Show Codes.

[Sasha]

So. Good? Bad? Do them? Don't do them? Do them for kids? Please back up with actual facts, not "Well people need to know that everything possibly done to help them was done". Then why doesn't that apply to every patient? or "They survive better" when it's been proven, children have a poo poor survival rate.

Why or why not?

 

[Veneficus]

It takes no more effort to do a code for real than do a fake one.

Not to sound too arrogant, but I like to think I am a real healthcare provider, not a hack. That means I make hard decisions like starting or stopping efforts based on prognosis and other medical indications not off emotions and showmanship.

I am also aware that succeed or fail, somebody is going to get a bill. I consider it extremely unprofessional to make make a futile effort orputon a show that is goingto cost survivors thousands if not tens of thousands of dollars.

If in thisthe patient ends up on life support, it also saddles a family memberwith the decision to pull the plug or go broke waiting for a "miracle"

If you feel the need to put on a show, make a pilot and try to get picked up by a netowork.

Part of this job is delivering bad news. Like it or leave it.

 

[EMERG2011]

I recognize the fact that even when all medical interventions are utilized, there is less than a one in 10 chance of survival, and even less so when the patient has been down for an excessive period of time before EMS arrives - however I strongly believe that it is our duty to give every patient a chance at survival, no matter how infinitely small that chance is. Even if it is a waste of resources, time, and energy; we have a duty to the community to do do everything we can, if not simply to be able to say "we did all we could" to the family. Doing so, might not bring back the patient, but it will bring some measure of finality and closure to the family.

 

[reaper]

That is why you need to learn to tell the family that there is nothing you can do. If they have been down to long, then they have been down to long. Do not prolong the tragedy any longer, by doing a hopeless "show code". These are the tough decisions that a real provider must learn to make and back up. We are not miracle workers. We are resuscitators, not resurrectors!

 

[Ridryder911]

. Doing so, might not bring back the patient, but it will bring some measure of finality and closure to the family.

I always hear and read this, but how does EMS "pretending" to resuscitate bring closure? What would one really think of our profession later on realizing that it was all done in vain and never should had been attempted? Does producing a large EMS and ED bill really aid in bringing closure? Or is "closure" for the EMS providers?

I ask, if performing on a patient that was obviously dead not only be unethical but could be raise other problems such as age discrimination? Working on infants but not the elderly? Could investigation upon why would one start and iniatiate such efforts knowing and willingly realizing that it was all for "show" ?

If the patient meets criteria to resuscitate, then do so; if not they should be declared deceased as any other patient. Be ethical, professional, and empathetic. It is going to hurt and grieving is going to occur no matter if it measures was not performed by EMS or by prolonging it for another 20 minutes for a healthcare provider to inform them "it was too late".

Declaration of death; should be made based upon standard criteria not upon emotional basis.

R/r 911

 

[EMERG2011]

Lets think about this - you're a layperson who has just found their loved one down on the ground, possibly cold to the touch. Do you really want someone to roll in and say "nope, they're already dead," or would you rather they at least pretend to try. The utter apathy demonstrated by some of the medics that I've worked with is appalling. For the love of god, this is someone's moment of need, and if putting on a show worthy of an Academy Award is what they need, then I'm ready for my closeup Mr. Demille.

 

[Epi-do]

Lets think about this - you're a layperson who has just found their loved one down on the ground, possibly cold to the touch. Do you really want someone to roll in and say "nope, they're already dead," or would you rather they at least pretend to try. The utter apathy demonstrated by some of the medics that I've worked with is appalling. For the love of god, this is someone's moment of need, and if putting on a show worthy of an Academy Award is what they need, then I'm ready for my closeup Mr. Demille.

Not working someone who you obviously can do nothing for is not apathetic. It's doing your job. At this point the survivors are your patients and you need to take care of them. Giving them false hope that something can "maybe" be done is just wrong. Furthermore, it has been my personal experience that most times when called for a cardiac arrest that is nonviable, the family already knows that nothing can be done, but aren't sure what the next step is as far as who to call or what to do. (I can say this with confidence because I have families comment that they called because they "just didn't know what to do.") They know their loved one is gone. They don't want you to violate/dehumanize their loved one by doing something that isn't going to change the ultimate outcome of the situation. These family members don't need you to put on a show. They need you to be empathetic and willing to assist them in making the first few calls to get the ball rolling for what comes next.

