# Your patients asks you "Am I going to die?"



## Wee-EMT (Jan 8, 2009)

Your patients asks you "I'm I going to die?"
What do you tell him when you know he is most likely to die?


----------



## Ridryder911 (Jan 8, 2009)

I would ask "do you feel like, your are going to die?" as impending doom is a good indicator of a serious condition. If the patient is presenting with a case of a high probability of dying, then I am inform them I am going to treat and help them the best I can and I need their help. Never lie to a patient as they can see such and will not gain trust in you. Use common sense.


----------



## akflightmedic (Jan 8, 2009)

I say "yes, we all are".


----------



## TomB (Jan 8, 2009)

I say, "Sorry, not in my ambulance. It's not allowed."


----------



## Epi-do (Jan 8, 2009)

It depends upon what is going on with the patient.  The scared teen that took 2 phenergan and 3 zoloft last night at 10:30 and it is now 3:00 in the afternoon the next day - I tell them that no, they aren't going to die, at least not right now.  The patients that truly have a good chance of dying, I tell, "I am going to do all I can to help you."


----------



## Epi-do (Jan 8, 2009)

Wee-EMT said:


> What do you tell him when you know he is most likely to die?









  So this part of the question just registered in my brain.  I guess you can disregard the first part of my answer above.


----------



## Noctis Lucis Caelum (Jan 8, 2009)

TomB said:


> I say, "Sorry, not in my ambulance. It's not allowed."



My kind of answer!! ^_^


----------



## marineman (Jan 9, 2009)

TomB said:


> I say, "Sorry, not in my ambulance. It's not allowed."



If the patient seems to have a sense of humor we've thrown in "that involves too much paperwork"


----------



## Hastings (Jan 9, 2009)

The moment you tell a patient they aren't going to die, they will.

It's true. Personal experience.


----------



## stephenrb81 (Jan 9, 2009)

I usually have 2 answers for that question

Serious answer for the frantic/upset: "We're doing everything we can to try and keep that from happening"  I'll then pop off a few "small-talk" type questions that don't require my full attention if I'm in the middle of treatment so they aren't AS focused on the situation (Trying to deter their 'emotional freak-out' as best as possible)

If they are trying to remain proud/act tough then I may throw in some humor, something along the lines of "I sure hope not, the guys won't ever let me live it down" with a smile. Then give them my serious answer above.

Real example for my humor response: Had a pt that was stabbed with a regular kitchen/dinner fork.  Fork still in LUQ just below rib cage on our arrival.  Pt was in good spirits on the scene and once in the ambulance asked "Am I going to die?" I couldn't answer No because its a piercing abdominal trauma and I wasn't going to answer Yes or It's Possible because I didn't want the patient to get hysterical.  So with eye contact I replied "I'll tell you what, We will do everything we can to keep that from happening *IF* you promise me you'll research how to properly eat with a fork" 




I won't ever lie to a patient but I want to stay away from the answer "Most likely".  My ultimate goal is to keep them as calm *as possible*, whether its trying to get them focused on small talk or make them smile with a little humor.


----------



## Sasha (Jan 9, 2009)

TomB said:


> I say, "Sorry, not in my ambulance. It's not allowed."



I've seen someone enforce that really really strictly. One patient WAS going to die in her ambulance, she made her driver stop the truck, yanked the stretcher out and he died outside the ambulance. She said that way you don't have to stick around with the M.E? And that once someone dies in the truck, then it's "marked"

She was a little scary h34r:, and I don't think she works here anymore.

I've never had someone ask that, because I do IFT! Most of my patients are stable. We do get a few Non-DNR patients who try to die while you're not looking, though.


----------



## BossyCow (Jan 9, 2009)

I generally use the line.... "We're going to do everything we can to make sure that doesn't happen"


----------



## Airwaygoddess (Jan 9, 2009)

*For the patient.......*

This is one of those questions that will always be asked by a patient, when the patient asks this question, it does depend on the place and the time, that is for sure.  I will talk to the patient and tell them we will do everything that we can for them, what is hard for me is when the family or frinds will ask that questions.  Any thoughts on that??


