September 30, 2006 in City

Use of rebreather mask restricted for firefighters

By The Spokesman-Review
 
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Background and the latest updates

Spokane firefighters are under new orders to no longer use a so-called “anti-spitting” device like the one strapped to the face of Otto Zehm, who died two days after lapsing into unconsciousness during a March 18 convenience store struggle with police.

The clear “non-rebreather” masks carried by Fire Department paramedics now can only be used with oxygen supply lines and a source of oxygen, Assistant Fire Chief Brian Schaeffer said in a departmental order issued last month.

“From this time forward, gauze masks shall be used for patients who are spitting or who otherwise are creating a danger of contaminating the caregiver and are not in need of oxygen therapy,” Schaeffer said in an Aug. 11 directive to all Spokane fire personnel. Non-rebreather masks, the order said, “shall henceforth only be used when oxygen is being delivered to the patient.”

Previously, there was no official policy regarding their use, but the plastic masks were occasionally used by paramedics to prevent uncooperative patients from spitting on responders, according to Fire Department records.

The chief’s letter and an internal review of the Fire Department’s involvement in the Zehm incident, completed in August by Schaeffer, were released Friday by the city attorney’s office, two months after The Spokesman-Review filed a state public records request for the public documents.

Under a new “mask utilization policy,” Fire Department paramedics will issue gauze masks if they are needed to prevent spitting by “violent patients.”

Spokane Fire Chief Bobby Williams, in a Sept. 21 letter to Mayor Dennis Hession, said Fire Department paramedics in the future would only use the non-rebreather masks with oxygen connected.

The department also will implement seven other policy and training changes in light of the Zehm death, the chief’s letter says, avoiding any mention of potential city liability for using the non-rebreather mask in the March 18 incident.

The fire chief’s letter said the internal review “was conducted with the intent of looking at the systems in place and used within the Spokane Fire Department, and not to evaluate whether the mask used had any impact on the outcome of the incident.”

On July 14, the same day The Spokesman-Review reported the plastic non-rebreather mask had been strapped to Zehm, Assistant Fire Chief Brian Schaeffer issued a directive for an internal investigation.

“I am extremely concerned about our personnel’s action and resulting patient outcomes,” Schaeffer said in a July 14 e-mail that was obtained as part of the newspaper’s Open Records Act request.

Dr. Sally Aiken, Spokane’s medical examiner, said last week she doesn’t believe the plastic mask, with only a dime-size hole for breathing, played any role in Zehm’s death. But her findings are being challenged by attorneys at the Center for Justice, a Spokane public-interest law firm that is representing Zehm’s family.

Breean Beggs, the director of the Center for Justice, applauded the Fire Department’s thoroughness and openness in reviewing use of the mask.

“We hope this report serves as a model for the type of review that will be conducted by the Independent Review Panel appointed by Mayor Hession tasked with reviewing the Police Department’s handling of Otto Zehm’s death,” Beggs said after reviewing the chief’s letter and internal review.

The Fire Department, Beggs said, “appears to have undertaken a comprehensive review and analysis of current policies and procedures and developed specific action plans for the implementation of necessary changes.”

“Of these recommendations, the two with the most relevance to the Zehm death are the recommendation confirming established medical practice that non-rebreather masks must include a minimum oxygen flow and that personnel should prevent positional asphyxia by regular medical monitoring of all restrained individuals,” Beggs said.

The department’s internal review includes reports from firefighters who initially were called to the convenience store to remove Taser darts from two police officers’ weapons that had lodged in Zehm’s body. As Zehm screamed and struggled, police also said he was spitting, and they asked paramedics for a mask.

With its oxygen supply line cord removed by Fire Department paramedics, police officers put the modified device on the struggling mentally ill man. By that time, he was on the floor of the North Division convenience store, after a protracted struggle with as many as seven police officers who stunned him with Taser guns, then hog-tied him on his stomach.

Police officers involved mistakenly believed Zehm was a robbery suspect, but he actually was only in the convenience store to buy soda pop and a Snickers bar.

Other changes ordered by the fire chief include training for paramedics dealing with restrained patients who may experience positional asphyxia or excited delirium syndrome.

The department also will develop a system to notify on-duty battalion chiefs of any medical incidents involving restraint of the patients by police or jail officers.

Additionally, the Fire Department will ask the Spokane County Emergency Medical System Council for a critical review of medical protocols for removal of police Taser barbs by paramedics and guidelines for restraint of aggressive or violent patients during transport to a hospital.

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