Omg dont touch me!
- Thread starter MissTrishEMTB08
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reaper
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Hate to tell you, but in FL the direct family can and does over turn a DNR. It does not matter if you have the original in hand. If the husband would have stated that he wanted her worked, then you have to work them. Most "good" systems in FL, also have protocals for hospice pt's. They are in hospice to end life peacefully. If the family or staff state that there is a DNR present on a hospice pt, but cannot find the original, a lot of systems are setup to honor that verbal DNR.
The pt you had was unable to make medical decisions at that time. I would have asked the husband what he wanted and honored that request. Your partner did the right thing!
Sasha
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Ok I was gonna stay out of this because when I was in school, I was actually classmates with MissTrish, she introduced me to EMT life amd we talk almost daily.
Not working a patient with out a valid DNR in hand is not a personal opinion, according to our text books and Florida state law you HAVE to work them, no ifs ands or buts. Seriously, if that husband wanted to come back and sue the pants off of her company and the EMT himself then yeah, he would totally have grounds too. Why? Because they had no DNR in hand. In Florida, it doesnt matter if they cant find it, then as far as the EMS provider is concerned they do not have one. Period. End of story. If you do not work a cardiac arrest with out a DNR you can and probably will lose your license if it ever gets brought up.
At that point, with no DNR, it doesnt matter what the family wants, that patient is getting worked all the way to the nearest hospital.
reaper
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Read above posts!
Ridryder911
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Amazing those that have very little to no experience and education attempting to describe what to do versus those with experience and higher education and license.
Anyone can sue for anything. Heck, they can sue for the remark that was made to the nurse.
R/r 911
Anyone can sue for anything. Heck, they can sue for the remark that was made to the nurse.
R/r 911
Sasha
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So experience gives you the right to ignore laws?
reaper
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Again, read posts and understand the laws!
Sasha
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I do understand the laws, exactly as our text book states them and exactly what I was told by the state medical director when I asked a question during our practical exams.
No DNR? Work them. Plain and simple.
MedicPrincess
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No so fast ma'am. That is the textbook/correct answer for the state test. If you are transferring a patient from one medical facility to another you can get by with a white copy/or no copy. Thats what protocols and medical control are for.
I once had a daughter tackle me to the ground as I went to get up from my knees, after the mans wife had presented the DNR. She was screaming thats not what he actually wanted. After having my new found "friend" pulled off me, a very short discussion ensued with her and the wife, and long story short.... we worked the heck out of him.
Why'd they show the DNR? Who knows? But the point is, The DNR is not neccessarily the be all/end all in some terrible heartbreaking cases.
MissTrish- in one of your posts you mentioned being a medic student? How long did you WORK as an EMT before starting medic school? I specifically say WORK, because working as an EMT and just having your card but doing something else is different.
I think, especially since your on a BLS truck now, once you finish Paramedic school and get out on the road you will have the same OMG moment a lot of new (and even old ones still can have) Paramedics have had. OMG this isn't what they taught us to do in school! OMG this is a crappy decision I have to make, and nobody will be happy with it! OMG I have to decide whether or not to work this fairly young person who is clearly dead but the people around are begging me to do something. OMG why is everyone looking at me.... OMG OMG OMG I AM the ONLY paramedic on this scene and my EMT is even newer at this than I am and all I have with me are volunteers that aren't even first responders yet!!!!
You going to have repeated OMG Moments. The key is to being able to remained focused on whats best for your patient and their health.
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Not in any sense, but it does provide for one thing you young and extremely impressionable EMT's do not have. Its called the ability to use common sense, critical thinking, and combine both into a collaborative level of care.
You, my dear, are wrong in your ascertation that every pt. in cardiac arrest and not in possession of a DNR has to be resuscitated. Two prime examples:
1. Trauma arrests and 2. Pts. with a presentation incompatable with life.
Neither pt. is an appropriate candidate for CPR and the professional organziations know it; they are the ones who advise the individual medical directors and assist in the development of protocols. They are one's who utilize evidence based research to make the determination of what is best for the overall population of patients. That is a representative example of medicine.
Get rid of the darn textbook. It is generic and does not meet the above criteria. I don't give a rat's a$$ what the textbook says, I want a medic who can explain the rationale and why's of pt. care. Not someone who can read left to right and realize that words make a sentence and that sentences make a paragraph!
If you want to be successful as a medic, you need to know the hows and whys, not just the whats...........................................