----------



## Epi-do (Jan 9, 2009)

Airwaygoddess said:


> what is hard for me is when the family or frinds will ask that questions.  Any thoughts on that??



I usually go with the same sort of tactics.  I will say something along the lines of "[Patient's name] is hurt very badly/very sick, but we are goign to do everything we can to help them until we get them to the hospital."

If family is asking that question, they typically already know what the answer is/could be.  I think they are just looking for reassurance that something is being done their loved one, and a little compassion.  Fortunately, I haven't had that question for family very often because I am typically busy with patient care, but I have overheard the officer in charge give a similar answer on multiple occassions.


----------



## Veneficus (Jan 9, 2009)

as the devils advocate, what would  you want to be told if the situation was reversed?


----------



## akflightmedic (Jan 9, 2009)

the truth

cause if I am somehow still able to speak and you know I am dying and do not tell me, I will haunt you forever.


----------



## BossyCow (Jan 9, 2009)

Veneficus said:


> as the devils advocate, what would  you want to be told if the situation was reversed?



I do tell the patient the truth. That I am going to do everything in my power to keep them alive. I've never had anyone I was sure was gonna die be alert enough to have a conversation with me. I've had many patients I was sure were gonna die who survived to call for my rig again and again. I do not consider myself an authority on it.


----------



## Bosco578 (Jan 9, 2009)

The ones I have had that did die were in no shape to ask. The ones that have asked are usually just run of the mill Tags. :beerchug:


----------



## Hockey (Jan 9, 2009)

During my ride time as a student, we had a elderly F fall and dislocate her hip.  She was DNR and pretty much DN everything other then transport to hospital.  

The medic let me run the call, and her v/s were at 70/40 and she held my hand and kept calling me "Daddy" and then she mumbled something about oh I can see you now Daddy.  She grabbed my hand pretty hard and then gone...


That...kind of shook me up for a while...sure wasn't what I ever expierenced before, nor do I want to again...


On the brighter side, I had a older lady fall.  While in transport she was all boarded c-spined up and everytime we hit a bump she told me she might throw up.  I told her if she does, she better not throw up on me...

Asked her not to so I didn't have to clean the Ambulance up.  And if she puked on me I would have to put a tube down her mouth.  She was a jokingly lady.  Arrived to hospital, moved her onto hospital bed, and BOOM! All over the RN! Smiled, gave my report, and said have a great day


----------



## rhan101277 (Jan 9, 2009)

We don't want people dying in our ambulances either.  We do cpr and bagging until we get to the hospital.  Unless they are DOA and the funeral home can't come get them.


----------



## Everett (Jan 9, 2009)

That would be hard for me too answer. As a Christian I'd try to give my patient the truth in hopes he/she would turn to Christ and repent, however as a person I don't think I could handle it if it were my news. 

Then again, truth is always the best route under special circumcstances.

I'd say yes and no.


----------



## Elliot (Jan 10, 2009)

just do the best you can!


----------



## TomB (Jan 11, 2009)

Okay, playing Devil's Advocate, how is it given to us to know that a conscious and talking patient is most likely going to die (from this emergency)? Let me guess! Like something from the movie "Signs" with Mel Gibson? As soon as the object is lifted, then the patient dies? Okay.... I suppose it's _remotely_ possible. If it's possible to know that a patient is most likely going to die, then yes, you let that person know in case he or she has any last words, which should be carefully recorded.


----------



## Veneficus (Jan 11, 2009)

TomB said:


> Okay, playing Devil's Advocate, how is it given to us to know that a conscious and talking patient is most likely going to die (from this emergency)? Let me guess! Like something from the movie "Signs" with Mel Gibson? As soon as the object is lifted, then the patient dies? Okay.... I suppose it's _remotely_ possible. If it's possible to know that a patient is most likely going to die, then yes, you let that person know in case he or she has any last words, which should be carefully recorded.



Because you triaged them to the "will receive no further resources" category during your MCI triage. 

Wounds incompatible with life, such as uncompensated bood loss with delayed transport for whatever the reason. (particularly in the military)

Talking to the patient prior to a traumatic arrest in any form for that matter.

Could be lots of reasons I think.


