# When does a Paramedic not resuscitate a patient?



## RickVS (Apr 16, 2011)

I'm not in the field, but have a couple questions. If a paramedic goes to a scene where a victim just collapsed due to a coronary/choking/stroke, the paramedic I assume will attempt to bring the victim back. If a paramedic is called to a scene where the victim was decapitated by a piece of equipment, obviously there will be no attempt to resuscitate. So here are my questions: 1) where is the line drawn between the two above extremes as to when a paramedic needs to resuscitate a victim and when it is not necessary 2) can a paramedic declare somebody dead when it is obvious that they are truly dead and 3) does the paramedic have to keep resuscitating the victim all the way to the hospital or can they quit on scene at some point?

Thanks. I used to be a EMT-P 30 years ago, but I suppose a lot has changed.

Rick


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## NomadicMedic (Apr 16, 2011)

RickVS said:


> 1) where is the line drawn between the two above extremes as to when a paramedic needs to resuscitate a victim and when it is not necessary 2) can a paramedic declare somebody dead when it is obvious that they are truly dead and 3) does the paramedic have to keep resuscitating the victim all the way to the hospital or can they quit on scene at some point?



1) When the death is obvious. Any condition incompatible with life, such as decapitation.

2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.

3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.


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## MrBrown (Apr 16, 2011)

Our Ambulance Officers can decline commencment of resuscitation when it is either futile or not in the besr interests of the patient. eg end stage cancers, unwittnessed arrest with asystole as initial rhythm 

Sent from Brown's smartypants GTI-5580 Android using Tapatalk


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## IrightI (Apr 16, 2011)

n7lxi said:


> 1) When the death is obvious. Any condition incompatible with life, such as decapitation.
> 
> 2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.
> 
> 3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.



Couldnt have said it better myself.


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## DesertMedic66 (Apr 16, 2011)

n7lxi said:


> 1) When the death is obvious. Any condition incompatible with life, such as decapitation.
> 
> 2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.
> 
> 3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.



Same as #1. 
#2 EMTs and medics can declare death (at least in this area)
#3 It varies. Some codes we will transport and some we won't. It's a case by case thing


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## RickVS (Apr 16, 2011)

*Thanks for the info.*

Very helpful, everyone.

Rick


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## firecoins (Apr 16, 2011)

I won't resusitate anyone who has a perfusing pulse and is breathing on their own.  Just won't do it. Its not worth it.


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## ihalterman (Apr 16, 2011)

firecoins said:


> I won't resusitate anyone who has a perfusing pulse and is breathing on their own.  Just won't do it. Its not worth it.



Funny as hell, but I'm not sure it will help the OP.


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## MrBrown (Apr 16, 2011)

Ambulance Officers can choose not to resuscitate a patient when it is clinically futile (eg asystolic unwitnessed arrest) or not in the best interests of the patient, e.g. somebody dying from end stage cancer or with a clearly described directive.


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## medic417 (Apr 17, 2011)

So what law firm are you with and who are you trying to hang by getting blanket statements from people?


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## HotelCo (Apr 17, 2011)

n7lxi said:


> We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.



I transport most codes from a private residence with family on scene around here. I don't want to be left on scene with family who saw me stop doing CPR, with no PD. More of a 'scene safety' thing than anything.


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## HotelCo (Apr 17, 2011)

medic417 said:


> So what law firm are you with and who are you trying to hang by getting blanket statements from people?



Also... this.


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## Sasha (Apr 17, 2011)

medic417 said:


> So what law firm are you with and who are you trying to hang by getting blanket statements from people?



My thought exactly!


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## Sasha (Apr 17, 2011)

HotelCo said:


> I transport most codes from a private residence with family on scene around here. I don't want to be left on scene with family who saw me stop doing CPR, with no PD. More of a 'scene safety' thing than anything.



Man up and explain there's nothing that you can do. People will be grateful they can say their goodbyes in the comfort of home instead of the cold hospital room with the thought of a ridiculous, pointless bill in the back of their minds.


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## HotelCo (Apr 17, 2011)

Sasha said:


> Man up and explain there's nothing that you can do. People will be grateful they can say their goodbyes in the comfort of home instead of the cold hospital room with the thought of a ridiculous, pointless bill in the back of their minds.



