Describing What Happened

      Attack One is running frequently on a Saturday evening, and the crew's paramedic student, from the local community college, has been very active during this tour as a rider. Just before midnight, the dispatch is to an apartment complex for a report of a child down. Dispatch indicates a party is going on at the location.

   In fact, as the crew pulls up in front of the building, they find a large number of holiday partygoers attending an event that extends across the entire two-story building, its sidewalks and outdoor hallways, and out into the parking lot. A sound system blankets the entire area with music. Crew members make their way to the apartment from which their call originated, but cannot find a patient. One reveler suggests the child may have been taken to an adjacent apartment. There, they are referred to the next one down. Finally, at the third site, a young woman in the front room is holding a pale and unresponsive infant.

   The woman says she is the child's aunt, and doesn't know where her sister--the child's mother--is. She was called by the people in the first apartment to get the child after the child was found "not responding." No one could locate the parents, but they had called 9-1-1. They had no idea what happened to the infant, who is 6 months old; the party is very loud and crowded, and somehow the infant was found down on the couch. The aunt took the child back to the parents' quieter apartment, but couldn't get him to respond. He has not vomited and, to the aunt's knowledge, has no medical problems, though he was born six weeks premature.

   On rapid evaluation by the crew, the child responds only to painful stimuli. He shows no signs of trauma. He is mildly retracting, with a respiratory rate of 36, and no rash. The paramedics had noted large quantities of alcohol and the smell of marijuana in the first apartment, so they perform a fingerstick blood sugar. It is normal at 65.

   This infant is very ill, with an altered level of responsiveness for unknown reasons, and the parents can't be found. With the wild party on scene, the crew thinks it best to make a rapid transport to the local children's hospital and ask the police to investigate further and continue the search for the parents. A beat officer is already on scene, and crew members advise him of what details they have. They strongly suggest an investigative team be brought in, and tell him marijuana was being used in the apartment where the child was reportedly found. They will begin a report for CPS at the hospital. The crew also advises the on-duty EMS chief of the event before leaving the scene, and relay the name and badge number of the officer investigating.

   The child has no change in condition en route to the hospital. But in the medic unit, with better lighting, the crew notices some mottling of the skin in an irregular pattern over the torso. They also note the child is small and thin, possibly related to his premature status, but more pronounced than they've seen in other infants. They apply supplemental humidified oxygen and transport safely to the children's hospital.

Hospital Course

   On arrival in the ED, the child has no fever and no significant change in exam. But rapid lab tests find he is very acidotic, and the mottling of his skin becomes more pronounced in the first hour, with a noticeable straight line of clearing over his back. He is sent for a CT scan of his head and found to have small areas of bleeding in his brain. He is dehydrated, and his respiratory status deteriorates over another hour, so he is intubated and placed on a ventilator.

   About an hour after the child's arrival at the ED, a police investigator arrives with additional findings. The parents have not yet been located, but they apparently dropped the child off at the apartment where he was first found at around 2000 hours. They placed the child in a blanket on the front couch so he could be watched during the party. Apparently, one of the party guests did not know there was a child under the blanket, and sat on him for some time. After the guest left, one of the apartment residents found the child in the blanket, noted he wasn't responding and called for help.