Ethically Speaking.....

[joemt]

You have arrived at the home of a 68 yo male who is in Cardiac Arrest.... Upon your arrival his daughter is doing CPR, as you walk in and complete your scene survey she looks up at you and says "Help him"... you are a volunteer with a local VFD, a few of your fellow responders energetically relieve the daughter of doing CPR on her father. As you begin to monitor, maintain, clear and support the airway you ask a few questions...

"How long has he been down?", the daughters reply is "about 15 minutes". You then ask... "When did you start CPR?" The daughter says "immediately, we were all watching a movie together and he clutched his chest and fell to the floor." You ask about pre-existing medical conditions and she says "He was diagnosed with an aneuryism about 6 months ago, the doctor told us that his time was limited, but I'm not ready for him to go yet."

As your team mates are setting up the equipment, doing CPR, etc (and you are maintaining airway), you ask if the ambulance has been called, and which hospital the family wants the patient transferred to.... The daughter tells you that the ambulance should be on the way, and that they want him taken to a hospital 45 minutes south of your current location (by the way, you are appx. 30-40 minutes from the incoming ambulance as well).

After doing CPR for about 25-30 minutes, the daughter comes up to you and pushes a paper in front of your face, she states "This is his DNR, he didn't want anything done!" What do you do now?

 

[MMiz]

I evaluate the paperwork and contact medical control. I've heard of this happening many times.

 

[Chimpie]

I evaluate the paperwork and contact medical control.

I agree.

Now, DNR aside, if I was to make the decision on whether to keep going w/ CPR and shocks, I would say stop. Too much time has already passed too much time will pass to get a bus there, too much time will pass before they get him to the hospital.

 

[Ridryder911]

I would review the paperwork.. if it was current, and official. I would cease resuscitation efforts, cancel the EMS unit and notify LEO and M.E., funeral home.

R/r 11

 

[gradygirl]

I agree with the guys. His wishes override everyone else's as he was competent when he made his decision to get a DNR.

My best friend was found not breathing, pulse undetermined. He had been down for an unknown amount of time, but at least 15-25 minutes. His father called 911 and was instructed to do CPR. He was revived, but it was ultimately determined that he had no brain function whatsoever. He was left with basic life functions that stretched out his death for 6 weeks.

During that time, we were all given false hopes after false hopes. Knowing what I know now, I don't necessarily disagree with the decision to start CPR, but I do disagree with his multiple times he was revived during his stay in the hospital, because his family was not prepared to let their obviously brain dead son go.

 

[MedicPrincess]

Evaluate it. Valid DNR, Stop CPR. Our service would notify Med Control as well. Scene would be turned over to law enforcement who is dispatched with us to all reported cardiac arrests.

 

[davis513]

Wow, what a timely topic. As I mentioned in another post I just started EMT-B school this week and the first night of class we covered DNR's. The instructor told us to do exactly what EMTPrincess said to do. Review the DNR to ensure that it is signed and still valid and if so, honor the DNR regardless of the family's wishes.

 

[ffemt8978]

Wow, what a timely topic. As I mentioned in another post I just started EMT-B school this week and the first night of class we covered DNR's. The instructor told us to do exactly what EMTPrincess said to do. Review the DNR to ensure that it is signed and still valid and if so, honor the DNR regardless of the family's wishes.

Okay, but what do you do if the patient has a valid DNR but the family insists that you attempt to resuscitate? (I'll post our procedures later)

 

[MariaCatEMT]

I agree with the guys. His wishes override everyone else's as he was competent when he made his decision to get a DNR.

My best friend was found not breathing, pulse undetermined. He had been down for an unknown amount of time, but at least 15-25 minutes. His father called 911 and was instructed to do CPR. He was revived, but it was ultimately determined that he had no brain function whatsoever. He was left with basic life functions that stretched out his death for 6 weeks.

During that time, we were all given false hopes after false hopes. Knowing what I know now, I don't necessarily disagree with the decision to start CPR, but I do disagree with his multiple times he was revived during his stay in the hospital, because his family was not prepared to let their obviously brain dead son go.

So sorry about your friend.....wow:sad: