# Pediatric Cardiac Arrest



## taporsnap44

You are a paramedic unit composed of a medic and a basic. You are toned out for a 7 week old cardiac arrest. Arrive on scene and find the mother and farther very upset, leading you to the baby. The mother states that the baby was sleeping in his crib when she checked on him 3 hours ago. Before the call she went to check on him and he was unresponsive, not breathing and no pulse. You are 7 minutes from the hospital, and an engine is on scene for manpower. 

This scenario is to see how other providers would handle this. I have not yet been on a pediatric cardiac arrest but have been discussing this with various people as to how to handle. Do you grab the baby and run out the door, doing CPR and such enroute to the hospital. Or do you work the code in the ambulance or in the house.


----------



## Shishkabob

Totally depends on how long the kids been down, as chances are it will probably be called on scene if it's been an extended period.  If not, PALS.  There's a 3 hour gap between when the baby was last seen alive, and when it was 'confirmed' that he was down.  Could already be too late.   Add on top of that, dispatch time.


There's not much a hospital can do in a cardiac arrest that you can't do on scene.


----------



## NREMTB12

funny that this article comes up, just yesterday in Metro we had a 2 year old that had fallen into a swimming pool and was pulse less and apneic, basically the hospital is a 5 min drive from that residence, so they had the FD run in and grab the child and then got in the back of the rig and they were gone, ambo was on scene maybe 15 sec. tops, i dont believe the kid made it, though not at the fault of the medics becuase they did exactly what i would have done...get them to definitive care as quick as possible


----------



## PapaBear434

That was my very first released call, except it was a seven MONTH old.  I was the basic, I was riding with a medic, Engines showed up...

Oh, I didn't mention that?  The call was on the city border of Norfolk and Virginia Beach, and no one had any idea who's call it was, so EVERYONE came.  We were the only ambulance, but we had two engines, three chiefs, three "zone" cars with medics on board...  And everyone wanted to ride in my truck to the hospital.


----------



## Ridryder911

No difference than if it was an adult except the history and of course medication(s). 

R/r 911


----------



## taporsnap44

Ridryder911 said:


> No difference than if it was an adult except the history and of course medication(s).
> 
> R/r 911



That was my thought, stay on scene or in the back of the ambulance and work it until ROSC or you have to call it.


----------



## sdaileyemt

My teacher has brought up similar situations but I would grab and run. Go code 3 for about a mile then cut it to code 1 contact base and call it. Simply because you said 3 hours since last seen "alive". But I would do that one not really to give the parents hope but to show them you did soothing and with parents and pedi death parents can get combative and my scene can be come extremely unsafe. Just my though again only a student with a few rides under my belt so if I am wrong let me know please I am here to learn.


----------



## LucidResq

sdaileyemt said:


> MyGo code 3 for about a mile then cut it to code 1 contact base and call it.



You do realize that in this situation, the parents are almost certainly going to be right behind you.


----------



## Shishkabob

sdaileyemt said:


> Go code 3 for about a mile then cut it to code 1 contact base and call it.



And here we go.  Puts public at risk, does nothing for patient, and puts you and your partner at risk.


/grabs popcorn and waits for Rid


----------



## sdaileyemt

Well I could have fire buy me a window, Like talk to them bout paperwork of some sorts just to give me time to get far away enough to were they can't be right behind me. And if not then go code 3 all the way but definitely get in and out ASAP. Valid point though I did not even well I mentioned it but never clicked. Thank you. Sorry re read Linuss' post, You are right bout public risk, So i guess scoop and go code 1 we are 7 Min out so no reason for code 3 the patient is more then likely passed so I would attempt CPR in route but check with my Medic and Med Control and call it.
And what is RID?


----------



## Shishkabob

If it's not going to make the slightest bit of difference in pt outcome, you have no reason to be going LS back to the hospital.


----------



## sdaileyemt

Ya see my edited post you do have a point I did not take into consideration. Only thing I thought was leave scene ASAP! Because it can turn violent.

Also apologize if any of my posts sound stupid or if I do not know terms or abbreviation I am a student here to learn lol


----------



## reaper

Not many pedi codes turn violent. Show coding is not helping the parents. If the pt is viable, then work it as normal. If it is not viable, call it and turn your attention to the parents. They will need your help more then a pt that has been down to long!


