Thursday, May 17, 2012

Clinton man's death raises issue of state ambulance coverage

Posted By on Thu, May 17, 2012 at 3:57 AM

UNAVAILABLE: Southern Paramedics provides ambulance service to Clinton, but rules prevented it from transporting an injured man to Little Rock recently. He died without advanced treatment.
  • UNAVAILABLE: Southern Paramedic provides ambulance service to Clinton, but rules prevented it from transporting an injured man to Little Rock recently. He died without advanced treatment.

Leslie Newell Peacock reports further on circumstances in the death of a Clinton lawyer following a brief scuffle with a man he tried to bar from his restaurant.

Though it wasn’t mentioned specifically, the incident involving Brett Blakney of Clinton, who died of a head injury May 4 because there was no transport available to take him from the county facility to Little Rock’s advanced care hospitals, prompted much discussion at Tuesday's Trauma Advisory Council meeting about the need for change in transport rules and regulations.

Blakney, 43, the former Clinton city attorney, was taken to Van Buren County Memorial Hospital after a man punched him and knocked him to the ground outside Blakney’s restaurant, the Black Dog Grill around 10 p.m. May 3. Responsive at first, Blakney later became unresponsive at the hospital and an emergency room nurse there told police that unless he was transported, “he’s going to lay here with that head injury and bleed to death.”

By the time the hospital determined that no helicopter would be available because of fog, Southern Paramedic had sent one of its two ambulances in Clinton to Little Rock with another patient and rules didn’t allow the other ambulance to leave the county, CEO Gary Padget said. Blakney died at the hospital around 4 a.m.

Emergency Medical Services rules and regulations currently require that 911 calls take precedence over hospital transport, which meant Southern could not release its one ambulance in Clinton for out-of-county transfers until the second had returned to the county.

Dr. Todd Maxson, the health department’s medical consultant, said the trauma system should create an urgent trauma transfer rule, adding, “The [trauma] patient has to have the same priority as a person calling 911.”

As of this year, the trauma system requires that transport services receiving trauma dollars have agreements for backup ambulances should they be unable to respond to emergency calls. These so-called “backfill agreements” were to have been filed with the state Health Department by March 31. The council learned Tuesday that fewer than 50 percent — 41 out of 116 of the ambulance services getting trauma dollars — have filed backfill agreements, also known as mutual aid agreements.

Dr. James Graham, council chair, expressed surprise that checks had gone out to ambulance services that had not filed their backfill agreements. If they do not do so by the end of the fiscal year, they will lose their trauma dollars in fiscal year 2013.

The Health Department said Southern Paramedic was one of the companies that had not filed its backfill agreements with the state. However, department spokesman Ed Barham said, Southern, which has contracts with the trauma system for service in Arkansas, Lonoke, Monroe, Van Buren, Prairie and Woodruff counties, uses its entire system as backfill. When Blakney needed an ambulance, the closest would have taken an hour and a half to reach Clinton, Barham said. Clinton is an hour and 20 minutes from Little Rock.

Southern received $14,205 from the state for its service in Van Buren County and a total of $92,071 for the six counties it serves.

Evans also said that Level 4 hospitals — the lowest level of service in the trauma system — need “education” in which patients need ambulance transport and who do not. He said non-emergencies — he cited a three-hour transport for a broken arm — were wasting resources, and “they’ve got, on the hospital’s end, to do a better job.”

Evans recommended the council define an urgent trauma transfer rule immediately, but the council would have no regulatory authority to enforce it until the rule was adopted and approved by the state Legislature, a process that takes months. The rule will be drafted by the council’s quality assurance group instead.

Graham, in an interview before the meeting, said ambulance service in rural areas of Arkansas was a “major challenge” and crucial to “making the system work right. If you had your druthers, you’d staff five or six [in a county] and never run out of one.” Instead, some ambulances services are volunteer — “they’re having a chili dinner to put gas in the truck.”

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