You come deal with the people around here for a bit, and then we'll see if you still think that way. We've had medics attacked while helping the patient. I'm not about to have them see me stop helping, tell them that's that, and hope the gangbanger is calm enough to be rational.


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## DesertMedic66 (Apr 17, 2011)

HotelCo said:


> You come deal with the people around here for a bit, and then we'll see if you still think that way. We've had medics attacked while helping the patient. I'm not about to have them see me stop helping, tell them that's that, and hope the gangbanger is calm enough to be rational.



Same here.


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## usafmedic45 (Apr 17, 2011)

medic417 said:


> So what law firm are you with and who are you trying to hang by getting blanket statements from people?



LOL Nah, they'd go get the protocols of the service, the medical literature and an expert witness such as myself to hang the person(s) in question.


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## usalsfyre (Apr 17, 2011)

HotelCo said:


> You come deal with the people around here for a bit, and then we'll see if you still think that way. We've had medics attacked while helping the patient. I'm not about to have them see me stop helping, tell them that's that, and hope the gangbanger is calm enough to be rational.



I'm sorry, but this sounds like a copout. I've ceased efforts in the ghetto, and in the rural, rural backwoods. Never had a problem either way. As long as it's handled with compassion and discrestion most people understand.


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## HotelCo (Apr 17, 2011)

usalsfyre said:


> I'm sorry, but this sounds like a copout. I've ceased efforts in the ghetto, and in the rural, rural backwoods. Never had a problem either way. As long as it's handled with compassion and discrestion most people understand.



Think what you want. I do what I do based upon my experiences in the area I'm in.


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## Shishkabob (Apr 17, 2011)

n7lxi said:


> 1) When the death is obvious. Any condition incompatible with life, such as decapitation.
> 
> 2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.
> 
> 3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.



You may not, but I pronounce death, just the same as I make a diagnosis.   Now, I don't sign the death certificate... but that doesn't mean I'm not pronouncing.   In the end, it's my decision if a patient is worked or not, not some person elected to the position of JP who has no medical background whatsoever.


As for the OP, a Paramedic (or in some places, EMTs) can make the determination, aside from obvious injuries incompatible with life (such as decapitation), along with other signs not generally compatible with life, such as rigor mortis or dependent lividity.  

Sometimes it's a judgement call.  If you get called for a difficulty breathing and arrive to find the patient in cardiac arrest, you might work it.  If you get called for an auto-accident and find the patient in cardiac arrest, chances are you won't work it.


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## Veneficus (Apr 17, 2011)

HotelCo said:


> Think what you want. I do what I do based upon my experiences in the area I'm in.



I've been attacked while working the code, so I am guessing if the people are going to attack, it won't really matter what is being done or not.


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## usalsfyre (Apr 17, 2011)

HotelCo said:


> Think what you want. I do what I do based upon my experiences in the area I'm in.



We'll agree to disagree then. I don't know your specific circumstances. I can say in my area I've done death notifications(either ceasing resuscitation or not starting it at all) a few times a month for all age, socioeconomic and common racial groups and never run into a problem


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## HotelCo (Apr 17, 2011)

Veneficus said:


> I've been attacked while working the code, so I am guessing if the people are going to attack, it won't really matter what is being done or not.



We've had medics here attacked while helping patients as well. Why give them more reason to be upset? Throw em in the ambulance, call the hospital en route, and tell them what's going on. At that point, it's the doc's choice whether we continue working it, or not.



usalsfyre said:


> We'll agree to disagree then. I don't know your specific circumstances. I can say in my area I've done death notifications(either ceasing resuscitation or not starting it at all) a few times a month for all age, socioeconomic and common racial groups and never run into a problem



I've done the same, but I choose not to when I don't feel it'd be safe for me to do so. So, like you said, I suppose we'll agree to disagree.


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## Veneficus (Apr 17, 2011)

HotelCo said:


> We've had medics here attacked while helping patients as well. Why give them more reason to be upset? Throw em in the ambulance, call the hospital en route, and tell them what's going on. At that point, it's the doc's choice whether we continue working it, or not.



Sounds like a great plan to me. 