----------



## mikeylikesit (Jan 12, 2009)

here's what i tell them, "one day, and one day i will to" usually gets them away from it. you don't want them to lose hope though, mostly because the will to survive is an important tool for them to utilize in a time like that.


----------



## mycrofft (Jan 13, 2009)

*Been there.*

You look them straight in the eye, you tell them "We're going to take care of you", and then you do your damndest to do that. If you have to go on to another victim, you make them comfortable quickly, take  a beat, look them straight in the eyes, tell them "I will be back", and damnwell make sure you are.

I can honestly say that I've had many more people who were not going to die soon say they thought they were going to, than people who really were going to die soon say that they thought they were.

Did that even make sense?


----------



## bstone (Jan 13, 2009)

Everett said:


> That would be hard for me too answer. As a Christian I'd try to give my patient the truth in hopes he/she would turn to Christ and repent, however as a person I don't think I could handle it if it were my news.
> 
> Then again, truth is always the best route under special circumcstances.
> 
> I'd say yes and no.



I really hope you don't offer this unsolicited piece of religious advice to a dying patient, do you?


----------



## stephenrb81 (Jan 13, 2009)

Everett said:


> That would be hard for me too answer. As a Christian I'd try to give my patient the truth in hopes he/she would turn to Christ and repent, however as a person I don't think I could handle it if it were my news.
> 
> Then again, truth is always the best route under special circumcstances.
> 
> I'd say yes and no.





bstone said:


> I really hope you don't offer this unsolicited piece of religious advice to a dying patient, do you?



Agree'd with bstone

You should remain respectful of the religious views of your patients and not force your own upon them.  Perhaps they are content with their own views.  There is a spot on everyone's medical record for their religious preference so that their needs may be met in the event they require it.  It is not appropriate for anyone to attempt to convert them while they are on their death bed.   I was raised Southern Baptist, I would not appreciate to spend my dying moments having to listen to a Mormon/Muslim/Jehovah Witness/Wiccan/Atheist/Holy-Believers-Of-Missing-Socks-From-The-Dryer/Etc... attempt to convert me to their beliefs


----------



## mycrofft (Jan 13, 2009)

*I think that the intent about telling the truth was about time.*

If told they are dying, they will have time to make peace with themselves,regardless of specific creed.
Pretty luxurious to have an alert oriented pt able to have that time on an emergency run.


----------



## mycrofft (Jan 13, 2009)

*I think that Everett's intent about telling the truth was about time.*

If told they are dying, they will have time to make peace with themselves,regardless of specific creed.
Pretty luxurious to have an alert oriented pt able to have that time frmo emergency runs.


----------



## Sasha (Jan 13, 2009)

stephenrb81 said:


> Agree'd with bstone
> 
> You should remain respectful of the religious views of your patients and not force your own upon them.  Perhaps they are content with their own views.  There is a spot on everyone's medical record for their religious preference so that their needs may be met in the event they require it.  It is not appropriate for anyone to attempt to convert them while they are on their death bed.   I was raised Southern Baptist, I would not appreciate to spend my dying moments having to listen to a Mormon/Muslim/Jehovah Witness/Wiccan/Atheist/Holy-Believers-Of-Missing-Socks-From-The-Dryer/Etc... attempt to convert me to their beliefs



Don't forget Pastafarian! May you be touched by His noodley appendage! RAmen!


----------



## WFDJustin (Jan 29, 2009)

you tell him that you will do the best you can to prevent it. never promise a patient or a patients family something you cant always deliver.


----------



## medic417 (Jan 29, 2009)

Wee-EMT said:


> Your patients asks you "I'm I going to die?"
> What do you tell him when you know he is most likely to die?



If after exam I am confident he will die I answer.  Yes you are most likely going to die.  Is there anything I can do to help you be more comfortable?


----------



## PapaBear434 (Jan 29, 2009)

Everett said:


> That would be hard for me too answer. As a Christian I'd try to give my patient the truth in hopes he/she would turn to Christ and repent, however as a person I don't think I could handle it if it were my news.
> 
> Then again, truth is always the best route under special circumcstances.
> 
> I'd say yes and no.



Do that to me, and I'll do whatever is in my power to haunt you until you completely lose your marbles.  