 

[Mountain Res-Q]

Not working someone who you obviously can do nothing for is not apathetic. It's doing your job. At this point the survivors are your patients and you need to take care of them. Giving them false hope that something can "maybe" be done is just wrong. Furthermore, it has been my personal experience that most times when called for a cardiac arrest that is nonviable, the family already knows that nothing can be done, but aren't sure what the next step is as far as who to call or what to do. (I can say this with confidence because I have families comment that they called because they "just didn't know what to do.") They know their loved one is gone. They don't want you to violate/dehumanize their loved one by doing something that isn't going to change the ultimate outcome of the situation. These family members don't need you to put on a show. They need you to be empathetic and willing to assist them in making the first few calls to get the ball rolling for what comes next.

Logically, the family knows that nothing can be done.

Emotionally, they want you to perform a miracle.

All that “acting” Is gonna do is provide false hope. They do not need that or want it. They want everything to be okay. The reality is that it will not be okay, so why torture the family in the process of flogging the deceased? Emapathy is the only thing we can provide that will make a difference. The grieving process is hard enough to cope with without us complicating it with dramatic acting. Be direct... be professional... be honest with them. It's not apathy... it's realistic and should be tempered with compassion. We are not actors, we are not miracle workers, we are health care professionals that will do everything to help someone when help can be provided. If we can't provide help for the patient than we provide help to the family... help coming to terms with a fact that they likely already know... their loved one is gone. It may be a long road for closure for them... but it can only begin once we allow them to acept the fact that there is nothing we can do.

 

[Veneficus]

Lets think about this - you're a layperson who has just found their loved one down on the ground, possibly cold to the touch. Do you really want someone to roll in and say "nope, they're already dead," or would you rather they at least pretend to try. The utter apathy demonstrated by some of the medics that I've worked with is appalling. For the love of god, this is someone's moment of need, and if putting on a show worthy of an Academy Award is what they need, then I'm ready for my closeup Mr. Demille.

Just so you know there are serious legal issues with "pretendng" to try.
You definately don't want to end up on the news or in court with "improper" treatment and a dead person.

I encourage you to find out what a resuscitation attempt at your hospital can cost. Nobody needs the grief of that. Especially in an aggresive billing agency that will take a cut out of death benefits first. (if the family has any to begin with) Your little show could put an entire family (multiple generations) on the street.(that may take generations to recover) That is "help" nobody needs.

Medical providers are called upon and respected for their knowledge and skills, not for their ability to put on a show.

If you really want to see how people react to intensive resuscitation efforts, have a look at cardiac post op. Listen in the waiting room to the grief of family memebers who see relatives in that condition with all the machines, sounds, and tubes supporting a patient. When the patients die, that is the image forever.

Being the person to tell a family that they should sign the form to take a loved one (especially a child) off life support sucks. There are also some very inhumane aspects when they say "no."

Yea a funeral sucks, for all those involved, but there are worse things. Last year I saw an 8 year old pt. who went into DIC secondary to sepsis. The family believed it was religiously unacceptable to discontinue life support and demanded all actions be taken. The family kept a 24 hour prayer vigil bedside after both arms, both legs, and the right side of the kid's face including eye were amputated. Then they watched as the necrosis spread across the rest of the face, turning it black until the poor kid finally coded.

Divorces and suicides are caused when vegatative patients need constant care with associated costs.

The family may want a show, it may even make them feel better for a few minutes or hours. But it causes harm in the long term. The number one rule in medicine is not "make people feel good" it is "Do no harm."

There is a such thing as end of life care. Infact it is its own specialty. While your passion and desire to care for people is admirable, it seems you need more education about what caring for people involves. I am sure your local hospice would be happy to teach you about end of life care. Most do it for free.

 

[daedalus]

I really see more respect for death as an area we need to improve upon in basic EMT and even paramedic education. While my program certainly had a great section on dealing with death and how to deliver the news, than we go on to teach ACLS even in the face of certain failure. Let us stop trying to raise the (obvious) dead or the dead with very poor prognosis if resus is successful (likely vegetable status pre-arrest).

 

[el Murpharino]

Lets think about this - you're a layperson who has just found their loved one down on the ground, possibly cold to the touch. Do you really want someone to roll in and say "nope, they're already dead," or would you rather they at least pretend to try. The utter apathy demonstrated by some of the medics that I've worked with is appalling. For the love of god, this is someone's moment of need, and if putting on a show worthy of an Academy Award is what they need, then I'm ready for my closeup Mr. Demille.

