staten island advance.

first-aid kit on ferries contains a big gap
oxygen, life-saver for those with serious injuries, isn't among medical supplies on boats in Island fleet.
10.21.2003

First-aid supplies onboard Staten Island ferries do not include supplementary oxygen, which can be used to slow the effects of extreme blood loss, officials have confirmed.

Kerry Griffiths, the British operating room nurse credited with saving Meiers Corners resident Paul Esposito's life after last week's ferry crash, said yesterday that had the paramedics not provided him with oxygen from a canister he probably would not be alive.

While the ferryboats carry four automatic defibrillators and staff who know how to use them, Ms. Griffiths, who was a passenger aboard the ill-fated Andrew J. Barberi, said that would not have helped had Esposito, 24, lost his airway.

Ms. Griffiths, who returned to Britain last night, found the critically injured Esposito on the lower deck of the boat. She used a belt as a tourniquet on his now-amputated legs, an action doctors said saved his life.

The tourniquet stopped the bleeding, allowing Esposito's heart to pump blood to his organs at normal pressure.

But in an interview yesterday at Esposito's grandparents' Westerleigh home, Ms. Griffiths said that the tourniquet would have meant nothing had a few more minutes passed before Esposito got oxygen.

Just before paramedics arrived, Esposito told Griffiths he was feeling dizzy, and she knew he was about to pass out.

Loss of consciousness occurs when the brain isn't getting enough oxygen, which is normally carried there by the blood. Esposito had lost a lot of blood before the tourniquet was applied.

Told there was no oxygen on board, Ms. Griffiths made Esposito focus on taking large breaths, but as normal air only contains 21 percent oxygen, it wasn't sufficient.

When he started to fade, she grabbed his hand, telling him, "You're not going anywhere. You stay with me now."

She forced him to stay awake because, "If you start to lose consciousness, you're going down a slippery slope," she said.

As soon as a paramedic - and oxygen - was within reach, Ms. Griffiths applied a high flow to Esposito's airway and within minutes his condition had visibly improved.

She and the paramedics then worked together to stabilize Esposito, rolling him onto a stretcher.

"Thank God he got oxygen. That's all I can think," she said, adding that she was alarmed and concerned that a boat that carries up to 6,000 people did not have supplementary air.

As helpful as it can be in an emergency, pure oxygen carries its own risks. Oxygen can explode if struck, or be equally dangerous if used by those aren't trained.

"Medical gases, that we're going to let people breathe, have to meet very tough standards," said Dr. Jeffrey Nicastro, director of trauma and surgical critical care at Staten Island University Hospital.

"You can't just leave an oxygen bottle on the ferry for the next five years. It needs to be changed and evaluated. It's a big deal, a pretty huge logistical nightmare," he said.

Nicastro stressed that the essential first step for a bleeding patient is a tourniquet, but that oxygen could help once the hemorrhage is stopped.

He also noted that the most successful method in any trauma entails getting a patient to help before any and all other steps.

"When you try and do too many things in the field, patients do more poorly. That's clearly documented," Dr. Nicastro said.

There have been no reports of oxygen being supplied to the three new ferry boats currently under construction.

While there are alternatives to oxygen, including forced inhalation through intubation or an air bag and mask, without a trained practitioner to carry out the procedure, the materials could be rendered useless.

But Ms. Griffiths was adamant.

"You have got to have oxygen. It's like fluid," Ms. Griffiths said. "Any time, any place, anywhere. What if we hadn't been close to land? I don't even want to think."