How to cope

[EMTinNEPA]

You obviously don't know real life yet! You have a dead body; it is a crime scene until otherwise proven. Yes, I have seen bull headed medics be placed into cuffs. Wait until they have a child abuse case that was mistaken for SIDS, and then see how things will occur. So the Police gave you an escort.. Great! Now you admitted your crew now has placed more than themselves in danger; when it should had never occurred to begin with!

Why would anyone with any brain matter that pretends to have any medical or knowledge ask the family...? What would you like me to do? How do you think they would respond? DUH! If you have to ask the family "what would like us to do?" Then you sure hell don’t need to be there! Apparently, anyone that would ask a grieving family such a question is incompetent. Prove me wrong.

Do they not teach your medics, rigor setting in = dead? Geez.. Did they ever take an AHA Healthcare Provider CPR there? How unethical and inconsiderate your guys were. Are they that ignorant or just lacked cerebral perfusion? Thank you EMS for asking what to do (knowing all along the efforts were futile) and now creating thousands of dollars of charges; all because you did not know how to determine death!

Let me ask you, would they done the same if it was an adult? If not then they are performing age discrimination as well!

Sorry, but you hit a raw nerve as I have seen too many "life savers" that did not have the integrity to be able to call a dead child dead because "they" were uncomfortable. Sorry,the emergency is not about them nor their feelings. Be a medical professional, more than that do your job!

Inform the family it is too late, close the door, secure the scene until LEO arrives and ask only pertinent and direct questions without any accusations or emphasis. Attempt to comfort the family within reasons and empathy. They are your patient, be professional and the family will defintely far resect you more than to later find out that you only were only performing a "show" code.

R/r 911

First off, I wasn't even on the call, so the police didn't give me anything.

Gee, I guess when you're as old as you, it's easy to win an argument by saying "you don't know real life yet". I know what rigor is. I know rigor = it's too late. Maybe the family wants everything possible done for their peace of mind. Ever think of that?

And how can I prove or disprove competency based on your opinion? You wouldn't work it so that means nobody should work it. You can't prove or disprove an opinion.

As for medics getting hauled off in hand-cuffs, you are supporting such a thing, right? Weren't you just complaining about badge-toting blowhards a week ago? So it's ok to take a medic to jail for trying to set a grieving family's mind at ease, but a reckless driver gets off just because he has a dying relative?

Yes, they would have done the same if it were an adult. Every code I've ever worked where PD was on scene, they not only escorted us to the hospital, but helped us code the patient as well. So no, no age discrimination.

As for EMS workers who would not call a dying child just because it would "bother" them, you have interacted with me on here before, right? I've had people try to stage an intervention over how detached I am. I'd call that baby in a heartbeat.

As for my actions, I believe what we have here is failure to communicate. Here is what I would say, in this hypothetical situation as my mind formulates it right now. "Mr. and Mrs. So-and-so, I'm sorry, but there is nothing we can do for your child. They've been down for too long and the odds of us getting them back are non-existent. All efforts to resuscitate your child at this point would be futile. Is there anything you would like us to do?" None of this "don't know how to determine death, dur, what do you want us to do?!? Oh noes, I don't know!!" crap you keep failing at throwing out, so how about instead of a strawman argument, you address what I'm actually saying? It's a novel concept, I know, but, call me crazy, the discussion tends to go much more smoothly if everybody tries it out.

 

[Ridryder911]

First off, I wasn't even on the call, so the police didn't give me anything.

Gee, I guess when you're as old as you, it's easy to win an argument by saying "you don't know real life yet". I know what rigor is. I know rigor = it's too late. Maybe the family wants everything possible done for their peace of mind. Ever think of that?

And how can I prove or disprove competency based on your opinion? You wouldn't work it so that means nobody should work it. You can't prove or disprove an opinion.

As for medics getting hauled off in hand-cuffs, you are supporting such a thing, right? Weren't you just complaining about badge-toting blowhards a week ago? So it's ok to take a medic to jail for trying to set a grieving family's mind at ease, but a reckless driver gets off just because he has a dying relative?

Yes, they would have done the same if it were an adult. Every code I've ever worked where PD was on scene, they not only escorted us to the hospital, but helped us code the patient as well. So no, no age discrimination.

As for EMS workers who would not call a dying child just because it would "bother" them, you have interacted with me on here before, right? I've had people try to stage an intervention over how detached I am. I'd call that baby in a heartbeat.

