1. #1
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    Default Flordia Duty to Act...

    I just read the article about the Ft Lauderdale medics and was a little bit ****ed off about the way they were notified about there dismissing and the circumstances behind it all. We all have a duty to act ,but what bothers me is the fact 4 medic must have seen something that would have made them come to the conclusion that he could not be saved. I believe that there is more to this story than what I have read and would like to hear from our brothers in Flordia and see what they say.



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    I'd like to hear more also. The civilian press is not likely to have the sort of clinical information we would like to see to come to understand what happened.

    The only information in the article is that the man was asystolic. Our protocol states that resuscitation does not have to be initiated in situations of obvious death: rigor, lividity, pulselessness with penetrating trauma, etc. It also states that resuscitation can be terminated if the pt. remains asystolic after intubation, IV, several rounds of drugs, etc.

    An asystolic patient has minimal chance of successful resuscitation. However, we need to hear more about the physical findings and the local protocol before we know whether the medics were right or wrong.
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    They should have known the protocol and followed it, of course. However, I can't help but to smell a rat on the police side of the matter.

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    Post Firefighters Support Medic

    Firefighters back fired paramedics in Lauderdale

    By Shannon O'Boye & Brittany Wallman
    Staff Writers
    Posted August 14 2003

    Fort Lauderdale Fire Rescue Chief Otis Latin gave four firefighter/paramedics letters Wednesday telling them they are suspended without pay and will be fired effective Sept. 11 unless they appeal.

    They were dismissed because they did not start CPR on a 21-year-old man who collapsed outside the city jail after running from police, struggling with them and getting pepper-sprayed, according to their notification letters.

    It's the first time in fire department history that four paramedics are being fired at once, a city spokeswoman said. That may look harsh on the surface, but termination is appropriate "if the problem was serious enough," Mayor Jim Naugle said.

    Two of the paramedics, Keith Webster and Michael Bucher, checked out the victim, Raymond Sterling Jr., at the jail on April 19 and left. Minutes later Sterling, 21, collapsed and police called them back. Lt. Michael Hicks and Driver/Engineer Walter Schrubb responded, as well. All four agreed that Sterling was dead and could not be revived.

    Union representatives said the paramedics followed the proper protocols for pronouncing someone dead in the field, but fire administrators disagreed.

    "You failed to provide appropriate care by not starting cardio-pulmonary resuscitation on the young adult arrestee in the circumstance of an `unexpected death' of a patient you had determined to be `lucid' only minutes earlier," Latin wrote to Webster and Bucher.

    The South Florida Regional EMS protocols state: "Only in cases of obvious prolonged death should CPR not be started or discontinued on infants, children, young adults or cases in which an unexpected death has occurred."

    Hicks, the fire-rescue lieutenant, said all deaths can be considered "unexpected" unless a person is very old or very sick and has a "do not resuscitate" order. He said paramedics use discretion and make judgment calls every day and it was their opinion that Sterling could not be revived.

    None of the police officers outside the jail attempted CPR on Sterling either, but they were cleared after a joint investigation by the police and fire-rescue departments.

    "I think for the police if they had to put their mouth on [Sterling's] mouth, his mouth was bleeding, so that may have made them say we're not going to try to resuscitate him that way," said Sterling's aunt, Toni Pompa. "I believe his life was very insignificant because he's black, has gold teeth and has corn rows."

    Community activists agree. Leola McCoy, of northwest Fort Lauderdale, said African-Americans are growing weary of "the police always investigating themselves and declaring they have done nothing wrong."

    "The paramedics are not the only ones culpable," she said. "He was in the police department's custody. They are trying to relay the blame on one department vs. another. The casual attitude [on the part of authorities] is deplorable. This was negligence."

    Police spokesman Detective Mike Reed said the department knows there are unanswered questions. Those questions will be answered when the State Attorney's Office completes its investigation into the case, he said.

    "We are by no means done answering all the questions of the community," Reed said. "We will have a follow-up meeting."

    Reed said police will publicize the community meeting and bring investigative records and reports so residents can see all the facts and make up their own minds.

    "We're open to questions and their responses 100 percent," he said.

