San Antonio Chief Details Mistakes Made

By Brian Chasnoff, Express-News

A San Antonio paramedic who responded to the scene of a head-on collision last month failed to check for the pulse of a victim trapped inside a car with a severe head injury, city officials revealed Tuesday.

Instead, Mike Gardner, a paramedic with five years’ experience in the Fire Department, deemed merely by looking that Erica Nicole Smith, 23, was dead â€” a violation of the Fire Department’s standard operating procedures.

Checking for vital signs “is part of the protocol, and it’s part of the protocol for a reason: To save lives,” City Attorney Michael Bernard said.

Smith’s life was not saved.

Gardner told someone to place a tarp over her body, and Smith remained inside the smashed Honda Accord for more than an hour in near-freezing temperatures before a medical examiner called to the scene noticed that she was breathing.

Paramedics again were called, and Smith was taken to a hospital, about two hours after the 4 a.m. crash. She died there the next day.

“I’m sorry for what the Smith family has endured,” Fire Chief Charles Hood said Tuesday, “and I’m sorry for the mistake that was made on our part for the incident.”

Hood added, “Medical protocol was definitely violated in this instance. It was an error in judgment.”

Hood’s apology and his admission of error, delivered in an interview late Tuesday with the San Antonio Express-News at City Hall along with Bernard and City Manager Sheryl Sculley, represent stark reversals in the city’s response to the incident. The day after the incident, Hood refused to apologize, instead casting blame on Jenny Ybarra, 28, who was charged with intoxication manslaughter after she veered into oncoming lanes of traffic on Loop 410 and smashed into the Accord on Dec. 16.

Hood that day added he did not expect the paramedics to be disciplined. He told the Express-News the next day that paramedics had sought Smith’s pulse but could not find one.

“We were assuming (they had checked for her pulse),” Hood explained on Tuesday.

Sculley added, “Because it is standard operating procedure to do that.”

Paramedics here are required to seek vital signs regardless of a patient’s injury, according to protocol. Gardner, 35, has been permanently barred from working as a paramedic in San Antonio. He was transferred to the Fire Department’s firefighting division.

Three other paramedics involved in the incident, including two who arrived at the scene more than two hours after the wreck in a second wave, have been de-authorized for an indeterminate length of time and transferred to the firefighting division. They are: Michael Collins, 39, who arrived on the scene with Gardner and treated Ybarra; and William Bullock, 33, and Jeremy Huntsman, 30, both of whom responded to the scene after officials realized Smith was alive.

All four paramedics were in the 21st hour of a 24-hour shift that began at 7 a.m. the previous day, Hood said.

Chris Steele, who heads the San Antonio Professional Firefighters’ Association, said he met with the four paramedics Monday after their meeting with Hood. He said they had a “basic feeling” about “what was coming,” but all were so exhausted that they’re “pretty much not emotional anymore.”

Upon de-authorization, paramedics are demoted to fire apparatus operator and lose their license to practice emergency care in this city. The demotion would guarantee a pay loss of at least $1,000 a month, Steele said, not including the dozens of overtime hours paramedics normally work if they choose.

A supervisor of the Fire Department, Sculley said the incident has sparked plans to improve training.

“We’re going to use this incident to incorporate into additional training, immediately,” she said.

Officials also are casting a wary eye toward the city’s communications center. In another blunder, a Fire/EMS dispatcher miscoded the call from the scene of the collision as a non-high speed auto accident, officials said.

“Had it been coded as a high-speed auto accident, then certain equipment would have been dispatched,” Hood said.

Those resources, including a ladder truck with the Jaws of Life, were dispatched to the scene after the medical examiner realized that Smith was breathing.

Hood said the Fire Department likely would seek to incorporate new technology, including computer-aided dispatch capabilities, into the center.

Smith’s relatives, including her father, said Tuesday that city officials’ admissions of error have not quelled their own outrage.

“I’m very angry,” Robert Smith said. “It’s a struggle, minute by minute.”

