# Chopper 5 HD video used to clear paramedics



## MMiz (Dec 23, 2009)

*Chopper 5 HD video used to clear paramedics*

On Friday night, Chopper 5 HD took video of what appeared to be paramedics standing around a victim covered with a yellow sheet. But it turned out, the victim was, in fact, alive.

It was a story that seemed eerily familiar to many in San Antonio.

In 2007, a drunk driver plowed into a Honda Accord on Loop 410.

Two passengers were rushed to the hospital, but passenger Erica Smith was assumed dead, and covered win a yellow sheet.

*Read more!*


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## Onceamedic (Dec 23, 2009)

let me get this straight - the criteria for death in Texas is lack of a palpable pulse? ...  and department protocols state if 1 medic can't find a pulse, an other will check?  in a trauma?  

What happened to asystole in 3 leads?


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## LucidResq (Dec 23, 2009)

I have a feeling they might be giving the dumbed-down version of what the protocol actually is... easier to just say "check for a pulse" to the general public rather than giving a brief rundown of ECG and leads and asystole....


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## Jeffrey_169 (Jan 12, 2010)

Kaisu said:


> let me get this straight - the criteria for death in Texas is lack of a palpable pulse? ...  and department protocols state if 1 medic can't find a pulse, an other will check?  in a trauma?
> 
> What happened to asystole in 3 leads?



Very good question. All the more reason I advocate giving everyone a chance. The truth is it probably isn't even the medics fault, they were following protocol, but we are Medics not coroners. I don't blame the Medics here, I blame the system,and it obviously failed in this example.


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## rhan101277 (Jan 13, 2010)

Well if I have any doubt I will be using my stethoscope.  Even with the faintest heartbeat I should be able to hear the valves opening and closing.


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## spinnakr (Jan 13, 2010)

Jeffrey_169 said:


> we are Medics not coroners. I don't blame the Medics here, I blame the system,and it obviously failed in this example.


I actually would blame the medics, precisely because they aren't coroners.  I don't know if this is different elsewhere, but in Ohio, neither basics nor medics have the legal capability to pronounce anyone dead on scene.  It's my understanding that even in cases of obvious death (such as decapitation), death is pronounced only after consulting with medical direction.  If there is ANY doubt, work the patient.

I think this would have been one of those "work the patient" times.


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## Aidey (Jan 13, 2010)

As someone else said, what happened to asystole in multiple leads? This wasn't a case of "should the patient be worked or not?", it is a case of paramedics not doing a proper assessment to determine if there were vital signs present.


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## nomofica (Jan 13, 2010)

I agree with the ECG statements. 3-lead on and working the code. 

Not entirely enthusiastic about the protocol stating two paramedics determine no cardiac output via palpating to not work the code. Sounds like a lazy way to play medic. Granted it's the media delivery the story to the every-day-person, so of course details will be dumbed down to the point where it's inaccurate. I've give 'em that much.


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## rhan101277 (Jan 13, 2010)

Aidey said:


> As someone else said, what happened to asystole in multiple leads? This wasn't a case of "should the patient be worked or not?", it is a case of paramedics not doing a proper assessment to determine if there were vital signs present.



I think in a trauma asystole in multiple leads is not required.  If you spend time hooking all that up and you have another salvageable patient then that is more time that you are taking away from someone you can help.  I would check for pulse/breathing, then re-check and use my stethoscope and move on.


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## usalsfyre (Jan 13, 2010)

In Texas the JP actually pronounces death, however local protocol guides the determination not to begin resucitative efforts. 

Does anyone here *REALLY* think we're going to make much of a difference in blunt force trauma arrest?


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## Aidey (Jan 13, 2010)

rhan101277 said:


> I think in a trauma asystole in multiple leads is not required.  If you spend time hooking all that up and you have another salvageable patient then that is more time that you are taking away from someone you can help.  I would check for pulse/breathing, then re-check and use my stethoscope and move on.



You are describing a mass casualty incident, where there are not enough resources to help multiple patients and those that meet "black" criteria are not assisted. Even so, before those labeled black are actually declared dead they need to be confirmed to have no vital signs. 

I'm not talking about those that are obviously dead, such as decapitated, detrunkated, or mashed flat. Even those with brain matter showing should have asystole confirmed via EKG since it is possible to still have vital signs with brain matter exposed. 

If you have two patients, and you can't handle hooking up a 3 lead for 35 seconds to one before you hook it up to the other you have bigger issues going on. You can always have one person start CPR until the EKG becomes available, and then stop CPR if you determine that the pt is non-viable. 

In both of the situations described there were multiple paramedics on scene, which implies multiple ALS units, and hopefully more than one EKG. When it comes down to it, neither of the patients received a proper assessment, and that is the problem that needs to be fixed.


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## VentMedic (Jan 13, 2010)

usalsfyre said:


> Does anyone here *REALLY* think we're going to make much of a difference in blunt force trauma arrest?


 
If the trauma patient still has a pulse that is not a trauma arrest. 

Trauma centers are full of patients who have suffered a severe trauma and many often do very well.


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## VentMedic (Jan 13, 2010)

nomofica said:


> Not entirely enthusiastic about the protocol stating two paramedics determine no cardiac output via palpating to not work the code. Sounds like a lazy way to play medic. Granted it's the media delivery the story to the every-day-person, *so of course details will be dumbed down to the point where it's inaccurate*. I've give 'em that much.