----------



## sdaileyemt

O ook well then, My teacher just mentioned when we were talking bout the anger stage of death that in pedi cases it can and at least in our area can turn violent, But if it is a non violent then definitely try CPR and resuscitation in a room away from the parents, I would do that as a new EMT because it would be hard to concentrate with mom and dad yelling in my ear, I know something to get used to but not the time to learn i will learn when Susie falls off her bike lol. And then call it if needed and comfort the parents just be real with them listen to them talk to them do what they need. I personally would either way hope I NEVER have to see this ontop of being a new EMT I am a new dad so ya.


----------



## Sasha

So let me get this straight... You are going to put you and your partner at risk fir a dead person ... Give the family false hope by dramatically speeding away... Violate the childs body... Add a hospital bill onto of a funeral and ems bill.... And allow the family to drive to the hospital in an emotional state because you can't break the news? Some patient advocate.


----------



## Shishkabob

If it's an acute medical incident, chances are the parents will be in too much disbelief to get angry.  You're there to help, they know it, and generally don't fight you.

Yes, people will "bug" you, but it's for the better if you let them watch.


----------



## ResTech

I have only had two pediatric arrests.. one was a two year old who fell into her grandparents swimming pool one Summer and the other was last month which was a 5 month old at a daycare facility. 

If the child is viable, I feel picking up the child and going straight to the Ambulance is a good idea. Then you have the child in your comfort zone and away from the distraction of the parents. I think this saves time. I do firmly believe the parents should always be allowed to see their child during care if time permits and not be kept in the dark.


----------



## sdaileyemt

Sasha said:


> So let me get this straight... You are going to put you and your partner at risk fir a dead person ... Give the family false hope by dramatically speeding away... Violate the childs body... Add a hospital bill onto of a funeral and ems bill.... And allow the family to drive to the hospital in an emotional state because you can't break the news? Some patient advocate.



Well you did not have be so rude and disrespectful said on several occasions I am a STUDENT I am LEARNING! And after hearing over statements I changed mine, Were I live/going to be working it is a BAD city, number 5 crime rate in US so yes if I believe it is going to get violent DAMN right I am OUT it is there emergency not mine as my instructor says. But like I said if it is a safe situation do everything I can call it and confront the parents and help them. So please I appreciate all the the REAL help.


----------



## Ridryder911

sdaileyemt said:


> Well I could have fire buy me a window, Like talk to them bout paperwork of some sorts just to give me time to get far away enough to were they can't be right behind me. And if not then go code 3 all the way but definitely get in and out ASAP. Valid point though I did not even well I mentioned it but never clicked. Thank you. Sorry re read Linuss' post, You are right bout public risk, So i guess scoop and go code 1 we are 7 Min out so no reason for code 3 the patient is more then likely passed so I would attempt CPR in route but check with my Medic and Med Control and call it.
> And what is RID?



That's me. Okay... here we again! Did your EMT class have an theatrical and acting as a portion of it too? C'mon where in the hell; did you ever read you would start CPR and then stop for dramatics? Either do the job correctly or get out. Your basically saying... "I can't deal and do my job!" I'll let the ER tell them that they are dead and might as well tell them I was negligent. Yeah, I gave the family false hopes and now have also gave them an additional $3.000-5,000 bill. Congratulations! 

Now, not to be rude. We will teach you and assist you in how to do things right. You giving false hope is unethical and could have serious consequences. 

If the child is dead.... he/she is dead. You inform the family, assist them for counseling, etc. and should have LEO at the scene already. Until otherwise proven it is a crime scene and medical examiner division will handle the rest. 

*Late entry: did not see you were a student, so don't be thin skin and you will learn! 
R/r 911


----------



## sdaileyemt

Well thank you I do realize my first post was deffo not the route to go, But I agree with my revised plan haha, apologize if the first one was sounding like a **** move just something I herd about it and in my first instinct sounded right but DEFINITELY wrong move.


----------



## Ridryder911

sdaileyemt said:


> Well thank you I do realize my first post was deffo not the route to go, But I agree with my revised plan haha, apologize if the first one was sounding like a **** move just something I herd about it and in my first instinct sounded right but DEFINITELY wrong move.



Were rough, but you will learn. I understand about "bad neighborhoods" but that is why LEO should be on the scene or at least plenty of personnel.

You will learn here there is very, very few time that l/s are really needed to transport. You are a medical professional (per say) and should be able to treat the patient so there is never no need to "act" or give a false impression. 

Remember, we are a tough crowd but you will learn if you stick it out..

R/r911


----------



## Sasha

sdaileyemt said:


> Well you did not have be so rude and disrespectful said on several occasions I am a STUDENT I am LEARNING! And after hearing over statements I changed mine, Were I live/going to be working it is a BAD city, number 5 crime rate in US so yes if I believe it is going to get violent DAMN right I am OUT it is there emergency not mine as my instructor says. But like I said if it is a safe situation do everything I can call it and confront the parents and help them. So please I appreciate all the the REAL help.