    When the four fired paramedics arrived at the fire chief's office Wednesday morning to get their termination letters, nearly 50 of their off-duty co-workers greeted them. The group marched from a nearby fire station to the office building and then walked each of the firefighters straight into the chief's office as a show of support. They waited outside in the hallway during the meetings and then walked each of the firefighters out.

    None of the four signed their termination letters, and all said they will fight to get their jobs back. The first step will be requesting a hearing with a grievance resolution committee. If nothing changes after that hearing, the firefighters will ask an arbitrator to decide if their terminations were justified.

    That process could take as long as a year. The paramedics will be without pay or benefits during that time, so their fellow firefighters are taking up a collection to help them make ends meet.

    "We're upset four of our brother firefighters are being terminated," said Mike Salzano, a union representative. "We've been collecting money. ... We've got a benevolent association with 400 firefighters, and we've got thousands of firefighters ready to support them."

    Mayor Naugle said he had not been briefed on the specifics of the investigation, but he had been told that "the protocols weren't followed and that resulted in a man's death."

    "Everyone deserves to be treated the same, whether they are a prisoner in custody or a citizen on the street or a person who collapsed here at City Hall," he said.

    Staff Writer Gregory Lewis and Staff Photographer Lou Toman contributed to this report.

    Shannon O'Boye can be reach at soboye@sun-sentinel.com or 954-356-4597.
    Last edited by captstanm1; 08-16-2003 at 04:44 PM.
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    Right, wrong, or indifferent, police, or fire responsibility, there is certainly going to be chaeck with a lot of zeroes written over this matter.

    Are police officers in Florida required to be CPR or first responder certified? If so they have a duty to act as well. CPR should hav ebeen initiated if they are certified, mouth to mouth - can't say, it all comes down to scene safety and unless I have a facemask or BVM I don't blame 'em for not doing ventilations. The CPR is inexcusable.

    Firefighters not doing CPR and working the code, well, it sounds like fresh code, asystolic or not, I think he should have been worked. I realize that this is armchair quarterbacking, but this is just my opinion.

    ACLS allows for cardiac arrests to be worked. The Paramedics claimed that they were not told he was sprayed with pepper spray. Hello? Can you not smell it? I guarantee if the guy was sprayed you would know it.

    I feel that they probably should have called the doc on the radio and get medical control approval to not work the patient. Pass the buck and let him take the responsibility, he makes several times what I do and has a much better liability policy. It basically sounds like the protocols were violated by these guys and at the very least a department wide review of protocols needs to be initiated.

    As for a suspension without pay? These guys have not been found guilty and the process and investigation appears to be ongoing, so they should be suspended with pay until a determination has been made.
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    as far as I know, police are required to be certified first responders, which includes AHA CPR cert. as well

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    Have any of you sat through ACLS within the last year or so. During our lest recert we watched an AHA "round table discussion". One topic was Asystole. Their exact words were "in our opinion no asystole patient should be worked".

    I think I would get ahold of AHA on this one.

    Asystole = DEAD!!! Whether they are 14 or 80. Only exception should be children due to hypoxia.

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    So following this philosophy no cardiac arrest patient should be worked because of the reduced likelihood of being resuscitated? The general figures are that less than 5% of patients that have a cardiac arrest actually leave a hospital with no deficit. Most of them are candidates for being in nursing homes because of brain damage so why should we work them?

    These guys did NOTHING for this patient other than put him on a monitor and go "Hey, lookie there Vern, it's asystole. Let's not work him." This violates ACLS, regardless of what is shown on a video tape in class. He was still a "fresh code" and these guys violated their protocols. They didn't even start compressions, like they are trained and expected to do, even make an attempt to go through the first round of drugs. No contact with a doctor to get medical control authorization not to work a person.

    The only times we don't work a patient is a DNR, decapitation, brain matter exposed, rigor mortis set in, relative lividity. Any other times, we can call the doc on the radio. These guys violated department policy and protocols. I don't necessarily agree with firing them, but punishment is definitely in order. This along with department wide re-training to ensure nothing else is done like this again.

    As for the police, they are just as wrong as the medics for not initiating CPR or connecting a defib to the patient if they were equiped to do so. If they weren't, they damned sure better get equipped.
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    I think the ball was fumbled on the first call out; he should have been transported the first time.

