# why give false hope



## Flightorbust (Nov 15, 2011)

Ok so Ill warn you now this is a bit of a vent thread. But last time I did a clinical in the ER we have an ambulance come in. The medic came rolling in with a 6 month old baby. The first thing I thought while taking over compressions is this kids dead. I saw what looked like dependent lividity. I then heard some one mention rigor. The whole time were working this kid the mom is in the doorway hoping that we can do something. You could see the hope on her face. While doing compressions I wasnt putting out a femoral pulse so someone took over. I didnt find a femoral pulse on the child when eather when he was doing the compressions. But why pull a :censored::censored::censored::censored::censored: move like that. Why give false hope? Your looking at 2 signs of obviouse death (Rigor and the lividity) and you still run it. GROW SOME BALLS, and tell the parents instead of making it worsw on them.


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## Sasha (Nov 15, 2011)

Because the medics are too cowardly to say "I'm sorry, there's nothing we can do."


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## abckidsmom (Nov 15, 2011)

I taught PALS this weekend to some providers who were on their upteenth recert.  To shake it up a little, we included telling the aprents the baby died in the scenario.  We included calling resources for the parents, and dealing with the repercussions of good and bad word choice.

It was one of the coolest exercises I've ever done in a merit badge class.  There was actual learning, and pushing outside of the comfort zone for people who did not want to be there at all initially.  Very rewarding.

Me personally, one of the things I like to do the most is tell people that their loved one has died.  Not because I like that they died, but because I like being as gentle yet honest as possible with bad news.  It is satisfying to know that even in a completely sucktastic situation, somebody was totally on the team of the family, and was taking good care of them.


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## JPINFV (Nov 15, 2011)

Sasha said:


> Because the medics are too cowardly to say "I'm sorry, there's nothing we can do."




How much training, education, and experience does the average medic have with death notifications?


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## abckidsmom (Nov 15, 2011)

JPINFV said:


> How much training, education, and experience does the average medic have with death notifications?



In my experience, none.  Everything I know about the subject I learned in nursing school or working alongside my mom when I was growing up.  She likes to help people in our community (small town friends) when the time comes that they need hospice.  I have been around dying people intermittently all my life.


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## Flightorbust (Nov 15, 2011)

So am I wrong for being pissed that this was even ran? I mean its bad enough that the police have to come and question the parents and do an autopsy since the death was unattended. But then making the parents watch there child poked with needle's, intubated and CPR done. I will say this was my first death. That doesnt bother me. I can deal with that just fine. Or am I getting mad as my way of compensating.


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## abckidsmom (Nov 15, 2011)

Flightorbust said:


> So am I wrong for being pissed that this was even ran? I mean its bad enough that the police have to come and question the parents and do an autopsy since the death was unattended. But then making the parents watch there child poked with needle's, intubated and CPR done. I will say this was my first death. That doesnt bother me. I can deal with that just fine. Or am I getting mad as my way of compensating.



Maybe a little.  

If they weren't comfortable telling the mom, and dealing with whatever she asked or said, then they might have said a million hurtful things that would have stuck with that woman forever.  Whenever she thought about her baby, she might hear the struggling medic say, "There's a purpose in this, you can always have another baby" or some other BS that could uproot her whole greiving process.

Is there real harm knowing that people who wanted to help, tried to help, did their best, and failed to resuscitate the baby?  Not really.  It just delays the inevitable notification, and puts the mom in a place where there are chaplains and pediatricians and plenty of staff to help her when she gets the news.

But yeah, I get pissed in the face of ignorance too.  It's tough to see something done the total opposite of the way you would have done it, and see pain added to the situation as a result.


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## NomadicMedic (Nov 15, 2011)

I think, in your heart of hearts, you know it was wrong. If the child had dependent lividity and rigor then the medics never should've ran that code. Instead, they should have been compassionate caregivers to the family. As some of the other posters have mentioned, a lot of medics have a very difficult time in saying the words "your loved one has died".