Sweetie, that was not rude or disrespectful. Student or not, you post your reply, expect to get responses to what you post, and not all are going to be filled with rainbows and butterflies. I was just pointing out how ridiculous your answer would be and how much you would have been doing instead of saying "I'm sorry, there is nothing we can do." And it's not just you, there are others who feel that obivously dead pediatrics get show codes (Though I have to wonder the legal aspect of show coding.. I'm thinking a lawyer could have a field day with it.) because they believe the parents want "Everything possibly done" and that older patients only get half an effort, they also believe because pediatrics are young and healthy they have better survival rates so they need to be rushed to the magical hospital with CPR, tubes, lines, even if they are obviously gone, when in contrast the healthier you are the quicker you die and all that has been done was jerking the family's emotions around while putting them further in debt.

Grates my nerves.


----------



## Medic744

If the baby is still warm (cause your not dead until cold and dead) I would grab and go.  We have had several pedi codes in our territory and we grab the child and run with them.  Unless there is an obvious reason that there is no chance of getting them back (injury incompatable with life, rigor, etc.) I am more than willing to do everything in my power to work a child.  At the end of any call you need to be able to know that you did everything that you could to provide the most favorable outcome.  We don't call anything in the field, its not part of our protocol.  Either we work it or we don't.


----------



## Hockey

Baby warm, transport

Warmish/cold

Transport

Thats just how we do it here though


----------



## reaper

I have seen Pt's that were dead for hours and still warm. That is not a factor to look at. What if that baby was wrapped up in a heavy blanket all night? The body will be warm, but obviously dead!


----------



## medic417

Medic744 said:


> If the baby is still warm (cause your not dead until cold and dead) I would grab and go.  We have had several pedi codes in our territory and we grab the child and run with them.  Unless there is an obvious reason that there is no chance of getting them back (injury incompatable with life, rigor, etc.) I am more than willing to do everything in my power to work a child.  At the end of any call you need to be able to know that you did everything that you could to provide the most favorable outcome.  We don't call anything in the field, its not part of our protocol.  Either we work it or we don't.



Actually your not dead until warm and dead.  Wow not calling in the field, so your service is non compliant with current pre hospital medical standards.  You should voice concern for your safety and the publics safety.


----------



## taporsnap44

Isn't it also against AHA guidelines to transport a patient with CPR in progress?


----------



## ResTech

> Isn't it also against AHA guidelines to transport a patient with CPR in progress?



Why would it be against AHA guidelines to transport a patient with CPR in progress???? CPR is the standard of care and the only option that is going to circulate blood! Thing about your question... I'm sure you can then answer it for yourself.


----------



## ResTech

Evaluating skin temperature is a factor to evaluate when determining down time. Granted, a child wrapped in a blanket is gonna maintain body heat and not dissipate as quickly but that is something u keep in mind. How do we know for sure when a baby actually stopped breathing? They could have stopped five minutes before they were found or 45mins.... long as they are still warm and show no obvious death signs.... I would give the benefit of the doubt solely because no exact down time can be established.

I've also had a code where a patient's bed was smack up against a window air conditioner. Obviously they were cold from the A/C but downtime was reported to be less than 10. You just have to think a little bit but definitely evaluate skin quality.


----------



## redcrossemt

Went through a PEPP class recently and heard the "run to the ambulance" mentality described as "emergency football". You get to the scene, the parents throw the "football" to you, and you run to the truck.

If you're already with the patient on-scene, you have your equipment with you as you should, and you believe the patient is viable - why not deliver the rescue breaths and at least start resuscitation on-scene? Several people have mentioned that going to the truck is faster... I'm not sure how it could be faster for me to get all of my gear and the patient out to the truck then it would be to start care bedside.

Obviously, there are reasons to go to the truck, or at least a different part of the house - lack of light, lack of space, etc.


----------



## ResTech

When u take 10 seconds to pick up the child and go direct to the Medic unit... you then dont have to mess with packaging the patient, dealing with the IV lines, pulling the ET tube, etc. And you dont' have to mess with a stretcher.... that's where some of the time savings come into play. Either way is cool and certainly not wrong... just a matter of preference. 

And in some locales where the FD arrives first... they start care and soon as they hear the Medic unit mark up on scene..... they scoop the child and go right to the EMS crew.


