LONG Story--Medical Role Thrust on Frantic Mother

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Medical Role Thrust on Frantic Mother

Safety: Just two paramedics were sent, so L.A. woman had to help treat dying

baby in ambulance. Inquiry is underway.

By RICH CONNELL and ROBERT J. LOPEZ, Times Staff Writers

In the middle of the night, a Caracia was jolted by the crying and

gasping of her 2-month-old son. Within minutes, her terror surged when two Los

Angeles city paramedics drafted her in a frenzied and futile battle to keep him

alive.

Jostled in a swerving ambulance, she struggled with one hand to position a

mask over the infant's mouth. With the other, she squeezed a rubber bag, pumping

air into his still lungs. Alongside her, a paramedic rhythmically pushed on the

infant's chest, hoping for a heartbeat.

" All I wanted, " she said, breaking down, " was to save my son. "

Caracia, 34, was unprepared and untrained for the responsibility thrust

upon her in the most frightening moments of her life. She was in the back of the

ambulance because a Fire Department dispatcher did not send enough rescuers,

according to records and interviews.

Only two paramedics arrived at her Van Nuys apartment in the predawn hours

of Sept. 19. One had to drive to the hospital, leaving the other no choice but

to turn to the mother.

" It's unfair, I think, to ask somebody to do something on their own child

or family member that they are not trained to do, " said paramedic Haney of

the department's quality assurance unit.

A spokesman for Fire Chief R. Bamattre said Haney has been assigned

to investigate the incident. The inquiry was triggered by a complaint from one

of the on-scene paramedics, who believed that they did not have enough backup.

A preliminary review, Haney said, has found that the dispatcher " most

likely " should have sent four additional firefighters. A final determination is

pending.

Although the baby was alive at the time of the emergency call, Haney said

it is hard to conclude whether dispatching more people would have changed the

outcome.

A coroner's spokesman said that, although a final report has not been

completed, it appears that infant Becerra died of natural causes.

The disclosure of his death comes at a time when the department's emergency

medical system is under scrutiny from Los Angeles officials, who have vowed to

bolster staffing and curb dispatching mistakes. A City Council committee has

scheduled a hearing Monday on the problems.

In July, a report to the chief found four " grossly inappropriate "

dispatches in fatal cases. The report also estimated that during a 60-day period

earlier this year, 160 people may have been sent the wrong level of medical

care.

Chief Bamattre has maintained that the dispatch breakdowns recently brought

to light are rare in a system that handles more than 275,000 emergency medical

calls a year.

But the July report suggested that the department does not actually know

how many mistakes are being made because dispatchers often fail to obtain key

information from callers about the severity of their problems.

According to the report, these lapses may be partly the result of

dispatchers forming " negative impressions " about callers, doubting what is

reported, imposing their own " preconceived notions " about medical emergencies or

coming up with their own snap assessments, called " dispatcher diagnosis. "

The chief question under review by the Fire Department in 's case is

why the veteran dispatcher classified the call as being about a " sick person "

rather than a full-blown emergency. This judgment was made after the father told

the dispatcher that the baby was cold, pale, unresponsive, having trouble

breathing and had undergone heart surgery.

The 34-year-old father, Becerra, said in an interview that the

dispatcher kept interrupting and challenging him about the infant's condition.

" He seemed like he wasn't listening, " Becerra said.

Although fire officials declined to identify the dispatcher, they described

him as a good employee with no previous record of problems.

At the request of The Times, three veteran Los Angeles paramedics reviewed

a transcript of the family's emergency call, with the understanding that they

would not be named. All agreed that there were enough red flags for the

dispatcher to send two paramedics and four backup firefighters--the maximum

response.

As one concluded, the dispatcher " misread what was there. "

Baby Was Born With Heart Defect

, the youngest of three brothers, was born July 11 with a heart

defect that required surgery three days later. After a week in the hospital, he

was taken home with no restrictions on his activities, his medical records show.

