Dispatched to residence "person not breathing"

[firecoins]

Not talking this pt!

Just because an AED says "no shock-able rhythm", does not me you can call it! What if they are in PEA? This is why AED's are not used as a final decision maker.

You need a MONITOR!

I am the final decision maker and yes I am allowed according to local protocol.

 

[reaper]

Glad I don't live in that state.

 

[BEorP]

As a Primary Care Paramedic in Ontario I would not need to treat this patient and would not need to call a physician to make this decision for me.

 

[MMiz]

As a Primary Care Paramedic in Ontario I would not need to treat this patient and would not need to call a physician to make this decision for me.

That's what I call progressive protocols!

 

[MedicPrincess]

So even paramedics have to call to get permission to say the pt is dead? Or if the protocols exist can you call it anyway? I thought I remember reading somewhere that only a doctor can say someone is dead.

As a Paramedic, I can call it. I do not need to make contact with medical control..... I can also stop and call it after CPR has been started. Sucessful Intubation, 2 rounds of drugs, Asystole still present on the monitor = Signal 7 (DOA).


Straight from my protocols... And of course, at the end of every protocol we have is the "contact Med Control if any questions arise."

• 1. Resuscitation should not be attempted in the field in cases of:

1. 1. Rigor mortis

1. 1. Decapitation
   2. Decomposition
   3. Dependent lividity.
   4. Incineration
   5. Obvious massive head or trunk trauma, which is incompatible with life (provided the patient does not have vital signs.)
   6. If asystole on the cardiac monitor and any four (4) of the following are present:
      1. Vital signs absent
      2. Pupils fixed and dilated
      3. Advanced age and/or general physical condition of the patient would indicate no resuscitative measures should be taken.
      4. The length of time in arrest with no resuscitative measures is longer than compatible with life
      5. No independent influences are evident such as drugs or cold
      6. Terminal illness that indicates no resuscitative measures should be taken
   7. Other obvious signs of death
      1. The victim of blunt trauma who is pulseless, apenic, and without a palpable blood pressure or heart tones upon arrival of BLS or ALS providers.
      2. The victim of a multicasualty incident in cardiopulmonary arrest whose use of prehospital care resources would jeopardize the care, health, or well-being of other critically ill or injured patients or the providers at the scene of accident, injury, or illness.
      3. The patient who, upon arrival of EMS personnel, is attended by a physician licensed in the State of Florida; AND where the physician is willing to write a statement of his relationship to the patient, a "do not resuscitate" order, and a rationale for this order on the run report. EMS personnel must attempt to verify the identity of the physician before withholding cardiopulmonary resuscitation.
      4. A patient whose personal physician communicates via telephone that resuscitative effort should not to be initiated or resuscitative efforts should be discontinued. The physician must agree to accept the responsibility for pronouncing the patient dead to at least two (2) emergency personnel (EMT, paramedic, and law enforcement) via the telephone. The witnesses MUST sign the EMS Run Report.

1. IF resuscitation was initiated, consider discontinuing efforts in the field if:
   1. A patient remains in asystole in three leads despite being properly intubated, ventilated, and given several rounds of ACLS drugs (epinephrine and atropine) and/or failure of early transcutaneous pacing.
   2. Effective spontaneous ventilation and circulation have been restored.
   3. Resuscitation efforts have been transferred to persons of no less skill than the initial providers.
   4. The rescuer is exhausted and physically unable to continue resuscitation.

 

[BossyCow]

Just some clarification on the semantics here. We in the field can make the determination not to start CPR. Once that determination is made, we call med control, inform them of what we see that supports our decision to not start CPR due to the pt meeting the criteria of "obvious death". At that time, Med control 'calls it' On our reports, we document that med cont. stated time of death as..... attach the strip of asystole in at least 2 leads... document the lividity and rigor and leave the body with the sheriff/coroner.

So technically, I don't think we are calling the code, but the doc is based on what we tell him.

 

[MedicPrincess]

Just some clarification on the semantics here. We in the field can make the determination not to start CPR. Once that determination is made, we call med control, inform them of what we see that supports our decision to not start CPR due to the pt meeting the criteria of "obvious death". At that time, Med control 'calls it' On our reports, we document that med cont. stated time of death as..... attach the strip of asystole in at least 2 leads... document the lividity and rigor and leave the body with the sheriff/coroner.

So technically, I don't think we are calling the code, but the doc is based on what we tell him.

As stated before... I DO NOT have to call med control before deciding to not to work a code. If CPR has been started, we can also call it without calling med control. Med Control is only RECOMMENDED if we have intubated, got our line, and pushed 2 rounds of drugs.

 

[mikeylikesit]

Just so were all clear, an AED is not a diagnostic tool to determine a death. i don't care if you have the new one that can show a rhythm off of two leads it is not definitive enough. I will not waste the pads on something that i feel is irrelevant for the matter, i will use my monitor.

 

[SCFD8REZ]

The fact that the person is DOA can only be determined after the initial assesment, obviously the first thing everyone should do in this case is the initial assesment and only after this would you find out that the patient is displaying signs of Rigor Mortis, as well as no pusle, and no active respirations. Everyones protocols are a little different and everybody has different prefrences, there are many people in my organization who would say, " you know what, nobody is ever going to yell at you for trying to save a life.But they will for sure yell at you if they wake up half way to the funeral home and you didnt even try." This type of call is very common in my district being that we have three nursing homes within one mile of the station. If there was obvious RM that is a tell tale sign of death, this person will be cold to the touch and lifeless, which means they have probably been there for a while . You can now only help the family with the grieving process. This is a very clear cut call.