----------



## reaper

ResTech said:


> Why would it be against AHA guidelines to transport a patient with CPR in progress???? CPR is the standard of care and the only option that is going to circulate blood! Thing about your question... I'm sure you can then answer it for yourself.



Yes, the AHA does call for the pt to be worked on scene. The evidence is clear, CPR is not effective in the back of a moving ambulance. If you get ROSC, then transport. If they code en route, then work them as normal.

A lot of agencies are starting to transport a working code, for billing reasons. Medicare and Medicaid does not pay, if no transport. Is it a good reason to put people at risk? NO! But, services do need to get paid.


----------



## ResTech

I understand the factors that come into play during transport that can make CPR less effective than in a non-transport environment. But generally speaking, they're are major issue with effective CPR being performed regardless of the environment by all level of care providers including in-hospital as well. 

I'll have to look up that guideline... it seems crazy for the AHA to advocate against transporting a patient with CPR in progress. How else is the patient supposed to get to the hospital? Or are they also now advocating against transporting pulseless patients all together and calling them on-scene if no ROSC?


----------



## reaper

Basicly. Work them for 20 minutes or 3 rounds of drugs. If no ROSC, call med control and call it. In most arrests, what will the ED do, that you are not?


----------



## Shishkabob

Open heart thumping


----------



## reaper

Here is actually a decent article from JEMS, on the subject of transporting arrest pt's.

http://www.jems.com/news_and_articl...sporting_Dead_Patients_The_Final_Chapter.html


----------



## medic417

ResTech said:


> Why would it be against AHA guidelines to transport a patient with CPR in progress???? CPR is the standard of care and the only option that is going to circulate blood! Thing about your question... I'm sure you can then answer it for yourself.



Actually if no ROSC AHA says call it in the field.


----------



## ResTech

I didn't know that was something they advocated as an actual guideline and recommendation, especially for a pediatric arrest. I agree with the principle overall, however for adults but not for kids.


----------



## reaper

Why? If I may ask. There is no difference between the two, on who should be worked or not.


----------



## medic417

ResTech said:


> I didn't know that was something they advocated as an actual guideline and recommendation, especially for a pediatric arrest. I agree with the principle overall, however for adults but not for kids.



Dead is dead, adult, child, infant, neonate.


----------



## ResTech

Dead is dead... your right. I say I disagree with working pedi codes and calling them in the field because children are as healthy as can be with perfect hearts in most cases. I just feel they should be transported to an ED where labs can be drawn and any contributing factors identified and treated that may not be immediately identifiable in the field.... is this significant and usually reveal ne thing that makes a difference... most cases not but some it may. 

Plus, in the ED some physicians will try some far shot treatments and continue treatment longer for a child then for a 85 y/o who had two previous MI, HTN, and smoked for 60 years.


----------



## Medic744

medic417 said:


> Actually your not dead until warm and dead.  Wow not calling in the field, so your service is non compliant with current pre hospital medical standards.  You should voice concern for your safety and the publics safety.



Sorry about the mix up, Im a littlev sleepy today.  As far as standards we are above and beyond.  Again we do everything we can to save someone.  Its not our job to call it in the field just like on a patient whos obviously been dead a while its not our job to determine cause of death.


----------



## HotelCo

Ridryder911 said:


> No difference than if it was an adult except the history and of course medication(s).
> 
> R/r 911



I fully agree.


----------



## redcrossemt

ResTech said:


> When u take 10 seconds to pick up the child and go direct to the Medic unit... you then dont have to mess with packaging the patient, dealing with the IV lines, pulling the ET tube, etc. And you dont' have to mess with a stretcher.... that's where some of the time savings come into play. Either way is cool and certainly not wrong... just a matter of preference.
> 
> And in some locales where the FD arrives first... they start care and soon as they hear the Medic unit mark up on scene..... they scoop the child and go right to the EMS crew.



I'm advocating for not going to the medic unit, unless there's ROSC. Same with first responder coverage areas... medics should come inside and work it.


----------



## redcrossemt

ResTech said:


> Dead is dead... your right. I say I disagree with working pedi codes and calling them in the field because children are as healthy as can be with perfect hearts in most cases. I just feel they should be transported to an ED where labs can be drawn and any contributing factors identified and treated that may not be immediately identifiable in the field.... is this significant and usually reveal ne thing that makes a difference... most cases not but some it may.
> 
> Plus, in the ED some physicians will try some far shot treatments and continue treatment longer for a child then for a 85 y/o who had two previous MI, HTN, and smoked for 60 years.



