“I’m a paramedic, not a doctor!” Was a paramedic’s failure to administer adrenaline inconsistent with the exercise of reasonable care? Which case won?
Ambulance called after woman suffers severe asthma attack
On the evening of 21 July 2002, a 25-year-old chronic asthmatic woman drove to her friend’s home in Cairns. She was wheezing badly as she walked into the house, so she walked back to the car to look for her Ventolin puffer.
Returning from the car after using the puffer, the woman requested to be taken to hospital.
As she and her friend were walking towards the car, she collapsed on the front lawn.
Her friend performed mouth-to-mouth resuscitation whilst awaiting the arrival of the Queensland Ambulance Services.
Patient’s condition improves after paramedic administers Salbutamol
Two ambulance crews arrived on the scene within six minutes and found the woman in respiratory arrest.
She had tachycardia, ie a rapid heartbeat of greater than 100 beats per minute. Her blood pressure was also very high.
The paramedic tasked with the making the treatment decisions concluded that the patient was “hypoxic and deprived of oxygen” and so he ventilated and oxygenated her.
He also administered Salbutamol, and found that it improved the patient’s condition, allowing air movement in and out of her lungs.
Patient’s condition worsens on way to hospital and paramedic administers adrenalin
The patient was placed in the ambulance for transport to hospital.
However, on the way there, her heart rate dropped markedly, her respiratory rate reduced and her blood pressure became absent.
The paramedic assessed cardiac arrest as imminent, and so administered adrenaline.
The initial dose had no effect but the second dose produced some return of cardiac output for 30 seconds.
It was at this point that the ambulance was directed to stop. The patient had air trapped in the pleural space, causing the lung to collapse, and so the paramedic performed an incision in the chest wall to allow the air to escape. This action decompressed the left lung and prompted an immediate improvement in the patient’s heart rate and blood pressure.
However, on arrival at hospital the patient had no respiratory effort and no carotid (neck) pulse.
More adrenalin was administered by hospital staff, provoking an immediate response with a carotid pulse becoming discernible and increasing.
Patient survives, but oxygen deprivation results in vegetative state
The medical staff had saved the patient’s life. However, she sustained severe brain damage as a result of oxygen deprivation.
She lived in a vegetative state for the next thirteen and a half years until she passed away in 2016.
Patient’s guardian initiates negligence lawsuit against State of Queensland
Prior to the patient’s death, her litigation guardian commenced negligence proceedings against the State of Queensland as the provider of the ambulance services.
After her death, the claim survived in the hands of her estate.
The case was decided by the Supreme Court of Queensland is in favour of the ambulance service, but this decision was overturned by the Court of Appeal. The case then made its way to the High Court of Australia.