The call comes in early in the morning around 12:30am to take a elderly female back to the nursing home after treatment at the ER for dyspena.
My partner and I arrive to find a 88 year old female with a GCS of about 4 working hard to breathe on 15 lpm by mask. Rate was about 32, SPO2 91%.
We ask the ER doc what O2 he wants her to go back on as the nursing home can only provide 6 lpm by concentrator. The doc then informs us she is hospice care and hands us a newly minted DNR.
We switch her over to a cannula at 6 lpm per the doc and begin the transport.
She makes it about 10 minutes and codes.
As we arrive at the nursing home I leave my partner in the back so I can run in and talk to the charge nurse and try to explain the situation. The charge was just as confused as I was. I guess what we were both wondering is why the ER didn't put her on the cannula and let the dying process happen there?
There are specific protocols for letting a patient die in the ER and there are also protocols for letting them die in a nursing facility under the care of hospice. There are NO DEFINED protocols for allowing them to die in the squad.
It all was very alien to me. My mind knew I had to follow the direction of medical control but my soul was screaming to do something... ANYTHING!
We knew she was going to go. I just didn't want her to go without her family around. I had offered to let them ride in the squad but they chose not to for one reason or another.
I feel sad.
Rest in Peace.
3 comments:
I stumbled upon your blog and this was the first post that I read. I just wanted to say ...
It'll be okay, Brother. There wasn't anything that could be done, given the circumstances ... Try not to burden yourself with thoughts over a decision that wasn't your's to make. I'm sure that you've had, and that you will have, plenty of opportunities for things to go differently, to go better.
Thanks.
Up the O's till you get to the SNF. Short version is the "DEFINED" protocol for EMS in this situaton is the same as any other DNR. Had a call back in the day when I was in EMS 8 yrs, but working at a new service, had a similar patient code 10 feet out of the parking lot of the hospital, and was ordered to DNR, and continue xport to the Hospice. Go figure.
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