If the kid's heart is perfect, why did they arrest? In all reality, probably a respiratory arrest. Quickly institute PALS/ACLS guidelines, including aggressive airway management, and you have the best shot of resuscitation. 

By the time you transport and the hospital gets blood gases or any other sort of lab, they'll just be dead-person lab values. Depending on where you are and the experience level of the doctors, the hospital may try extraordinary efforts... but it's unlikely that they will result in ROSC, except in unusual circumstances like cold water drowning.

For the most part, I've rarely seen hospitals work codes based on labs. Usually, they focus on ACLS - and a problem search (H's and T's). Unless you have unusual circumstances, or you know the hospital can fix something you can't, work it on scene.


----------



## tterrag

reaper said:


> Here is actually a decent article from JEMS, on the subject of transporting arrest pt's.
> 
> http://www.jems.com/news_and_articl...sporting_Dead_Patients_The_Final_Chapter.html



Nice post man, The articles are good


----------



## maxwell

Sasha said:


> So let me get this straight... You are going to put you and your partner at risk fir a dead person ... Give the family false hope by dramatically speeding away... Violate the childs body... Add a hospital bill onto of a funeral and ems bill.... And allow the family to drive to the hospital in an emotional state because you can't break the news? Some patient advocate.



I'd say it's you who is the questionable patient advocate.  Check it.  Families know when their loved one is really dead (or, they have for the 20 or so pedi codes I've run).  You always, always, always, want to show the family that you've done your best, no matter how old the patient is.  This isn't violation of a child's body, if it is, then it aint CPR you're doing.  Driving away dramatically?  No, let the family know what's up, be real.  Sure, there's risk there.  Real simple advice.  Get over it.   There have been MANY studies that say families have a better time accepting their grief when they are present for heroic measures.  

My answer:  Tell the family what's up.  Be real.  Don't give them hope.  But work the code on the way to the ER.  The only exception for this is if you have findings incompatible with life.  General rule for pedi codes: run 'em.


----------



## reaper

maxwell said:


> I'd say it's you who is the questionable patient advocate.  Check it.  Families know when their loved one is really dead (or, they have for the 20 or so pedi codes I've run).  You always, always, always, want to show the family that you've done your best, no matter how old the patient is.  This isn't violation of a child's body, if it is, then it aint CPR you're doing.  Driving away dramatically?  No, let the family know what's up, be real.  Sure, there's risk there.  Real simple advice.  Get over it.   There have been MANY studies that say families have a better time accepting their grief when they are present for heroic measures.
> 
> My answer:  Tell the family what's up.  Be real.  Don't give them hope.  But work the code on the way to the ER.  The only exception for this is if you have findings incompatible with life.  General rule for pedi codes: run 'em.




General rule for Pedi codes: Run them as you would any other code! Leave emotions at the door.


----------



## Ridryder911

reaper said:


> General rule for Pedi codes: Run them as you would any other code! Leave emotions at the door.



Yeah, it's called medicine with a twist of true empathy. 

R/r 911


----------



## daedalus

sdaileyemt said:


> My teacher has brought up similar situations but I would grab and run. Go code 3 for about a mile then cut it to code 1 contact base and call it. Simply because you said 3 hours since last seen "alive". But I would do that one not really to give the parents hope but to show them you did soothing and with parents and pedi death parents can get combative and my scene can be come extremely unsafe. Just my though again only a student with a few rides under my belt so if I am wrong let me know please I am here to learn.



I know others here have told you, but I hope that I never hear of something like this happening. The thought of your scenario of fleeing the scene code 3 with a child and than cutting down to no code a mile away all for a show makes me literally cringe. 

It is immature, irresponsible, a waste of resources, dangerous to the public, unethical, immoral, and totally below the standards of our profession. It is quite frankly disturbing. We do not play, pretend, or act! Thats for hollywood, not a medical profession! Do you see doctors and nurses pretend to rush a dead child to the ICU or OR and than when they get around a corner out of sight of family, stop and call the death?

You do nothing except endanger the public and your crew, give the parents false hope, incur ambulance and hospital bills as pointed out, and show some pretty careless judgement.


----------



## sdaileyemt

OK I under stand what I said was wrong looking at the whole picture like I said I am a student if you wanna keep ripping my *** for it YOU are the immature one NOT me. Grow up


----------



## firemedic1563

OK, so i agree in theory with field termination of effort. However, please remember that we all are in very different places with very different rules and resources. In MD, without rigor AND lividity, and in absence of "Injuries Incompatible with Life", it can be difficult at best to terminate efforts. It requires the MD agreeing, and even with the best advocate clearly painting the picture of futility, many if not most of our ED MD's want to make the call after THEY look at the patient. And I do say look because I have seen them hop in the back of unit outside ED after an hour or more of CPR and call it there.

