As I lie in my bed right now, I can hear the sirens in the distance. From our (my) bedroom, I hear sirens every day. It’s been that way for years. Our house is up on a hill, a block or so from Los Angeles’ Sunset Boulevard. A few blocks down on Sunset Boulevard is the fire station. With no obstruction, sound carries, and, needless to say, I can hear sirens wail like a banshee– every day. And every time the shriek echoes in Echo Park (now you know how this area got its name), it hauntingly reminds me of the help Ruth never got.
Ruth had been in and out of HealthCare Partners clinics four times before her death. At no time was her case considered urgent or an emergency. The day she died, HealthCare Partners ordered a BLS vehicle to transport her to the hospital. Big mistake! And why this mistake (and there were many) had to happen is one of the many issues that are still unaddressed. And it is this addressing that needs to happen.
To those who are unfamiliar with the acronym “BLS” (yes, I had to become familiar with all this jargon, too), the letters stand for “Basic Life Support.” There are two kinds of medical transports, staffed by appropriately trained EMTs (Emergency Medical Technician). The BLS vehicle is the lowest level, and the EMTs have an EMT-Basic certification. On the other end of the spectrum, there is the ALS (Advanced Life Support) vehicle staffed by EMTs with the high level certification. The ALS is what most of us would commonly think of as an “ambulance” staffed by highly trained paramedics. Ruth had neither the “ambulance” nor the paramedics. HealthCare Partners did not call for one.
When Ruth was taken into the medical transport, she effectively left the purview of HealthCare Partners. (This is one of a number of situations which makes this case so insanely hard to comprehend to many people, but this point shall be left for another time.) Within ten minutes of being in the transport, these low level EMTs had determined that this case was a dire emergency. Why an “emergency services” physician at HealthCare Partners (his bio even contains those exact words) couldn’t determine what a lowly trained EMT figured out in ten minutes is a puzzle that needs to be solved. (Actually I’ve already answered this question, but the words of a “grieving husband” holds no sway in the court of public opinion, so others must solve this irregular picture as well.)
And this is where the sirens that I hear every day leaves a sickening feeling in my stomach. A BLS vehicle cannot legally turn on its siren. Only an ALS transport can do so. So as Ruth was taken to Glendale Memorial Hospital in late afternoon rush hour traffic coming out of downtown Los Angeles, the BLS could not turn on its sirens to make those in front of them get out of the way. By the time Ruth entered ER, her system had virtually collapsed. The attending physicians had to pump her chest in an effort to get Ruth’s heart beating again, and failing that, had to resort to electric shocks from the instrument that everyone who has grown up in an era of medical TV shows knows all too well. As Ruth’s system somewhat stabilized, one of the nurses, livid with rage, went looking for the EMTs. “I want to know the name of your supervisor,” she yelled. (The verb is not simply a literary device I’m using for emphasis.) “Why the hell was a person in her condition brought in a BLS?”
Why indeed.
Our house is not in a cul-de-sac inside a private gated community. Our house is in a place where everyday I can hear the sirens wail its mournful dirge reminding me of the care Ruth never got. And every day, my heart breaks.