 
Since this FD was involved in another mispronoucement of death, their review and refined protocols have been watched by many including other EMS agencies.   If you read some of the EMS sites geared toward Medical Directors, Educators and those in EMS who want more than fluff reading, you might find it has also been discussed in a manner that is not just for the media.

Of course statements made by the media may even have more credibility than those made on an anonymous EMS forum where some believe everything written here without checking the facts for themselves.


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## medic417 (Jan 13, 2010)

Asystole is a workable rhythm, that is why it is no longer the standard in determining death.  Also the protocols also mention other items besides pulse-less.  Remember you are condemning based on a news report not based on facts.


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## rhan101277 (Jan 31, 2010)

medic417 said:


> Asystole is a workable rhythm, that is why it is no longer the standard in determining death.  Also the protocols also mention other items besides pulse-less.  Remember you are condemning based on a news report not based on facts.



Maybe if you witness a good rhythm turn asystole.  Then you can attempt pacing.  But it isn't workable if they have been down long, pulseless and apneic.  You would be just giving the family false hope to try to do a work up.


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## AnthonyM83 (Jan 31, 2010)

rhan101277 said:


> I think in a trauma asystole in multiple leads is not required.  If you spend time hooking all that up and you have another salvageable patient then that is more time that you are taking away from someone you can help.  I would check for pulse/breathing, then re-check and use my stethoscope and move on.


 Huh? We since we do even work up cardiac arrests in MCI's? Why would that be a worry. That's a pretty specific circumstance, too....




rhan101277 said:


> Maybe if you witness a good rhythm turn asystole.  Then you can attempt pacing.  But it isn't workable if they have been down long, pulseless and apneic.  You would be just giving the family false hope to try to do a work up.



But is really a reason to maintain asystole as a standard in determining death? Since you can't always be sure how long they've actually been down, I don't think having protocols that determine death just on that is a good idea. It wouldn't just be "giving the family false hope" to try a couple rounds of ACLS, since I've seen patients recover from asystole. I'm not saying transport them...just give them a chance. Few minutes,  nothing, then call it. Family's not going to be destroyed by being told patient is dead a few minutes after, versus right away.


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## usalsfyre (Feb 1, 2010)

Did they "recover" from being found with asystole or did they have a rhythm change. Asystole is the lack of all electrical activity, even hypoxic cells will depolarize. Asystole is indicative of gross hypoxia and/or cell death.


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## Melclin (Feb 1, 2010)

*I'm sure we're all aware, but I may as well post it.*

Battistella, FD. 1999, Field triage of the pulseless trauma patient. Archives of Surgery, 134 (7), pp. 742-746

No patient (0/212) with electrical asystole survived. Five of 134 patients with an initial electrical heart rate between 1 and 39 beats/min survived long enough to reach the intensive care unit but died within 48 hours (4 died within 24 hours). No patient survived to leave the hospital if the initial electrical heart rate was less than 40 beats/min.

Just thought I'd add it too the mix.


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## VentMedic (Feb 1, 2010)

*We don't fly dead patients either. There were studies many years ago that showed that with advanced training or even a physician could not make a difference for the traumatic arrest that occurred in the field.*


*http://www.annemergmed.com/article/S0196-0644(89)80003-4/abstract*

*Aeromedical transport of patients with post-traumatic cardiac arrest*

Patients experiencing cardiac arrest secondary to trauma make up 8% to 15% of air ambulance scene flights in reported series. Our study examined the role of aggressive physician intervention at the accident scene in conjunction with rapid air transport to a trauma center in reducing the mortality after post-traumatic cardiac arrest. We retrospectively studied 67 patients who experienced cardiac arrest before the arrival of the flight team. Fifty-eight patients were victims of blunt trauma, and nine sustained penetrating trauma. Forty-seven patients were transported to the base hospital; 20 were pronounced dead at the scene after resuscitation attempts were made. Six patients developed a pulse and blood pressure and were hospitalized; *none survived to hospital discharge.* Review of autopsy data revealed that the majority of patients had head or thoracoabdominal injuries or both that were incompatible with life. We conclude that physician intervention at the scene and rapid aeromedical transport are not likely to improve mortality after traumatic cardiac arrest.


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## EMSLaw (Feb 1, 2010)

So, the studies confirm what we knew anecdotally - truama arrests almost always stay dead?


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## alphatrauma (Feb 4, 2010)

EMSLaw said:


> So, the studies confirm what we knew anecdotally - truama arrests almost always stay dead?



basically

In close to 20 years of field/ER/ICU/OR... I cannot remember seeing first hand, or hearing of any successful outcome after trauma arrest. Does it/can it happen? Sure, people win the lottery all the time.

As far as "working it a few minutes on scene" to see what happens, then calling it...  not in my neck of the woods. You start working a patient, viable or not, you'll more than likely be working that patient until you clear the ED.

- just posted from my phone. I love technology


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## TransportJockey (Feb 4, 2010)

alphatrauma said:


> basically
> 
> In close to 20 years of field/ER/ICU/OR... I cannot remember seeing first hand, or hearing of any successful outcome after trauma arrest. Does it/can it happen? Sure, people win the lottery all the time.
> 
> ...



Ya'll still transport working codes? I know out here if you work it till you're satisfied they ain't coming back, we can call MCEP and ask for permission to terminate.


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## AnthonyM83 (Feb 5, 2010)

Our system differentiates blunt versus penetrating traumatic arrest. I haven't seen the studies, but am told that penetrating traumatic arrests do have a chance if taken a trauma center. Don't remember the percentages, though.


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