As for ped's (and others in special circumstances), I have a somewhat unique outlook on them. Having worked as a member of a dedicated Pediatric Critical Care Team, that transports only ped's, I have worked at least a few dozen ped arrests in a few years, and have seen extended CPR times that resulted in positive outcomes. Yes it is rare. But even after EMS transport to local ED, ED time, our response time of 25 minutes to that facility, load time, and return time, the patient's recovered after the heart rested on ECMO for some time. Again, rare, but we are in an area where any of our hospitals are within a 15 minute flight of two of the nations top pediatric center's.

That said, that was a pediatric patient with a undiagnosed heart defect that went into arrest because of the stress on the heart. Good cpr was performed from time of arrest. 

My point is that consideration needs to be given to the circumstances, distances to specialty centers, resources, etc. However, with signs of death, why start CPR? In that case, remember that the parents are also patients, victims of stress. Empathy can go a long way. On all my pediatric transports, wether 911, or critical care team, I make sure somebody is acting as a liason to the family.


----------



## paccookie

taporsnap44 said:


> You are a paramedic unit composed of a medic and a basic. You are toned out for a 7 week old cardiac arrest. Arrive on scene and find the mother and farther very upset, leading you to the baby. The mother states that the baby was sleeping in his crib when she checked on him 3 hours ago. Before the call she went to check on him and he was unresponsive, not breathing and no pulse. You are 7 minutes from the hospital, and an engine is on scene for manpower.
> 
> This scenario is to see how other providers would handle this. I have not yet been on a pediatric cardiac arrest but have been discussing this with various people as to how to handle. Do you grab the baby and run out the door, doing CPR and such enroute to the hospital. Or do you work the code in the ambulance or in the house.




Depends on a lot of things.  Are there obvious signs of death - rigor, lividity, glassy eyes, etc?  Is baby cold to the touch?  Or is baby warm?  It could be that the child took his or her last breath seconds or minutes prior to being found and could be viable.  Not likely, but it is possible.  I would assess the patient before making a definitive decision.  Unless there were obvious signs of death, I would work it.  No one knows how long that child was down.  As to how to work the code, follow PALS.


----------



## daughertyemta

I would load the baby up and get them in my enviroment.  Start all the necessary tx.  Given that the baby showed no signs of rigor or anything of that nature.  Even if I knew I wasn't going to get that baby back..with no signs of rigor...its a show code...Do everything I can...leaving the parents with some peace of mind knowing we did all we could instead of walking in their house and saying yep..your baby is dead.  Some might say a waste of time and effort but I call it compassion.  Parents are in shock and they think you can fix it.  Put yourself in their shoes if you had a little one like that.  And more then likely its SIDS something your not going to fix anyways.


----------



## Ridryder911

daughertyemta said:


> Even if I knew I wasn't going to get that baby back..with no signs of rigor...its a show code...Do everything I can...leaving the parents with some peace of mind knowing we did all we could instead of walking in their house and saying yep..your baby is dead.  Some might say a waste of time and effort but I call it compassion.  Parents are in shock and they think you can fix it.  Put yourself in their shoes if you had a little one like that.  And more then likely its SIDS something your not going to fix anyways.




Here we go again ! Geeez, I did not know so many Paramedics wanted to be actors? 
Amazing, I never read or taught to pretend anything! 

Remember the emergency is NOT about you, it's about the patient and the patient is dead. It's *NOT* compassion it's being unethical, mean and cruel! Your placing false hopes and ideas and basically being gutless because you can't do your job. 

Be empathetic, the patient is now the family. The family needs to have chaplain, family, etc.. called and later on grief counseling if appropriate. What they do *NOT* need is a $1000 EMS bill and a $5,000 ED bill because a EMT or Paramedic was not able to do what they should had done. Inform them there is nothing can further done. Guess what? Someone will and it is not a good idea for them to think you did not know your job or you treated the body without respect (yeah, running a code is pretty traumatic on the body). 


If the child is workable, then work them for the right reason. If they are dead, then there is NO difference between being a child or an 80 year old granny.....

R/r 911


----------



## daughertyemta

Sasha said:


> So let me get this straight... You are going to put you and your partner at risk fir a dead person ... Give the family false hope by dramatically speeding away... Violate the childs body... Add a hospital bill onto of a funeral and ems bill.... And allow the family to drive to the hospital in an emotional state because you can't break the news? Some patient advocate.