/proud member of the heathen hordes


----------



## EeyoreEMT (Jan 30, 2009)

*Everyone dies, eventually*


```
The hardest question to answer. When it's a child asking, I never tell them yes, I alway am honest when something is going to hurt and explain everything we do and why, and sometimes let them help (obviously not critical) like hold this ice pack for me here... Adults and their family... each case is different. The ones who are not falling to pieces to the point you can't understand what they are saying, 
"Everything that can be done is being done for them....is there anyone I can call for you or you would like to call?"
```
If they can handle it, be honest explain what is being done for them so they can understand. The hardest thing to do is give infant's clothes back to the family and say, I'm sorry, we did all we could. After every child I code, I pray as I'm working them that whatever is to be, happens, and ask God to bless them. I walk out the door, and the day goes on.


----------



## EeyoreEMT (Jan 30, 2009)

*Everyone dies, eventually*

The hardest question to answer. When it's a child asking, I never tell them yes, I alway am honest when something is going to hurt and explain everything we do and why, and sometimes let them help (obviously not critical) like hold this ice pack for me here... 
      Adults and their family... each case is different. If the patient asks, and they are usually the older one's humor is the best bet, yes, not today though, we only take dying people on Tuesdays, or something like that. Now if the patient tells you they are going to die, they usually do. I  had a lady screaming at me, 3 stories up I'm dyinig, can't you hurry. She yelled at me for 5 minutes while I tried to get history, meds, allergies, crank her o2 to 6 lpm (her max) and calm her down. We got her on the stairchair and started down the 3 stories of deck stairs, all 90 degree turns, 1/3 of the way down, she leans forward. I look at my partner so he can brace to stop, I hold on to her shoulders and while I'm leaning her back telling her how important that was-she coded!
     The ones who are not falling to pieces to the point you can't understand what they are saying, "Everything that can be done is being done for them....is there anyone I can call for you or you would like to call?"
     If they can handle it, be honest explain what is being done for them so they can understand. The hardest thing to do is give a parent's child's clothes back to the family and say, I'm sorry, we did all we could. After every child I have had to code, which has been too many, I pray as I'm working them that whatever is to be, happens, and ask God to bless them. I walk out the door, and the day goes on.


----------



## Aidey (Jan 30, 2009)

I generally use something along the lines of "Not if I have anything to say about it", and alter my tone from funny to serious depending on the situation and I've never had a bad reaction to it. I've found that the patients who may not make it to the hospital alive generally aren't in good enough condition to ask anyway.


----------



## NEMed2 (Feb 3, 2009)

That pt deserves a gold star


----------



## BossyCow (Feb 3, 2009)

Everett said:


> That would be hard for me too answer. As a Christian I'd try to give my patient the truth in hopes he/she would turn to Christ and repent,



Repent for what? The sin of dying in your ambulance? 
What makes you assume that the pt isn't a christian and already repented... are you assuming that they were forgiven and then squeezed in a few more sinful acts between redemption and their critical health event? This belief system really confuses me.


----------



## 281mustang (Feb 3, 2009)

bstone said:


> I really hope you don't offer this unsolicited piece of religious advice to a dying patient, do you?


 That should be grounds for termination IMO. Even just telling them they're going to die is an imcompitent thing to do. If the professional they trust to save their life is telling them they're going to die many of them will lose their will to survive. Whatever bedtime story you were told as a child is for you to practice on your own time. Your religious views are just that, YOUR religious views, so leave them at the door.


----------



## medic417 (Feb 3, 2009)

281mustang said:


> Even just telling them they're going to die is an imcompitent thing to do. .



I disagree.  You never lie to a patient.  If death is obvious I will tell them while I plan to do all within my power to help them that there may be nothing more I can than help them be comfortable.  I will ask if they want me to give a message to anyone in case my efforts do not work.  Sometimes this at least lets them say goodbye.  I will not lie to my patients or their familys.


----------



## Veneficus (Feb 3, 2009)

281mustang said:


> That should be grounds for termination IMO..



Agree with that.




281mustang said:


> Even just telling them they're going to die is an imcompitent thing to do. If the professional they trust to save their life is telling them they're going to die many of them will lose their will to survive..



But I take issue with this.

