medic417
The Truth Provider
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Maybe you need glasses that was what I was responding to not your statements.
Pediatric Cardiac Arrest
- Thread starter taporsnap44
- Start date
Maybe you need glasses that was what I was responding to not your statements.
Medic744
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What I said was in essence unless my child has obvious signs of death then I would want them worked, not given up on or had a BS show code done on them. When it comes down to it then the ones who are griping about cost of the code would be the ones to do a show code. To me that is a waste of time and money. Either work it or don't but do everyone a favor and don't half-a** it. Those that are willing to only do it half way are the ones Im talking about.
medic417
The Truth Provider
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Thanks for the clarification. You scared me for a minute the way your other post read sounded like you wanted a show code. Sorry for my misunderstanding.
Medic744
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Its all good in the hood. Mother or not I am still a reasonable/rational person.
I don't know anyone who wouldn't work ANY code, unless it was obvious the pt had passed (with the obvious exceptions). Pedi calls are always emotional, even if we are the most calm and collected person on scene, they still have to deal with their emotions once the calm hits. If I'm on a basic & medic crew, the medic is calling the shots. If it were me, we would work the code on the way to the hospital, l/s if necessary. A child deserves better treatment than just putting in enough effort to make the parents feel like you did something.
traumamama
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Our nearest hospital is 60 miles away. Our medical director has said we can call them on scene and our protocol deals with all the s/s : lividity, ALS more than 20 minutes away, injuries incompatible with life, etc. To prolong it, take the baby away doing CPR like they do on tv only makes it harder on the family. It gives them a false sense that the baby will be ok because the calvary is here. The parents become your patient now and they need your comfort and support.
traumamama
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Some of my people had a hard time with it; especially on pedi calls. But once they thought about it long and hard they realized it was probably best. They can focus on the parents and other family members and what it is going to take to help them through all of this.
Melclin
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My posts always seem so long....
If I may weigh in....
h34r:
There has been some research done here about how people consider paramedics, and why they call 000 (911). Also I have noticed these things myself in videos and through limited experience.
1. Parents/loved ones, should be connected with the process. Sending them into the other room (unless they are getting in the way) is not on. Separating them from their child in any way (such as driving off to hospital while show coding) appears to lead to profound feelings of helplessness and disconnects them with the dying process. They feel that everything possible was done if they actually see it being done. The importance of not separating a child and their parents is so much so that we are instructed to organise with police and coroner, to, if possible, transport parent holding baby to specific ED's where they gradually separate the two, and have counseling and general support at hand for the parents. Effectively, they are the patient, not the child.
2. If they are present during the resuscitation, the fact that their kid is dying is introduced slowly. There is no false hope. Starting CPR/ transporting only lends to a false sense of security, if it's medically unnecessary. People really do often feel that everything will be okay once the paramedics arrive, this is magnified by attempts at CPR, and further magnified by transportation (we forget how little the public knows about whats going on). It's a big shock if they leave the room when "their kid is sick" and help arrives and everything is ganna be alright, and they come back and their kid is dead and an even bigger shock if you transport and they get to the hospital expecting things to be alright and their kid/loved one is dead. It's questionable whether anything can really make the death of ones child better but introducing the idea of death before the pronouncement appears to be marginally better for their long term psychological health.
One of the conclusions of one of my lecturers PhDs was that people call 000, not necessarily when they feel there is a medical emergency that requires medical attention, but when they lose the ability to cope with the situation. As such its silly to approach this from a purely medical point of view and just say, "dead baby? PALS..end off story". Look into some of the reasons why the parents can't cope with the situation.