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    Post ?????Fire Chief Demotes Another Medic

    Here is another story that relates to the entire incident. Can someone who has been around a while (like me) tell me if this is the same Otis Latin that came from Washington D.C.? Didn't he make a shambles of that department??? Someone has to put a stop to this nonsense. I am not completely familiar with the details of the entire incident...but this is a bit much I believe....
    ______________________________________

    Lauderdale fire chief demotes EMS veteran

    By Shannon O'Boye
    Staff Writer
    Posted August 16 2003

    It's been a rough week for Fort Lauderdale Fire-Rescue.

    On Tuesday, City Manager Floyd Johnson announced on a live radio show that four paramedics were being fired before the men had been notified.

    The next day, more than 50 firefighters descended on the fire-rescue administration office to protest the firings.

    On Friday, Fire Chief Otis Latin demoted a popular, 18-year veteran based on accusations that he was bad-mouthing the chief and the department's medical director, union officials said.

    Keith Earle, who technically held the rank of lieutenant but who had been acting as an EMS captain for the past five years, got no advanced warning or hearing. Latin simply called him to his office Friday afternoon and told him he was being demoted, said union president Ian Kemp.

    Earle, 52, will lose 5 percent of his pay and will go from driving an SUV as a supervisor to working on a fire engine.

    Latin did not return several calls seeking comment Friday afternoon. Neither of his deputy chiefs could be reached, and Latin's assistant, Jeff Justinak, declined to comment.

    Earle "is an EMS guru," union representative Mike Salzano said. "He's one of the most senior guys when it comes to EMS and training, and we're going through all these problems with EMS and training.

    "This has been a rough week," he said. "It puts us down even more."

    Latin this week fired four paramedics who did not try to resuscitate a young man who died in police custody after being pepper sprayed. One of those paramedics, Keith Webster, could not pass an exam that tested his paramedic skills, but Latin hired him anyway and then allowed him to become the lead medic on a rescue truck.

    The fired medics said they did not try to resuscitate the man, Raymond Sterling Jr., because he was dead by the time they got to him.

    Department rank-and-file are standing by them. They had a fund-raiser for the men Wednesday.

    Union officials reviewed their contract Friday to see what they can do to get Earle's position back.

    "The sad part of this story is he's not being removed for his qualifications or lack of performing his duties," said union president Kemp. "He's being removed from his duties because the information the chief has -- and it's not substantiated -- is [Earle] has concerns on the way things are being done, as a large majority of our members do."

    Shannon O'Boye can be reached at soboye@sun-sentinel.com or 954-356-4597.
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    One of those paramedics, Keith Webster, could not pass an exam that tested his paramedic skills, but Latin hired him anyway and then allowed him to become the lead medic on a rescue truck.
    ????!!!!!

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    Default A Kitchen Lawyer's Defense:

    Keith Webster, could not pass an exam that tested his paramedic skills, but Latin hired him anyway and then allowed him to become the lead medic on a rescue truck.

    As the lead medic, Mr. Webster made the DNR call and his subordinates followed his direction.

    Florida has a statute which defines the standard of care as that level of care, skill and treatment which is recognized as acceptable and appropriate by reasonably prudent similar healthcare providers under similar circumstances. In other words, the standard of care may sometimes be described as doing what a reasonably prudent doctor (or nurse, dentist, etc.) would do under the circumstances.

    Since Mr. Webster, failed the skills portion of his training and certification, the jury cannot expect him to perform to the levels stated in the statute.

    The co-defendants likely were unaware of Mr Websters failure in this area and thus followed his direction due to his position as lead medic on the scene.

    The fact is, Mr. Otis Latin placed a unqualified person in this position and bears the responsibility for his actions and/or inactions.

    I have nothing further.

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    Since Mr. Webster, failed the skills portion of his training and certification, the jury cannot expect him to perform to the levels stated in the statute.
    Don't necessarily dissagree, but can we honestly say that a jury would look at it that way, instead of looking at the teary-eyed "victim's" family?

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    But CPR (which was not performed) is not a paramedic skill.