As for my actions, I believe what we have here is failure to communicate. Here is what I would say, in this hypothetical situation as my mind formulates it right now. "Mr. and Mrs. So-and-so, I'm sorry, but there is nothing we can do for your child. They've been down for too long and the odds of us getting them back are non-existent. All efforts to resuscitate your child at this point would be futile. Is there anything you would like us to do?" None of this "don't know how to determine death, dur, what do you want us to do?!? Oh noes, I don't know!!" crap you keep failing at throwing out, so how about instead of a strawman argument, you address what I'm actually saying? It's a novel concept, I know, but, call me crazy, the discussion tends to go much more smoothly if everybody tries it out.

Here's a simple solution. Someone needs to educate those medics what death is or better yet remove them from action. Performing or even attempting resuscitation on someone that has early signs of rigor mortis or putrification demonstrates gross incompetency. There is NO excuse and quit trying to justify stupidity.

Will your company pay for the medical expenses as it should; because of their incompetency?

In regards to Police I said.."bull headed medics" as in obviously stupid not knowing the proper thing to do and now I ask; Why Police escorts?

So you are saying, they'll work about anything then?... Or should I ask; when do they not attempt to resuscitate someone? Especially if signs of rigor is not proof enough?

 

[EMTinNEPA]

I might as well be talking to a brick wall. Fine, Rid, you're right. Happy now?

[/my involvement with this thread]

 

[exodus]

I'm trying to figure out why anyone would tx or even touch an obviously dead verifiable death...

By obviously dead:
Decapitation
Evisceration of heart or brain
Incineration
Rigor Mortis
Decomp

 

[Ridryder911]

I might as well be talking to a brick wall. Fine, Rid, you're right. Happy now?

[/my involvement with this thread]

Not really. Rather nauseous that we have this caliber of so acclaimed "medics". It is sad, sad statement we have such acclaims to be medically trained that not only admit of doing such but not even recognize the harm both emotionally but financially. Can one imagine an hospital calling a code on a person that had early signs of rigor mortis.. and then admitted that they were only "doing it" because they had asked the family; what would they like for them to do? .. Then charge or diffuse it by acclaiming they did not want to cause discomfort? .. it is the exact same thing in the prehospital environment.

There is no brick wall. There is being obviously wrong and detrimental and then there is being human and making an error.

I'm trying to figure out why anyone would tx or even touch an obviously dead verifiable death...

By obviously dead:
Decapitation
Evisceration of heart or brain
Incineration
Rigor Mortis
Decomp

You too?

R/r 911

 

[Aidey]

How could you cope with something like this? : You get a call about a mother who says her baby is not breathing. When you get on scene and go into the house, you see an infant lying down in a bed in the bedroom with a blooded nose. You and your crew do everything you can to save the infant’s life, but nothing works. The infant is dead, and you have been elected to tell the parents that their child is dead. After you break the news, the parents go through the stages, and you have to leave the dead baby with the parents there at the scene. :sad:

How else have you dealt with stressful situations that have happened in your life? None of us will be able to tell you what will work best for you because different people cope with things differently. Some people exercise, some people ride roller coasters, some people drink (bad bad bad idea), some people volunteer in a homeless shelter, or they go to church, or they talk to a counselor.

There are a multitude of different methods, and if you aren't sure what to do talk to a supervisor in your company, a mentor, a priest/pastor/rabbi/whatever.

It's not unusual for people to have a hard time dealing with their first couple of codes. Once you do learn to deal with it, it does get a lot easier. Just because you have a hard time with a code doesn't mean you are unfit to ever treat another patient again, it just means you are human.

Issues arise if you consistently can not deal with codes, or can't find a way to deal with the emotions. If no matter what you do you just can't stop thinking about it, then maybe this isn't the best field for you.

 

[Veneficus]

I'm trying to figure out why anyone would tx or even touch an obviously dead verifiable death...

By obviously dead:
Decapitation
Evisceration of heart or brain
Incineration
Rigor Mortis
Decomp

Simple,

lack of desire to take personal responsibility for decisions and not wanting to fulfill any of the difficult job requirements of medicine like telling family members that nothing can be done.

We could count for days the ways a majority of EMS providers want to do as little as possible, from education to personal responsibility.

 

[AJ Hidell]

Maybe the family wants everything possible done for their peace of mind. Ever think of that?

Ever watch EMS run a code on someone you love?

I can assure you that it is not comforting, and offers no peace of mind.

 

[Aidey]

For you maybe AJ, but can you speak for everyone in the world? No.

I've watched the hospital code someone I knew and cared about, and in the long run I was glad they did it. She didn't survive, but the fact that they tried was worth a lot.

If a family, or a lawyer, ever asks me "Did you do everything that you could" I like to be able to answer "yes" truthfully.

 

[AJ Hidell]

For you maybe AJ, but can you speak for everyone in the world? No.

