What to Do - Next Time

[Guest guest]

Names and places have been omitted to protect the innocent and others.

What do you do when when backup Paramedics from EMS agency #2 arrive on a

cardiac arrest scene taken by primary EMS agency #1, staffed by ECAs, and are

told " We don't need you. I called it. The JP is on the way. The family has

been told there was nothing to do for him? "

The ECA's welcome is a surprise to the paramedics, who are prepped to work a

code. An assessment from the door revels an approximately 77 y.o. male pateint

on the floor. He looks grey and dead. There is a BVM near the patient and

perhaps a stand alone blood presssure machine. No evidence of an AED or pads on

the patient.

Possible scenario: The ECA certified polilce chief must have responded first

and was on the scene when the EMS agency #1 ECA staffed ambulance arrived. The

police chief probably initiated CPR. The ECA ambulance arrived 5-10 minutes

later. The president of the mostly ECA EMS was on the ambulance.

In here sometime the police chief requests backup assistance from EMS agency #2.

Two paramedics and an MICU are dispatched. It is about 12 minutes from toneout

to arrival on scene. The ECA EMS president does not know about the call for

help.

CPR ceased before the MICU arrived. It is unknown how long the pateint was not

worked from the time he was discovered unconscious to the police chief's

arrival. How long did the police chief work the patient - dunno. Did the

responding ECA ambulance crew work the patient - dunno. But we do know the ECA

EMS president did not request additional EMS help; the ECA EMS president " called

the code " before the MICU arrived; the JP was on the way and the family had been

told essentially, " I'm sorry. There is nothing more we can do. " All this

before the paramedics arrive.

The paramedics from EMS agency #2 ran leads 1, 2 & 3. They found asystole in

one lead, some occassional irregular " P-like " waves in another lead and an

occassional hard-to-describe ventricular trace in another lead. No indication

of life-supporting cardiac activity. The patient was warm and his eyes dilated.

Pulseless, apneic.

There were no extreme conditions that under our protocols would have dictated

DNR.

What would you do? Start to work the patient? Add your condolences to the

family? Pick up your toys and go home? Call agenct 2's medical director for

guidance/

Who is in charge of the scene? Why?

Comments? Contact me by responding to this message or at L1USMA62@...

Thanks

Bob Tarbet, LP

McGregor