I have had the experience to throw people in the rig, drive a few blocks and then terminate efforts for the reason you described. 

When in Rome, do as the Romans do.


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## DrParasite (Apr 17, 2011)

HotelCo said:


> I transport most codes from a private residence with family on scene around here. I don't want to be left on scene with family who saw me stop doing CPR, with no PD. More of a 'scene safety' thing than anything.


seriously?  don't PD go to your possible DOAs?  it's an unattended death, it needs to be investigated by the police.  it's a law enforcement matter, PD needs to be there.  If nothing else, PD should be there to make sure the scene isn't disturbed until the detective can arrive.


HotelCo said:


> You come deal with the people around here for a bit, and then we'll see if you still think that way. We've had medics attacked while helping the patient. I'm not about to have them see me stop helping, tell them that's that, and hope the gangbanger is calm enough to be rational.


you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER?  wow.

We have had EMTs and medics attacked.  usually it's by EDPs, people under the influence, or people who don't want EMS there.  rarely is it by a bystander who doesn't like the way you are treating the patient (unless you are disrespecting them, which is why you should treat everyone with respect, especially in the public eye).

If you have a reason to transport a dead body (homie pulls out a gun and says "you will save my momma!!!"), then by all means do so.  

but in my experience, even in the ghetto, if the person is dead, and you treat them and the scene with respect, not even the homies will give you a problem.


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## HotelCo (Apr 17, 2011)

DrParasite said:


> seriously?  don't PD go to your possible DOAs?  it's an unattended death, it needs to be investigated by the police.  it's a law enforcement matter, PD needs to be there.  If nothing else, PD should be there to make sure the scene isn't disturbed until the detective can arrive.
> you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER?  wow.



You've never been to Detroit, have you? PD barely responds to 911 calls...



DrParasite said:


> you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER?  wow.


 Where did I say that? I'd rather they find out in a well-lit ER with PD, then them seeing me suddenly stop doing CPR in a back room, at night.



DrParasite said:


> We have had EMTs and medics attacked.  usually it's by EDPs, people under the influence, or people who don't want EMS there.  rarely is it by a bystander who doesn't like the way you are treating the patient (unless you are disrespecting them, which is why you should treat everyone with respect, especially in the public eye).


Glad it doesn't happen in your area.



DrParasite said:


> If you have a reason to transport a dead body (homie pulls out a gun and says "you will save my momma!!!"), then by all means do so.
> 
> but in my experience, even in the ghetto, if the person is dead, and you treat them and the scene with respect, not even the homies will give you a problem.


In your experience.


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## DesertMedic66 (Apr 17, 2011)

DrParasite said:


> seriously?  don't PD go to your possible DOAs?  it's an unattended death, it needs to be investigated by the police.  it's a law enforcement matter, PD needs to be there.  If nothing else, PD should be there to make sure the scene isn't disturbed until the detective can arrive.
> you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER?  wow.
> 
> We have had EMTs and medics attacked.  usually it's by EDPs, people under the influence, or people who don't want EMS there.  rarely is it by a bystander who doesn't like the way you are treating the patient (unless you are disrespecting them, which is why you should treat everyone with respect, especially in the public eye).
> ...



For DOA's we arrive first because it comes in as a medical call. Then once say time of death we call PD so they can do their investigation. 

Quiet a few people in this area don't want you to just arrive and say "we cant do anything" or start CPR and then stop. So it's just safer to transport and contact the ED and have them say what they want you to do. If there is odvious signs of death then I'll just call it on scene.


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## HotelCo (Apr 17, 2011)

firefite said:


> If there is odvious signs of death then I'll just call it on scene.



This


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## mycrofft (Apr 17, 2011)

*Dear OP,*

*When he is the Spawn of Satan*.


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## abckidsmom (Apr 17, 2011)

firefite said:


> For DOA's we arrive first because it comes in as a medical call. Then once say time of death we call PD so they can do their investigation.
> 
> Quiet a few people in this area don't want you to just arrive and say "we cant do anything" or start CPR and then stop. So it's just safer to transport and contact the ED and have them say what they want you to do. If there is odvious signs of death then I'll just call it on scene.



Just wondering...if you're working it just for the people, do you intubate and give all the drugs and everything?

