Re: Going through the motions....

May 2, 2004

I did " family CPR " ONCE on a retarded gentleman who was about 34 and was

obvious. However, it was Christmas morning, and the family was very obviously

distraught. We " worked " the pt in front of the family, and when we got in the

truck and called report I let the ER know that it was " family CPR " and that the

gentleman was NOT VIABLE by any means. (He'd been down about 2 hours) the

hospital also put on a decent show, and the family was none the wiser and

extremely

appreciative. After all, it was Christmas Day. Outside of that though, kids

are about the only exception I've ever made. Pt care is not always just about

the pt, it's about the family too.

There are many different circumstances, and each call is different. There's

no point in arguing on scene though, that is what initiates law suits. Load the

pt, and GO! What you do (or don't do) in the back of your truck is between

you and your partner.

May 2, 2004

I did " family CPR " ONCE on a retarded gentleman who was about 34 and was

obvious. However, it was Christmas morning, and the family was very obviously

distraught. We " worked " the pt in front of the family, and when we got in the

truck and called report I let the ER know that it was " family CPR " and that the

gentleman was NOT VIABLE by any means. (He'd been down about 2 hours) the

hospital also put on a decent show, and the family was none the wiser and

extremely

appreciative. After all, it was Christmas Day. Outside of that though, kids

are about the only exception I've ever made. Pt care is not always just about

the pt, it's about the family too.

There are many different circumstances, and each call is different. There's

no point in arguing on scene though, that is what initiates law suits. Load the

pt, and GO! What you do (or don't do) in the back of your truck is between

you and your partner.

May 2, 2004

I did " family CPR " ONCE on a retarded gentleman who was about 34 and was

obvious. However, it was Christmas morning, and the family was very obviously

distraught. We " worked " the pt in front of the family, and when we got in the

truck and called report I let the ER know that it was " family CPR " and that the

gentleman was NOT VIABLE by any means. (He'd been down about 2 hours) the

hospital also put on a decent show, and the family was none the wiser and

extremely

appreciative. After all, it was Christmas Day. Outside of that though, kids

are about the only exception I've ever made. Pt care is not always just about

the pt, it's about the family too.

There are many different circumstances, and each call is different. There's

no point in arguing on scene though, that is what initiates law suits. Load the

pt, and GO! What you do (or don't do) in the back of your truck is between

you and your partner.

May 2, 2004

Phil, your law school application has been approved.

Welcome to the alligator loafers team.

-Wes

May 2, 2004

Phil, your law school application has been approved.

Welcome to the alligator loafers team.

-Wes

May 2, 2004

Phil, your law school application has been approved.

Welcome to the alligator loafers team.

-Wes

May 2, 2004

Just curious, was the remark " for the family's sake " was a quote from

the crew or the impression from the FRO?

Mike

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

>>From: E. Tate

>>FR's were astounded when the EMS crew decided to work this patient

" for >>the family's sake " .

May 2, 2004

Just curious, was the remark " for the family's sake " was a quote from

the crew or the impression from the FRO?

Mike

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

>>From: E. Tate

>>FR's were astounded when the EMS crew decided to work this patient

" for >>the family's sake " .

May 2, 2004

In a message dated 5/2/2004 3:08:37 PM Central Standard Time,

preyn2@... writes:

1. Not only has the lady died, which is a

natural event, the family presumably now gets a

fat EMS bill. Personally, it bothers me to spend

other people's money when I know it's futile.

Anybody else?

..

When a person is no longer viable. Why work them? For the family? Isn't

honesty the best policy with the family. Explain to them why right then and

right there. Let them know what you would like to do but due to circumstances

wont do any good. Teaching in a compassionate way. The family will begin to

move through the stages of grief. Be ready to give them resources to help them.

..

2. That ambulance and the FRO crew are now out

of service and unable to assist other people who

may need help and actually be " helpable. "

..

No, they are not out of service. They do have " Helpable " patients. The

family of the deceased. You may not be giving meds, or transporting, but you

are

there to help nonetheless. You are still treating someone. Not every thing

we do to help people revolves around medications and transport.

..

3. What happens if (when), during the movement

of the deceased, the ET becomes dislodged? Does

this now raise the question of whether she was

viable until " the medic failed to intubate

correctly? " Now the agency is liable, right?

..