I understand about "medical hexing" The idea that you tell a patient they will not fare well and they get depressed and don't. But there are circumstances where an alert patient has wounds or a medical condition inconsistent with life. When there are no more heroic measures because all they will do is speed death. Caring for a dying patient is just as much a part of healthcare as the biomedical part. It is not the most fun part or the most glamorous but it is equally important as anything else we do. Some will say “it is not my job.” That is utter rubbish. Palliative care is part of the paramedic curriculum. I have had to do it as a medic and if it happened to me it happens to others.  (Much as I like to think I am special.)

When you accepted the respect of a healthcare provider, you accept the responsibility no matter how unpleasant the task. If you don’t, then it is time to leave.


----------



## daedalus (Feb 3, 2009)

Veneficus said:


> Agree with that.
> 
> 
> 
> ...



I am going to have to second this opinion. +2

Expecting a patient to repent for their sins in your ambulance is grounds for getting your ticket pulled. Read your job description, it reads that you are there to save lives, not souls. Saving lives is the medical professional's responsibility. Saving souls is the chaplain/priest/wiccan high priestess's job.

Second, watching the movie Signs will give a good example of when you must tell a patient who is alert that they are going to die. In this example a patient is impaled into a tree and pinned in between the car and the tree. Her body is severed in half and the pressure of the car and tree and keeping her from bleeding out. Once removed, she will die. This is not science fiction like the rest of the movie.


----------



## emtfarva (Feb 3, 2009)

*I wouldn't Know*

I haven't had an situation where that has come up. I have had PT that said they were going to die but they were not even close. I have had a PT that has died (not in the ambulance) and not ask that question. of course thta PT was in resp distress. they also died the next day. but beside that I wouldn't know what to do. I would like to think I could come up with the right answer. But I will not know until it happens to me.


----------



## 281mustang (Feb 4, 2009)

Veneficus said:


> Agree with that.
> 
> 
> 
> ...





daedalus said:


> I am going to have to second this opinion. +2
> 
> Expecting a patient to repent for their sins in your ambulance is grounds for getting your ticket pulled. Read your job description, it reads that you are there to save lives, not souls. Saving lives is the medical professional's responsibility. Saving souls is the chaplain/priest/wiccan high priestess's job.
> 
> Second, watching the movie Signs will give a good example of when you must tell a patient who is alert that they are going to die. In this example a patient is impaled into a tree and pinned in between the car and the tree. Her body is severed in half and the pressure of the car and tree and keeping her from bleeding out. Once removed, she will die. This is not science fiction like the rest of the movie.


 I agree. After rereading my post I was probably a little too vague and should of went into more detail about that part. I was talking about in refrence to when a patient still has a chance at surviving but it's not likely. If their death is inevitable and there is absolutely nothing you can do then that is a completely different situation.


----------



## CAOX3 (Feb 9, 2009)

Not lyng to patients, having them repent in the ambulance and writing good by notes to their family members.

My god i really am old school.


----------



## PapaBear434 (Feb 9, 2009)

CAOX3 said:


> Not lyng to patients, *having them repent in the ambulance* and writing good by notes to their family members.
> 
> My god i really am old school.



WRONG.  It's not the 50's, you don't assume everyone is a "good Christian" and wants you to preach to them.


----------



## poppawilly (Feb 9, 2009)

my kids nanny was killed in an automobile accident after leaving a birthday party for one of my kids.  when i arrived on scene, she was lying outside the car.  she was alive at the time but appeared to be slipping away quickly.  one look at her and it was obvious to me her chances of survival was slim.  i told her i was gonna do everything i possibly could for her and asked her to stay with me.
when the helicopter arrived, she was loaded for transport.  shortly after the helicopter lifted off, she coaded forcing the helicopter to divert and died a short time later.
moral of the story, i was honest with her.  she didn't ask if she was gonna die but i did hold true to what i told her.  being a basic, my treatment was limited.  i applied oxygen, treated for shock, and packaged for transport.  she was alive when she was loaded into the helicopter so i can have peace with that.  i had a hard time dealing with losing her in flight but i did everything i possibly could for her on scene.


----------



## fortsmithman (Feb 9, 2009)

I'd tell him odds are you not dying in this ambulance because I'm not driving my partner is.