I've been in a situation like you describe just a few times.  Our ghettos weren't quite as unfriendly, and our PD were all over the place.  I get it, but I wish people didn't have to live such lives of ignorance.


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## DesertMedic66 (Apr 17, 2011)

abckidsmom said:


> Just wondering...if you're working it just for the people, do you intubate and give all the drugs and everything?
> 
> I've been in a situation like you describe just a few times.  Our ghettos weren't quite as unfriendly, and our PD were all over the place.  I get it, but I wish people didn't have to live such lives of ignorance.



PD doesn't come unless we request them. After we call for them they can take up to 5 mins or over to arrive on scene. On those calls we arrive on scene and load them up quickly into the rig then call the ED and see if they want us to intubate, push meds, just do CPR, or nothing at all. From what I've seen basically everyone gets transported unless it's completely odvious they are dead.


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## DrParasite (Apr 17, 2011)

HotelCo said:


> You've never been to Detroit, have you? PD barely responds to 911 calls...


your right, I never have been.  I would imagine that PD still investigates possible homicides (which every unconscious is until proven otherwise).  I mean, they do respond to shootings right?  what about unsafe scenes, PD goes to them right?  I mean, you got a guy running around attacking people with a baseball bat, PD gets sent, not an ambulance right?  and if the scene isn't safe, than wait for PD, that's why units are supposed to stage.


HotelCo said:


> Where did I say that? I'd rather they find out in a well-lit ER with PD, then them seeing me suddenly stop doing CPR in a back room, at night.


so you would rather tie up an ambulance on an over burdened system (you do still get Detroit FD responding to cardiac arrests, right?), instead of leaving the dead body for the ME/funeral home to take away?  

Don't get me wrong, I know you guys don't have enough units to handle the volume, but transporting dead bodies because you are afraid of what the family would do (especially when you have all those FF's on scene with you) makes me think maybe they are unsafe scenes that PD should be sent to first.


HotelCo said:


> Glad it doesn't happen in your area.


your right, your agency does EMS in the most dangerous city in the US, my agency only does EMS in the 3rd most dangerous, two completely different places.

And learn something new every day, I though it was a standard practice to send a PD unit on any cardiac arrest because an unattended death needs to be investigated to rule out foul play.  I guess it's not in some parts of the US.


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## DesertMedic66 (Apr 18, 2011)

DrParasite said:


> your right, I never have been.  I would imagine that PD still investigates possible homicides (which every unconscious is until proven otherwise).  I mean, they do respond to shootings right?  what about unsafe scenes, PD goes to them right?  I mean, you got a guy running around attacking people with a baseball bat, PD gets sent, not an ambulance right?  and if the scene isn't safe, than wait for PD, that's why units are supposed to stage.
> so you would rather tie up an ambulance on an over burdened system (you do still get Detroit FD responding to cardiac arrests, right?), instead of leaving the dead body for the ME/funeral home to take away?
> 
> Don't get me wrong, I know you guys don't have enough units to handle the volume, but transporting dead bodies because you are afraid of what the family would do (especially when you have all those FF's on scene with you) makes me think maybe they are unsafe scenes that PD should be sent to first.
> ...



So you have never had a call where someone doesn't mention there is a gun in the house? What if someone starts getting aggressive while you are on scene of a Dif breather that goes into arrest. The police aren't going to be there. 

Firefighters are no good when someone pulls a gun or a knife or any weapon. 

For my area PD does not respond to deaths until we call then except for shooting and stabbings. 

We are famous for getting the "unknown medical aid". So we won't be able to tell if the scene is safe until we pull up.


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## the_negro_puppy (Apr 18, 2011)

We may declare life extinct:

After 20 minutes of resus effort with no ROSC
Patient presentation of at least ten minutes of pulseless and unresponsiveness with no CPR w/ asystole 2 leads.
Obvious death (rigor, lividity)
Inevitable death/injuries decapitated, cerebral destruction etc


I think it is poor practice to transport patients in cardiac arrest (unless extenuating circumstances) Not only is it difficult to attempt resus on a patient in the back of a moving vehicle, the public is also endangered by a lights and sirens drive that has a very poor prognosis.

