What would you do?

So we are saying "give the parents false hopes & having an EMS bill and now a ER bill, an emotional lift ?" Not only that representing that we do not know what we are doing ?.... hmmm far as I recall obvious signs of death ( even AHA :BLS) CPR should not be performed. i.e rigor mortis. Dead is dead... declare it, take care of the family. Give empathetic care to the parents and help notify family, chaplain, counsleor, etc... for them.

Profesional and tactal empathetic discussion can occur. They will be told somewhere by someone that child is dead..pretending to perform a code ( knowing ther is NO chance of resucitation at all!) on a obvious non-viable patient could be percieved as unethical. Just because the patient is an infant, in an OBVIOUS non-viable patient should not matter.

The problem is rigor in jaw is very tale-tale sign... again, they crew screwed up and have learned their lesson. It appears it was handled diplomatically and well. I am sure they learned from it as well.

No matter by whom or when the parents are told, most parents have death and dying, grieving & emoitonal problems. It is a very sad situation.

Be safe,
R/R 911
 
Last edited by a moderator:
Very well said Rid - thats why my response I was harsh because the crew did not take in consideration the obvious signs of death and had already initiated resuscitation efforts and if I am correct once you start you cant stop until the ER Doc or ER Nurse calls it upon arrival in the ER or unless Med Control tells you stop in the field. Again if it were my crew I would have suspended them for a week, verbal lashing, and required to take a refresher course.

And you hit the nail on the head when you said it was unethical - why put on a show for the family when you know the patient is not a viable one, only for the family to be completely let down in the end, and possibly the family later learns you put on a show which would upset them further. Dead is dead and grief is grief.

-CP
 
For once I agree wholly with Rid, this is a case where there is no chance of saving the child, so your job is now to prepare the parents for the reality of it all. Compassion starts with being honest, not giving false hope. If there was a slim chance of viability then that changes things, but any person who has been in fire or EMS for even a year would see that this is the wrong course of action with the presentation of rigormortis. These guys make us all look bad when they made that decision. I would not come down too hard on them though since, as I stated before, ped's and common sense tend to exclude each other. But it should be A+R'd into their heads.
 
I don't care about the bill, or the ER bill, I care about the safety of the scene, which could get ugly quick, I don't want to be at that scene any longer than I have to be.
 
I have actually been part of that crew a couple times in recent years as bad as it sounds.

I have some questions first actually.

How many people responded and were on scene when EMS arrived.

Just how safe was the scene?

I understand rigor is rigor and most of us realize that the chances for survival are as good as you winning the lotto in all 50 states on the same day but does the family? Besides, realistically speaking almost every person in EMS/Police and Fire will go the extra mile for a ped. Without fail.

Here it is two dudes and a truck. If I have to do CPR on your dog to walk out of the house alive I will. If I think I’m going to get an a** kickin for telling you your kid is dead we scoop the kid, go to the truck and tell em we are going to x hospital and go.

Call the ER, advise them of what you are doing and why, i.e. I want go home at the end of the day and come on in. Let the ER with the big staff and armed security tell the family.

Some scenes we have been able to help the family along the grieving process with both young and old but in this city the mindset of “everyone goes” has been so ingrained that if you don’t take someone and start mentioning how they are as stiff as that nice new 42 inch plasma TV ( i.e. rigor, dependent lividity, etc, etc..)you are probably going to get hurt. It's unethical I guess for giving false hope but in certain cases reality or lack thereof makes the difference for you going home at night.

Every scene is different, every single one. 2nd guessing a crew when you weren’t there is crazy unless they are pushing D50 down the tube or something…

Either way, if I were a supervisor (I am not) I guess you have to look at the crew, their past performance, the scene, etc. At worst I could see counseling them on what could be considered poor judgment for a first offense.
 
