What would you do?

[richmedic101]

Let's say your a supervisor for a big city EMS agency. One day your co-dispatched for a pediatric cardiac arrest. You minutes from the scene, when you hear the crew state; "we have the patient, we're going to the truck, send PD!" Your dispatch center calls you and repeats the traffic. your answer is, "I'm almost on scene, do they need me to continue in?" After a pause you are advised to continue in. Upon arrival you find a seasoned paramedic with two firefighters attempting to ventilate a five month old. The paramedic states to you, "we probably shouldn't have started resuscitation, but I didn't know what to do." You assess the patient and find that rigor mortis had set in. The rigor mortis is so bad that the jaw is not pliable enough to secure an airway. No other procedures had been begun at this time. As the supervisor, what do you do?

True story! Happened recently. I'll tell you the outcome later.

 

[Wingnut]

Wow, well coming from a total noob, if the CPR was worth doing for the parents sake, maybe..but if rigor is that bad, we all know there's nothing that can be done. Why did the parents/caretaker wait to call the ambulance or rather what were they doing that they didn't know the baby was dying or had already passed?

This is a nightmare of mine, my husband laughs that I still check the kids breathing every few hours at night when they're asleep.

 

[Ridryder911]

As a supervisor I would stop or cease the resucitation effortts, since there is obvious conclusive signs of death. If needed contact medical control, advise situation. Notify M.E. & LEO, treat the family and grief.

Then afterwards, I would have a personal session with the medics and hopefully medical director with them as well. They should be reprimanded for not recognizing conclussive signs of death & not performing their job accurately.

Good luck,
R/R 911

 

[TalkEMS]

Originally posted by Wingnut@Dec 9 2005, 12:01 AM
Wow, well coming from a total noob, if the CPR was worth doing for the parents sake, maybe..but if rigor is that bad, we all know there's nothing that can be done. Why did the parents/caretaker wait to call the ambulance or rather what were they doing that they didn't know the baby was dying or had already passed?

This is a nightmare of mine, my husband laughs that I still check the kids breathing every few hours at night when they're asleep.

Sounds like a SIDS case. Nothing the parents would've been able to detect or really prevent. If the crew had already removed the child from the home and the parents were not handling it well I would advise the crew to go ahead and transport for the parents ease of mind but they better be able to document why they moved the child and recall every detail concerning how they found the child. I'll deal with the coroner and if he doesn't like my call he can take it up with my bosses (most of who would do the same thing I did). Its not a black and white thing. I'm not a big one on jerking people around and come out and say someone is dead if they're dead but a SIDS case is that gray area in my book.

Interested in hearing how this played out ...
Matt

 

[rescuecpt]

Do CPR for the parents sake - if they're not in the rig, call medical control and get their approval to discontinue (here, even with obvious death, if you start, you have to get permission to stop) but continue to bring the baby to the hospital. At least that's what I would do, so the hospital staff (who are better trained and more experienced) can tell the parents and counsel them.

 

[Jon]

Depends on your protocols.

At the very least, get on the phone with OLMC and explain, get permision to cease efforts.

I really like the idea of sitting down with the crews and the Med. Director and "repremanding" the crew(s) involved, but CAREFULLY.

Jon

 

[CaptainPanic]

As long as parents are standing right there, at least continue with resuscitation efforts - for the parents sake.

Then when you load the child in the rig, call Med Control advise them that you are coming in with a pedi that has obvious signs of death (rigor mortis), but since resuscitation efforts had already begun before you arrived on scene, you need him to call it to stay within legal limits.

Then the crew needs to return to the station give them a good verbal lashing, suspend the crew for a week, and have them complete a refresher course before being eligible to return to their duties.

-CP

 

[TalkEMS]

Originally posted by CaptainPanic@Dec 9 2005, 10:05 AM
Then the crew needs to return to the station give them a good verbal lashing, suspend the crew for a week, and have them complete a refresher course before being eligible to return to their duties.

-CP

:blink: Where's the compassion?!

 

[MedicPrincess]

Originally posted by CaptainPanic@Dec 9 2005, 10:05 AM
Then the crew needs to return to the station give them a good verbal lashing, suspend the crew for a week, and have them complete a refresher course before being eligible to return to their duties.

-CP

WOW!! That seems really harsh. Perhaps it was thier first Pedi Code. Suspending them for working a code seems very harsh, even is rigor had set in.

'Round these parts, the medic and go ahead and call it, but before they do they almost always get on the phone with Med Control. Just for CYA purposes.

 

[CaptainPanic]

Upon arrival you find a seasoned paramedic with two firefighters attempting to ventilate a five month old. The paramedic states to you, "we probably shouldn't have started resuscitation, but I didn't know what to do."

