Code 2 with hospice and dnr orders

"Unaccompanied death" is not a crime.

Not a crime scene (someone dying does not a crime scene make), but they have to bring their "pushed, jumped or fell" card and fill it out.

A crime scene gets real tense for you real quick. A simple cause of death initial look-around is not so much.
 
mycrofft said:
I don't know if being in an ambulance keeps it from being an "unaccompanied death", but it might not…not a crime, but a classic basis for coroner's intervention.
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Depends. In California, it's a corner's case if it occurs after 20 days of seeing a physician. Considering that this is a hospital to home transport, that criteria shouldn't apply. Considering that it's a hospice case, the rest of the criteria most likely does not apply.

http://www.co.merced.ca.us/documents/Sheriff%27s%20Department/Frequently%20Asked%20Questions.PDF

http://www.leginfo.ca.gov/cgi-bin/displaycode?section=gov&group=27001-28000&file=27490-27512
 
Christopher said:
If you're not resuscitating the patient...guess what: you've pronounced them dead.

Please don't parrot silly EMS phrases like "we don't pronounce people dead."
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Surely you realize the legality of pronouncing someone dead vs. deciding they aren't coming back? Or maybe EMS is done different one state to the south.
 
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vcuemt said:
Surely you realize the legality of pronouncing someone dead vs. deciding they aren't coming back? Or maybe EMS is done different one state to the south.
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I must make a diagnosis of 'death', 'dead', 'died', 'ceased to be', 'is no more' in order to decide to not resuscitate the patient.

I don't sign their death certificate, but I've certainly "pronounced" them dead.

I'm reminded of the hordes who believe we can't/don't/aren't/isn't/willn't/wouldn't/shouldn't diagnose...
 
Christopher said:
I must make a diagnosis of 'death', 'dead', 'died', 'ceased to be', 'is no more' in order to decide to not resuscitate the patient.

I don't sign their death certificate, but I've certainly "pronounced" them dead.

I'm reminded of the hordes who believe we can't/don't/aren't/isn't/willn't/wouldn't/shouldn't diagnose...
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Perhaps that's what you do. I follow my protocol when deciding whether or not to begin resuscitation. No diagnosis necessary.
 
I generally follow protocol on this stuff. Usually the protocol is that I can transport the now deceased patient to the mortuary of their choice (if known) or I return to the point of origin. This is, of course, only when dealing specifically with hospice/DNR patients. Otherwise I'm working to either prevent the code or I'm working the code...

In any event, I must first determine that the patient is now "absent vital signs." While I don't "diagnose" death, and am not the person that signs that death certificate, my findings will certainly make it clear that I've determined that the patient is, in fact, dead and no longer needs services...

Yes, we diagnose all the time, within the limits of our education, experience and law/regulation. What we're not doing is making medical diagnoses. That's for physicians. Nurses make Nursing Diagnoses. Paramedics make Field Diagnoses. We all diagnose so that we can develop a plan to provide care for our patients. If we don't diagnose and treat symptomatically, then we're doing nothing more than responding to stimuli. See x, do y...
 
vcuemt said:
Perhaps that's what you do. I follow my protocol when deciding whether or not to begin resuscitation. No diagnosis necessary.
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(please read 'you' to be the Royal You/plural you/y'all you, not 'you' you)

Protocols are simply guidelines that set the floor, not the ceiling, of your care. They cannot possibly replace sound clinical judgement, and when used they should only supplement it. You should be willing to stand behind your diagnosis/pronouncement of death without relying solely on protocol.

My problem with this whole thread is not the act of pronouncing somebody dead, which people are scared of it seems, but that somebody wasn't willing to use the word "dead" with a patient's family.

They hid behind "pronounce" being some special fantasy legal word reserved for magical fairy medical examiners in white vaulted towers (with rainbows 'n stuff; void where prohibited by law; remember you will go to jail if you say it aloud).

If you're not willing to confidently say, "they're dead, and I pronounced them dead", then you'd better be doing full resuscitation.

Akulahawk said:
Paramedics make Field Diagnoses
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Dodging that one, so I'm sorry I opened this can of worms...language is also a tricky subject in EMS apparently.
 
Been there done that in LACO. If DNR going to hospice center, continue on. Inform staff before removal of body off unit. If they accept, GREAT! if not such as in my case you roll out an ALS truck pronounce and roll back to facility you took out of due to most likely your MAR thats up the street will not want the body.
 
Legal issues aside, if you're not attempting resuscitation you'd better have made the decision they're dead, otherwise you're the one who killed them <_<
 
vcuemt said:
Perhaps that's what you do. I follow my protocol when deciding whether or not to begin resuscitation. No diagnosis necessary.
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"At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul."
 
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eastman said:
why are you even transporting a hospice patient with a dnr?
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Because DNR doesn't mean "do not treat". A hospice patient may have something simple, like an easily treatable UTI. Would you not treat that patient?
 
Misread the post, thought theoretical patient was being worked against dnr
 
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