Pensacola, Florida
Tuesday July 23rd 2019

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EMS: Inside Pandora’s Box

By Jeremy Morrison

It’s been nearly two years since the death of Dawn Bybee’s son and more than a year since she last met with Escambia County officials about improving the county’s Emergency Medical Services.

Bybee was beginning to feel like nothing was going to happen, and her concerns about safety among emergency personnel were going to go unaddressed. Then she learned about Escambia County Medical Director Rayme Edler’s letter to the Florida Department of Health.

The letter accompanied a request for the state to investigate Escambia’s EMS, and while it is exempt from public records request, the correspondence raises concerns ranging from falsifying reports to not having current certifications to lying about medications given in the field.

Bybee said she’s glad to see the medical director forcing a reckoning for EMS. She feels the process is needed to cleanse the department and isn’t surprised by the recent flurry of high-level resignations that have occurred as the county is investigated.

“The community has a hero in Dr. Edler, and they don’t even know it,” Bybee said. “She’s opened Pandora’s box; she’s cracked the egg. That’s why people are resigning.”

Jackie Nichols also has peered into that Pandora’s box. She got a look a few years earlier when her son Aubrey died after being transported by Escambia’s EMS. Aubrey Nichols was a local Pensacola musician. His mother recalls a song he was writing just before he passed.

“Blindness is surely a curse, but seeing everything is so much worse,” Nichols said, relating her son’s words to the county’s EMS issues. “We can’t go back to not knowing.”

Seeing Everything
Sean Harris was five days away from getting married, out celebrating his bachelor party. As a group he was with walked across Pine Forest Road, an SUV hit Harris and a friend.

Bybee, a registered nurse, was waiting at the hospital when Harris arrived. She recognized his feet.

“I said, ‘He’s mine. I’m going with him,’” Bybee recalled, seeing her son come out of the ambulance. He would die hours later. His friend had already been pronounced dead.

Sometime later, Bybee requested the evidence from her son’s case from the Florida Highway Patrol. Along with the medical report and accident report was a video of the scene taken in the moments following the accident by the driver of the involved vehicle.

Bybee watched the video along with her husband, Tobin Bybee, Sean’s stepfather, who is also trained as a nurse. The two were surprised at what they saw.

“We both look at each other in the same places, and we’re like, ‘did that really just happen?’” she said.

In the video, a paramedic and EMT tend to the two men at the accident scene. There doesn’t appear to be much care given, and the handling appears rough. At one point, a medic lifts one of the face-down men by his shoulders, only to let him flop back down onto the ground.

“They followed no trauma protocol,” Bybee said.

Also, the first responders in the video were both males. This struck Bybee as odd since a female EMT was listed on her son’s medical report.

At first, the grieving parents chalked all this up to an isolated incident. Then in September, Tobin witnessed a man get hit near the intersection of Ninth Avenue and Creighton Avenue. It was pretty bad, and he stopped to help, waiting with the man as he gasped for breath and bled. But once EMS arrived, they yelled at him, told him to get back and proceeded to run a scene he considered to be fraught with error.

That’s when Bybee went to Escambia County with her concerns. She called then-Medical Director Paul Henning but had a tough time getting her messages returned and a meeting scheduled.

“Never heard, never heard, never heard,” Bybee said.

So she decided to call then-County Commissioner Grover Robinson.

“They were having a tough time getting staff to meet with them,” Robinson recalled about setting the meeting up recently.

Around this same time, Bybee had also expressed her frustrations with the county’s EMS on the Escambia Citizen’s Watch Facebook page. She invited people on the community online forum to join her for the meeting with county officials.

“Thirteen people went with us,” Bybee said, “one of which was Dr. Edler.”

Edler, still months away from becoming medical director, had seen the video. She too was apparently concerned.

“She was furious, like, ‘are you kidding me?’” Bybee said.

County officials attending Bybee’s meeting included then-County Administrator Jack Brown, Assistant County Administrator Matt Coughlin, Mike Weaver, who recently resigned as public safety director, and Steve White, then-chief of EMS. During the meeting, Bybee showed the video of EMS at her son’s accident scene and discussed the need for improved training and the importance of ensuring some measure of accountability among EMS responders.

“It was all about education and change,” Bybee said.

Commissioner Robinson said he recalls that as well.

“We wanted to change some of the ways we did stuff, our procedures,” said Robinson, who now serves as Pensacola’s mayor.

That was in February of 2018. A couple of months later, Dr. Edler came on as medical director and was soon after that raising various concerns about EMS operations.

According to a statement released by the county recently, an internal investigation based on the medical director’s concerns—but “not tied to any case or external complaint”—was launched in January this year before being turned over to the state.

Miles from the Hospital
Sometime during her mission to get Escambia County to address what she considered shortfalls with its EMS, Bybee met a couple of other local parents unfortunately familiar with the heartbreak of losing a child.

Tony and Jackie Nichols lost their son, Aubrey, in 2014. A local musician, Aubrey suffered a heart attack and was cared for by Escambia EMS.

Aubrey had complained of chest pains when he was on the road with his band Timberhawk—“He said, ‘Guys, I feel like I’m having a heart attack,’” his mother recalled—but felt better after a nap in the back of the van.

But one night in October, he felt the pains again. His girlfriend called 911, and EMS was on the way. While on the scene, EMS attempted two intubations, or the tracheal insertion of a tube to allow for air flow.

Aubrey died at the hospital, and his parents noticed something weird when they got a bill in the mail. It listed an intubation at the hospital as well. Upon inquiring, the Nichols were told that the additional intubation was required because the one provided by EMS was accidentally inserted into the esophagus.

“So, they apparently threw our son in the back of the rig and filled his belly full of air,” said Tony.

Jackie, also a nurse, wonders why EMS even attempted to intubate in the field. She said, “Just shock, CPR, get him to the hospital—that’s all they needed to do.”

Aubrey Nichols’ parents say they don’t know if the care their son received from Escambia’s EMS contributed to his death. But they do know that responders spent precious time inserting a tube into his esophagus before getting him to the hospital.

“I don’t know if my son would have lived; he may not have,” Jackie said. “But he was four miles from the hospital.”

Hoping for Change
Neither the Nichols nor the Bybees have the option of suing Escambia County about the care EMS provided their sons. They’ve checked around.

“I’ve talked to four attorneys,” said Bybee.

In Florida, a person can’t sue on behalf of someone who was 25 or older, unmarried and without children. Bybee didn’t let the fact that her son was so close to being married go unnoticed during one of her meetings with Jack Brown last year.

“I said, ‘The reason I can’t hold Escambia County responsible is because my son was 28 and five days away from getting married,’” she told Brown.

But both the Bybees and Nichols say that’s not why they’re interested in pushing Escambia to address its EMS division anyway. They’re motivated to speak up by an aching question left lingering in the wake of their loss—“Would our kids have lived if it had been exposed?”

These parents are hoping that their input—and the input of others—will spur change and lead to improvement within a system they see as in need of attention.

“You’re only putting more and more lives at risk if you’re not doing it properly,” Bybee said.

Another question also nags at Bybee. She knows the problems identified with her son’s EMS service were only learned because she dug into the records, and her voice was only heard by Escambia County because she was persistent in her pursual. How many people never ask any questions, never know about the specifics of the emergency services provided to their loved ones?

“Most people have no clue,” Bybee said. “They have no clue. It was an accident; he died. That’s what they were told at the ER without ever digging in.”