When they arrived on scene it seems like they did not check for obvious signs of death and didnt they realize that the body was abnormally cold??

Youd think if they were Medics they would have come in contact with several codes as EMTBs and as Medic students, and had training over pediatric codes.

I can understand making a few mistakes on your VERY first code butit shouldnt be an obvious mistake such as completely missing obvious signs of death. Plus it clearly stated that the medic was seasoned and he knew he had fouled up big time. I think they forgot the common sense factor here.

-CP

 

[hfdff422]

Common sense and ped's are not as readily interchageable as common sense and geriatrics. I have over 40 hours of just SIDS and I am still woefully underprepared for the situation (that is for the B level).

 

[CaptainPanic]

Well if it was THAT difficult to pry the jaw open to get access to the airway, I think I would probably consider calling it on scene, before CPR was initiated. Took the parents into another room and had the coroner come and declare DOA. And have my crew attempt to keep the parents calm.

 

[richmedic101]

Great feedback! Thanks. Well here's what happened. I arrived on scene and found suspiscion of "foul play". Examples: The child was wrapped tightly in a blanket including occluding the mouth and nose. The parents had no emotional reaction to what was going on. Dispatch advised when pre-arrival was given the phone was just set down with no one coming back to it (not uncommon, but with everything else it raised some red flags). I "called the code", which ALS providers in my system can do without OLMC. The PD showed and obviously turned the ambulance into a crime scene. It tied up my unit and crew for five hours (upper management not too happy with that). All remaining evidence is preserved as best as possible with the detectives collecting it upon arrival. It turns out that the father (911 caller) was Nigerian and understood little english. The wrapping of the body was a religous custom for him. The mother was moderately retarded (Downs-I believe) and wasn't sure what was going on. The final piece was that the child had a terminal disease (wasn't told by detectives what). Obviously PD and ME were very upset with my crew. They stated that if it were a crime, that by taking the child out of the scene, PD had no right to enter the house now without a search warrant. This is bad, being that the parents then had the opportunity to destroy evidence. Long story short, CISM peer review was activated. The crew was not permitted to finish their shift. The call was QI'ed by me, my bosses, and the crew present. The crew was re-educated on dead is dead. They returned to work two days later.

 

[Strike3]

This is absolutely incredible some of the harsh responses I've read here. I thought we were all taught that you "work" a possible SIDS case, for the families sake. Put on the show, and at least take the kid out of the house. I was educated in CA, and this was taught in our BASIC class. Why a crew would be reprimanded for giving a mother and father a little piece of mind is unimaginable. Dead is dead. That's fine. I know there are signs and symptoms not compatible with life, that's fine too. But a SIDS case is a special issue, and we were taught differently.

 

[hfdff422]

Originally posted by Strike3@Dec 9 2005, 10:46 AM
This is absolutely incredible some of the harsh responses I've read here. I thought we were all taught that you "work" a possible SIDS case, for the families sake. Put on the show, and at least take the kid out of the house. I was educated in CA, and this was taught in our BASIC class. Why a crew would be reprimanded for giving a mother and father a little piece of mind is unimaginable. Dead is dead. That's fine. I know there are signs and symptoms not compatible with life, that's fine too. But a SIDS case is a special issue, and we were taught differently.

Not cold, necessary. Our system allows BLS providers to call it on scene with OLMC under the same criteria as for any other patient. If the parents are hysterical, then a FF or PD or other EMT will console them. We are taught to allow a little latitude on calling a possible SIDS case. It is recommended that a borderline viable patient be treated as a fully viable patient, and a patient is non-viable when there are at least two of the criteria met. These are not protocols, just recommended ot diffuse a horrible situation. This scenario was not one of those situations.

 

[rescuecpt]

No matter how seasoned you are, a lot of experienced ALS and BLS providers are deeply affected by infants, I can't say that I would be able to follow protocols perfectly either.

 

[Jon]

PoorMedic - Who initiated CPR? Did FD arrive first and start CPR, and your crew find CPR in progress? Or did your crew start with CPR.

Sounds like you handled everthing right. I'd love to work under a supervisor like you. Maybe I'll move :lol:


Jon

 

[PhillyMedic]

I would take the child to the closest hospital, doing basic CPR, and inform the hospital enroute what is going on, and to have social workers, etc in the ER for the family.

 

[Strike3]

Originally posted by PhillyMedic@Dec 9 2005, 04:46 PM
I would take the child to the closest hospital, doing basic CPR, and inform the hospital enroute what is going on, and to have social workers, etc in the ER for the family.

I completely agree with you. That would be my course of action. I feel that in no way this crew should have been punished. Granted, none of us were there to see the actual child, but still.

 

[TTLWHKR]

Always do something, or the parents will have an emotional breakdown.