Here we only transport if we have a ROSC or patient arrest enroute close to hospital.


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## DrParasite (Apr 18, 2011)

firefite said:


> So you have never had a call where someone doesn't mention there is a gun in the house?


well, if it's not mentioned, how would I know???  and I'm sure people have had guns in their house, but as long as you don't disrespect them, and do what you are supposed to do, 99% of the time they will not only let you do your job, but make sure no one else messes with you.  and how many times has a gun been pulled on me?  0.  I've also never been shot or shot at, something I am pretty happy with. 





firefite said:


> What if someone starts getting aggressive while you are on scene of a Dif breather that goes into arrest. The police aren't going to be there.


two things will happen. #1, as a general rule, any arrest that I witness gets worked all the way to the hospital.  hell, I work most witnessesed arrests, unless they show signs that they aren't coming back no matter what I do. #2, if someone starts getting aggressive, you either request police to respond immediately (if we do it, it is a city wide request for all available police officers, and they won't stop until they are advised that the situation is under control), or say screw the patient, take you and your partner out the door you came in, leave all your equipment (or use it as more stuff to throw in between the aggressor and yourself), run to the ambulance and drive away, and wait for PD to get there to make sure everyone behaves.  remember the whole scene safety thing?  taught day 2 of EMT class?  if it's not safe, leave and call for help.  not exactly rocket science.


firefite said:


> Firefighters are no good when someone pulls a gun or a knife or any weapon.


having 4 firefighting around you is a great deterant to having a knife or gun pulled on you.  once it's pulled, yeah, you are in a jam, but someone is much more likely to start something when it's just two EMTs who he or she can take easily, vs 2 EMTs and 4 firefighters, esp when the 4 firefighters are watching your back while you two are working on the patient.


firefite said:


> For my area PD does not respond to deaths until we call then except for shooting and stabbings.


interesting, maybe you should propose changes, for your own safety?


firefite said:


> We are famous for getting the "unknown medical aid". So we won't be able to tell if the scene is safe until we pull up.


yeah, we get them too.  you pull up find the scene is not safe, you leave until PD makes it safe.  not exactly rocket science here...


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## Smash (Apr 18, 2011)

mycrofft said:


> *When he is the Spawn of Satan*.



Hey, I'm just here you know!

Oh, sorry, thought you were my wife for a moment...


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## Smash (Apr 18, 2011)

I've ceased resus in pubs (bars for you lot) where these types of chaps drink 






And never had a problem.


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## STXmedic (Apr 18, 2011)

I've got to agree with that being a horrible excuse to transport an arrest. I work in the "getto" in a major city also, and I've worked and called plenty of arrests in not-so-nice parts of town. Worked on family of Mexican Mafia and Latin Kings and never once had a problem. Quite the opposite, they are usually very grateful you tried and understanding when you tell them their friend or family member didn't make it. If things do start escalating; talk them down or leave. And that pretty red button on top of the radio is a wonderful help in a tough spot  As far as guns, near every house we go into has guns, no matter what the socio-economic state of the area. I'm in Texas, I'd be worried if they DIDNT have a gun


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## HotelCo (Apr 18, 2011)

PoeticInjustice said:


> I've got to agree with that being a horrible excuse to transport an arrest. I work in the "getto" in a major city also, and I've worked and called plenty of arrests in not-so-nice parts of town. Worked on family of Mexican Mafia and Latin Kings and never once had a problem. Quite the opposite, they are usually very grateful you tried and understanding when you tell them their friend or family member didn't make it. If things do start escalating; talk them down or leave. And that pretty red button on top of the radio is a wonderful help in a tough spot  As far as guns, near every house we go into has guns, no matter what the socio-economic state of the area. I'm in Texas, I'd be worried if they DIDNT have a gun



Once again, I've explained my choice is based upon experiences in the area I work, and events that have occurred to other Paramedics in the area. I see no need to repeat myself after this post.

Also: Your red buttons work?


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## DesertMedic66 (Apr 18, 2011)

DrParasite said:


> well, if it's not mentioned, how would I know???  and I'm sure people have had guns in their house, but as long as you don't disrespect them, and do what you are supposed to do, 99% of the time they will not only let you do your job, but make sure no one else messes with you.  and how many times has a gun been pulled on me? 0.  I've also never been shot or shot at, something I am pretty happy with.



