Pediatric Intubation and IO Placement by Paramedic [Compartment Syndrome]
Case #148
A 1-year-old girl was playing on a swing set in her family’s backyard.
The swing set suddenly collapsed.
A beam struck her in the head.
She was knocked unconscious.
Her parents called 911.
2 paramedics responded to the call.
On arrival, the child was unresponsive.
The paramedics noted shallow, irregular breathing.
She had a depression to the left occipital skull.
A portion of their documentation is shown here:
The paramedics decided to intubate her at the scene.
One paramedic placed an IO in her left tibial region while the other paramedic looked for a good IV site.
An IV was obtained several minutes after the IO was placed.
She was given fentanyl and lidocaine for premedication.
RSI was successful on the first attempt.
On arrival to the ED, staff noted that her left leg was very swollen.
Fluids were stopped and the IO was removed.
She was admitted for a skull fracture.
Over the next few hours it became apparent that her left leg compartments were extremely tense.
She underwent a 4-compartment fasciotomy of her left leg.
The patient made a full neurologic recovery.
However, she was left with permanent scarring of her left leg and reduced function.
Her family contacted a law firm.
A lawsuit was filed against the 2 paramedics.
They were employed by a hospital-based EMS group.
The hospital was also sued.
The plaintiff hired a paramedic expert witness, who wrote a detailed 8-page opinion.
The defense hired a pediatric critical care physician to defend their actions.
Both opinions are shown below: