Thursday, September 30, 2004

Colder Weather

The weather is turning here in Ohio. I think we are getting some of the backlash from all the hurricanes down south.

I was in the squad the other day and I think I might have saw the first of many leaves fall on my squad as I was pulling away from a scene where there was a DOA. Kind of strange for that to happen right at that instant and it got me thinking of something I wanted to discuss with you guys.

Has anyone ever "worked" anyone just for the bystanders?

Today's EMS Lesson. Consider this.
You arrive to the scene of a 65 year old male. You origional call was for patient unresponsive not sure if they are breathing.
As you approach the scene you notice several vehicles in the driveway. You enter the home to find a 65 year old male down on the bathroom floor (like this has never happened before). 4 or 5 people are standing around screaming and crying. They yell at you to "DO SOMETHING!" , "Help Him!"
Upon your inital AX you notice dependent lividity and it is apperant to you that this man has been down for awhile. Cardiac monitor reveals "almost" perfect asystole. You could turn the gain up a bit and maybe get what "looks" like fine v-fib.
Suddenly in walks a 16 year old child, presumed to be the pt's grand daughter and she begins to sob uncontrolably.
You are faced with a difficult decision.
In my carrer I have faced this situation a few times. Every time the situation comes up I struggle with it. We have done both. We have worked them and we have called them. It seems that you can never have a preset thing you will do. It seems to me that the decision must be made on a case by case basis. Tell me what you do. Tell me how you deal with the situation.
Fall is comming and with fall comes cooler weather. Be sure to switch your duty gear to a light jacket and be mindful of the rain. Rain will get you sicker and quicker than cold weather alone. Wear a ball cap if your company approves one, and keep heavy rain gear up front with you behind the seat rather than packed away in an outside compartment. Watch the tread on your boots and keep them shined.
The rain always makes a mess out of your professional appearance. Be mindful of your squad, remember the appearance of your squad and your uniform do a lot to put the patient at ease. If you show up dishevled with dirty truck dont be surprised if your patients are less than trusting of you.
Talk to you guys soon.


Clear government said...

In response to your posed question, "What to do?" Should you "work" the patient in response to the audience? It is up to you. You recognize the variables.

EMS work is a response leading to what we want to happen. You might think me extremely cynical but I explain ABCDE as a set of routines to perform while in periods of extreme distress while another person is expiring. You know if you had multiple patients you would have triaged your patient to become the last one treated. ABCDE is also the best hope for someone who is not dying.

You know that sometimes resucitative efforts are distressful. But probably less distressfull than doing nothing, at least for the audience. They want to know that everything has been done. But, If you had begun, someone somewhere would have to do the stopping.

To continue my cynicism, I would have done it for practice. I am only a 91W medic in the Guard who cannot get deployed. I do medic support for weapons training with a humvee ambulance because it has to be done according to regulations. We can load and go to the nearest hospital. We do not have AED or oxygen.
I live in a metropolitan area well served by professionals. I am not going to get a lot of experience unless something major happens. Then I may want a little live practice in my background.

I hope I am not too offensive to you.

Nurse Mia said...

What a thought-provoking posting. I have so much I'd like to say on the subject - i wish you had the trackback feature installed. I will probably post a long response to your post on my own site in a day or two. I will definitely link to your blog as I find it a very interesting perspective. Thanks for inspiring my own creative juices as well as sharing a very touching story.

BiffMalibu said...


No you do NOT run this guy with dependent lividity. Your ER doctor will burn you at the stake. He was 65 he had a good life, you need to stand up and be a man and tell the family there's nothing to be done. At the very very best you would have brought back a vegetable that you will be carting back and forth from nursing home to ER with pulse ox's of 80's and 2L cannula and whatever your last post was about.

The only time I would consider running something that was obviously futile would be children, and no one would blame you for that.

It also sounds like you could have really used the police on scene. Don't hesitate to call them when family members go berserk.

cg said...

Personally I think calling it is the right thing to do, she is 16 a young lady with coping mechanisms.
The gentleman was dead and calling it that way is th honest approach

ML said...

I responded to a 5am SIDS call... my paramedic partner took one look at the half-purple baby and hugged the mother tight as she told her there was nothing we could do. Lividity = no blood flow = irreversible organ death. The truth is hard, but people would rather hear it than empty promises.

Paramedic Blogger said...

This topic hits me where I live. There are lots of decent reasons medics use to justify working hopeless codes. I'm not calling names; I've done the same myself. But I won’t work an obvious deceased anymore. I realized a few themes in these situations seem consistent.

One - The family knew Mom or Dad (whoever) was gone when they called. They just did not know what else to do.

Two - Admit it, working the job is less stressful than dealing with the family grief head on.

Three - When you do "go through the motions" several bad things happen like,

The family gets false hopes up, only to get them dashed AGAIN by the ER Doc.

The family, you, and your partner are needlessly risked in a wasteful emergency run to the hospital.

Maybe worse, somebody you could have helped now waits too long for your backup unit.

I really think the courageous thing to do is tell the truth. Tell them he is gone, and nothing will bring him back. Point out he has been passed away for some time, and you hope it was peaceful.

Then do the REAL courageous thing, Give Them The Hug They Need. I know we don't cover this much in school, but there are times this is the hardest thing and best thing you can do for someone who has just lost a loved one.

Don't chicken out.

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John S. said...

I just discovered your blog and wish to make a comment. Not long ago the team was faced with a woman who apparently passed in her sleep. When the second bus (which I was in) arrived on the scene, the first team was working the patient. They never checked for dependent lividity or asked how long she was down. When we got to the hospital, the ER Doc had at us for not running the patient properly. Working on the patient wasn't a show for the next of kin. Had I known, at the time, I would have called it and stepped up to the husband and explained. Our resources are much better than in the past and our training better. Do the right thing and call it. Have the police get the coroner and get back in service. You don't want to waltz into an ER with someone they can't do anything for.

tdmason said...

Every person should be worked unless there is obvious clinical death such as rigor mortis, dependant lividity or trauma incompatible with life. In these cases you can justify your actions of not working these patients. Any patient that does not present with these signs should be worked. Time down is often inaccurate because bystanders are not usually medically trained and may not check for a pulse the proper way if at all. If you don't work a patient you should be able to back it up with something solid as to why you didn't. Time down isn't solid.

Joe said...

You call it and its not even a decision. I provide medical care to those that need it in an ambulance. I do not haul bodies from place to place like a hearse. (I know EMS started with hearses but they also used to give 10 mg of epi and got everyone back for their short stay in the ICU) Working someone who is clearly dead adds stress to the system you work in, the family who gets hopeful, and on the ER in which you transport. Would you work this guy if he was in rigor and his arm was up in the air? Of course not. Would you work him if he was in decomp and when you pushed on his chest his ABD swelled? Of course not. In my system we are allowed to work someone in asystole or PEA for 20 minutes and then call them too. Why would we contribute to ER overcrowding when someone is not coming back? And its not like the ER is this magical place that is going to do something you aren't. We have and use the same drugs, same ET tubes, and some of the best compressors (FD).

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