If you look at number one. This one wont happen? But don't forget all

intubations get CCollars to help with ET tube maintenance. Also Check, recheck,

and

check once more ... where is your tube? And document how you know.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

May 2, 2004

Question. How many EMS services have in their protocols to call for Medical

Direction when in doubt?? I do believe that calling or Medical Control and

having them evaluate the situation is a valid option? Dead is dead. Rhythms

are workable. Medical Control is the ultimate authority. Use what you know.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

May 2, 2004

So, based on your logic, we should work the asystole algorithm

regardless if the patient exhibits signs/symptoms incompatible with

life.

I think the problem with the ACLS algorithms are people's

interpretations of them. Usually on the front cover of medical

textbooks reads a disclaimer that states albeit non-verbatim " the

treatment modalities contained herein should be construed as a

substitute for sound clinical judgement... "

Have we lost our clinical judgement by working a patient in asystole

even though all signs/symptoms state s/he is dead just because ACLS

invented an algorithm that states we *can* work asystole? The real

question is, *should* we?

Regards,

Alfonso R. Ochoa

> In a message dated 5/2/2004 8:52:41 PM Central Standard Time,

> asclapius@a... writes:

>

> I'm having difficulty understanding your logic behind the " asystole

> being a workable rhythm according to ACLS " argument.

>

> While you are correct that an algorithm does exist for the treatment

> of asystole, the algorithm also states to search for the " 5 H's and

5

> T's, " and also to consider termination of efforts if no cause can be

> determined.

>

> From another point of view, asystole literally corresponds to an

> absence of electrical activity of the heart, which means certain

> death.

>

> All this being said, if an EMS crew comes across a pulseless and

> apneic patient with signs/symptoms incompatible with life, attaches

> the ECG monitor and finds an asystolic rhythm, seems to me that they

> are using the available tools to in fact verify that the patient is

> indeed deceased.

> .

> Remember your " treatment " for Asystole. You can pace, use atropine

etc.

> That means do something!! That means treatable. Not necessarily a

good out

> come. But it is treatable.

>

> Tom LeNeveu

> Learning Paramedic

>

> EMStock 2004 is just around the corner. Come join the fun and learn

a little

> while your at it.

>

May 2, 2004

So, based on your logic, we should work the asystole algorithm

regardless if the patient exhibits signs/symptoms incompatible with

life.

I think the problem with the ACLS algorithms are people's

interpretations of them. Usually on the front cover of medical

textbooks reads a disclaimer that states albeit non-verbatim " the

treatment modalities contained herein should be construed as a

substitute for sound clinical judgement... "

Have we lost our clinical judgement by working a patient in asystole

even though all signs/symptoms state s/he is dead just because ACLS

invented an algorithm that states we *can* work asystole? The real

question is, *should* we?

Regards,

Alfonso R. Ochoa

> In a message dated 5/2/2004 8:52:41 PM Central Standard Time,

> asclapius@a... writes:

>

> I'm having difficulty understanding your logic behind the " asystole

> being a workable rhythm according to ACLS " argument.

>

> While you are correct that an algorithm does exist for the treatment

> of asystole, the algorithm also states to search for the " 5 H's and

5

> T's, " and also to consider termination of efforts if no cause can be

> determined.

>

> From another point of view, asystole literally corresponds to an

> absence of electrical activity of the heart, which means certain

> death.

>

> All this being said, if an EMS crew comes across a pulseless and

> apneic patient with signs/symptoms incompatible with life, attaches

> the ECG monitor and finds an asystolic rhythm, seems to me that they

> are using the available tools to in fact verify that the patient is

> indeed deceased.

> .

> Remember your " treatment " for Asystole. You can pace, use atropine

etc.

> That means do something!! That means treatable. Not necessarily a

good out

> come. But it is treatable.

>

> Tom LeNeveu

> Learning Paramedic

>

> EMStock 2004 is just around the corner. Come join the fun and learn

a little

> while your at it.

>

May 2, 2004

So, based on your logic, we should work the asystole algorithm

regardless if the patient exhibits signs/symptoms incompatible with

life.

I think the problem with the ACLS algorithms are people's

interpretations of them. Usually on the front cover of medical

textbooks reads a disclaimer that states albeit non-verbatim " the

treatment modalities contained herein should be construed as a

substitute for sound clinical judgement... "

Have we lost our clinical judgement by working a patient in asystole

even though all signs/symptoms state s/he is dead just because ACLS

invented an algorithm that states we *can* work asystole? The real

question is, *should* we?

