Fatal crash in Nipomo

Mr. Pierce was not the Willow Road project’s first victim.

Jesse Maldonado Jr., while employed by KCI Environmental (San Luis Obispo) on the Willow Road interchange, died secondary to heat-stroke. He worked on a crew installing erosion-control measures (placing wattles along the road bed to catch any run-off), which required using a sledge hammer, pounding stakes into the ground. The worksite temperature was 94 degrees F.

There has been no published followup on this tragedy. Certainly, none of the self-congratulatory Nipomo press releases about the completion of the project mentioned the man who lost his life in the construction of the project.

So I am taking this opportunity to apologize to Mr. Maldonado and his family for the lack of acknowledgement of the sacrifice he was called on to make for the Willow Road exchange construction project. His death was unnecessary and very likely could have been avoided.

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Mr. Maldonado, while working for KCI on the Willow Road project, on 10/12/11, first exhibited symptoms of heat-related illness at 2:20 PM. Dr. Young, an Emergency Department physician, pronounced Mr. Maldonado dead on 10/12/11 at 3:59 PM.

Normal core body temperature is 98.6 degrees F. At the time of Mr. Maldonado’s arrival at AGCH his core body temperature was almost 109 degrees F (108.9 degrees F); a heat stroke is consistent with a core body temperature of 105.9 degrees. By the time of Mr. Maldonado’s death at AGCH, his body organs had started to emulsify.

What happened in the intervening 1 hour and 39 minutes between the initial call to 911 and Mr. Maldonado’s death is a tragedy that did not need to occur. Contributing to this unnecessary death was KCI, its staff and employees not following of California heat-related illness regulations, and a delay between when Mr. Maldonado was obviously in trouble and when 911 was called. (KCI did not make the call; Mr. Maldonado’s wife, notified by staff at the site of her husband’s problems, immediately called 911 at 2:29 PM, 9 minutes after Mr. Maldonado was first noted to be incoherent-to-unresponsive.)

Because of the lack of training of KCI staff in dealing with worksite heat-related illness, the only treatment given to Mr. Maldonado before the paramedics arrived on scene was to have him go sit in a pick-up truck and drink some water. There was no close-by shade (other than the pick-up truck, which is not considered “shade” by State regulations) and cooling measures available, as required by California State law. At the first report of Mr. Maldonado’s problems, he was able to sit up in the pickup truck, but he was responsive but not able to really communicate with others.

Further complicating the problem was the time period between the arrival of first responders at the worksite (between 2:35 and 2:45 PM) and the time of the parmedics reaching the hospital, at 3:28 PM. CalFire reported it received the emergency call “shortly before 3:00 PM.” It took 1 hour and 39 minutes, from the time of Mrs. Maldonado’s 911 call to the time Mr. Maldonado arrived at Arroyo Grande Community Hospital. It is only 8 miles between the KCI Willow Road exchange worksite and AGCH.

Reviewing the coroner’s report shows, between the time Mr. Maldonado reported condition at the time that he, according to KCI staff, first exhibited signs of heat-related illness and the initial contact by paramedics, Mr. Maldonado’s heat-related problems greatly worsened. He was in real trouble.

According to the coroner’s comprehensive report, a written report from San Luis Ambulance indicates that the initial exam by 911 personnel on scene showed, on medics’ first contact, Mr. Maldonado had a carotid pulse but poor capillary refill and his skin was “ashen.” According to the coroner’s report, AGCH medical records indicates, on first contact by the paramedics on arrival at the jobsite, Mr. Maldonado was in a pickup truck, with an “altered mental status, rapid breathing and no obtainable pulse.”

Mr. Maldonado arrived, via paramedics, at AGCH at 3:28 PM. He was declared dead at AGCH at 3:59 PM.

Despite the State of California’s new legislation on employer requirements for avoiding and responding to heat-related illness on the job, and massive efforts by the State to educate and inform employers, workers and the public, because of a lack of proper training and education of its staff, Mr. Maldonado tragically died. Let’s hope talking about it helps raise awareness, so that worker safety can be improved.

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GPS LOCATION OF WORKSITE.

The location of the worksite, per the coroner’s report, was:

GPS Coordinates: North 35 degrees at 3.414 feet, by West 120 degrees at 30.151 feet, elevation 341.5 feet.

(GPS Coordinates: 35.0569,-120.502517)

http://maps.google.com/maps?q=…

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RECORDS REFERNCES:

Nichols, Jeff, Senior Deputy Coroner #0897. Coroner’s Report (Investigation) #16709, Jesse Robert Maldonado Jr.

Center for Disease Control: Frequently Asked Questions about Extreme Heat.

http://www.bt.cdc.gov/disaster…

U.S. Department of Labor: OSHA’s Campaign to Prevent Heat Illness

(http://www.osha.gov/SLTC/heati…

Heat-Related Prevention and Information (http://www.dir.ca.gov/dosh/hea…

Cal/OSHA Adopts Revised Heat Safety Regulations, 9/19/2010 (http://www.dir.ca.gov/DIRNews/….

U.S. National Medical Library, National Institute of Health. (http://www.nlm.nih.gov/medline….

“Investigation Into Nipomo Construction Continues.” (http://www.sanluisobispo.com/2…

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