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911 calls shed light on VA response

911 Call – Caller 1

911 Call – Caller 1 continued

911 Call – Caller 2

911 Call – Police

Copyright © 2014 Albuquerque Journal

The first of two 911 callers from Albuquerque’s Veterans Affairs Medical Center remained calm as Vietnam veteran Jim Napoleon Garcia lay dying on June 30 in the center’s cafeteria.

“It’s the canteen service and the patient coded, nonresponsive, chest compressions right now,” the unidentified female caller said.

She told the Albuquerque Fire Department dispatcher the victim was “bleeding actively out of his mouth and nose.”

“We called our rapid response here at the hospital but unfortunately they won’t respond to him because he’s out of the main medical building,” the woman said at one point.

The man, whose name she didn’t know, was being hooked up to an emergency defibrillator, she said.

“Paramedics are already on their way out there,” the dispatcher told her.

“There’s a table of doctors sitting right next to him and none of them are doing s—,” the woman continued.

“OK, I’m sorry about that,” the dispatcher responded.

The release of the 911 tapes and a detailed dispatch log were released by the city of Albuquerque officials Thursday after a request by the Journal.

The log shows that Albuquerque Fire Department rescue unit Rescue Five arrived at the VA canteen, also known as the cafeteria, 6½ minutes after being dispatched at 12:30 p.m. that day. The first 911 call was received four minutes earlier, at 12:26 p.m., the log shows. During that period, the dispatcher was asking for information about the victim and his systems.

The VA Medical Center in southeast Albuquerque, where Vietnam veteran Jim Napoleon Garcia died on June 30. (Adolphe Pierre-Louis/Albuquerque Journal)

The VA Medical Center in southeast Albuquerque, where Vietnam veteran Jim Napoleon Garcia died on June 30. (Adolphe Pierre-Louis/Albuquerque Journal)

Once there, paramedics spent another 20 minutes or so trying to revive Garcia, who was ultimately transported to the VA Medical Center’s emergency department. The log does not state when he arrived at the emergency room.

He was pronounced dead sometime after arrival.

Garcia’s family came forward to identify him to the news media earlier this week, but had no comment on what occurred in the cafeteria. He was 71.

The VA’s response to the emergency remains under investigation by VA officials.

“But based on input that we’ve already received, we will make changes to aspects of our policy,” VA spokeswoman Sonja Brown said Thursday evening.

Under that policy, a group of VA health care providers is designated as the Code Blue Team to respond to medical emergencies in which patients are found to be without respiration or pulse.

The team includes one physician or designee and two nurses to help in defibrillation, intravenous access and administration of medications.

The policy, first enacted in 2010, allows the team to respond to the main hospital and clinics, and five other nearby buildings in the sprawling VA campus at 1501 San Pedro SE.

Though it sits just west of the main hospital, the canteen or cafeteria isn’t included in the response team area.

Under the policy, emergencies outside the response area are to be covered by the Albuquerque Emergency Medical Services system.

Whether intervention by the VA’s Code Blue team could have made a difference in saving Garcia’s life wasn’t clear Thursday.

The VA’s emergency department is about a five-minute walk from the VA cafeteria.

But Albuquerque Fire Department Chief David Downey said in cases involving possible heart attack victims, it wouldn’t be appropriate to immediately load the patient onto a stretcher or gurney and rush the person to an emergency room.

Instead, rescue crews try to revive the patient first.

“You work the code where it occurs,” Downey said.

AFD rescue crews follow a protocol for apparent heart attack victims that takes about 20 minutes, he said.

The protocol includes CPR, then defibrillation, and then the administration of IV medications. Then the process is repeated.

The AFD defibrillator is more advanced than the automatic external defibrillator that is often available in public places, he added.

It wasn’t known Thursday what type of defibrillator was used on Garcia before AFD rescue crews arrived.

According to city records, a second 911 caller told a Fire Department dispatcher, “We’ve got people doing CPR.”

“Nurses? Doctors?” asked the dispatcher.

“Nurses,” the male caller said.

“Is he awake?”

“No he’s out,” the caller replied.

“Is he breathing?”

“It doesn’t look like (it),” the caller said.

Asked whether doctors near Garcia failed to respond to the emergency, the VA’s Brown said in an email Thursday, “Regardless of who was sitting at nearby tables, VA staff along with Kirtland AFB personnel immediately responded in providing basic life support to this Veteran. The staff were heroic in their attempts to save the life of this Veteran.”

Downey, from the AFD, said it isn’t unusual for paramedics to be called to emergencies at other medical buildings in town, including urgent care centers staffed by medical personnel.

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