    I know, Latin has his share of trouble to explain in this, but I won't forgive 4 guys because Latin hired someone he shouldn't have. That's too close to the Bob Moran "they're only volunteers" defense.

    And yes, this is only based on the news articles which I doubt are anywhere near the whole true story.

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    NOTE OF DISCLAIMER: I am not an EMS expert, I am far from it. Furthermore, I was not there. I do not know the exact circumstances of the situation. With that said ...

    Percentage of patients saved by performing CPR, even after it seems as if there is no chance of saving them = something greater than 0%

    Percentage of patients saved by NOT performing CPR, even after it seems as if there is no chance of saving them = 0%

    Again, I was not there, I don't know exactly what happened ... however, I would probably tend to error on the side of "something greater than 0%", especially when, in terms of the rescuers, there is no life-safety issue.

    Stay Safe

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    can we honestly say that a jury would look at it that way, instead of looking at the teary-eyed "victim's" family?
    They can if they can lay the blame elsewhere, ie Latin.

    I, in no way, condone the actions of not begining PC in this situation and I feel disipline is called for. I don't think the termination of four sounds correct. Had this whole story revolved around the actions of one, I'd say maybe there's a history here, but four?

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    Here is a related story from yesterday's paper...... hwoods...if you are reading this.... Is this the Otis Latin that was one of the many recent Chief's who ruined D.C.F.D.????


    Fort Lauderdale community questions officers' role in pepper spray death

    By Shannon O'Boye and Greg Lewis
    Staff Writers
    Posted August 17 2003

    Fort Lauderdale The city fired four paramedics this week for not trying to save a young man who died outside the city jail after being pepper-sprayed by police. But some members of the community think the police officers involved bear responsibility, as well.

    Besides concerns about the traffic stop that ended with the death of Raymond Sterling Jr., they question the care the 21-year-old received by police as they waited for the paramedics to arrive. All the officers were trained in CPR, and one is a state-certified emergency medical technician.


    "The police could have done a better job," NAACP branch president Bill McCormick said. "They had him in custody, and they should have done something."

    A joint investigation recently completed by the police and fire-rescue departments exonerated the officers, but officials gave no details to explain why.

    "I think it was both the police and the paramedics' responsibility that this young man got the proper care," said Lillie Mackie, who was outside the Elks Club on Friday night selling tickets to support the Dillard High School Band. "The police knew he was in trouble and should have done more. The police are the ones that put him in trouble."

    Jeffrey Taylor, who said he has spent 20 years working security in the military and for a private firm, said it's well known that some people have adverse reactions to pepper spray. "They should have known something was wrong," he said. [The police] transferred their responsibility."

    Police officials cannot talk about the details of their investigation until the State Attorney's Office presents the case to a grand jury for review, department spokesman Detective Mike Reed said. Once that happens, Chief Bruce Roberts will schedule a community meeting.

    "If anybody has questions about why or why not something was not done, those questions will be answered at the final community meeting, when we can freely talk about it," Reed said.

    How it happened

    Sterling, who was driving with a suspended license, ran from police early April 19 when they tried to pull him over for speeding, Reed said. The officers struggled with Sterling and pepper-sprayed him once he was handcuffed because he did not want to get in the squad car, Reed said.

    When Sterling got to the jail, he complained of being tired and thirsty and having pain in his legs, so the officers called fire-rescue. Paramedics Keith Webster and Michael Bucher checked him out and left. Minutes later, Sterling collapsed.

    The officers called the medics back. While they were en route, Sgt. Greg Salters told a police dispatcher that the medics needed to hurry because Sterling's pulse was fading, but none of the officers started chest compressions or rescue breaths.

    When medics Webster and Bucher got back to the jail four minutes later, Sterling was in asystole, or without a heartbeat, they said. Webster, Bucher, paramedics Walter Schrubb and Michael Hicks and EMT Hector Loiz agreed that Sterling could not be revived and did not try to do so.

    Fire Chief Otis Latin fired all of them except for Loiz for that decision, but the police officers -- John Clarke, Nick Coffin, Carlton Smith, Michael Lopinot, Alec Lassman, Al Diamond, Greg Salters and Patrick O'Brien, the EMT -- received no discipline.