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## Flightorbust (Nov 15, 2011)

abckidsmom said:


> Is there real harm knowing that people who wanted to help, tried to help, did their best, and failed to resuscitate the baby?  Not really.  It just delays the inevitable notification, and puts the mom in a place where there are chaplains and pediatricians and plenty of staff to help her when she gets the news.
> .



Yes I feel there is. How much damage was done with false hope. You take some one who is already low, Bring them up only to drop them even lower. Then add the medical bills that the family will incur in this economy


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## Fish (Nov 15, 2011)

Flightorbust said:


> Ok so Ill warn you now this is a bit of a vent thread. But last time I did a clinical in the ER we have an ambulance come in. The medic came rolling in with a 6 month old baby. The first thing I thought while taking over compressions is this kids dead. I saw what looked like dependent lividity. I then heard some one mention rigor. The whole time were working this kid the mom is in the doorway hoping that we can do something. You could see the hope on her face. While doing compressions I wasnt putting out a femoral pulse so someone took over. I didnt find a femoral pulse on the child when eather when he was doing the compressions. But why pull a :censored::censored::censored::censored::censored: move like that. Why give false hope? Your looking at 2 signs of obviouse death (Rigor and the lividity) and you still run it. GROW SOME BALLS, and tell the parents instead of making it worsw on them.



You don't transport dead people, no matter the age. You inform the family on scene that their loved one has died, and once you have expressed your empathy and done all you can for them(which is limited since EMS is not in the business of grief counceling) you hand it over to the appropriate resources on scene. PD has a mobel Mental health/Grief Counceling team.


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## Flightorbust (Nov 15, 2011)

I just want to thank you guys. If nothing else youve validated my feelings of being pissed and thats helped.


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## SSwain (Nov 16, 2011)

As a current EMT-B student, and a father of two kids....what would be the best way to tell the parents their baby has died?
I want to know from both sides of this issue...how do you say it? and how will it be heard?


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## NomadicMedic (Nov 16, 2011)

You can't cover it up with any  euphemisms. You can't say things like "passed" or "no longer here". You have to be straightforward. I'll look them in the eyes, hold their hand, and tell them that their child has died. I'm a father too, and I can imagine the incredible pain and anguish that they feel. However, you need to make sure that they hear you and that they know that it's final, and that there was nothing anyone could do. And then, I'll sit with them, cry with them, whatever ... The way that each individual medic deals with this is different, but you need to do what works for you.


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## systemet (Nov 16, 2011)

I would try not to be too harsh on that crew.  These calls are very stressful, and sometimes people take the easy way out and run to the hospital.  I'm not saying that this is right.  In fact, I'll emphatically state that it's the wrong decision, and when it's done with the intent of avoiding giving a death notification, outright cowardly.  But these are never easy situations.

In some situations the crew is confronted with a volatile scene, without adequate law enforcement resources, and simply has to deal with what they given.  This also becomes very complicated when one of the parents has murdered the child.

I would make sure that you're angry because you perceive that the crew didn't act in the best interests of the mother, not simply because you wouldn't have had to deal with the situation if they had called it on scene.  They're not responsible for the kid being dead.

I was always taught to be as professional as possible, try and get everyone in one place, work out who the parent(s) are, be gentle with the news but use the word "dead", and be prepared for reactions ranging from nothing to anger directed at me.  I was also told, you can't make the situation better, only worse.  So try not to make it too much worse.  Don't take any negative reactions from the family personally.  It's the worst day of their lives.  

The best you're going to accomplish here is leaving the impression that you were professional, thorough, polite and demonstrated some empathy.  The parents are probably still going to hate you for the rest of their lives, just because you were there when their kid died.  That's ok, just don't give them any more reasons.


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## ah2388 (Nov 16, 2011)

Since I started in EMS a year and a half ago, I have always said to myself, that I hope I have the strength to perform the actions you've advocated for.

It's definitely the right thing.