In the following month, his weight nearly doubled to 13 pounds. " He looked

fine, " said Dr. , who saw a few days before he died. " We

did not view him as a risk. "

On Sept. 19, the baby awoke about 3 a.m. He was " white, white, white, "

crying and struggling for air, his mother recalled.

's father said his first impulse was to rush the baby to a hospital.

But his panicked wife urged him to call for help.

Cradling in his arms, Becerra reached a bilingual Fire Department

dispatcher about 3:15 a.m., according to a tape of the call, which was conducted

in Spanish. Becerra immediately volunteered key information about the kind of

emergency it was.

" Hey, listen, my son doesn't respond, " the father said, adding that the boy

was only 2 months old.

After getting Becerra's address and phone number, the dispatcher asked: " Is

he conscious, your son? "

" He is moving now very slowly. "

" Is he conscious, " the dispatcher repeated. " Yes or no? "

" Yes, " the father answered.

" OK. Is he breathing then? "

" No, he's real cold, my son. He's just. . . . "

" Sir! " the dispatcher interrupted, raising his voice. " Answer me, yes or

no. He's conscious, yes? "

" Yes. "

" He's breathing? " the dispatcher asked again.

" Well, it doesn't look like. . . . "

" Yes or no? "

" No. "

" No, " the dispatcher said. " How can he be conscious but is not breathing. .

.. . "

" No, " Becerra said.

" That, that is impossible, sir, " said the dispatcher.

" Uh-huh, " said the father, who then imitated the gasping sounds coming from

the baby.

" Then he's breathing? "

" Um, hum. "

" OK, does he have fever?

" No, sir. "

" What happened, now? "

" I don't know. He just got up. Cried a lot, " Becerra said, adding: " He is

very pale. He changes color because he had a heart operation. "

" He had problems with the heart before? "

" Yes, " Becerra answered. " He was operated on, and he's real strange now.

He's now getting cold. "

The dispatcher told Becerra to lie down without pillows, face up and

head tilted back so he could breathe. He also instructed the father to keep an

eye out for the ambulance.

" OK, " the dispatcher said. " Bye-bye. "

Becerra said he then asked, " What do I do next? "

He heard no words of advice. " No one was there, " the father recalled.

Paramedics Expected 'Sick Person' Only

In the opening seconds of the call, the dispatcher deployed two emergency

medical technicians, who, unlike paramedics, cannot administer drugs to

stimulate a patient's heart.

As the conversation progressed, the dispatcher apparently realized that the

situation was more serious than he initially thought. So he canceled the first

dispatch and ordered two paramedics into the field. He did not, however, make it

a full emergency with backup firefighters.

As the family waited, 's breaths grew further apart, recalled the

father, who was still holding his son.

The rescue ambulance raced past rows of apartment buildings in the

working-class Van Nuys neighborhood, arriving in about seven minutes. The

paramedics bolted up to the second-floor apartment.

They seemed stunned by the gravity of what they found at the front door,

the mother said. They were expecting to find simply a " sick person " because of

the dispatch.

" They took him out of my arms, " the father recalled, whose wife added: " All

they said was, 'Let's go! Fast!' "

As the paramedics ran down the stairs to the ambulance, the parents

followed. One rescuer motioned for the mother to get in. He quickly showed her

how to work the breathing bag while his partner jumped behind the wheel.

For several excruciating minutes, the mother said, she tried to keep the

air mask from sliding off her son's mouth as the ambulance, siren blaring, sped

toward the hospital. " How am I supposed to do this? " she asked herself. The ride

was a blur. The only thing Caracia said she can remember is trying to revive her

baby.

The ambulance rolled up to the emergency room of Valley Presbyterian

Hospital in Van Nuys at 3:35 a.m., records and interviews show. The father, who

had left the couple's other two young children with an aunt next door, arrived

minutes later--in time for a doctor to tell him and his wife that their son was

gone.

The official time of death was 4:14 a.m., about half an hour after the

ambulance arrived at the hospital.

Caracia believes that might still be alive if the paramedics had not

arrived alone.

" If they could have come with more people, " she said, " they could have done

something. "