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June 10, 2011
Report faults DC medic in heart attack response
By Andrea Noble
WASHINGTON — A D.C. paramedic who told a Northeast man he was likely suffering from acid reflux hours before the man died of a heart attack did not know or follow numerous department protocols - including those specifically outlining the action to take when a patient complains of chest pain, according to a report issued by the city's Office of the Inspector General.
The report, released June 2, said that the paramedic involved in the 2008 case suggested Edward L. Givens take Pepto-Bismol and that Givens' chest pains had not subsided when the emergency crews left his home.
The crew found Givens, 39, on the floor of his home after his mother called 911 - "an indication that he may have experienced something more serious than what was later described as simple acid reflux," the report says.
Although they asked Givens multiple times whether he wanted to be taken to a hospital and he declined, the report suggests responders should have done more to persuade him to go.
When Givens asked one of the four emergency workers who responded if he needed to go to the hospital, the responder replied, "That's up to you; if you want to go we will take you," according to the report.
Standard procedures say paramedics can offer saline intravenously, provide oxygen, aspirin and nitroglycerin to patients suffering from symptoms associated with a heart attack, and should take the patient to a hospital if the chest pain persists after administering those medications.
The inspector general's report also faults emergency workers for not recording fundamental information, such as Givens' first name, age and medical history and interactions with his family members on a patient care report. The reports are typically passed on to hospital personnel when a patient is taken to a hospital but are considered necessary even in cases in which a patient is not taken to a hospital to provide medical and legal documentation of responder's actions.
Many of the issues outlined in the inspector general's report mirrored claims in a $17 million lawsuit that has been brought by Givens' mother, Lolitha Givens. An attorney for the Givens family, William Lightfoot, declined to comment on the report while the civil suit is pending.
A 2009 investigation by The Washington Times into the training and education of the District's paramedics found many could not pass basic written exams testing their medical knowledge or that they mishandled basic life-saving procedures during videotaped assessments.
The test results of the paramedic who treated Givens were among those criticized by experts in the report by The Times, and the lawsuit filed by the Givens family accuses the fire department of being aware of the paramedic's "poor performance" but leaving him in the field.
D.C. fire officials declined to comment about the paramedic's current status within the department or about retraining or education efforts since the Dec. 2, 2008, incident. However, city government records from March indicate the paramedic has worked for the department for 21 years and is still employed as a firefighter/paramedic.
A breakdown of department initiatives developed after Givens' death are mentioned in the inspector general's report and include an initiative rolled out in January 2009 to better identify and monitor patients who have suffered acute heart attacks. The initiative also required advanced life support responders to attend a refresher class on reading electrocardiology machines, which monitor heart activity.
In March 2010, the department approved a policy that required permission from a supervisor before any responders left the scene of a call when a patient declined to be taken to a hospital, according to departmental documents included in the report.
In order to address other issues documented in the inspector general's report, the inspector general recommended the fire department more strictly enforce the full documentation of all responses, provide clarification on what responders are required to say to patients who decline ambulance transport, improve protocol on handling complaints of chest pain, and providing documentation of a transport decline to patients and family.
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