Fri | Mar 23, 2018

Letter of the Day | First aid might have saved Dominic

Published:Saturday | October 1, 2016 | 12:01 AM


I am a Level Four paramedic/emergency medical services (EMS) instructor employed to the University of the West Indies. My job is to train EMS professionals at the basic to advanced levels. I have been teaching and working in the field of EMS for more than 14 years.

First, there are multiple levels of EMS practitioners. The skill provided at each level is way above or beyond first aid.

The pre-hospital management given to Dominic James, the schoolboy who collapsed on a football field recently, should have been first aid. I cannot say if this would be enough to save the young man's life, but it does leave unanswered questions.

I am very certain that if he fell and was seizing and gasping, oxygen could not stop that. He would require medication to stop his seizure, then aggressive airway and cardiac management. Finally, the cardiac monitor, when placed in defibrillation mode, does not start back the heart. It kills the weak impulses caused by ventricular fibrillation and pulseless ventricular tachycardia, which are the only two rhythms that can be defribrillated.

This, with the use of ACLS drugs, is what allows the primary electrical stimulus of the heart to return. Dominic might have been in a rhythm for which no shock was required.

I do not believe that ambulances with trained medical personnel can be at every Manning Cup event, because Jamaica's EMS system is nowhere near the First World level. This is because of poor regulations, poor public awareness, poor standard of care and scope of practice.


Chain link to survival


Now if there is no first aider, the EMT does what the first aider should have done. If there is no EMT care, the paramedic does what the EMT should have done. If there is no paramedic care provided, the nurses and doctors must do what the paramedic should have done. This is the chain link to survival, and if there is a break in that chain, the patient's chances of survival are greatly diminished.

My suggestion would be to have the coaches and teachers trained and equipped with jump bags until our Jamaican EMS system, by some miracle, reaches where it needs to be. I also recommend that you review the curriculum for training EMS practitioners at all levels mentioned above to get a better understanding of the level of training, skills, medication and knowledge required for these professionals to be certified or licensed.

There is a saying that emergency personnel are like a spare tyre; they do not become important until they are needed. Sadly, in Jamaica, they are not seen as important at any time. Dominic deserved a First World response, whether he would have survived or not.