Their thinking is "baby isn't breathing, looks really sick, don't know what to do, call EMS". DEFINITELY NOT- "Baby isn't breathing, no pulse, I can do CPR, but my baby is essentially dead, need EMS for definitive airway control and ALS drugs but probability of good outcome still abysmal". It's significant because the difference between "looks really sick" and "actually dead" are quite different, and you have to facilitate the difficult transition in their minds. If that requires some sort of procedure or action that is not strictly medically necessary (but doesn't put anyone else in danger and doesn't give false hope) like continuing CPR for a little longer than is maybe medically necessary to give your partner a chance to tell the parents that the outcome is unlikely to be good and start that whole process, then that appears to be a good idea. However, actually attempting a full resuscitation algorithm on a kid in asystole, who's cold, pulseless, has lividity and rigor, and was last seen alive 8 hours ago is definitely counts as show coding.
EXAMPLE: I've know medics to work ped arrests that you could say were hopeless. The justification there is that the signs of death were present in part but they didn't want to make the decision not to start given the possibility of making an incorrect assessment due to the heated atmosphere of a kiddy code (the lividity might be a bruise, they were cold because there were under the A/C) and in the time it took for the more experienced and better trained MICA paramedics to arrive and make the final decision, it them a chance to prepare the parents and show them that everything was being done to help. That seems reasonable to me.
If I may weigh in....
h34r: There has been some research done here about how people consider paramedics, and why they call 000 (911). Also I have noticed these things myself in videos and through limited experience.
1. Parents/loved ones, should be connected with the process. Sending them into the other room (unless they are getting in the way) is not on. Separating them from their child in any way (such as driving off to hospital while show coding) appears to lead to profound feelings of helplessness and disconnects them with the dying process. They feel that everything possible was done if they actually see it being done. The importance of not separating a child and their parents is so much so that we are instructed to organise with police and coroner, to, if possible, transport parent holding baby to specific ED's where they gradually separate the two, and have counseling and general support at hand for the parents. Effectively, they are the patient, not the child.
2. If they are present during the resuscitation, the fact that their kid is dying is introduced slowly. There is no false hope. Starting CPR/ transporting only lends to a false sense of security, if it's medically unnecessary. People really do often feel that everything will be okay once the paramedics arrive, this is magnified by attempts at CPR, and further magnified by transportation (we forget how little the public knows about whats going on). It's a big shock if they leave the room when "their kid is sick" and help arrives and everything is ganna be alright, and they come back and their kid is dead and an even bigger shock if you transport and they get to the hospital expecting things to be alright and their kid/loved one is dead. It's questionable whether anything can really make the death of ones child better but introducing the idea of death before the pronouncement appears to be marginally better for their long term psychological health.
One of the conclusions of one of my lecturers PhDs was that people call 000, not necessarily when they feel there is a medical emergency that requires medical attention, but when they lose the ability to cope with the situation. As such its silly to approach this from a purely medical point of view and just say, "dead baby? PALS..end off story". Look into some of the reasons why the parents can't cope with the situation.
Their thinking is "baby isn't breathing, looks really sick, don't know what to do, call EMS". DEFINITELY NOT- "Baby isn't breathing, no pulse, I can do CPR, but my baby is essentially dead, need EMS for definitive airway control and ALS drugs but probability of good outcome still abysmal". It's significant because the difference between "looks really sick" and "actually dead" are quite different, and you have to facilitate the difficult transition in their minds. If that requires some sort of procedure or action that is not strictly medically necessary (but doesn't put anyone else in danger and doesn't give false hope) like continuing CPR for a little longer than is maybe medically necessary to give your partner a chance to tell the parents that the outcome is unlikely to be good and start that whole process, then that appears to be a good idea. However, actually attempting a full resuscitation algorithm on a kid in asystole, who's cold, pulseless, has lividity and rigor, and was last seen alive 8 hours ago is definitely counts as show coding.
EXAMPLE: I've know medics to work ped arrests that you could say were hopeless. The justification there is that the signs of death were present in part but they didn't want to make the decision not to start given the possibility of making an incorrect assessment due to the heated atmosphere of a kiddy code (the lividity might be a bruise, they were cold because there were under the A/C) and in the time it took for the more experienced and better trained MICA paramedics to arrive and make the final decision, it them a chance to prepare the parents and show them that everything was being done to help. That seems reasonable to me.