But statistically, which is more likely to offer them comfort? I believe that studies have shown that families are more comforted by finality than by the false hope of a traumatic resuscitative event, and the person being whisked away to never be seen alive again. Then, of course, there is the fact that they are now going to be driving themselves to the ER in a state of mind that they should not be driving, creating an unnecessary danger to themselves and other drivers. Plus the fact that you are doing the same thing in the ambulance. There is no benefit analysis that can justify this practice.

I've watched the hospital code someone I knew and cared about, and in the long run I was glad they did it. She didn't survive, but the fact that they tried was worth a lot.

Hospital code is a completely different thing on multiple levels.

If a family, or a lawyer, ever asks me "Did you do everything that you could" I like to be able to answer "yes" truthfully.

If a lawyer asks you if you can justify what you did with the medical and scientific evidence, you'll have to truthfully answer "no, I just did it because I thought it might make the family feel better". And they can make a good case that you did it only for financial reasons.

 

[Aidey]

Statistically, I bet you have no better idea than anyone else here. I bet I could also find studies contradicting your studies. People's reactions to death are such a variable thing that I don't think anyone will be able to conclusively prove what the majority of anyone wants. Especially considering cultural and religious differences.

Why? They didn't do or give her any medications the medics in the field couldn't have. In fact, if they hospital hadn't of been visible from the facility they probably would have continued to work it on scene.

Will I? What makes you think I would have done anything that went against medical and scientific evidence?

 

[Veneficus]

without passion or prejudice

Passion:

–noun 1. any powerful or compelling emotion or feeling, as love or hate.
2. strong amorous feeling or desire; love; ardor.
3. strong sexual desire; lust.
4. an instance or experience of strong love or sexual desire.
5. a person toward whom one feels strong love or sexual desire.
6. a strong or extravagant fondness, enthusiasm, or desire for anything: a passion for music.
7. the object of such a fondness or desire: Accuracy became a passion with him.
8. an outburst of strong emotion or feeling: He suddenly broke into a passion of bitter words.
9. violent anger.
10. the state of being acted upon or affected by something external, esp. something alien to one's nature or one's customary behavior (contrasted with action ).


prejudice:

–noun 1. an unfavorable opinion or feeling formed beforehand or without knowledge, thought, or reason.
2. any preconceived opinion or feeling, either favorable or unfavorable.
3. unreasonable feelings, opinions, or attitudes, esp. of a hostile nature, regarding a racial, religious, or national group.
4. such attitudes considered collectively: The war against prejudice is never-ending.
5. damage or injury; detriment: a law that operated to the prejudice of the majority.

–verb (used with object) 6. to affect with a prejudice, either favorable or unfavorable: His honesty and sincerity prejudiced us in his favor.

—Idiom7. without prejudice, Law. without dismissing, damaging, or otherwise affecting a legal interest or demand.


The reason people solicit the aid of medical providers of all levels is for unbiased knowledge which they often do not possess or are not capable of acting with in a time of stress. Rather than argue, please be encouraged to be a professional and knowledgable provider. An emergency or health crisis is not the time to act based on emotions, real or perceived. Part of the responsibility of any medical provider is to act within the best interests of those seeking their aid. There is a big picture which always must be considered. Money is unfortunately part of that picture.

How much piece of mind do you think it will bring a family when they go bankrupt from a futile resuscitation? A couple days in the ICU could run 10's of thousands of dollars. (prior to a funeral expense)

If you don't know the potential costs, it is very important you find out.

I agree with Rid in this case. If death is too much for you to handle, you are not cut out for this work. If you truly care about people, please put aside your own desires for their benefit and step down.

If you really want to be a medical professional, please take the time to educate yourself on the more unpleasant aspects, as well as temper your emotions so that you can better serve your patients.

"I want to say I did everything possible."

This job is not about your wants.

 

[ffemt8978]

How about we get back on the topic of how to cope with the scenario, and not preach protocols, ethics, and legalities? If you want to discuss those items, start your own thread.

 

[CAOX3]

Why does everyone think the rules change when a child is involved?

Would you think of working an obviously dead 75 yo? Children die, yes it sucks. But it happens.

As far as coping with these instances, most people will never realize their having an issue with it till its to late. Thats why strong relationships are needed to recognize when someone is in trouble.

 

[trevor1189]

Why does everyone think the rules change when a child is involved?

Would you think of working an obviously dead 75 yo? Children die, yes it sucks. But it happens.

As far as coping with these instances, most people will never realize their having an issue with it till its to late. Thats why strong relationships are needed to recognize when someone is in trouble.