Regards,

Alfonso R. Ochoa

> In a message dated 5/2/2004 8:52:41 PM Central Standard Time,

> asclapius@a... writes:

>

> I'm having difficulty understanding your logic behind the " asystole

> being a workable rhythm according to ACLS " argument.

>

> While you are correct that an algorithm does exist for the treatment

> of asystole, the algorithm also states to search for the " 5 H's and

5

> T's, " and also to consider termination of efforts if no cause can be

> determined.

>

> From another point of view, asystole literally corresponds to an

> absence of electrical activity of the heart, which means certain

> death.

>

> All this being said, if an EMS crew comes across a pulseless and

> apneic patient with signs/symptoms incompatible with life, attaches

> the ECG monitor and finds an asystolic rhythm, seems to me that they

> are using the available tools to in fact verify that the patient is

> indeed deceased.

> .

> Remember your " treatment " for Asystole. You can pace, use atropine

etc.

> That means do something!! That means treatable. Not necessarily a

good out

> come. But it is treatable.

>

> Tom LeNeveu

> Learning Paramedic

>

> EMStock 2004 is just around the corner. Come join the fun and learn

a little

> while your at it.

>

May 3, 2004

I agree with not putting a monitor on someone you've decided is

already dead, but I'm not sure that is the argument I would use.

Barely a hundred year ago, some coffins were rigged with alerting

devices for the " corpse " to use if he or she found themselves buried

prematurely. Physicians of the day were fairly sure death had taken

place, but occasionally, the patient was only mostly dead, but not

totally dead.

The well-to-do even left instructions that their body remain above

ground for 72 hours before being decapitated and then placed in the

ground (obviously in the " no-alert " style coffin at that point.)

<< wegandy1938@a... wrote: My point is this: For thousands of years

people were diagnosed as dead without the aid of a cardiac monitor.

Yet, somehow we have gotten the idea that they're not dead until we

run a strip on them. >>

May 3, 2004

About 17 years ago, we were called to an " unresponsive patient " . We arrived

on scene, along with PD and a couple firefighters who showed up " just in

case " , to find a distraught 19 y/o female who grabbed my partner's arm and

stated " My Granddad's in here, He stopped breathing! " . We evaluated the

patient, began CPR and ACLS, attempting to revive the patient, who was in

" fine " V-Fib (per my Medic, I was a new EMT-SS). The rest of the family

began filtering in, demanding we stop CPR and " let him go, he wants to die " .

Since this was before the days of OOH DNRs (patient had no advanced

directives or living will, we later found out), we contacted Med Control,

who said basically to Hades with what they want.

The family who wanted the patient to die sued for, among other things

" wrongful life " (is there such a thing?), negligence, and assault. We were

exonerated. Had the situation been reversed, and the granddaughter had sued

for us NOT doing CPR, we would have most likely lost, as that WOULD have

likely been considered negligence, since the patient was still " viable "

(depending on your point of view) when we first evaluated him (Gene, am I

thinking correctly here?), although the patient ultimately did die at the

hospital, several days later.

Would what we had done been considered been considered " family CPR " for the

granddaughter? Probably. For the granddaughter. All I can say for this

one is that I am glad we have the OOH DNR orders these days. IMHO, they

save a PILE of hassles!

Barry McClung, EMT-P

May 3, 2004

Barry,

So-called " wrongful life " suits can be divided into two basic groups: those

for wrongful birth, where genetic tests were misinterpreted and a child was

born with birth defects, and those following CPR. The CPR cases have usually

involved disregarding of a patient's DNR or Living Will, and often because the

existence of the document was unknown to the healthcare provider.

It is important to separate out those cases where a patient's expressed

desires were known and those where it was not.

A survey in 1978 showed that a significant percentage of physicians said they

would refuse to honor a patient's stated desires not to be resuscitated;

however, that attitude has most surely changed.

The difficulty for EMS arises when a patient is not clearly unresuscitatable

and the family requests that nothing be done. The DNR law should be followed

to the letter in those cases.

To my knowledge there has never been a successful case won on the principal

of wrongful CPR. If any of you other law geeks know otherwise, please come

forth.

The " wrongful birth " cases have also not fared well, but now with embryo

implants and genetic engineering on the threshold of practice, who knows what

the

future will hold?

GG.

In a message dated 5/3/2004 7:41:48 AM Central Daylight Time,

barrymcclung@... writes: