Analyze

            This past spring break (2016), on a Monday night while at home, I responded to a motor vehicle accident as a Good Samaritan. The accident happened at approximately 19:00 hours on my street in Blackstone, Massachusetts. My father was on our front porch when he heard a car barreling down our back country road which has a long straight away before taking a sharp turn. Before the impact he knew that the driver would not anticipate the curve fast enough at the speed he was traveling. Sure enough, there was a loud bang and the sound of a car rolling over, which I could hear from inside the house (approximately ¼ mile from crash).

I grabbed both of my personal first aid kits and a flashlight while my father called emergency services. I walked to scene with my father and younger brother. I sped walked and arrived at the crash site first.

The vehicle was a ‘90s sedan that went straight into a telephone pole, which broke like a toothpick, and rebounded backwards and flipped 90 degrees on its left side. Parts of the car, tools, and glass were on ground, airbags deployed. There was a car seat in back, and for a moment I thought a child but it was just clothing. Front right tire was up inside front passenger compartment. Hazards flashing. Driver window was rolled down. No people in the car.

My brother and father directed traffic on either end of the crash site. They almost certainly prevented at another crash by a car who didn’t see the accident but saw my brother flag them down with his light.

I saw man standing 20’ from crash site, talking to people in a gold SUV. When I arrived I start asking medical questions and the people in the SUV leave – they were by standards who pulled up but left after I started taking over. The man in question appeared to be a lower/middle class white/Hispanic, male in his 30s. He was driving an older car with lots of tools in the back which were now all over the road. Our neighborhood is a small country community and I know he was not from our neighborhood. I assumed he was some kind of mechanic, bases on tools in car. He was wearing dirty jeans and stained hoodie. He was definitely a blue-collar worker. He may have been from downtown Blackstone which is largely lower middle class and blue collar, or he may have been from Woonsocket, Rhode Island, which is known as “the Detroit of Rhode Island”.

As I tried to obtain basic medical information from the patient, it was apparent he had an altered mental status, and did not appear to understand fully what was going on. I am not certain if it was alcohol and/or drugs as for safety reasons I did not get close enough to the patient/suspect to tell. He was ambulatory and verbal. The interesting part of our conversation was to the best of my ability as follows:

“Are you sure you’re okay? Umm yeah. Are you hurt anywhere? I’m fine. [I did visual inspection of patient using flashlight which revealed no major injuries other than minor cuts from airbag]. [He starts to edge away from scene]. You should wait for ems to check you out. Wait, you’re right! I might die?! You appear to be okay externally but things like internal bleeding, and a full assessment could reveal other problems. Naaaa [turns and starts to walk away down street]”

I attempted to convince the patient to wait on scene but he was going through several mode swings during my interactions with him from fear, anxiety, agitation, and anger. While I was talking to the patient, the first officer from the neighboring town arrived on a motor cycle. I informed the officer at the scene of the situation about the patient/suspect fleeing the scene. The officer took note of it and continued to work to secure the crash site. Another officer arrive from my town from the west. I informed the same and he stated that he would need me to make a witness statement and proceeded to the crash site. A third and fourth officer arrived together the same time as two ambulances (indicated because of rollover) from the east. One of them told me again that they would need a witness statement.

I met back up with my dad and brother who were no longer needed to control traffic with law enforcement on scene. Neighbors had started coming out to see the commotion. We were all talking near the scene while waiting for officers. Finally one of the officers asked another officer if he should go look for the suspect. He left approximately 20 minutes after my last contact. I never spoke with the arriving EMS as they came from the east and I was on the west of the accident but officers told them that the patient was missing. Eventually multiple officers and cars were out looking for patient/suspect but was not found as far as I am aware. I finally was given the chance to give my testimony which, to the best of my knowledge, mirrors this report. After reading out loud in front of the officer and my father and brother to confirm accuracy, the officer asked me something very strange. First, he asked me to add what the suspect was wearing (which I had forget to include), but then he also asked me to state that I saw the suspect drive into the telephone pole and that I smelled alcohol on the patients breath. Neither of these things were what I told any of the officers and ran counter to my testimony as written. I include the suspect’s clothing description but I did not add the second mention and stated that I had not witnessed those things. After my report I left the scene with my brother and father.

Some of the policies and procedures relevant to this case were: scene safety, dealing with aggressive/combative patients, and HIPPA did not apply to me as a bystander so I gave full testimony including medical status to the officers.