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## BigBad (Nov 16, 2011)

*Have some heart*

Yes Obvious signs of death.  But 6 months old, new mother?   Sometimes it's more for the mother than anything else to let her see the process that even the ER could do nothing.  Has no regard to "grow some balls"  

Where I work we are never dinged for transporting a dead kid.   Our medical directors and doctors all "get it"


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## lawndartcatcher (Nov 16, 2011)

This is why:

http://www.boston.com/news/local/breaking_news/2009/06/two_new_bedford_1.html

Providers (ALS and BLS) are taught that you work the hopeless pediatric code for the parents. Take a moment to think for a second: You're a parent, and your entire world has just come crashing to a screeching halt when you find your child lifeless. You call 911 because, like it or not, we're the people that are supposed to know what to do. How would you feel if a couple of paramedics walked in, looked down at your (dead) child, and said "Sorry, there's nothing we can do. By the way, get ready for a whole bunch of police and the medical examiner to come in to your house, ask you to re-hash the most terrible event that will ever happen to you again and again, and not even leave you with one physical location that feels safe (since that's going to be where their "baby died")." 

If you say "sorry, he's dead" that's it. They didn't get to say goodbye, the room where their child lived is (probably) also the room where their child died, and nothing is ever going to expunge their guilt and anger. Worse, you (and our entire profession) may become the target of all of that anger - "Why didn't you help our baby? Why did you let him die?". Regardless of the fact that the child was dead before you got there you're going to be looked at as the monster who "wouldn't save our baby". (Not "couldn't"; "wouldn't"). 

No parent wants to see their child stuffed full with tubes and wired like a Christmas tree, but no parent wants to see their child sick or dead, either. If you work the child it a) gets the child out of the house ("The child later died at Rampart General hospital..."), b) it looks like you tried everything you could, and c) it gets the parents into a physical location (the hospital) that's got the kind of support help they'll need. It won't help every parent but it's a start.


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## Sasha (Nov 16, 2011)

Or, you could allow them to spend a few quiet moments with the child, saying their goodbyes, instead of ripping their child from them in a fruitless attempt to revive them and stuffing them full of tubes and wires and playing with the mother's emotions by giving her a sense of hope and sticking them with a ridiculous bill.


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## abckidsmom (Nov 16, 2011)

lawndartcatcher said:


> This is why:
> 
> http://www.boston.com/news/local/breaking_news/2009/06/two_new_bedford_1.html
> 
> ...



You said this so well.  

Working the arrest "for the parents" is not always the right thing to do, but I just do not believe that the majority of medics or crews out there have the skills necessary to get the parents through this event without saying something exceptionally hurtful and stupid.

Speaking now as a parent who has experienced loss, I will say that the insensitive thing you say in this situation is magnified and NEVER FORGOTTEN.  I am a forgiving person, and I try to forget, but it just doesn't go away.  When I think of that time, I remember what that doctor said.  

I think that this knowlede should lead you into being cautious, but still comforting.  Do not EVER think that you can fix it, or make it better for the parents by what you say.  In the heat of the moment, anything other than appropriate sympathy and practical help is running the risk of trying to "fix it" with words.

In my experience, guys especially are oblivious to this "fixing" that happens.  It's really important that you (general you) think these things through beforehand to know what not to say to the family.


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## abckidsmom (Nov 16, 2011)

Sasha said:


> Or, you could allow them to spend a few quiet moments with the child, saying their goodbyes, instead of ripping their child from them in a fruitless attempt to revive them and stuffing them full of tubes and wires and playing with the mother's emotions by giving her a sense of hope and sticking them with a ridiculous bill.



Sasha, I agree with you on this, but I really believe that the majority of people in this field do not have the skills needed to let this happen in the peaceful way you describe.  It is not something that is taught, and does not come naturally to everyone.


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## hippocratical (Nov 16, 2011)

I was taught to start CPR unless there are major obvious signs of death (DRIED), and if in any doubt, then start CPR.