Can we say compassion??? Or patient advocate??? You need to learn those terms again...Im guessing maybe you've been a medic for wayyyy to long and are burnt out!?   I wouldn't want you as my medic if thats the way my family would get treated!  If that was my baby, I would want you to do EVERYTHING you could!!  Even if that meant poking my baby with needles, tubes, and meds!  Seriously you need to think about how that family feels and not how much work you have to do! We run lights and sirens for all kinds of stupid crap but an arresting pedi is not worth all your effort??  :glare:


----------



## daughertyemta

Ridryder911 said:


> Here we go again ! Geeez, I did not know so many Paramedics wanted to be actors?
> Amazing, I never read or taught to pretend anything!
> 
> Remember the emergency is NOT about you, it's about the patient and the patient is dead. It's *NOT* compassion it's being unethical, mean and cruel! Your placing false hopes and ideas and basically being gutless because you can't do your job.
> 
> Be empathetic, the patient is now the family. The family needs to have chaplain, family, etc.. called and later on grief counseling if appropriate. What they do *NOT* need is a $1000 EMS bill and a $5,000 ED bill because a EMT or Paramedic was not able to do what they should had done. Inform them there is nothing can further done. Guess what? Someone will and it is not a good idea for them to think you did not know your job or you treated the body without respect (yeah, running a code is pretty traumatic on the body).
> 
> 
> If the child is workable, then work them for the right reason. If they are dead, then there is NO difference between being a child or an 80 year old granny.....
> 
> R/r 911



Well you can work your codes how you do and Ill work mine how I do.  I do believe I put in there that I would work them if they were workable!  Meaning no signs of rigor or etc....


----------



## Medic744

In the past month I have worked a 50ish cardiac arrest of unknown cause and down time and an 18 month old with a down time of approx 2min. First one didn't make it and the baby cried all the way to the hospital for me.  Both were worked originally by bystanders and good bless my first responders and police dept.  Both were worked with the same level of care appropriate to their situations.  When we arrived on scene for the pedi we snatched the baby out of the PDs arms and immediately started working him and as soon as dad was in the front seat and we secured a driver we were out of there.  Just because the down time was known and ROSC was achieved by bystanders didn't mean that child was out of the woods and even if we had to work a full code on the child I wouldnt have done anything less than everything I was trained to do.  Unless it is obvious that ANYBODY is gone and has been for a while then they are getting worked to the full extent of my ability.  You can say to leave your emotions at the door and in the moment that is possible but at the end of the call those emotions will catch up to you.  On a side note as a mother if something were (God forbid) to happen to my child and the crew that arrived in essence gave up before even working it and not trying or doing a show code then yes you had better have a LEO on scene.


----------



## medic417

Holy unprofessional batman crap.  If a patient has obvious signs of death you would get mad at them for not doing a show code.  I think someone really needs to reconsider if they belong in the medical profession.


----------



## daughertyemta

medic417 said:


> Holy unprofessional batman crap.  If a patient has obvious signs of death you would get mad at them for not doing a show code.  I think someone really needs to reconsider if they belong in the medical profession.



 I think you need to re-read the statements...it has been put out there UNLESS there were obivous signs of death!  Put ur reading glasses on or retire!


----------



## medic417

Medic744 said:


> .  On a side note as a mother if something were (God forbid) to happen to my child and the crew that arrived in essence gave up before even working it and not trying or doing a show code then yes you had better have a LEO on scene.





daughertyemta said:


> I think you need to re-read the statements...it has been put out there UNLESS there were obivous signs of death!  Put ur reading glasses on or retire!



Maybe you need glasses that was what I was responding to not your statements.


----------



## Medic744

What I said was in essence unless my child has obvious signs of death then I would want them worked, not given up on or had a BS show code done on them.  When it comes down to it then the ones who are griping about cost of the code would be the ones to do a show code.  To me that is a waste of time and money.  Either work it or don't but do everyone a favor and don't half-a** it.  Those that are willing to only do it half way are the ones Im talking about.


----------



## medic417

Medic744 said:


> What I said was in essence unless my child has obvious signs of death then I would want them worked, not given up on or had a BS show code done on them.  When it comes down to it then the ones who are griping about cost of the code would be the ones to do a show code.  To me that is a waste of time and money.  Either work it or don't but do everyone a favor and don't half-a** it.  Those that are willing to only do it half way are the ones Im talking about.



Thanks for the clarification.  You scared me for a minute the way your other post read sounded like you wanted a show code.  Sorry for my misunderstanding.