Besides, even if they did drop right in front of you, all you would have to do is pick up the phone, call medical control, and explain that a hospice pt. has passed. No MD in his or her right mind is going to overrule an advanced directive, durable POA, or hospice order. I haven't seen one in 17 years, I'd be interested to hear other views (Vent - calling you specifically as you would really be able to provide some professional insight and experience in this matter)
Ridryder911
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As one that provides and writes & reviews for many of those textbooks, I ask this; Do you have a specific textbook ..just for Florida? Then you need to review and read again.
No experience, does not make me right. Knowing the general law and having multiple degrees and experience in this speciality does. Especially in regards to a student and over those that lack clinical and expertise in this matter.
Did somewhere in your training, they failed to teach the ability to use critical thinking skills, that everything is not black & white? That there is "undue influence"that can occur. That the Paramedic can be held as responsible for resuscitating the patient as much as NOT resuscitating the patient. That the Paramedic held undue considerations of the patients wishes and wants, even after being informed from the family and knowingly that the patient had a terminal illness or disease process?
That the EMS service can be held liable for going against the wishes of the deceased for causing undue monetary and emotional stress on the family? Did all measures performed, did so to ensure that the wishes of the patient were carried out?
The same if he/she had not resuscitated the patient.
Again, the law and alike life is not black and white. You can't always have it your way. You can be damned from either side. Dependent on the view, if you will get screwed or not. Sure we teach to favor on the side of the patient. That is the best CYA.
In real clinical practice, one does what is best for the patient and at the current time. Again, a Paramedic should have access to a licensed physician. Obtain a verbal order. It's not hard to do, I do it daily.
As well, as not resuscitating someone (unless it is special circumstances) that has been down > 15 minutes. No, I never hook up an ECG to determine death either. Why? If I need that to determine their dead, I should be working them.
Textbooks are suggested guidelines and standards. They are a reference point, not the end all and exact. Again, a beginning not the end.
Listen to those that have progressed passed the naivete's of a student. We are attempting to teach you.
R/r911
No experience, does not make me right. Knowing the general law and having multiple degrees and experience in this speciality does. Especially in regards to a student and over those that lack clinical and expertise in this matter.
Did somewhere in your training, they failed to teach the ability to use critical thinking skills, that everything is not black & white? That there is "undue influence"that can occur. That the Paramedic can be held as responsible for resuscitating the patient as much as NOT resuscitating the patient. That the Paramedic held undue considerations of the patients wishes and wants, even after being informed from the family and knowingly that the patient had a terminal illness or disease process?
That the EMS service can be held liable for going against the wishes of the deceased for causing undue monetary and emotional stress on the family? Did all measures performed, did so to ensure that the wishes of the patient were carried out?
The same if he/she had not resuscitated the patient.
Again, the law and alike life is not black and white. You can't always have it your way. You can be damned from either side. Dependent on the view, if you will get screwed or not. Sure we teach to favor on the side of the patient. That is the best CYA.
In real clinical practice, one does what is best for the patient and at the current time. Again, a Paramedic should have access to a licensed physician. Obtain a verbal order. It's not hard to do, I do it daily.
As well, as not resuscitating someone (unless it is special circumstances) that has been down > 15 minutes. No, I never hook up an ECG to determine death either. Why? If I need that to determine their dead, I should be working them.
Textbooks are suggested guidelines and standards. They are a reference point, not the end all and exact. Again, a beginning not the end.
Listen to those that have progressed passed the naivete's of a student. We are attempting to teach you.
R/r911
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Foxbat
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I agree with you - except that one phrase.
I think there is a huge difference between a patient being combative due to his/her illness and a drunk S. o. B. who takes a swing at you because he/she can. The latter should be prosecuted so next time he or those like him will think twice before attempting something like that.
Risk of being attacked/abused is an inherent risk in EMS, as the risk of being injured is in the fire service. This does not mean that arsonists should not be punished or that attacking EMS provider should be tolerated because it is "part of the job".
reaper
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I agree, but you will hardly ever get a conviction on the charge. A "drunk" is under the influence of a mind altering substance. Any Good attorney can argue that the Pt did not know what they were doing.
If the drunk Pt is to combative, then let LEO handle it. If they are calm or just Aholes, then don't antagonize them. A lot of people in EMS push these people to being combative. They like to "mess" with the drunks and end up pissing them off.
If the drunk Pt is to combative, then let LEO handle it. If they are calm or just Aholes, then don't antagonize them. A lot of people in EMS push these people to being combative. They like to "mess" with the drunks and end up pissing them off.
I agree with most of what was said except for this section. My advice, though coming from someone much less experienced than others, is ALWAYS to obtain an EKG strip from a patient no matter how dead they appear or what the circumstances are. There is no downside. It is vital in covering your ***. Always confirm death with the EKG and always have the proof. Make a habit of hooking the EKG up to every patient, even if you've already made the decision not to work them.