----------



## medic417 (Feb 10, 2009)

fortsmithman said:


> I'd tell him odds are you not dying in this ambulance because I'm not driving my partner is.



Its good that you understand that your partner drives better than you do.


----------



## mikeN (Feb 11, 2009)

At my clinicals this morning a lady was at the ED with a bad reaction to ace inhibitors. A younger lady in her 40's. Well she was crashing fast and was still alert. The look on her face that she knew she was going to die SOON. You would have though she saw death right there standing behind the doctors and nurses just waiting for her.  It was :censored::censored::censored::censored:ing  scary because I knew she was going to die. This lady had massive angioedema and nothing was working. She died in the OR within the hour. This news ruined a lot of peoples afternoon.


----------



## psychomedic (Feb 21, 2009)

I tell them that dying is not allowed in my ambulance...


----------



## medic417 (Feb 21, 2009)

psychomedic said:


> I tell them that dying is not allowed in my ambulance...



We should never lie to a patient.  If you want to see I am going to do all I can to prevent it fine.  But when people know they are dieing and you lie it does not help them.  And peopel do die in the ambulane all the time, just because some disregard current standards and do rolling codes does not eliminate the fact person was dead in the ambulance.


----------



## DevilDuckie (Feb 21, 2009)

I would say "We're going to do everything we can for you" then ignore everything else they say.


----------



## HasTy (Feb 21, 2009)

The most important thing is to not lie to your patient...lying is a terrible thing in this business...anyway thats another discussion... I would tell the patient that you they have severe injuries but you are going to do everything you can to get them to the hospital where the doctors will be waiting to do everything that they can.


----------



## Fragger (Feb 24, 2009)

I tell them "Not if I can help it, stay with me !!"


----------



## Veneficus (Feb 25, 2009)

Fragger said:


> I tell them "Not if I can help it, stay with me !!"



hopefully you don't say that to your DNR patients.


----------



## CAOX3 (Feb 26, 2009)

Fragger said:


> I tell them "Not if I can help it, stay with me !!"



What is this "Bringing out the dead"


----------



## PapaBear434 (Feb 26, 2009)

Yesterday morning I just had a seven month old cardiac arrest.  It was on the borderline of the city, so both city's Fire/Rescue showed up, though we were the only ambulance there.  As I am still only BLS certified, and there was two cities worth of medics in the back, I decided to excuse myself and sit up front, ready to ride hot as soon as they got the tube in and they gave me the ok.  No point in taking up room as a Basic on a major call like that when you have more medics than you know what to do with.

Mom sat up front with me, so I spent a good chunk of time trying to talk her down from her understandable hystarics.  Dad came to the door, and he was equally as upset, but had to be told he couldn't ride along.  While we waited, I got them to calm down a little to give us some information.  The little guys name, if he's been sick, what medicine he was on...

Once I got the all clear, I hauled *** to the nearest hospital trailed by our EMS Chief, a Fire Chief, the neiboring city's EMS and Fire Chiefs, and three EMS zone cars that the paramedics came in.  Somehow, people still managed to not see/hear us coming, or just plain tried to "beat the ambulance" and make the turn before they could get inconvenienced by a dying infant.

The entire time, all I could tell Mom when she asked if her little boy was going to be all right is "We have two cities worth of medics back there, and they are the best we have on the ground.  They will do everything they can."

He wasn't, of course.  We got him into the trauma room, and I had to get Mom and Dad out of there because they kept trying to jump in there and grab their little boy.  I escorted them out to the nurses station, got them some chairs, and continued to talk to them until they had a spare nurse to take them off to whatever waiting room they had.  As we were doing our report and having the grief councilor lady coming by and seeing if any of us needed a debriefing session, we got word that he didn't make it and they called it at 0907.  Wherever they had taken Mom and Dad, we soon heard their wailing all the way down in the Rescue room.

All in all, not a great way to start the day.  But I hope, at the very least, I gave them hope without leading them on into false hope.  In the end, that's all we can really do as EMT's.  Don't lie, but tell the truth:  That you will do whatever you can.


