Expert EMT Evaluates Improper Transportation of Heart Attack Victim

This case involves a female patient in Mississippi with a history of open heart surgery who was admitted to the hospital with complaints of chest pain. After undergoing a series of tests at her local hospital it was determined that she was suffering from a myocardial infarction that would require additional treatment beyond the capabilities of the diagnosing hospital. Blood pressure readings taken around this time indicated that the patient’s blood pressure was very low. Nevertheless, the patient was prepped for transportation by paramedics, who also noted the patient was suffering from shortness of breath. The ambulance left the original hospital, and en rout the patient began to display signs of disorientation and agitation. Eventually, the ambulance arrived at the hospital, by which time the patient’s condition had deteriorated significantly. It was alleged that the patient was not sufficiently stabilized before transportation to the second hospital.

Question(s) For Expert Witness

1. Do you have experience transporting patients with a diagnosis of an ongoing heart attack?

2. In general, what steps are taken in order to certify that a patient is stable enough for transport?

Expert Witness Response E-092548

The main concern which needs to be recognized here is that a myocardial infarction is an ongoing and evolving event. Time is muscle and this patient's chance of survival without immediate intervention is not good. Stability for this patient requires a systolic blood pressure of 90, which was never the case. This means the patient was in cardiogenic shock, which carries a high mortality risk. Stabilization, if it could be achieved, is unlikely to change the outcome, although it could buy more time to get the patient to definitive care. The standard for stabilizing a patient in cardiogenic shock is to provide a vasopressor, specifically Dopamine, titrated to a systolic pressure of 90 minimum. The patient's restlessness and agitation would have been the result of cerebral hypoxia secondary to cardiogenic shock. Based on the information provided this patient appeared to be in cardiogenic shock secondary to an acute myocardial infarction and needed angioplasty-stent PCI. It is speculation as to whether this patient could have been stabilized, however the attempt should have been made.