Change in RSI Procedure Disputed in Colorado Springs

Oct. 4--An emergency room doctor said Wednesday that a government panel's change in when a life-saving procedure can be used could put patients at risk.

"I don't think that change is of benefit to the people of El Paso County," said Hal Watz, who works for Penrose-St. Francis Health Services.

"It sounds like we're looking out after the community," he said, but instead the change means delaying a lifesaving measure.

Watz's comments came at a meeting of the Emergency Services Agency, which oversees the American Medical Response ambulance contract.

On Sept. 5, the board, chaired by El Paso County Commissioner Sallie Clark, held a closed session and afterward asked AMR to change how it uses rapid sequence intubation for 120 days, pending study. Commonly called RSI, the procedure paralyzes so a paramedic can insert a breathing tube.

The ESA board said it wanted AMR to perform the procedure only when they're on the phone with a doctor. Before that, AMR paramedics used RSI under standing orders.

Board member Marilyn Gifford, Memorial Health System's emergency chief, triggered discussion of RSI last month, pointing to a July incident in which AMR paramedics used RSI in a way she didn't approve of.

A state investigation cleared the paramedics, finding no grounds for discipline.

Jack Sharon, a Penrose doctor and an ESA board member, agreed with Watz.

"When somebody needs an airway, it's the first thing you address," Sharon said. "If you're calling in for an RSI, that patient needs an RSI. All we've done is delayed the RSI."

Sharon said a panel of emergency medicine experts with the El Paso County Medical Society last week expressed concern the moratorium was imposed without consultation with the medical community.

ESA board member Jeri Howells, the mayor of Fountain, suggested the moratorium be rescinded. "Why in the world would you want to impair people in the field?" she said.

Board member Jim Reid, the county's emergency manager, said he thought the moratorium allowed paramedics to use RSI without a doctor if it was an urgent situation.

That is not the case, said AMR's Ted Sayer. The only time the moratorium allows AMR's personnel to use RSI without a doctor on the line is if the crew is out of range and can't reach a doctor.

"Our impression was consultation with a physician was an added value," said another ESA board member, Colorado Springs Deputy Fire Chief Dan Raider. "If you have evidence that the moratorium is delaying, like what Dr. Watz is saying, I think this board should reconsider this issue."

Wednesday, Gifford said RSI "doesn't have to happen in a crash situation" and there often is time to get the patient to a hospital.

Watz countered, "I want that airway control before it becomes a crash situation." He suggested that creating barriers to care could constitute malpractice.

Board member and Colorado Springs Councilwoman Margaret Radford termed it a Penrose versus Memorial issue, adding, "What you've said is if we don't rescind this, we're going to kill somebody. I don't believe that. We discussed something that a lot of us were very worried about."

After two doctors told Radford the issue had nothing to do with Penrose and Memorial, she retracted her statement.

Clark referred the issue to the ESA's Medical Control Committee, chaired by Sharon, and asked for a recommendation within two weeks.

CONTACT THE WRITER: 636-0238 or pam.zubeck@gazette.com

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