----------



## EMSJunkie (Mar 24, 2009)

as many have said there really is many ways to go about this. We were taught back in class out of my teachers personal experience that is they ask if they're going to die they usually sense that they are. And more than likely their right. Always be honest with them they trust you and trust that your their to take care of them so be honest. Or as some have said tell 'em not on my watch you arn't. It just varies from different person to person. so far i havn't had that happen yet. but i've heard about it.


----------



## beckoncall62 (Mar 26, 2009)

*Will I Die?*

"Some day you will"


----------



## curt (Mar 26, 2009)

Well, the only one I've ever seriously had ask me that was some guy at the local college that got wasted as everything and the etoh convinced him that it'd be a good idea to, for no reason, break a window with his face- at 8 in the morning, mind. He was fine for the most part- had a pretty decent gash on his scalp, which had been stopped with at least 5,000 2x2 gauze pads held in place with some roller gauze by the fire department by the time we got there. Patient had no notable change in vitals, was no longer bleeding, and still had a respectable amount of alcohol both in his blood and on his breath. Well, he was a sad drunk, and all the way to the hospital, he commenced to asking the medic for life help and whether or not he was going to die. Good times.

 On a more serious note, if it's something that could go bad or is actively heading south for the ever, I typically try to respond with a classic sideways answer: "We're doing our best." Everything I've read on survival (life or death scenarios, lost in the woods, whatever) indicates that morale plays a huge part in it, and the last thing I'd want to do is skew somebody's odds by blowing apart their morale.


----------



## DavethetrainWreck (May 13, 2009)

If they are not I say "no you'll be fine". If they are or they're is a good chance I say "I will do all I can to help you but you gotta to keep your head up. Lets fight this one together"  Humor can work too depending on the patient so I'll sometimes say "you can't die in this ambulance its against regulations. this ambulance isn't set up for dying patients its only set up for saving patients"


----------



## andydrumm05 (Jun 1, 2009)

I usually say "Yes you will, but not now." And for some reason, it seems to calm them down.


----------



## SemiMedic (Jun 7, 2009)

I say "Depends on wether or not I'm on the will!"


----------



## KillTank (Jun 8, 2009)

Wee-EMT said:


> Your patients asks you "I'm I going to die?"
> What do you tell him when you know he is most likely to die?



change the subject and start talking about pancakes at Ihop.


----------



## rescuepoppy (Jun 8, 2009)

Don't have a set thing to tell them. Just try to keep their spirits up.  What is worse than someone asking if they are going to die is to have an accident victim that is in bad shape look at you and calmly tell you that they are dieing. That will really get the adrenaline flowing.


----------



## Pietie (Jun 30, 2009)

TomB said:


> I say, "Sorry, not in my ambulance. It's not allowed."


That Is the Perfect answer ill say, because it shows the patient that you know what you are doing and that you will do anything in your abbilaty to help that patient... respect for that answer TOM B


----------



## medic417 (Jun 30, 2009)

Pietie said:


> That Is the Perfect answer ill say, because it shows the patient that you know what you are doing and that you will do anything in your abbilaty to help that patient... respect for that answer TOM B



Why when its a lie?  Never lie to the patient.  If they are definitely dieing be honest.  If its bad but not sure then use the we're doing all we can to keep it from happening.


----------



## KillTank (Jun 30, 2009)

"you are in good hands and we are trying our best. Hang in there"


----------



## Medic744 (Jun 30, 2009)

Be honest but tactful. We tell our patients we are doing everything we can. (Then you might want to turn around and tell your driver to test if your unit has a govenor or not)^_^


----------



## HotelCo (Jun 30, 2009)

Sasha said:


> I've never had someone ask that, because I do IFT! Most of my patients are stable. We do get a few Non-DNR patients who try to die while you're not looking, though.


Those IFT patients are sneaky, gotta watch out. h34r:



rhan101277 said:


> We don't want people dying in our ambulances either.  We do cpr and bagging until we get to the hospital.  Unless they are DOA and the funeral home can't come get them.


Unless you have long transport times, If you've made the decision to transport a patient that is coding, I'd certainly hope you'd continue working the patient until you get to the hospital. (Keep in mind I live in the suburbs, transport time to a hospital is about 5 minutes, 7 minutes to a level I)



			
				BossyCow said:
			
		

> This belief system really confuses me.


