Did Breaking the Rules Save the Girl?

MD Responders Broke Rules to Save Girl.

A five year old girl reportedly went into cardiac arrest after an asthma attack, and was transported on board a fire engine to the nearest hospital while CPR was being done.  According to a Prince George’s County Fire/EMS Press Release, she began breathing on her own before they arrived at the hospital, and was discharged neurologically intact three days later.

First, this is an amazing story.  The chance of a child surviving a full cardiac arrest, especially neurologically in tact, is very poor.  Everyone involved in her rescue deserves recognition. Second, I was not there and any criticism is pure Monday Morning Quarterbacking.  I find myself apologizing more often than asking permission, and I may have made the same decision.  But after every call we should think about better ways to handle the next one.  It is here that I have a problem.

According to the PGFD Press Release, three rescuers were given an Emergency Services Award. Chief Bashoor is quoted as saying:

“Thanks to your skills, quick thinking and initiative to think outside the box a young girls life was saved.  For your performance, which undoubtedly saved the life of your patient you are hereby presented a Fire/EMS Department Emergency Service Award.”

The treatment that the firefighters delivered undoubtedly saved the patient’s life, but not necessarily the transport decision.  EMS systems in many communities are designed to have fire trucks arrive before ambulances to deliver first response.  There are goals for everyone to arrive in a certain amount of time.  On a normal day the nearest ambulance may be on another call, and a system should be prepared to respond to a child not breathing in a reasonable amount of time.  The ambulance’s ETA on this call was five minutes.  This seems like eternity while with a critically ill child, but is not an unreasonable amount of time for first responders to be with a patient on scene.

So what happens on the next call like this?  This one had a good outcome but the next may not.  Fire trucks are not designed to safely transport patients or crew members, but is this now an accepted practice? If it is, wouldn’t the community’s resources be better directed at more ambulances instead of first responding fire trucks?

Please remember that I have nothing but praise for the treatment these responders delivered.  I am just concerned about the precedent that may have been set by this call.




  1. There are exceptions to every rule. I do not believe a precedent has been set. Whenever children are involved, emotions run higher. I agree with your concern. I commend the crew for their actions, however, the outcome could have possibly been negative.

  2. Two thoughts strike me:

    1. If it’s a bad idea and it works, is it still a bad idea? To me, the answer hinges upon whether there was good reason based on the information at the time to do it anyway. This isn’t clear from the story given, nor is it clear whether the providers were adequately trained to use such information anyway.

    2. If breaking the rule was the right thing here, is it because this situation was an exception to the rule, or because the rule is wrong? In other words, not every fluke means the system needs to be changed, but it should always raise the question.


  1. […] who transported a pediatric patient via a firetruck instead of an ambulance. Bob Sullivan blogged about it last year and asks if breaking the rules were what actually saved the patient. I don’t think […]

  2. […] Bob Sullivan sounded the first alarm when asking if breaking the rules saved a life? […]

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