Because a child hasn't had a chance to have a full life. Therefore I think a lot of people will try to go above and beyond.

 

[Sasha]

Every patient deserves your best. 8 months or 80 years, it's not your place to decide who hasn't lived life enough yet. If you have the ability to go "above and beyond" your norm, then you are not doing your best on every call.

 

[trevor1189]

Every patient deserves your best. 8 months or 80 years, it's not your place to decide who hasn't lived life enough yet. If you have the ability to go "above and beyond" your norm, then you are not doing your best on every call.

Has nothing to do with not giving your best on every call. Children are more resilient than the elderly and are more likely to have a better recovery from a longer down time than someone who is 80.

 

[Katie Elaine]

Because a child hasn't had a chance to have a full life. Therefore I think a lot of people will try to go above and beyond.

Whether or not I would work the pediatric patient in this situation depends entirely on the instance, but if the same circumstances surrounded a geriatric patient, I would do the same thing. If rigor is setting in, or any other signs of obvious death/injuries incompatible with life are apparent, I would not work the patient. I would call a paramedic/someone qualified to pronounce, and I would have them call it. And until they arrived, I would explain to the parents the reasoning behind my call and why I wouldn't work the child, as well as let them hold the child, say their goodbyes, etc. But, if I had ANY reason at all to think the child was alive might have a chance, I would work it.

But to answer the OP's question on how to cope, everyone copes differently. I'm sure any death in the field would be tough to deal with the first time, but that's one of the downsides of working in EMS. You win some, you lose some, and you just need to get on. Something such as SIDS (which is what I'm assuming the case is after reading the original post), is something that you will need to deal with on your own. I can understand after a traumatic incident you might need to have a CISM meeting with a professional, but thats about the only case. While being compassionate with patients, you need to have a certain apathy when it comes to dealing with death.

 

[CAOX3]

Has nothing to do with not giving your best on every call. Children are more resilient than the elderly and are more likely to have a better recovery from a longer down time than someone who is 80.

Actually adults respond far better to resucitative measures then children do.

Nobody responds from long down times.

 

[Ridryder911]

How about we get back on the topic of how to cope with the scenario, and not preach protocols, ethics, and legalities? If you want to discuss those items, start your own thread.

Actually, it is on topic. It is called ineffective or having poor coping mechanisms. Medics love to spout off ..."who has the right to decide, or younger have a better chance, or what would you want done?"... All of this are well intentions but truthfully is irrelevant and just attempting again to justify our actions; when indeed they maybe inappropriate and most have not a clue of what is real facts.

Yes, we are human and thank goodness we have have feelings. However, there comes times to make decisions and yes sometimes these have to be made instantly and correctly without emotions (especially by the health providers). Patients and even families expect us to make good sound judgements. These judgements should come from education, clinical experience. It is unfortunate that EMS programs lack the required education to truly educate death & dying and now it is apperantly upon how to determine when resuscitation measures should never be instituted and how to deal with it.

Yes, making such decisions are hard. No one ever said it was not; but it is not our place to not be biased based upon our emotions. Our judgements have to way merit upon good sound clinical judgement not our emotions. There is much difference from empathy and sympathy. Yes, every patient deserves your best and sometimes that means you do nothing and the role of the patient changes to the immediate family or loved ones.

I have written thesis and studied in-depth on families viewing resuscitation measures on children for ENA citation for such. Yes, it is true that families accept death easier but there is much difference though in measures that should had been instituted and those that should had never occurred. It is our role to know these in detail and to follow upon these, no matter what our personal feelings are. We as well need to study and investigate what our actions may cause by doing inappropriate measures or statements.

It is during this emotional and delicate time that inappropriate statements or actions may have long lasting effects upon the survivors. To only find out that later that medical personal knew and willingly performed heroic acts because of their emotions not only can be devastating but costly both to the family and potentially to the rescuer.

There are well written standards for such events. These standards were not developed over night nor not studied in depth without clinical trials. It would be nice to be able to say ethics and legal persuasion should not be considered but it would be wrong. It is not we should be emotionless but to develop critical thinking skills and use proven scientific medical standards as our basis for treatment or even not to treat. By using your emotions for basis of your treatment is practicing medicine upon your self & not the given prescribed guidelines.

Medics need to learn coping skills. Realization that heroic efforts can actually be detrimental, that quality of life is just as important as having a save. Other factors such as long term treatment for the patient, increased disease process, acceptability for other illnesses not limiting the emotional and financial distraught that will be placed upon the family. All of this that can be brought upon by the actions of the EMT. Yes, a lot of weight and power for person of a 150 hour course. Again, actions should be followed by good sound clinical medical judgement.

R/r 911