I believe the idea is:
1) CYA 
2) To make the parents think that we at least tried.

I've never been in that situation (hope not too) but I can see that unless it was overwhelmingly obviously a very long dead child, then I'd probably start too. Not an easy one...


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## JPINFV (Nov 16, 2011)

lawndartcatcher said:


> This is why:
> 
> http://www.boston.com/news/local/breaking_news/2009/06/two_new_bedford_1.html
> 
> ...




So, rushing them to the hospital with lights and sirens (an act which puts everyone else on the road at risk, but especially puts the ambulance crews at risk), wasting the time of many members of the ED staff (who could be treating patients instead of a corpse), and forcing the parents to move to a highly active and unfamiliar place is better? Furthermore, who says that the family is going to have the ability to "say goodbye" in the ED? The staff isn't going to keep running a code because the family is 5 minutes away from even parking so that they have a chance to say "good bye."


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## JPINFV (Nov 16, 2011)

hippocratical said:


> I was taught to start CPR unless there are major obvious signs of death (DRIED), and if in any doubt, then start CPR.
> 
> I believe the idea is:
> 1) CYA
> ...




CPR can always be stopped by trained professionals. So i guess the question is, are paramedics trained professionals or just protocol monkeys?


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## JPINFV (Nov 16, 2011)

abckidsmom said:


> Sasha, I agree with you on this, but I really believe that the majority of people in this field do not have the skills needed to let this happen in the peaceful way you describe.  It is not something that is taught, and does not come naturally to everyone.




Well, of course it's not taught. We have to be able to package the foundation level (EMT) into a 2 week accelerated course.   ...but hey, remember that 2 week accelerated course meets the national standard, so it must be ok!


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## Shishkabob (Nov 16, 2011)

Before you get pissed look at their protocols.   Some agencies don't allow field pronouncements, and even some that do don't allow pedi pronouncements...


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## JPINFV (Nov 16, 2011)

Linuss said:


> Before you get pissed look at their protocols.   Some agencies don't allow field pronouncements, and even some that do don't allow pedi pronouncements...




Can I still get pissed at both who ever wrote the protocols?

/hates the 'superior orders' argument.
//Protocols that prevent field pronouncements means either the crews are too stupid to make sure dead people are dead, the local system is too lazy to actually train their providers in appropriate after death care, or both.


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## Shishkabob (Nov 16, 2011)

I agree it's stupid to not have them, and I've done my fair share of pronouncements and "No, there is nothing else that can be done" in my short career... 


But depending on the agency's culture, variation from protocol via med control might not be allowed.   



Not a fan of it, but you can't fault people for their agency's issues.


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## Flightorbust (Nov 16, 2011)

lawndartcatcher said:


> This is why:
> 
> http://www.boston.com/news/local/breaking_news/2009/06/two_new_bedford_1.html
> 
> ...


The article says they didnt do what a good analysis to make sure the child was dead. Obvious signs of death here are enough for a basic to call death.



Sasha said:


> Or, you could allow them to spend a few quiet moments with the child, saying their goodbyes, instead of ripping their child from them in a fruitless attempt to revive them and stuffing them full of tubes and wires and playing with the mother's emotions by giving her a sense of hope and sticking them with a ridiculous bill.


This is my point here.


abckidsmom said:


> You said this so well.
> 
> Working the arrest "for the parents" is not always the right thing to do, but I just do not believe that the majority of medics or crews out there have the skills necessary to get the parents through this event without saying something exceptionally hurtful and stupid.
> 
> ...


I agree that alot of people cant do it. I believe its something that should be taught. I know the person that was my instructor last time had always told us not to give the false hope. If some one asks if some one is going to be ok the normal responce is "were doing everything we can". Why would this be different. You dont give false hope and lie to make things look better then they are Also I want to point out that while "guys" may be oblivious it may have been a female medic that ran it.


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## systemet (Nov 17, 2011)

lawndartcatcher said:


> This is why:
> 
> http://www.boston.com/news/local/breaking_news/2009/06/two_new_bedford_1.html



No it's not.

* This is why you don't decide not to start resuscitation without assessing the patient properly

* This is why you don't decide not to start resuscitation, then piss off PD by removing a corpse from a potential crime scene, and piss off the hospital by bringing them a corpse like they're some sort of funeral home.

This situation does present an argument against not initiating futile resucitations when signs of obvious death are present, nor does it argue against calling a resuscitation after 15 minutes of asystole.  It argues against not doing your job properly.  



> Providers (ALS and BLS) are taught that you work the hopeless pediatric code for the parents.



This is not universal.  In some areas providers are taught that it's in the parent's best interest not to start a futile resuscitation, and to call it in the home.  

Which is the best approach seems to be a matter for debate.  Perhaps someone here has a psychology/counselling background and can tell us what the relevant literature states?



> Take a moment to think for a second: You're a parent, and your entire world has just come crashing to a screeching halt when you find your child lifeless. You call 911 because, like it or not, we're the people that are supposed to know what to do. How would you feel if a couple of paramedics walked in, looked down at your (dead) child, and said "Sorry, there's nothing we can do.



Pretty much exactly the same as how I would feel if they came in, rushed my kid to the hospital, and I got there to find their lifeless body on a stretcher with a bunch of doctors and nurses around, and some jackass in a white coat told me "Sorry, there just wasn't anything we could do".  

I think I'd feel numb, then hungry, then want to get drunk, and probably spend a day or two considering suicide, then I'd remember that my wife is currently pregnant and that I have responsibility to my future unborn second child.  I'd probably keep drinking too much for a little while, but then I'd tone it down before the baby was born.  I'd also probably pick up my gloves, go down to the gym, hit people and get hit for a little bit, too.  

And it would be the worst thing that ever happened to me, and I'd remember it for the rest of my life.



> By the way, get ready for a whole bunch of police and the medical examiner to come in to your house, ask you to re-hash the most terrible event that will ever happen to you again and again,



Which is going to happen anyway.



> and not even leave you with one physical location that feels safe (since that's going to be where their "baby died")."



Like I would ever walk into that room again, and not be reminded of my dead child.



> If you say "sorry, he's dead" that's it. They didn't get to say goodbye,



Calling the code in the home doesn't preclude the parents getting to say goodbye.  It just means it's done in a different place.  Unless there are clear signs of a violent act, they're going to get to hold the child and have some time if I call it in the house.



> the room where their child lived is (probably) also the room where their child died, and nothing is ever going to expunge their guilt and anger.



It's still going to be -- and possibly nothing is.  Do you really think they're going to feel less guilty or less angry because you've moved the baby to the hospital, done some CPR and given some drugs?  I think you're overestimating the potential impact we have on this situation.



> Worse, you (and our entire profession) may become the target of all of that anger - "Why didn't you help our baby? Why did you let him die?".



That's not worse.  It's utterly trivial.  The parents are going to be angry.  They're going to find somewhere to place blame.  If they choose to place it on me, that's fine.  Nothing is going to make their child come back, and as hard as it might be for you or me to endure, sometimes we get paid to have people dump on us for things we don't deserve.



> Regardless of the fact that the child was dead before you got there you're going to be looked at as the monster who "wouldn't save our baby". (Not "couldn't"; "wouldn't").



If that happens, and they actually think I "wouldn't save their baby", not that I was the one who told them "their baby was dead", then I've failed somewhere in explaining to them what's happened, and what's going on, which is a vital part of doing this.

The majority of the time it's not going to happen like this.  And when it does, you just have to fall back on the fact that you followed your training and your medical control guidelines.  




> No parent wants to see their child stuffed full with tubes and wired like a Christmas tree, but no parent wants to see their child sick or dead, either.



Agreed.



> If you work the child it a) gets the child out of the house ("The child later died at Rampart General hospital...")



Which saves you and me from having to deal with the parents, but passes that responsibility on to someone else.  It draws out the process, and changes where the parents are when they're told the kid's dead, which they probably already suspect.



> , b) it looks like you tried everything you could, and



It does.  But so does doing a proper examination of the child, finding obvious signs of death, and explaining to the parents that there's nothing you can do.

Running the asystolic arrest for 15' in the child's bedroom then calling OLMC, or d/c'ing based on protocol achieves the same.  But we should only do this in the absence of criteria for obvious death.



> c) it gets the parents into a physical location (the hospital) that's got the kind of support help they'll need. It won't help every parent but it's a start.



But those resources can be brought to the patient outside of the hospital, just as they are in other out-of-hospital arrest.  

By this logic, when I treated a 48 year old man who had a witnessed SCA in front of his wife and 3 kids, I should have run him to the hospital, instead of running the asystole protocol for 20 minutes and calling it.  Are we back to transporting all cardiac arrests, or just kids?  [I recognise that this borders on a "slippery slope" fallacy, but consider the reasoning]

The reality here, is that some parents are going to be ok with the resuscitation either not being started or being called in the house.  If you ask them afterwards, they won't mind.  Some are going to wish you'd taken the child to the hospital, even if it was futile.  The opposite is true as well -- some parents will be glad you took the child to the hospital, even if futile.  Others would wish that you hadn't.

Ultimately what you do in this situation is going to be decided by your regional medical control guidelines, and the reaction of the parents is going to depend on individual circumstances and the personalities involved.


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## Seaglass (Nov 17, 2011)

There's only one circumstance where I'd consider working an obvious death. If someone pulls a gun on us and demands we try to save the patient, I might work it for the sake of getting us into the ambulance and out of that situation. (PD comes to all of our codes, but we often arrive first, and bad stuff happens quickly.) 

So far, I've never had to do that. I'm good at talking people down, but if anything ever gets a family member so upset that I can't reach them, it may well be a dead baby.


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## systemet (Nov 17, 2011)

I just want to add to what I wrote above ---- this is my opinion.  It was what I was taught, and it was how we practiced in the area I worked in.  We were told that there was evidence to support this, and that this was in the best interests of the surviving family.  I have never looked for the primary research.  I'm not sure I would even know how to evaluate it, as it's so far out of my area of expertise.

If other people have been taught differently, I can respect that.  I don't think we're necessarily going to agree, but as long as all of us are doing what we perceive to be in the best interests of the family whoever's getting it wrong can rest in the comfort that at least they did what they did for the best reasons.

All the best.


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## medicnick83 (Nov 17, 2011)

I also just want to add, that besides obvious DOA's - if a person is being resus'd or such and the patient has passed away while on route to hospital, it's best to let the doctors deal with giving the bad news or (and I've seen this) we get involved in the emotional side of things and it's not a good thing.


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## systemet (Nov 17, 2011)

medicnick83 said:


> I also just want to add, that besides obvious DOA's - if a person is being resus'd or such and the patient has passed away while on route to hospital, it's best to let the doctors deal with giving the bad news or (and I've seen this) we get involved in the emotional side of things and it's not a good thing.



To add to this, in some places you may have difficulty finding somewhere to take your patient if you stop resuscitation in the ambulance.  If you're on scene at a crime, once resuscitation stops there's a good chance the police will want the ambulance and body to stay, and consider it part of their scene.  If you roll up to the hospital and say, "We'd like you to put this guy on the bed in the trauma room, then throw them in the morgue when you've got a bit of time", they may not be too accomodating!


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## bigdogems (Nov 17, 2011)

Funny. Im probably one of the most straight forward, non emotional, and often look at as one of the "least caring" at my work. Now this is mostly because I have an acceptance of death and there are plenty of times that there is nothing we can do. However, Im going to have to go against almost everyone here.... First of all. You weren't on scene so be careful to judge. Now if there were obvious signs of death yes it could have been called and nobody would have questioned the crew. I'm guessing one of two things happened. Either it was a pedi code and they got tunnel vision. Or hopefully in the other possibility. They were actually thinking of the family. Transporting wont make things worse for the family. It will give them comfort. In your opinion the parents will put more blame on themselves because they will think they let their baby die and didnt even know it. Now as far as Im concerned you could even stop CPR during transport and let the ER know whats going on. This at least gives the parents and bystanders the impression that everything possible was done to save their baby.


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## Shishkabob (Nov 17, 2011)

Except for the fact that taking a CPR to a hospital means another bill being stacked on the family.


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## bigdogems (Nov 17, 2011)

Linuss said:


> Except for the fact that taking a CPR to a hospital means another bill being stacked on the family.



I do completely agree with that one


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## Flightorbust (Nov 17, 2011)

I brought up this call in class. The entire class turned on me. The mothers in the class said that they would rather have the bill and know everything was done that could be. Personaly I still believe you shouldnt run an obvious death. I dont care who it is. But thats just me.


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## JPINFV (Nov 17, 2011)

So... basically your class has absolutely no idea how medicine works. CPR, defibrillation, drugs, etc doesn't care whether it's an EMS provider doing it or an RN and techs doing it under direct order from a physician. Besides, no one has yet explained how transport changes the outcome in patients who do not have ROSC.


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## Flightorbust (Nov 17, 2011)

JPINFV said:


> So... basically your class has absolutely no idea how medicine works. CPR, defibrillation, drugs, etc doesn't care whether it's an EMS provider doing it or an RN and techs doing it under direct order from a physician. Besides, no one has yet explained how transport changes the outcome in patients who do not have ROSC.



most of them no. There are a couple that work in the hospital, 1 in the ER. Most of them just see that its a kid and then think of there kids. Its sad tho that were almost done with the class and up to this point we really havent even touched on dead bodies in the field.....oh how I miss my old instructor lol


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## abckidsmom (Nov 17, 2011)

Flightorbust said:


> I brought up this call in class. The entire class turned on me. The mothers in the class said that they would rather have the bill and know everything was done that could be. Personaly I still believe you shouldnt run an obvious death. I dont care who it is. But thats just me.



I'm agreeing with JP that the mothers your class don't understand the way that medicine works, and there is no difference between ACLS in the field and ACLS in the hospital.

Besides, if it doesn't happen in the first 10 minutes, it doesn't matter anyway.

I just would rather not be in the care of people who don't know what to do and say when dealing with a bereft family.  I cannot overstate how hurtful it is as a parent to have a healthcare provider say all the wrong things during a time of loss.

I would always back up the people who transport the baby as an attempt to make sure they are not the ones who have to relay the bad news because they are not up to the task.


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## Shishkabob (Nov 17, 2011)

Flightorbust said:


> I brought up this call in class. The entire class turned on me. The mothers in the class said that they would rather have the bill and know everything was done that could be. Personaly I still believe you shouldnt run an obvious death. I dont care who it is. But thats just me.



I, as a Paramedic, can do EVERYTHING a physician can in a medical cardiac arrest.  



Not going to waste the gas, time, energy, or public's life/safety rushing a body to the hospital when I've already done everything they will, short of calling it, which I too, can do in the field.


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## JPINFV (Nov 17, 2011)

In other news, 3 paramedics and 2 civilians died as an ambulance going code 3 crashed into a car while the crew was senselessly flogging a dead baby for the sake of the parents.


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## Flightorbust (Nov 17, 2011)

Linuss said:


> , short of calling it, which I too, can do in the field.



Here a basic can call it if there are obvious signs of death.


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## JPINFV (Nov 17, 2011)

Flightorbust said:


> Here a basic can call it if there are obvious signs of death.



Arguably no pulse and multiple rounds of "do not shock" from the AED.


