A 58-year-old Charleston, South Carolina, man had eight broken ribs and other internal injuries when he was taken off an ambulance and given a sobriety test, according to the attorney for the man’s family. Nathaniel Rhodes lost consciousness at the police station, video shows, and he died four days later.

Police had a form that said Nathaniel Rhodes did not want to be taken to the hospital, but it was signed by a police officer, not Rhodes, attorney Justin Bamberg said in a press conference Monday that was broadcast live over social media.

I will say that I dislike intensely when lawyers try a case on TV. It smacks of a maneuver to engineer a settlement or some other action without due process. That being said, it’s very suspicious that the police officer signed what I’ll call as a patient refusal, not the patient.

Here is the back story. Or as much of it as I’ll share since I don’t want to violate the “fair use” standard.

Rhodes got into a car crash in August 2018, WCBD reports, and police say he had an open container in the car. Officers gave Rhodes roadside sobriety tests and then took him to the station for a breathalyzer test, according to WCBD.

There is a police station video in the article, which I urge the reader to view in it’s entirety.

This is a great video on just about everything you should NOT do on an EMS call.

The crew appears to be pretty nonchalant in their approach to the patient. The female EMS provider is a paramedic, her partner is an EMT. Which means that no matter what, she is in charge of the call. She seems pretty tentative in her approach to the patient.

The first problem is that she didn’t do a complete physical exam. In her defense, it’s not clear that she knew that Mr. Rhodes had been in a crash for some time. Still, she seems to have gone straight to what a former partner of mine referred to as “the symptom checker.” His use of the terms was derisive because as time went on, it seemed that our medical director was more interested in “numbers” than what the paramedics actually thought was going on.

Instead of immediately starting an examination, she starts asking Mr. Rhodes all sorts of questions. Her partner is, well who knows what her partner is doing. What he should have been doing was asking the questions and gathering information while she concentrated on patient care.

The medic lifts up Mr. Rhodes shirt after he tells her his right side hurts. She doesn’t do any sort of examination, most especially listening to breath sounds. She seems focused, or maybe obsessed with asking Mr. Rhodes about his seizure medications. About three minutes into patient contact, she hasn’t done anything to assess the patient.

At that point she finds out about the accident. Which is what we used to call “a clue” in EMS. There is a break in the video and next thing we see is that she has the cardiac monitor out and is checking his blood glucose level. Which is about the only thing she did right. After seeing that his blood glucose level is in the acceptable range, she does a bunch of other useless stuff.

She still hasn’t examined him, especially his breath sounds, perfusion status, or really his mental status.

This brings up to a pet peeve of mine. During my career I never had a cardiac monitor with a blood pressure cuff built in. Which means that I, and all of my co workers had to take manual blood pressures. The thing that requires is actually touching the patient. You can learn an awful lot about a patient’s condition by actually, you know, touching him.

After what we’ll call the examination is done, the crew gets ready to take Mr. Rhodes to the hospital. The medic tells him that they can’t get the stretcher into the booking area. That actually appears to be true. It’s also pretty stupid, but not their fault. I expect that will be one of the changes that will come out of this.

The EMT whines that he has a bad back and can’t lift Mr. Rhodes. Yeah, sure.

At that point the video ends, but the story just begins.

It’s obvious that this was not the crew that responded to the accident. During the course of the investigation that is ongoing as I type this, that crew can expect to be interviewed and their report examined. It would be interesting to see what they wrote, but I don’t expect that to be made public. What I’d like to know is what they wrote about the patient refusal. Both their examination, what they told the patient, and how the police officer came to sign for the patient.

I expect that at least one police officer is going to lose his job. Maybe more depending on what the investigation reveals.

I expect that the EMS crew will also be fired, although maybe not. The medic failed to do a proper examination and seems to have “under appreciated” the severity of the injuries Mr. Rhodes suffered. The fact that Mr. Rhodes died is prima facie evidence that he had serious injuries. Were they unsurvivable injuries? Maybe, but we won’t know that for a while, if ever.

Maybe nothing that the crew could have done would have changed the outcome for Mr. Rhodes, but that’s not going to get them off the hook.

Then their is the matter of their state certification. I have little doubt that the providers will be subject to an investigation into their actions on this call. The fact that there is video showing much of their interaction with Mr. Rhodes, including audio, is not likely to help them.

This video is difficult to watch as an EMS provider. For non medical people, it might not look too bad, but there are several lapses in following protocols and judgement. EMS instructors should use this video to teach their students what not to do.

Nothing is going to bring Mr. Rhodes back, but maybe seeing this video will help students understand what not to do on an EMS call.

We can only hope.