Erica Smith, a senior at Texas State University, was a passenger in the front seat of the Accord, driven by her friend Sabrina Shaner, 22. A police source who didn’t want to be identified because the case remains under investigation said Tuesday that Shaner was legally intoxicated at the time of the crash. She had not been charged as of Tuesday, the source said.

Shaner and Amber Wilson, 22, a backseat passenger in the Accord, suffered minor injuries in the wreck and were treated at a local hospital. All three occupants were wearing seatbelts, a police report said.

Texas-Fire note: This is a news and information website. We post news that is important or of interest to Fire and EMS professionals and volunteers throughout the state. The views offered in these stories do not necessarily reflect the opinions of Texas-Fire, its members or its producers.

Our thoughts and prayers are with the family and friends of the woman killed as a result of the DWI incident and also with the Fire and EMS professionals affected by this incident.

Posted on: Wednesday, January 9th, 2008.
Filed under Statewide News, Upper South.
669 views
Follow Responses RSS 2.0.
Leave a Comment or Trackback.

7 Responses to “San Antonio Chief Details Mistakes Made”

texaschick
January 9th, 2008 at 22:11
I find it interesting that not a whole lot of articles about this incident contain the fact that the woman’s brains were coming out of her head. Is it honestly necessary to check someone’s pulse when there’s brains on the seat? I don’t blame Mr. Gardner or any of the other paramedics and I wish that more articles would give the whole story and make it seem less one sided.

If you don’t believe me, go read this article:

http://www.ksat.com/news/15010345/detail.html

It’s one of the few that actually mentions that detail…
Former Paramedic
January 10th, 2008 at 13:31
It does not matter if there is brain matter exposed or splattered. There are many well documented cases of survivors of similar if not worse brain injuries.
Mookie
January 10th, 2008 at 15:36
I agree. When I was a brand new EMT, my training officer made me check for a pulse on a victim that was graphically injured (multiple ‘open’ injuries - including head) and I held it against him. It was hard on me (the victim was still under the car that killed her) and I considered it bad hazing. But it was and is a policy with the department. Stupid or not, still a policy.
fcro hollywood
January 12th, 2008 at 00:18
While Ms Smith’s story is tragic, this is still a high speed MVA involving ETOH. I’m not sure where ‘Former Paramedic’ practiced—but i, nor any other FF i know, has worked or heard of “many well documented cases” involving brain matter being splattered, and survivors of them. Can anyone say Triage?? The city of SA is throwing their FF’s under the bus, the media reports what they think is the story , and the public has no perception of the job, yet will draw conclusions from it. The bottom line is that several people’s careers are in trouble, the industry has another black eye, and Ms Smith is still gone. Our best wishes for all involved.
Fookie
January 12th, 2008 at 08:35
See Also - the driver of the car in which the fatality occurred has now been charged with dwi.

http://www.texas-fire.com/2008/01/11/second-driver-charged-in-left-for-dead-crash/
TxFirefighter
January 12th, 2008 at 15:57
I support Gardner… FF Gardner arrived on a scene of an accident with himself and his partner where he had four victims. At that point it is a mass casualty incident because he has more patients than he and his partner can handle. He had to triage those patients… and when he saw brain matter that told him that her injuries were incompatible with life. Unfortunately that apparently was not the case in this instance. However he still had to assess the other patients and determine which patient his immediate treatment would have the greatest effect on. I would have done much the same thing if I had pulled up on that scene first out. Should someone have taken vital signs or thrown a monitor on her? Sure… however expecting the first in unit in a MCI situation to take vital signs on a patient who was exhibiting signs of injury that most would consider incompatable with life? I think not. FF Gardner had three other patients to think about as well. I think San Antonio is hanging their boys out to dry… Where was the engine or truck company and the other transport units? Why is the first in medic getting hit for it?
bernie from NH
January 15th, 2008 at 16:52
i am a former paramedic i retired after over 25 yrs. i was taught was to check breathing and pulse. so the guy just overwhelme with the situation i have seen it happens a few times.maybe he needs a little time off like put him in a house just to do fire fighting.