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## Tigger (Nov 18, 2011)

Linuss said:


> I, as a Paramedic, can do EVERYTHING a physician can in a medical cardiac arrest.
> 
> 
> 
> Not going to waste the gas, time, energy, or public's life/safety rushing a body to the hospital when I've already done everything they will, short of calling it, which I too, can do in the field.



Can you put in a central line? 

Mind you transporting a code so that they can get a central line is some pretty bad reasoning, and it's almost certainly a futile effort, but I am not aware of a lot of ground-based providers that are currently doing this.


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## JPINFV (Nov 18, 2011)

Tigger said:


> Can you put in a central line?
> 
> Mind you transporting a code so that they can get a central line is some pretty bad reasoning, and it's almost certainly a futile effort, but I am not aware of a lot of ground-based providers that are currently doing this.




How many medical codes have you seen where the physician put in a central line?

Now, how many of those were codes brought into the ED in arrest by EMS?


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## Tigger (Nov 18, 2011)

JPINFV said:


> How many medical codes have you seen where the physician put in a central line?
> 
> Now, how many of those were codes brought into the ED in arrest by EMS?



One, and it was brought in by EMS. I understand it is not the norm however, and the whole thing was a mess. Guy walked into a fire station, dropped, was worked for 20 minutes, pulse obtained, transported, coded enroute, and was then worked for two *hours* in the ER. In the the ER he was shocked 12 times and received at least that many doses of epi, and after the doc finally decided to call it the next time he crashed, wouldn't you know he didn't and he was transferred to the ICU where he died the next day, unsurprisingly. 

The whole time I couldn't help wonder what the heck we were doing with this guy. The flat line was appearing on the monitor with too much frequency to equal survival.


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## Shishkabob (Nov 18, 2011)

If you want to go that route, yes, there are Paramedics who are able to do central lines.  However, in a medical arrest, an IO is just dandy.



There is, however, an exception to transporting an arrest:  My agency and a local cath center are doing a trial where persistant Vfibs, after exhausting all other methods in the field, are transported, non-priority with a Lucas device, to the cath lab where they do a cath.  Apparently it's showing good results for things such as coronary lesions.


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## usafmedic45 (Nov 18, 2011)

> Why give false hope?





> Because the medics are too cowardly to say "I'm sorry, there's nothing we can do."



Both of these comments could more or less be perfectly applied to a lot of threads on this forum, especially with regards to people failing exams and such. 



> Not a fan of it, but you can't fault people for their agency's issues.



No, but on more than one occasion I circumvented protocol by pointing out that moving an obviously dead body is a felony in most states as is interfering with a coroner's investigation of said dead body.  I can tell you from working that side of the equation that nothing makes a dead baby investigation more confusing that overzealous transport and the associated disruption of the crime scene.


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## usafmedic45 (Nov 18, 2011)

> Apparently it's showing good results for things such as coronary lesions.



Nothing like a well-perfused myocardium and hypoxic encephalopathy to make for good results.


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## JPINFV (Nov 18, 2011)

usafmedic45 said:


> Nothing like a well-perfused myocardium and hypoxic encephalopathy to make for good results.




I've always been mildly interested to wonder if a heart lung machine could be made portable enough to use in a pinch...


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## usafmedic45 (Nov 18, 2011)

Yeah, there are portable ECMO units that would work and they've tried it before. A PUBMED search should bring up the studies.  The technical issues with gaining access and priming the damn thing are the big hurdles for field use.  Also, stop and think about the dumbest paramedic on this forum...you really want them trying to do a venous and arterial femoral cutdown in the field?


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## Tigger (Nov 18, 2011)

Linuss said:


> If you want to go that route, yes, there are Paramedics who are able to do central lines.  However, in a medical arrest, an IO is just dandy.



I think we can probably agree that those are few and far between. It's also a silly argument on my part since as you note, there is not much reason to do preform one.


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## JPINFV (Nov 18, 2011)

usafmedic45 said:


> you really want them trying to do a venous and arterial femoral cutdown in the field?



To be fair, the indication would be asystole anyways.


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