Feel free not to believe.



281mustang said:


> Even just telling them they're going to die is an imcompitent thing to do. If the professional they trust to save their life is telling them they're going to die many of them will lose their will to survive.


So we should just spit sunshine at them?


----------



## Afflixion (Jun 30, 2009)

TomB said:


> Okay, playing Devil's Advocate, how is it given to us to know that a conscious and talking patient is most likely going to die (from this emergency)? Let me guess! Like something from the movie "Signs" with Mel Gibson? *As soon as the object is lifted, then the patient dies? Okay.... I suppose it's remotely possible.* If it's possible to know that a patient is most likely going to die, then yes, you let that person know in case he or she has any last words, which should be carefully recorded.



That's more than remotely possible saw a guy on FT Hood pinned up against a tree with a Bradley... He didn't die immediately after extrication but it was under 5minutes.


----------



## HotelCo (Jun 30, 2009)

Afflixion said:


> That's more than remotely possible saw a guy on FT Hood pinned up against a tree with a Bradley... He didn't die immediately after extrication but it was under 5minutes.



10 points to the person that can name the reason a person pinned against a tree for an extended period of time might die shortly after being freed.


----------



## NomadicMedic (Jun 30, 2009)

Crush injury leading to tamponade.

Just my guess...

The pinning object would impede blood flow to the legs (or whatever is crushed) creating tamponade, keeping the BP stable in the "non injured" trunk/head.

As soon as you remove the pinning object, the "beneficial" occluding aspect is gone, BP plummets and the pt dies from hypovolemic shock.

Am I on the right track?


----------



## SoCal (Jun 30, 2009)

Crush Syndrome... 

When a pt. is trapped, damage is done in the cellular level, causing Hydrogen Ions to be released from the damaged cells, causing catastrophic damage to the healthy cells. The environment becomes extremely acidic and the cells are releasing K+ from them, so when you relieve the pressure the H+ and K+ and other waste (ie... Rhabdomyolysis, etc... ) is allowed to rush back into the trunk, causing widespread septic conditions and electrolyte imbalances.... 

If they don't die immediately, they will die of MODS within the next few days. Not an easy way to die...


----------



## rmellish (Jun 30, 2009)

SoCal said:


> Crush Syndrome...
> 
> When a pt. is trapped, damage is done in the cellular level, causing Hydrogen Ions to be released from the damaged cells, causing catastrophic damage to the healthy cells. The environment becomes extremely acidic and the cells are releasing K+ from them, so when you relieve the pressure the H+ and K+ and other waste (ie... Rhabdomyolysis, etc... ) is allowed to rush back into the trunk, causing widespread septic conditions and electrolyte imbalances....
> 
> If they don't die immediately, they will die of MODS within the next few days. Not an easy way to die...



pH problems can also occur, acidosis in particular.


----------



## SoCal (Jun 30, 2009)

rmellish said:


> pH problems can also occur, acidosis in particular.



That's why I put "Extremely Acidic" in my post...


----------



## BuddingEMT (Jul 1, 2009)

stephenrb81 said:


> I usually have 2 answers for that question
> 
> Serious answer for the frantic/upset: "We're doing everything we can to try and keep that from happening"  I'll then pop off a few "small-talk" type questions that don't require my full attention if I'm in the middle of treatment so they aren't AS focused on the situation (Trying to deter their 'emotional freak-out' as best as possible)
> 
> ...



Great minds think alike ^_^


----------



## HotelCo (Jul 1, 2009)

SoCal said:


> Crush Syndrome...
> 
> When a pt. is trapped, damage is done in the cellular level, causing Hydrogen Ions to be released from the damaged cells, causing catastrophic damage to the healthy cells. The environment becomes extremely acidic and the cells are releasing K+ from them, so when you relieve the pressure the H+ and K+ and other waste (ie... Rhabdomyolysis, etc... ) is allowed to rush back into the trunk, causing widespread septic conditions and electrolyte imbalances....
> 
> If they don't die immediately, they will die of MODS within the next few days. Not an easy way to die...



I agree, not a way I'd want to die.


----------