Epi-do
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"Always," just like "never," is an absolute and we all know there are no absolutes in EMS (or life, for that matter). What is the point of putting the monitor on a patient that is rigored or has lividity present? What about the trauma patient that has obvious injuries incompatible with life? Certain patients are so blatently beyond any hope of even thinking about working them that applying the monitor really serves no purpose. Sorry, but I have to agree with Rid on this one. Using the monitor to confirm death just doesn't make alot of sense.
I absolutely EKG patients in Rigor or with other obvious signs of death, even though I know I will not be working them. Why? There is no reason not to. It is proof of death. Sure, you know they're dead. But now you can prove it to someone else. It's lazy not to do it, and reckless in this profession.
Hook up every patient to confirm death. EVERY. ALWAYS. I have no fear in using those terms in this case. The reason is that even though YOU don't need the confirmation, others may. Better to have it.
Except decapitation.
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Epi-do
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While I can understand what you are saying, I guess we are just going to disagree on this one. I just really feel that if there are obvious signs of death, a well written narrative documenting what was found upon arriving at the patient's side is all that is needed.
I'm somewhere between the two extremes expressed in this thread. I recognize the importance of critical thinking and common sense and realize that each situation needs to be taken as an individual case, but I also have the medic school philosophy of do absolutely everything you can to cover your *** no matter how unnecessary it seems. And obvious DOAs fall under that catagory. I know they're dead. I can justify why I didn't work them to my boss, my co-workers, or a review board. However, I want that extra bit of physical proof to be able to prove it to someone without any type of medical knowledge. I'm usually not a fan of "because we can" thinking, but in this case, it's foolish and lazy not to do it. It's fast, it's easy, and it has the potential (though 99% of the time, there wont be problems) to save your *** if you're forced into a position of explaining your inaction.
Ridryder911
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My medical director is the one enforcing do NOT hook up to the monitor. (Ever see a pacer fire and the family thinks they have activity?) The theory is if you need a monitor to determine death, you should be working them. An ECG is not going to save your arse if you declare death and they were really alive. No one will get in trouble but the reason being, you bring in a monitor then you should work them. A decision of not working them should be made by obvious reasons.. time of death, obvious signs (levidity), rigor mortis or signs of incapability of life (decapitatation). All conclusive signs of death, without use of an ECG.
If one needs an ECG on a obviously rigored patient, we have a problem.
I listen for apical heart beat as well as my partner, two set of ears are better than two and document such. We also have a doppler unit, if we want to verify. I have never seen it used.
If one needs an ECG on a obviously rigored patient, we have a problem.
I listen for apical heart beat as well as my partner, two set of ears are better than two and document such. We also have a doppler unit, if we want to verify. I have never seen it used.
piranah
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interesting
not to judge by any means.....I like to be very straight forward and honest and guess what.....there is a mental portion of pt care just as much as physical....i have let old ladies hold my pant leg or talk to me about what they're last words are to their family.....there is a bond between the pt and yourself that is unmatchable.....i find it a honor to be the last person they see before passing...it is a job like none i've ever done....and i love it.....i've spoken to pts about extremely personal things.....ive hugged husbands and been a shoulder for wives.....its part of the job....but just as so you should be empathetic.. hold yourself to be the one who makes them feel secure..............you probably work in the private setting...which is good exp. but you need to get used to comforting ppl...even the family......because the first time you have a child pass with the mother there.........its rough....they are going to need you...and THAT IS YOUR JOB...not only for the child but for the parent/sibling/boyfriend/girlfirend/husband or wife....it is taught in all the BLS,ALS whatever txts.......be ready because its not easy....but be sure to stay professional and upright.....
not to judge by any means.....I like to be very straight forward and honest and guess what.....there is a mental portion of pt care just as much as physical....i have let old ladies hold my pant leg or talk to me about what they're last words are to their family.....there is a bond between the pt and yourself that is unmatchable.....i find it a honor to be the last person they see before passing...it is a job like none i've ever done....and i love it.....i've spoken to pts about extremely personal things.....ive hugged husbands and been a shoulder for wives.....its part of the job....but just as so you should be empathetic.. hold yourself to be the one who makes them feel secure..............you probably work in the private setting...which is good exp. but you need to get used to comforting ppl...even the family......because the first time you have a child pass with the mother there.........its rough....they are going to need you...and THAT IS YOUR JOB...not only for the child but for the parent/sibling/boyfriend/girlfirend/husband or wife....it is taught in all the BLS,ALS whatever txts.......be ready because its not easy....but be sure to stay professional and upright.....