    "According to the [officers'] sworn statements, [Sterling] wasn't dead," police union president Tom Mangifesta said Friday. "You don't start CPR when there's a pulse, and you don't start mouth-to-mouth when you still have respiration... They're all fairly new officers, which means they were just recently in the academy and had advanced first aid and CPR" training.

    But Amanda Land, a health and safety expert with the American Red Cross, said people can start rescue breathing or chest compressions on a person who is clearly fading but still has a pulse.

    "If a person goes into cardiac arrest, they will die," she said. "You have a four-minute window to keep oxygenated blood flowing through the body until the medics will arrive... Not giving care is oftentimes going to do more damage."

    Sterling died because he experienced a massive sickle cell crisis outside the jail, Deputy Chief Medical Examiner Michael Bell said. His red blood cells became misshapen after physical exertion and prevented oxygen flow to the body. The pepper spray contributed to his death, Bell said.

    Obligated to help?

    No one can know whether quick action by the police officers could have kept oxygen flowing through Sterling's body. Officers receive at least 40 hours of "first responder" instruction at the police academy on subjects including how to assess a patient, perform CPR, stop bleeding and immobilize a back injury, said Medley Police Lt. Brad Sutherland, a police academy instructor. In 1989, the Florida Attorney General issued a legal opinion saying police officers are duty-bound to use that training.

    "A police officer has a legal duty to provide aid to ill, injured, and distressed persons who are not in police custody," the opinion states. It applies to people who are in police custody as well, according to Assistant Attorney General Gerry Hammond, who wrote the opinion.

    "You need to provide care within the scope of your training," Sutherland said. "If Fort Lauderdale doesn't carry oxygen units in their cars, the officers are so afraid of catching something, they're not going to give mouth-to-mouth. It's just not going to happen."

    The department's policy manual does not list first-aid kits among the standard equipment issued to officers. Also, Fort Lauderdale does not require officers to maintain their CPR certification or refresh the medical training they get at the police academy, Capt. Stephen Robitaille said.

    Union president Mangifesta said Sterling started the chain of events by running from police.

    "Let's go back to the root problem," he said. "Sterling fled police. ... Had Sterling not resisted, he wouldn't have been [pepper]-sprayed. He would have gotten a ticket, gone to jail and gotten out the next morning, plain and simple. Yes, it's a tragic accident, but who caused it? Who put the first step in motion to cause other people to react like they did?"

    Sterling's family and their supporters don't see it that way. They don't think the speeding allegation is legitimate.

    "We are still concerned about the actual stop," McCormick, of the NAACP, said. "We feel that it was a profile stop. We don't have the evidence to prove that yet. But [city officials] have only addressed half of what our complaint is -- a profile stop that went bad and medical neglect that went bad."


    Staff Writer Brittany Wallman contributed to this report.
    Shannon O'Boye can be reached at soboye@sun-sentinel.com or 954-356-4597.

    Copyright 2003, South Florida Sun-Sentinel
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    Florida has a statute which defines the standard of care as that level of care, skill and treatment which is recognized as acceptable and appropriate by reasonably prudent similar healthcare providers under similar circumstances. In other words, the standard of care may sometimes be described as doing what a reasonably prudent doctor (or nurse, dentist, etc.) would do under the circumstances.
    Ah, but he has been trained. He has the knowledge and the training and as a reasonable person I would find him guilty. The statute says NOTHING about having a certification. In addition, there was a duty to act and permanent harm did occur. The city is about to get slapped with a huge lawsuit and rightfully so.

    Did the chief mess up by hiring a person and allowing him to work in a capacity he was not certified to? Yes. However, the chief may be ultimately responsibel but this group of four guys is directly responsible for not working the patient when that duty to act did in fact exist.

    Granted about 95 percent of the coeds we work are just going through the motions but that is part of our job. To render a level of care and treatment appropriate, with the exception of when in violation of their protocols, which this case was not. Work the guy, get hime to the hospital or allow for the doc to call it. You have then acted in the best interest of your patient. That is a Paramedic's responsibility - to advocate for and provide the best for our patients.
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    "Let's go back to the root problem," he said. "Sterling fled police. ... Had Sterling not resisted, he wouldn't have been [pepper]-sprayed. He would have gotten a ticket, gone to jail and gotten out the next morning, plain and simple. Yes, it's a tragic accident, but who caused it? Who put the first step in motion to cause other people to react like they did?"
    Oh, I see; we've been on a wild goose chase! It was actually the patient's fault he laid there and died on the floor of a jailhouse.

