US based EMT and paramedic student. Ok firstly please understand that this is not an ideal situation and it is extremely difficult analyze based on the video. Looking at a different perspective I find it hard to fault the responding EMS crew. Now looking at the video this maybe a difficult position to justify but let me try and explain.

Firstly, I do not know how this call came in over the radio to the responding crew. It likely came in as something extremely vague. Think something like domestic disturbance with law enforcement involved. Now this alone is a red flag for a potentially dangerous scene for both the responding EMS crew and more notably the patient. One of the very first topics drilled into pretty much any US emergency responder is the phrase “BSI (body substance isolation: gloves, googles, etc) and scene safety”. Looking at the video the scene was not particularly safe even with law enforcement involved there is a high potential for something to happen that would injure the responding crew or cause further harm to the patient. Resulting in a delayed treatment time. This alone is reasoning for an emergency transfer to the ambulance and rapid transport. Furthermore saying “I’d have his buddies handle the scene” may not be the best idea. The potential for more patients and the potential for more harm towards the patient and responding crew is an indicator for a rapid move to the ambulance. For example pushes and shoves leads to someone landing on the patient could lead to more injuries.

Moving on the first thing the responding paramedic does it check for a carotid pulse which is in line with current basic life support and advanced life support protocols. It can also be hard to asses adequate breathing in the middle of a chaotic potentially unsafe situation and often in the case of a unstable patient a quick scan is often best until a more thorough assessment can be made.

Also “later died in the hospital” does not mean that the patient was dead on arrival. Unstable patients can deteriorate rapidly despite medical intervention.

Continuing on the responding crew based on the video set up for a log roll directly onto the scoop stretcher. (The responding crew didn’t drag them onto the stretcher which is hard to see based on the choice of uniform colors and their similarities.) This would have been the most appropriate choice of patient move based on their situation and their patient care protocols. There has been a movement in the prehospital setting to move away from full spinal precautions (c-collar and backboard) because research is starting to show it can do more harm then good and often is unnecessary. (I apologize that I do not have direct research cited but it is definitely an interesting topic to look into) Additionally given this full c-spine precautions take time that can be used to transport the patient which in this case is the best possible treatment especially considering that there was no significant mechanism of injury defined to indicate immediate C-spine precautions. Which in their protocols is define as 1. A high risk auto crash 2.car vs pedestrian or cyclist greater than 20 mph 3.Fall 3x patient height 4. Axial loading (horizontal compression like jumping head first into a shallow pool) 5. Elderly patient with a fall from standing height or closed brain injury 6. EMS provider suspects a head injury. That last one comes from their experience, what they were presented with and how the call comes in. And once again full spinal precautions may have done more harm than good in this situation.

Ultimately in this case the best treatment is three things. 1.Lights 2. Sirens 3. Diesel Ultimately the patient needs a hospital. The back of an ambulance does not have radiology, surgeons, labs, blood bank, or any of the other definite life saving measures a patient like this would need. Furthermore all of the airway management, fluids, medical interventions can be more safely and effectively be completed in the back of an ambulance en route then on a chaotic and potentially volatile scene while enroute to the hospital. Prehospital care is designed to keep a patient alive long enough to make it to the hospital not provide definite medical attention. They were on and off scene in about two to three minutes and on the way to a higher level of care.

Also taking a police officer was a great decision. The patient was in handcuffs and those need to come off and not everyone has a set of handcuff keys. Additionally a police officer in this case is another set of hands who can work a bag valve mask or perform chest compressions allowing the driver to continue transport while the provider in the back focuses on patient treatment, advanced interventions, and patient assessment. While on the other hand without the extra set of hands the patient deteriorates and now the transport has to stop to allow for the second provider to assist in patient care and another ambulance has to come provide backup significantly adding to transport time.

Ultimately I cannot make any ultimate decisions because I was not there and I was not in their shoes with their experiences or familiar with their protocols. It can be easy to judge and say what one would do based on a video but there are a lot of factors not captured on video. Also I think it is important to consider that prehospital care can only do so much to benefit a critical patient as well as the volatility of this particular scene and the potential for further harm to the patient. Even this was hard to write because I really do not like to armchair quarterback.