My point being that a scene can be more then it seems. Obviously your town is different then mine because people here don't say gun shot to the dispatcher. so PD has no reason to respond to a medical call (at least in this area unless we request them). Refusing to do CPR is a form of disrespect in some peoples eyes. I have been threated on scene with "save my momma or else you are the one thats gonna need to be saved". 



> two things will happen. #1, as a general rule, any arrest that I witness gets worked all the way to the hospital.  hell, I work most witnessesed arrests, unless they show signs that they aren't coming back no matter what I do. #2, if someone starts getting aggressive, you either request police to respond immediately (if we do it, it is a city wide request for all available police officers, and they won't stop until they are advised that the situation is under control), or say screw the patient, take you and your partner out the door you came in, leave all your equipment (or use it as more stuff to throw in between the aggressor and yourself), run to the ambulance and drive away, and wait for PD to get there to make sure everyone behaves.  remember the whole scene safety thing?  taught day 2 of EMT class?  if it's not safe, leave and call for help.  not exactly rocket science.



Yes that was taught in EMT class. But its not exactly easy to slip out of the house without anyone noticing you. let alone someone asking you what you are grabbing from your bag. and calling for PD while on scene???? down here that is asking for someone to try to kill you. (if we ask for assistance from police we normally get one or two units. we only have a total of 33 officers for a population of 40,000+).  



> having 4 firefighting around you is a great deterant to having a knife or gun pulled on you.  once it's pulled, yeah, you are in a jam, but someone is much more likely to start something when it's just two EMTs who he or she can take easily, vs 2 EMTs and 4 firefighters, esp when the 4 firefighters are watching your back while you two are working on the patient.



In an ideal world thats how it works. sometimes we cancel fire because they will have another call. and once again if someone wants to pull out a gun they will. 



> interesting, maybe you should propose changes, for your own safety?
> yeah, we get them too.  you pull up find the scene is not safe, you leave until PD makes it safe.  not exactly rocket science here...



uhhh im confused here. i said you wont know until you arrive on scene. and yeah i know its not rocket science.... i never said it was. You do things how you do them in your area and i will do them how we do them over here................... its not rocket science that our two areas are vastly different


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## STXmedic (Apr 18, 2011)

HotelCo said:


> Also: Your red buttons work?



Our red buttons work great! Especially since we have a decent concentration of PD in my area


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## HotelCo (Apr 18, 2011)

PoeticInjustice said:


> Our red buttons work great! Especially since we have a decent concentration of PD in my area



Our red buttons do a whole lot of nothing. They're not programmed. :angry:


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## DesertMedic66 (Apr 18, 2011)

HotelCo said:


> Our red buttons do a whole lot of nothing. They're not programmed. :angry:



Yep. They don't even go over the red buttons in orientation or anytime. For fire about 1/2 of their radios have working buttons. And police all of them are good to go.


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## medic417 (Apr 19, 2011)

What are these radios you speak of?  Is this some kind of black magic? 

City medics are spoiled.  Handheld will not reach the repeaters in my area, heck the truck radio doesn't reach it many places.


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## DesertMedic66 (Apr 19, 2011)

medic417 said:


> What are these radios you speak of?  Is this some kind of black magic?
> 
> City medics are spoiled.  Handheld will not reach the repeaters in my area, heck the truck radio doesn't reach it many places.



We have repeaters in the unit so it boosts the signal. Get too far away from the unit and well you won't be using them lol


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## DrParasite (Apr 20, 2011)

firefite said:


> My point being that a scene can be more then it seems. Obviously your town is different then mine because people here don't say gun shot to the dispatcher.


really?  you don't have people calling to report a shooting?  heck, once I took a 911 call from a person who said they were just shot in the abdomen.  was definitely a first for me. 





firefite said:


> so PD has no reason to respond to a medical call (at least in this area unless we request them). Refusing to do CPR is a form of disrespect in some peoples eyes. I have been threated on scene with "save my momma or else you are the one thats gonna need to be saved".


 and if that threat is made, than you work them, carry them out to the ambulance and transport.  I would do the exact same thing.  but I don't think refusing to do CPR on someone who is obviously dead is as big of an insult as you think, especially if you explain to the friends/family that there is nothing you can do.





firefite said:


> Yes that was taught in EMT class. But its not exactly easy to slip out of the house without anyone noticing you. let alone someone asking you what you are grabbing from your bag. and calling for PD while on scene???? down here that is asking for someone to try to kill you. (if we ask for assistance from police we normally get one or two units. we only have a total of 33 officers for a population of 40,000+).