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    Default After reading...

    These guys meaning both the Police and the Firefighters both appear to bear the responsiblity for this guys death. Both departments failed to act and the P.D. who have CFR training certainly should have started CPR before the medics got there. The first time the medics got on scene the PD should have insisted that the prisoner go to the hospital even if it was just to have him checked out by the Doc. They are in charge of that prisoner from the moment the cuffs are placed on his wrists until he walks out of the station door, they are responsible for that persons well being. As for the medics WTF were these guys thinking of ,I have been a paramedic for 5 years and EMT for 20 years If the arrest is a witnessed one you work the code no if's,and's or but's about it and let the doctor make the decision to call it.
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    I have a number of comments to this thread..

    1. The initial run, as for smelling the pepper spray. This is not generally true. I work in an area where pepper spray is used quite often, and I'm not sure I've ever smelled it on a person when we arrive. We go on a number of newly arrestee's that are complaining of something, anything, so that they may spend a few hours in the hospital prior to going to jail. I've yet to see one that was actually sick. That being said, if the patient was saying he was having trouble breathing, I would have checked lung sounds. Now then, lets say that checked lung sounds and they were clear, did everything else and found nothing obviously wrong, then I can't condemn them for turfing this patient.

    2. For those of you who have not recerted on ACLS within the past 2 years, AHA is taking a step back on aystolic patients. The percentage of patients who go home after being in asystole is much less that 5%, and is actually less than 1%. The news clipping states "the patient was 'lucid' only minutes before medics arrived" is not a fair statement. Minutes could mean 7-8 minutes, and remember, severe brain damage occurs at around 3-4 minutes, brain death occurs at around 5-6 minutes. I refuse to pass judgement against the paramedics for not initiating ACLS. because I simply wasn't there. But I will say the patient was obviously no longer faking at this point

    3. No one has commented on the demotion of the EMS officer without cause or proper procedure. Is the Chief on a witch hunt down there or what?

    4. As for the PD not initiating CPR. In Ohio, first responders and EMT-Bs don't have the same power to withhold care, due to the fact that they haven't been through any training in ACLS and can't properly assess a patient in cardiac arrest without running and interpriting an EKG.

    It bothers me sometimes to see how many people will yell and scream and abandon brothers for their choices on runs. None of us were there with them, none of us know the circumstances, so how can we sit there and say how terrible they are. I imagine that like our dept, these medics work in a depressed area where arrests are common, and running on faking inmates is just as common. I'm not saying by any means that every inmate is a piece of garbage that should not be treated, I just feel that you must take every one on a case-by-case basis. If the medics didn't see a need to transport on the initial run, then I believe them.

  22. #22
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    The EMS protocols that are followed by all fire-rescue departments in Broward County say medics can only declare a patient dead if he is unresponsive, not breathing, without a pulse and has fixed, dilated pupils and one of the following signs of death: massive internal injuries, tissue decomposition, rigor mortis or blood pooling in the lower extremities. Sterling did not have any of those four symptoms.
    Protocols are there for a reason. They weren't followed by anyone in this incident.

    I refuse to pass judgement against the paramedics for not initiating ACLS. because I simply wasn't there. But I will say the patient was obviously no longer faking at this point
    You think this is funny?? You think he was "faking??" Perhaps, you should reserve your judgement of the only real victim in this particular case. The man is DEAD...he has lost everything.

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    Apparently reading 1 line intended on lightening up my post caused you to miss the entire point of my post.

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    Hardly; I got your point, clearly. You made several excuses for these medics to not do their job, as their own protocols require. I see no need to "lighten" up posts at the expense of someone who is now dead.

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    I made no excuses, rather I made counter points and gave another angle to what may have occurred. My primary point is, I was not there, and neither were you. So who are either of us to pass judgement based on information reported by the press.

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