Well...the average layperson would probably do CPR because they don't realize that dead is usually dead. They watch TV shows that make people believe that resuscitation is more likely to be successful that it actually is. Here are a few factors to consider before starting the code:

Was the arrest witnessed by EMS or bystanders?
Was there defibrillation in the EMS setting?
Did you get any ROSC ?
Was bystander CPR performed?

Patients with these factors have an extremely low survivability rate if the cardiac arrest has no reversible causes. In these cases, that family becomes your patient(s). Do what you can for them...call their family physician and inform him/her, call clergy if needed, call the funeral director, help make the immediate arrangements....help the family in whatever way you can. You can show alot of empathy in these situations by explaining in simple terms that their loved one is dead and there is nothing that can be done to revive them, followed by assisting them.

You save many more resources than an ambulance by calling codes in the field. You also free up hospital staff that would otherwise need to attend to your patient - and as we all know, the hospital staff is going to perform the same ACLS procedures we do in the field for maybe 15 minutes and call it.

 

[46Young]

Once you make the decision to begin resucitative efforts, it's a 100% effort. Anything short of that, doing a "slow code" and such, will put you at risk for a malpractice suit. You never know if a family member or bystander onscene has enough of a medical background to recognize your failure to act, such as withholding meds and/or interventions, or token compressions, and such. We do typically get authorization to terminate efforts onscene, when prognosis warrants, after running the algorithm. We don't bill without txp. If protocol warrants, I'm always ready to work a code, but if it's OBVIOUS that it's too late to work the pt, we'll document lividity, and not butcher the pt with ET tubes, IV's cracked ribs, sternal/EZ IO, and such. I don't believe in show codes. If they're dead, tell the family an a tactful way, but it shouldn't be sugarcoated. Try not to use terms like "passed away", or "no longer with us". It is appropriate to say "(family member) is dead". "There's nothing we can do to bring them back at this time", or "We've done everything we can, but it wasn't enough to resuscitate (family member), then I'll give my condolences. While we're working, when time permits, I'll explain to the family that the pt's heart has stopped, that we're doing everything within our power, including a breathing tube and medications to start the heart beating again. The family hopefully understands at this point that the pt is already dead, and no false hope was given. I'll try to explain, in lay terms, possible differentials as to why the pt is in arrest, and why we're doing what we're doing. Giving false hope to the pt's family is damaging mentally. The family deserves closure, so the grieving process can begin.

 

[Ridryder911]

Lets think about this - you're a layperson who has just found their loved one down on the ground, possibly cold to the touch. Do you really want someone to roll in and say "nope, they're already dead," or would you rather they at least pretend to try. The utter apathy demonstrated by some of the medics that I've worked with is appalling. For the love of god, this is someone's moment of need, and if putting on a show worthy of an Academy Award is what they need, then I'm ready for my closeup Mr. Demille.

Let's think about this. How about having EMT"s that are medically sound and to be unethical and then know what they are doing? If you want to be an actor, go be one but medicine especially during a crisis mode is not the time.

I would like for someone that has the philosophy to "pretend" please show me any text, curriculum in which this was taught or even endorsed? So, then you are acting (pun intended) upon your own? Now, we know where that will get you.

Do you work all codes or just selected ones that might bother you?

Families and those that are grieving need to be treated with honesty and respect. Empathy, NOT sympathy should be given as a professional. Again, show me where doing such a procedure is nothing more than psychological displacement of the EMT not being able to handle the job and its requirements.

R/r 911

 

[firemedic7982]

Let's think about this. How about having EMT"s that are medically sound and to be unethical and then know what they are doing? If you want to be an actor, go be one but medicine especially during a crisis mode is not the time.

I would like for someone that has the philosophy to "pretend" please show me any text, curriculum in which this was taught or even endorsed? So, then you are acting (pun intended) upon your own? Now, we know where that will get you.

Do you work all codes or just selected ones that might bother you?

Families and those that are grieving need to be treated with honesty and respect. Empathy, NOT sympathy should be given as a professional. Again, show me where doing such a procedure is nothing more than psychological displacement of the EMT not being able to handle the job and its requirements.

R/r 911

+1.

Dead is dead. If they arent workable, don't work them. I would be more upset to know that someone did a "show code" than if they had just told me the truth.

 

[emtjack02]

I was recently told something in regards to arrest particularly pedi's
"There are worse fates than death" I believe it. I know that if they don't meet the field termination criteria we have to go full bore...

 

[CAOX3]

With the lousy survival rates of out of hospital cardiac arrest, I believe most codes are for show.