By Robert Mittendorf
The Bellingham Herald
BELLINGHAM, Wash. — Firefighters performing intubations on a recently deceased patient — inserting a tube-like device into their throat — isn’t standard practice in Whatcom County or elsewhere in Washington state.
Intubation is a medical procedure aimed at helping a patient breathe, a treatment usually performed in the field when a patient’s heart has stopped.
But when a patient dies in the care of firefighters, or is dead when firefighters arrive, what started as a medical emergency becomes a case for police or the medical examiner, according to local fire department officials and members of the Whatcom County EMS and Trauma Care Council interviewed by The Bellingham Herald this week.
“If the patient is deceased at the scene, it becomes a law enforcement issue,” said Chief Jerry DeBruin of Whatcom County Fire District 14 in the Sumas area, who heads the EMS Council’s education committee.
That’s necessary because authorities must rule out foul play in the death, even if a crime isn’t suspected.
Battalion Chief Joshua Morell of South Whatcom Fire Authority, who’s also co-chair of the EMS Council’s quality-control committee, said a patient’s body shouldn’t be altered once life-saving efforts end after what firefighters call a “cardiac code.”
“It’s pretty clear to me that we try to keep everything as it was when the patient is deceased,” said Morell, a 22-year firefighter and an evaluator for EMT training.
“Once the ‘code’ has been called, we leave tubes in place, leave the IVs in place, cover the body, call law enforcement and give the patient some respect,” he said.
Ben Boyko, division chief of medical services for Whatcom County Fire District 7 and a member of the EMS Council’s executive board, said the only reason that law officers wouldn’t be called is if the patient who died was at the end stage of a fatal illness in a hospice or skilled-nursing facility.
“It’s pretty clear that’s the standard,” Boyko said.
July incident
Both DeBruin and Boyko said that the July incident at a Bellingham Fire Department station, where firefighters used a recently deceased patient’s body for medical training, was improper and unusual.
One veteran fire officer resigned and another retired over the incident, and 10 other city employees — firefighters and office staff — received varying degrees of discipline, according to the city’s investigation.
In that late July case, an unnamed patient from a nursing home died en route to St. Joseph Hospital and was taken to the Broadway Street station, where fire department personnel and civilians practiced intubation on the body
“We rarely have that occur where a patient died in the back of an ambulance, because for us, we’ll continue (life-saving) efforts until we reach the hospital,” said Boyko, who’s also a paramedic.
Boyko said it’s more typical for a patient to die at the scene of an emergency, rather than en route.
“Once we cease efforts, we always contact law enforcement,” he said.
Standards elsewhere
Fire and EMS officials in King County said that intubations on a recently decreased patient are outside the standard of care for firefighters, emergency medical technicians and paramedics across the region.
“The Seattle Fire Department intubates when it’s necessary for life-saving efforts,” said Kristin Tinsley, spokeswoman for the Seattle Fire Department.
James Apa, spokesman for the Department of Public Health — Seattle and King County, which covers 35 EMS agencies that treat and transport patients, said paramedics and EMTs aren’t authorized to practice intubations outside approved training situations.
“What was reported in Bellingham is not how it happens in King County,” Apa said.
He said intubations required for training purposes are performed on live patients in the field or at a hospital under supervision.
“This is the standard throughout King County,” he said. “We’re well-recognized.”
Protocol review
DeBruin said that the Whatcom County basic life support protocols — which describe the standard of pre-hospital medical treatment — discuss end-of-life care but don’t specifically address procedures to take after a patient dies.
“I don’t know that there is a particular written policy,” DeBruin said.
“You try to do anything you can for the deceased — and for their loved ones.”
Still, DeBruin emphasized that the appropriate police agency must be contacted.
To illustrate, he cited his firefighters’ actions after a recent fatal wreck on a U.S. Forest Service road near Maple Falls.
He said the Washington State Patrol and the Whatcom County medical examiner were called, and firefighters were asked to take the body to the fire station in Kendall.
“We staged with the body until Dr. Goldfogel came to pick him up,” DeBruin said.
Morell said he’ll urge the EMS Council to add specific language to its protocols for patient death at an upcoming meeting.
“I’ll make a suggestion that we add that to end of life issues,” he said.