I guess middle of nowhere California is a lot different than the inner city.  you don't always sneak out unnoticed, but if your safety is threatened, do what you need to do.





firefite said:


> In an ideal world thats how it works. sometimes we cancel fire because they will have another call. and once again if someone wants to pull out a gun they will.


so you have a cardiac arrest, which you work to the hospital because you fear for your safety, and you cancel the fire crew that is there to help you because they have another call?  why not just keep them there to do CPR, to help carry, and to watch your back?  sounds like poor judgement on your part.  or maybe you just don't want to get crap from the FD because you have to do do EMS and they don't want to.


firefite said:


> uhhh im confused here. i said you wont know until you arrive on scene. and yeah i know its not rocket science.... i never said it was. You do things how you do them in your area and i will do them how we do them over here................... its not rocket science that our two areas are vastly different


hmmm, I have never been afraid for my life when working a cardiac arrest (well, outside of a traumatic arrest where the trauma was still flying and we got caught in the middle of it), and I have never cancelled another resource when I needed them to make sure I was safe, regardless of what was happening.  Plus, you work in the middle of nowhere California, and I work in an urban ghetto, one ranked in the top 25 most dangerous cities in the US.

I guess your right, our areas are vastly different.


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## DesertMedic66 (Apr 20, 2011)

DrParasite said:


> really?  you don't have people calling to report a shooting?  heck, once I took a 911 call from a person who said they were just shot in the abdomen.  was definitely a first for me.  and if that threat is made, than you work them, carry them out to the ambulance and transport.  I would do the exact same thing.  but I don't think refusing to do CPR on someone who is obviously dead is as big of an insult as you think, especially if you explain to the friends/family that there is nothing you can do.I guess middle of nowhere California is a lot different than the inner city.  you don't always sneak out unnoticed, but if your safety is threatened, do what you need to do.so you have a cardiac arrest, which you work to the hospital because you fear for your safety, and you cancel the fire crew that is there to help you because they have another call?  why not just keep them there to do CPR, to help carry, and to watch your back?  sounds like poor judgement on your part.  or maybe you just don't want to get crap from the FD because you have to do do EMS and they don't want to.
> hmmm, I have never been afraid for my life when working a cardiac arrest (well, outside of a traumatic arrest where the trauma was still flying and we got caught in the middle of it), and I have never cancelled another resource when I needed them to make sure I was safe, regardless of what was happening.  Plus, you work in the middle of nowhere California, and I work in an urban ghetto, one ranked in the top 25 most dangerous cities in the US.
> 
> I guess your right, our areas are vastly different.



I clearly said "sometimes we cancel fire". If it's an arrest then no we don't cancel them. The fire medic will normally hop in the back of the rig. But if we arrive on scene first for a broken leg then yes we will cancel fire. We have one ambulance for the city and the next city over has 2 ambulances (one medic unit and one BLS). So if we keep fire on scene for a call that two EMS workers can handle easily then what's the point of keeping fire there? It's literally a waste of time for them. They let EMS take over when we arrive on scene and they can't leave until they get cleared by us. Hmmmmmmm having them sitting on the engine talking or having them cleared so that they can run to another medical call. That's a simple choice for me. 
If I feel unsafe then I will do what I have to. If that means working an arrest and say we are going to the hospital then that's what I am going to do. My safety comes before anything.


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## DrParasite (Apr 21, 2011)

firefite said:


> I clearly said "sometimes we cancel fire". If it's an arrest then no we don't cancel them.


the thread topic is about Paramedic's and not resuscitating patients.  That implies that all content (except when expressly noted) is about the thread topic.

since you are not staying on topic, I am going to just leave you with your own thoughts, since further discussion will not get either of us anywhere


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