HILTON HEAD ISLAND – Beaufort County EMS is reviewing paramedics’ handling of two recent incidents after patients raised questions about the quality of the care they received after emergencies.
The reviews come after relatives of the patients complained to county officials about treatment by emergency responders that they observed.
One incident occurred in October, the other in December.
In the latter incident, a registered nurse who had observed paramedics treating her sister earlier that month wrote in a Dec. 22 letter to county officials that she is “left to conclude that training is deficient in Beaufort County EMS. … training would seem to be required to protect the health and safety of the citizens of and visitors to Beaufort County.”
In the other incident, a man whose car had flipped and crashed into a tree in October sent a similar email to the county about the treatment his wife received after the accident.
“I still can’t believe that after all the incidents that occurred with emergency services prior to my accident that they would still be so unresponsive,” Frank Ducey, a retiree who spent six years as a U.S. Navy Hospital corpsman, wrote to county officials. “Hopefully what I have written to you will make you realize that you do have a real problem with some of your paramedics.”
Beaufort County Attorney Ladson Howell said Friday the county would not discuss the complaints, citing patient privacy concerns.
“It doesn’t serve the public or the county well for us to respond,” Howell said.
Howell said Beaufort County EMS Director Donna Ownby is “conducting investigations of both incidents” and would “talk to the patients themselves and handle it on a personnel level.”
The complaints come after a year that saw at least three lawsuits filed against county EMS. Last month, county officials announced plans to hire consultants to examine the quality of the county’s EMS system.
THE DECEMBER INCIDENT
On Dec. 18, a Beaufort woman, Rachel Neese, developed a severe allergic reaction that caused her throat to swell, according to a letter written by her sister, nurse Ruth Neese.
The patient was “rapidly losing her airway,” Ruth Neese wrote.
Three registered nurses were present — the Neese sisters and a third family member, the letter states. All three have “extensive emergency department experience,” she wrote. Rachel Neese also has experience as a paramedic, Ruth Neese said last week.
One of the relatives gave the patient an EpiPen — a treatment that generally provides up to 20-minutes of relief before symptoms return — while another dialed 911, according to Neese’s letter.
“We were very clear in reporting the problem, the time of onset and time of EpiPen administration,” she wrote.
Emergency responders from Beaufort’s Fire Department arrived about six minutes after the 911 call, she wrote. A firefighter gave the patient oxygen and took her vital signs, she wrote.
An ambulance from Beaufort County EMS rolled up several minutes later, her letter said.
What happened next appears to be inconsistent with Beaufort County EMS protocols.
“The paramedic brought no equipment into the room that could have been used to treat my sister — no IV equipment, no nebulizer, no medication,” Neese wrote.
Beaufort County EMS Standing Orders tells paramedics to “ensure you have the equipment you need with” you on all calls.
“There was no rush to get my sister into the ambulance, either, which was very frustrating,” Neese wrote. “Time is critical after EpiPen use.”
Neese said in the letter that her sister later told her that “the paramedic considered not transporting her” and that the ambulance “did not travel lights-and-sirens to Beaufort Memorial.”
Additionally, “she received no treatment (en) route other than an IV start,” Neese wrote. “As a result, my sister’s symptoms of respiratory distress had returned by the time she arrived in the emergency department.”
Neese recommended in the letter that “protocols related to allergic reactions, anaphylaxis and airway management be reviewed with all personnel” and that treatment of patients who have had an EpiPen also be reviewed.
“… I am very puzzled as to why no protocol seems to have been followed,” Neese wrote in her letter, sent to County Administrator Gary Kubic, Ownby and EMS training officer Julie Williams.
Neese said last week she received no response.
Rachel Neese recovered after being treated at Beaufort Memorial, Ruth Neese said.
THE OCTOBER INCIDENT
The other incident, on Oct. 8, involved a Sun City Hilton Head couple who had been in a roll-over accident on S.C. 170.
Frank Ducey — traveling with his wife, Joan — swerved his 2007 Saturn Sky convertible off the road to avoid an oncoming car that had crossed into his lane, he said. The Duceys’ car flipped and landed on its roof; the passenger door and windshield were badly damaged.
The car was declared totaled the day after the accident, the Duceys said, but to the paramedics who responded, the damage seemed less severe. Their case report notes”minimal damage to the vehicle.”
The couple hung upside down in their seat belts in the moments immediately after the wreck. Frank Ducey said he managed to crawl out of the car but it took the help of a paramedic to extract his wife, he said.
There were mixed signals from the Duceys about whether they wanted to be treated by paramedics, whether Joan Ducey wanted be taken to a hospital and, if so, which one.
Both husband and wife initially refused treatment. Frank Ducey told paramedics his back hurt a bit, and both said they were cut by broken glass but had no wounds requiring stitches.
Then Frank Ducey heard his wife telling a Bluffton Township Fire District responder that she’d hit her head and it was hurting. That concerned Frank Ducey, so he reconsidered and told the county paramedics that he now thought his wife needed to go to the hospital, he said.
In his e-mail to EMS director Ownby and county administrator Kubic, Frank Ducey said the Beaufort County EMT he spoke to was reluctant to bring his wife to the hospital until Ducey insisted.
Initially, the EMT tried to talk him out of the idea, Ducey said.
The EMT said, “We checked her out and she seems fine to us,” Ducey wrote in his e mail to county officials
The ambulance left with Joan Ducey aboard. It headed toward Hardeeville’s Coastal Carolina Medical Center. The paramedics called the emergency room there to say they were on their way, according to the EMS case report.
But officials at Coastal diverted the ambulance to Savannah’s Memorial University Medical Center, a trauma center, because of the way the Duceys’ accident occurred, the report said.
The case report filed by the paramedics recounts more confusing interaction between them and Joan Ducey.
She questioned the need to go to Savannah and asked to be taken to Coastal Carolina instead; the paramedics told her they could not, according to the report.
After a paramedic explained “all of her options,” Joan Ducey decided she wanted to continue to Savannah, according to the report.
But after the ambulance resumed its trip there, Joan Ducey said the paramedics tried to talk her out of going.
“It was like they were being put out,” she said. “They made me feel like I was wasting their time.”
She sat on a bench — with no seat belt — in the ambulance during the trip, she said. When the ambulance pulled up to the hospital, one of the paramedic said, “We have to take you in on a stretcher, so could you please get in the stretcher,” according to Frank Ducey’s email to county officials.
County officials declined to discuss the procedures paramedics must follow when transporting — whether patients should sit on a bench or be strapped onto a stretcher.
In Savannah, hospital workers later put a brace on Joan Ducey’s neck, a device she wasn’t offered during the ambulance trip. In the emergency room, the paramedics told her to sit down while they went to talk to people at the front desk, she said. Soon afterward they left the hospital, but didn’t touch base with her on the way out, she said.
About an hour later, a hospital worker asked her why she wasn’t signed in, she said.
County officials declined to explain the procedure paramedics should use when handing off a patient to a hospital.
Joan Ducey had no serious injuries from the accident, hospital tests showed.
“Thank God my wife’s scans taken at Savannah were negative,” Frank Ducey wrote in his email to the county. “The good thing was that she got those CAT scans.”
Frank Ducey broke two ribs in the accident, an ailment diagnosed two days after the wreck, he said.
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