catastropic" nature of it.

If the paramedic arrived in 5 mins and the child arrested 3 minutes later, it is clear that the child was unfortunately probably almost peri-arrest when the paramedic arrived, and ... look, it's hard. You have a child here who's going to arrest on you, you're alone. The kid's probably not moving much air at all. All you can do is put on as much oxygen as you, try some salbutamol if you wish but the kid's not moving air... Support the airway, parenteral adrenaline+ roids, im initially, stick in an IO and try and support the kid as best you can, ALL on your own. You'll probably intubate the kid because your sats probe is just going beep beep beep lower and lower and then crap..... unless the adrenaline miraculously just works.... it does sometimes but I suspect it didn't here.

And you're doing this ALL on your own. Supporting the airway and breathing, delivering drugs. And possibly having to do crowd control as well - family etc...

Crap, you many not even have the bloody KIT you need. I don't know how you guys are set up in blighty but I gather it's pretty good though.

Then the child crashes. You're now doing ALS/CPR on your own. Honestly in a situation like this, where hypoxia will kill, and the chest is tight, imho, if you don't have an endotracheal tube in, delivering an FIO2 of unity, you are screwed. If you don't get oxygen in... basically you are screwed.

What COULD have made SOME DIFFERENCE is if the paramedic wasn't alone (ie the ambulance arrived together). Also, I have no idea what he/she had at her disposal or what the resuscitation was like - a nightmare I would have thought.

From me reading between the lines, it was a nightmare resuscitation. If the likely reversible cause of the arrest - hypoxemia - was not reversed, and there was no ROSC.... by the time the ambulance arrived... 15 or 20 mins later... the outcome would have been the same.

A few other points to ponder... not quite specific to the case but worth thinking about.

1. Regarding the satnav...It was not *THAT* many years ago that EMS vehicles had no GPS. That said...

2. Now, from personal experience I have had EMS vehicles on scene in 5 minutes but I don't live where you do. In say an arrest due to VF for example, minutes DO BLOODY COUNT because of the DEFIBRILLATOR. Or even something as simple as opening up an obstructed airway that no one had the sense to.

3. Regardless of this specific case, the SATNAV system used should be reviewed on a number of counts - the error of the reported position of the vehicle should be as low as possible, the SOFTWARE should BLOODY work, and the software should be easy to use. If you're in a rush you don't have bloody time to boot up crap and punch in a crapload of button pushes. My gripe with modern software sometimes. They don't bloody think about people who end up using the stuff.

Re: With all due sympathy.

Sympathy? That's the word in the dictionary between "shit" and "syphilis"?

I think my comment wasn't taken in exactly the right light.

OF COURSE it's a bad thing that a life was lost, and if the life could have been saved that'd have been a Very Good Thing (TM)

HOWEVER, you do get the terrible situation where good people die and there is nothing that anyone could do about it. Trying to attribute blame in those situations is meaningless and unduly distressing.

It depends on the Ambulance Trust which in vehicle computer system they buy, but basically it is NOT a sat nav, it's a multi purpose computer. The computer links to the control centre and displays information about the patient as well as directions and other stuff.

Also, the ambulances are in radio contact with a dispatcher in the control room, the call taker you speak to when you dial 999 is on the other side of the room to the person controlling the ambulance, so there's no delay, they can even listen into the call if the need more information whilst rerouting the ambulance. The control centre normally has manual control of routes if the need to, is updated on road closures by the police when they happen, and if all else fails can tell them where to go by radio whilst staring at a big OS map on a screen in front of them (dispatchers normally have at least three screens, one ALWAYS displaying a map with caller and vehicle locations).

The control centre staff can also do everything by paper if the computers go down; they have big maps, books, wipe off cards and flowcharts etc in their desks and there should be at least two backup control centres in different locations, though the last backup is normally the police or fire service. In North West England for example there is a control centre in Preston, Manchester and Liverpool, each with about 100 control staff.

A big problem with routing is callers not knowing where they are - if you call from a mobile or from behind some badly configured corporate switchboard that actually connects the call to the telco at a different address, then the dispatcher tends to be looking at a big red X over a mobile cell tower; they can still send an ambulance racing towards it, but if the call taker can't locate you from what you're saying it can take a while to find you.

In this case though it does look like a computer failure of some kind, as otherwise the first rapid car responder wouldn't have made it straight there.