After reflecting on the education I received and didn't receive, there are a few things that would have allowed me to be better prepared for this incident. How do I convince patients to stay on scene? When do you give up? I wish my EMT class was a little better scene on safety training. Being distracted by the emergency at hand, I did not truly take into account the fact that the power lines were live and drooping with half of the telephone poll pulling on them. Only supported by the next and previous poll but not drooping more than 3’ from normal, more than 15’ from ground, and 10’ above vehicle. Reflecting on it, I did not really consider the threat as I should have, and neither did the officers on scene. I don’t understand why it took so long for police to search for the suspect who could have had major medical issues. Should I have followed suspect/patient alone? When is a citizen arrest allowed/appropriate? Should I have asked for the badge number of the officer who asked me to misrepresent the truth on an eye witness testimony? What is the process to do that anyway? If I had the answers to these questions I feel I may have been able to provide better assistance, but then again perhaps not.

The policy was the multi-tiered approach designed by New York City officials in the event of an Ebola case. This included designation of eight hospitals as being care centers for Ebola cases, teaching non-designated hospitals or care centers how to identify Ebola candidates, communication with transportation services (both EMS and non-EMS), and running unscheduled drills to practice handling scenes with an Ebola candidate (the example given was someone falling ill in a subway car). The poly aimed to standardize the approaches and protocols used when dealing with a possible Ebola case. It focused on minimizing the excessive risk to citizens, EMS personnel, and healthcare workers in the event of a patient with Ebola. The policy also sought to train and drill these protocols, including unscheduled calls (mentioned above) and continued inspections to ensure preparedness. The obvious end goal was to minimize the possibility of wide-spread infection, either through improper handling or failed detection of an Ebola case.

Several leaders from various New York State agencies convened to outline plans for this policy. This included Governor Andrew M Cuomo, State Health Commissioner Dr. Howard Zucker, State Police Superintendent Joseph D'Amico, Port Authority Executive Director Pat Foye, and representatives from health care centers and agencies around the state.

The policy applies to New York state citizens, health care workers, EMS personnel, and leadership within health care centers. Additionally, the policy has parts that effect transportation agencies and their employees. In many ways, due to Ebola's nature and the nature of New York as a major metropolitan area, these policies will also have a global effect.

As described by Governor Cuomo, Dallas was the first major US city to see an Ebola case. This, in turn, allowed New York leadership to have some semblance of what methods did or did not work when trying to contain the disease. Moreover, the policy was implemented in response to the major Ebola outbreaks occurring at this time. This included those within Africa, Europe, and cases seen in Dallas. Moreover, the policy follows the city's "Safe-than-sorry" methodology discussed by Governor Cuomo; he, along with other state and city leaders, believed assuming an Ebola outbreak would occur within the state would give them the best chance of mitigating its effects and minimizing disease spread.

The Ebola outbreak is, by its very definition, a matter of public health. The outbreak presented a danger to the global health community and resulting policies dealing with this epidemic were public health policies. That being said, the policy in place mostly served as a protocol mostly for agencies of New York in the event the epidemic spread. It focused on standardizing the practices of health, transport, and government agencies in the event of an outbreak; it did not focus on individuals already effected with the disease, but more so on preventing the spread of the epidemic. 

The policy does not make any specific mentions of how to deal with vulnerable populations. However, if one were to consider the nature of New York, it can be argued that the city's entire population is vulnerable to outbreak. As a hub of trade, finance, travel, and business, New York is at a considerably higher risk than a city without this high metropolitan activity. The policy does include measures on how to treat individuals who show signs and symptoms in public locations, but does not mandate testing or health checks for individuals involved in transport, travel, or who have limited access to health care (the homeless).

While there was criticism of the policy (see the Washington Post's rebuttal), the policy appeared to be well received until implementation of quarantine for returning health care workers. This, and the backlash, caused the policy to be revised and invited confusion about guidelines. Leaders may have lost political points by staying firm with their guidelines, but chose to revoke their initial decisions-- leading to confusion and worry in the general population. 

The policy specifically includes elements directed specifically at first responders. This includes testing of various scenarios that contain possible Ebola cases. One of the main highlights of the taped press conference seemed to be communication between main health centers deemed fit to treat Ebola and urgent care/transporting facilities. This includes knowledge of first responders about which of these facilities can handle Ebola cases and how to treat a scene with a possible Ebola patient.

The NYS Ebola Preparedness Plan was a multilateral set of guidelines and protocols set forth by the Office of the Governor of the State of New York in anticipation of a potential outbreak of the ebola virus disease, also known as ebola hemorrhagic fever, in the State of New York. The stated goal of the policy was to prevent the further transmission and spread of the disease in the event of a isolated cases. The policy included guidelines for isolation, quarantine, treatment, and transportation, and involved numerous organizations, including various hospitals, EMS agencies, public safety departments, and transportation authorities.