----------



## Medic744

medic417 said:


> Thanks for the clarification.  You scared me for a minute the way your other post read sounded like you wanted a show code.  Sorry for my misunderstanding.



Its all good in the hood.  Mother or not I am still a reasonable/rational person.


----------



## NEMed2

I don't know anyone who wouldn't work ANY code, unless it was obvious the pt had passed (with the obvious exceptions).  Pedi calls are always emotional, even if we are the most calm and collected person on scene, they still have to deal with their emotions once the calm hits. If I'm on a basic & medic crew, the medic is calling the shots.  If it were me, we would work the code on the way to the hospital, l/s if necessary. A child deserves better treatment than just putting in enough effort to make the parents feel like you did something.


----------



## traumamama

Our nearest hospital is 60 miles away. Our medical director has said we can call them on scene and our protocol deals with all the s/s : lividity, ALS more than 20 minutes away, injuries incompatible with life, etc. To prolong it, take the baby away doing CPR like they do on tv only makes it harder on the family. It gives them a false sense that the baby will be ok because the calvary is here. The parents become your patient now and they need your comfort and support.


----------



## rescue99

You're right ..thanks for saying it.


----------



## traumamama

Some of my people had a hard time with it; especially on pedi calls. But once they thought about it long and hard they realized it was probably best. They can focus on the parents and other family members and what it is going to take to help them through all of this.


----------



## Melclin

*My posts always seem so long....*

If I may weigh in....h34r: 

There has been some research done here about how people consider paramedics, and why they call 000 (911). Also I have noticed these things myself in videos and through limited experience.

1. Parents/loved ones, should be connected with the process. Sending them into the other room (unless they are getting in the way) is not on. Separating them from their child in any way (such as driving off to hospital while show coding) appears to lead to profound feelings of helplessness and disconnects them with the dying process. They feel that everything possible was done if they actually see it being done. The importance of not separating a child and their parents is so much so that we are instructed to organise with police and coroner, to, if possible, transport parent holding baby to specific ED's where they gradually separate the two, and have counseling and general support at hand for the parents. Effectively, _they_ are the patient, not the child.  

2. If they are present during the resuscitation, the fact that their kid is dying is introduced slowly. There is no false hope. Starting CPR/ transporting only lends to a false sense of security, if it's medically unnecessary. People really do often feel that everything will be okay once the paramedics arrive, this is magnified by attempts at CPR, and further magnified by transportation (we forget how little the public knows about whats going on). It's a big shock if they leave the room when "their kid is sick" and help arrives and everything is ganna be alright, and they come back and their kid is dead and an even bigger shock if you transport and they get to the hospital expecting things to be alright and their kid/loved one is dead. It's questionable whether anything can really make the death of ones child _better_ but introducing the idea of death before the pronouncement appears to be marginally better for their long term psychological health. 

One of the conclusions of one of my lecturers PhDs was that people call 000, not necessarily when they feel there is a medical emergency that requires medical attention, but when they lose the ability to cope with the situation. As such its silly to approach this from a purely medical point of view and just say, "dead baby? PALS..end off story". Look into some of the reasons why the parents can't cope with the situation. 

*Their thinking is "baby isn't breathing, looks really sick, don't know what to do, call EMS". DEFINITELY NOT- "Baby isn't breathing, no pulse, I can do CPR, but my baby is essentially dead, need EMS for definitive airway control and ALS drugs but probability of good outcome still abysmal"*. It's significant because the difference between "looks really sick" and "actually dead" are quite different, and you have to facilitate the difficult transition in their minds. If that requires some sort of procedure or action that is not strictly medically necessary (but doesn't put anyone else in danger and doesn't give false hope) like continuing CPR for a little longer than is maybe medically necessary to give your partner a chance to tell the parents that the outcome is unlikely to be good and start that whole process, then that appears to be a good idea. However, actually attempting a full resuscitation algorithm on a kid in asystole, who's cold, pulseless, has lividity and rigor, and was last seen alive 8 hours ago is definitely counts as show coding.

EXAMPLE: I've know medics to work ped arrests that you could say were hopeless. The justification there is that the signs of death were present in part but they didn't want to make the decision not to start given the possibility of making an incorrect assessment due to the heated atmosphere of a kiddy code (the lividity might be a bruise, they were cold because there were under the A/C) and in the time it took for the more experienced and better trained MICA paramedics to arrive and make the final decision, it them a chance to prepare the parents and show them that everything was being done to help. That seems reasonable to me.


----------

