The case of Owen Lashomb spurred pediatricians and paramedics to combine efforts in improving emergency care

Cathy Hahn, M.D. says it is rare to see an ambulance to pull up to a pediatrician’s office. It has only happened four or five times in the 26 years she has worked at Pittsford Pediatrics. 

“The joke in the medical profession is that pediatricians are just for ‘snots and shots’," said Dr.Hahn. “But on that day, I knew we were in the midst of a crisis.”

On that September day, Hahn had detected a heart murmur in an 18-day old infant — Owen Lashomb of Honeoye Falls — which she knew could be fatal. Owen, born by C-section of Sept. 9 with no complications, had passed all the markers at his two-week check-up. But three days later, he was agitated and breathing faster than normal. His mother, Carly Weis, called the pediatrician's office, and a registered nurse recommended she bring him in — and, upon Dr. Hahn's examination of Owen, the entire staff went into "Alert Mode."

As Hahn ordered a nurse to call 9-1-1, she set into motion a whole series of events that have now combined to make her staff and members of the Pittsford Volunteer Ambulance Corps much more prepared to handle emergency care for infants.

“The great thing is we had the best result for the patient possible,” said Jonathan Smith, director of operations for Pittsford Volunteer Ambulance. "But I think all of us were able to learn something and improve our skills as well.”

Just a few days after the ambulance crew rushed the baby to the emergency room, Smith was in Hahn’s office to break down how to handle future episodes and communicate better.  Both professionals agreed that having more details about the baby’s symptoms prior to arrival would have helped the crew.

“If the caller says this is an ALS situation, the dispatcher can convey that,” said Smith. “If the physician says, ‘This is the worst emergency I’ve ever had in my practice’, that’s good information too.”

“We could have warned the paramedics on the way over that this was a possible life or death cardiac episode,” said Hahn. “Frankly, I wasn’t sure what training they had or if they had equipment for tiny infants, so I when they arrived, I simply told them, ‘Get this baby to the hospital.’”

After hearing that perspective, Smith invited Hahn and her partner Dr. Rahul Sengupta to the service station on Tobey Road.  He wanted them to meet his paramedics, EMTs and dispatchers.  He also wanted to give them a tour and show them the emergency care they are capable of providing in the back of an ambulance.

“Volunteer ambulance organizations have sometimes been viewed as simply transport mechanisms," Smith said. "It’s important that the community knows that when they call 911 for an ambulance, appropriately skilled and prepared folks show up.”

All EMTs and paramedics must be certified by New York state before working in a volunteer or paid position. Typically, it takes six months to complete an EMT program. Paramedics generally enroll for two years of schooling and they are required to complete 700 hours of clinical experience.

“It has been 25 years since my rotation in the emergency room, so it was good to hear about this high-level of training,” said Dr. Sengupta.  “I was impressed with how state-of-the art that vehicle is, stocked with medications, IV’s and ALS (Advanced Life Support) equipment. I learned a lot and it brought us to a deeper conversation.”

The two pediatricians talked with crew members for more than an hour and exchanged information about their work environments. The paramedics wanted to know what was in the pediatricians’ “crash cart” for emergencies. They asked if pediatricians kept epinephrine at their office and they wanted to know more about oxygen supplies for infants. 

The paramedics also complimented Pittsford Pediatrics staff for sending two people outside the building on the day of the emergency. Office manager, Laura Kosmerl, R.N helped flag down the driver and Erin Daniele, R.N. ushered the crew into the office.  

“That saves time and can save a life,” said Smith.

Hahn relayed to the paramedics that while they were transporting the baby, she was on the phone with the attending physician in the emergency room at Golisano Children’s Hospital. She warned that the baby might need special, time-sensitive medication and suggested he have it ready. Three hours after the baby was stabilized, Dr. Asim Abbasi gave her a follow up call. 

“He told me the diagnosis was correct and that they could not have asked for a better emergency outcome,” said Hahn.

After that phone call, she immediately convened a staff meeting and huddled with her co-workers to share the good news. They all were anxious for an update on Baby Owen. 

“I remember saying to them, ‘I want you to know that we saved a life here today at Pittsford Pediatrics.’ It was such a team effort,” recalled Hahn.

Owen suffered from severe coarctation of the aorta, meaning there was a narrowing in the aorta and Owen's was functionally pinched off — as he grew bigger, his lungs and organs were not getting the necessary blood and oxygen, and by the 18th day of his life he was struggling to breathe and had all the signs of heart and respiratory failure. After a battery of tests, and after the child's condition was stabilized enough to survive surgery, cardiac surgeon Dr. George Alfieres operated on Owen's heart, which was the size of a wanut, and repaired the pinched aorta which was about the diameter of a drinking straw. Owen continually improved and was released 16 days after his near-death experience. He is expected to make a complete recovery with normal heart function.

Not to rest on any laurels, Hahn organized a mock emergency drill at her office a few days after the episode. She wanted everyone on staff, including administrative personnel, to practice their roles in a crisis. She reviewed all emergency medical equipment in the office and demonstrated how to operate oxygen tanks. All oxygen tanks are now fitted with masks that can fit weeks-old babies, as well as toddlers and bigger kids. Also, emergency numbers are posted above every phone in the office as a result of the drill.

Pittsford Ambulance staff prepared a profile on Pittsford Pediatrics to document information on the layout of the office and the response strategy for future emergencies. Smith created a similar profile for the new Schottland YMCA on Jefferson Road before it opened in the fall. The profile includes details about entrances, hallways and the elevator system in order to move equipment efficiently through the building.

“These profiles give us great insight on how best to respond when minutes count,” said Smith.

Smith says he would be happy to meet with other Pittsford medical practices and business owners to facilitate similar meetings. “The more profiles we have in our system, the more prepared we are to assist in an emergency,” he said.

You can contact Pittsford Ambulance at 585-385-2401 or info@pittsfordambulance.org