In Indiana we have mandatory SIDS training- basically an hour of peds refresher and three hours of compassion training per session. They bring in parents who had children die of SIDS and do speeches, etc. The director of the organization that does this is who gives the talk to EMT classes and she is adament about being very frank and honest about what is going on. Her experience is almost text book of what to do. The cops and firefighters who responded first started rescue operations, the FD ambulance was next, they continued rescue operations while the cop went to get some information, then another volunteer FF from the neighborhood cam and found out all the info he could from the initial responders. The FF then went and started informing the parents what was going on, that the baby would not be resuscitated and they were going to have to start facing that fact- obviously with some more tact than that- and asked what he could do to help them. Keeping the rescue operation away from the parents (taking the parents to another room), telling them the truth about what is going on, offering what help you can, offering to contact support services, letting them see their child before the ME takes the child- with supervision if you or the cop thinks there are issues like that, using the terms he/she/the baby instead of it or the body, making sure they remember to involve other siblings in the situation are all important factors in an effective handling of the situation. If you handle it in a wishy-washy, indirect sort of manner you are being cruel. Offering false hope is just as bad as teasing- don't do it.
 
My protocols have very strict guidelines, and we are encouraged to NOT start resuscitative measures if we have a pt in asystole who is cool to the touch, and has an unknown down time...if the FD or PD arrives first and starts CPR, once we determine the above criteria, we can stop any further treatment...Like everyone else has said, to provide false hope, no matter how good the intentions are, is cruel...and could land you in the state EMS office for a very nasty QA session. However, if the absence of the aforementioned signs of death(rigor, levidity, asystole and cold, etc), by all means, work the code!

P.S. PEA/EMD is a workable rythmn.
 
rescuecpt said:
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.
Click to expand...



Amen to that. I'm not that seasoned, but i can tell you that my a***ole definatly puckers when i find out its a youngin. life's too short to sweat the small stuff. we are all gonna mess up. should we just get the rope out and tie the nuse now? or can we learn from our mistakes.
 
Yes we all mess up, but there is a difference between messing up and what a lawyer could consider malpractice, negligence, or theft by deception, or at the worst depraved indifference homicide...mind you I dont think anyone would take it that far, but in the litigiuos society we live in no one really knows who will sue who...
 
Do it for the parents...
 
I have to say, years ago, (I've been in for 11 years), we were taught to move in act like we were making an effort and then cease at the truck enroute in. Now, it is discouraged. As a mother, I can say that if i found my child not breathing, it would be hard for me to accept the fact and I would always wonder if EMS did all they could do for the child. As a provider, I feel that each situation is different. Go with the scene... what are the parents like? How for gone... morbidly speaking... is the child?

As far as what to do with the providers who started cpr, listen to the situation. What factors were involved in their reasons for what they did. Everyone... well anyone with a heart... has a soft spot for peds. offer support to the providers who were involved. If no harm was done, do make harm! It is not a problem, until it is a problem!!! Have a heart!!!
 
trauma1534 said:
I have to say, years ago, (I've been in for 11 years), we were taught to move in act like we were making an effort and then cease at the truck enroute in. Now, it is discouraged. As a mother, I can say that if i found my child not breathing, it would be hard for me to accept the fact and I would always wonder if EMS did all they could do for the child. As a provider, I feel that each situation is different. Go with the scene... what are the parents like? How for gone... morbidly speaking... is the child?

As far as what to do with the providers who started cpr, listen to the situation. What factors were involved in their reasons for what they did. Everyone... well anyone with a heart... has a soft spot for peds. offer support to the providers who were involved. If no harm was done, do make harm! It is not a problem, until it is a problem!!! Have a heart!!!
Click to expand...

Well said....
 
Do wat for the parents...?.. Give false hope, watching their obviously dead child being coded... in which is not a pretty site. Do things the right way, as like any other obviously death. Deal withthe situation, treat the family with empathy, preserve the scene.. age should and does not make the difference.

Be safe,
R/R 911
 
This SIDS subject has been going on for years it seems.....

I would, I would not and so on.... I have seen some pretty heated discussions on this subject..

R.N.,CCRN,CEN,CCEMT/P,NREMT/P &amp; all the other vowels <-Damnnnnnnnnnnnnnnnn!!
 
Last edited by a moderator:
DFDEMS, I think you got it cracked for the most part. Not all scenes are unstable but you are right, I am going home and will do what I have to to insure that.

Captainpanic....hmmm. Have you ever worked the street? Going by your age, if you have, I think maybe not enough to be a Monday morning quarterback. I'd be willing to bet there are alot of natures/scenes and so on that would cause you to vapor lock. Hardly a soul deals well with sick kids and your harsh response indicates a gross lack of experience if not compassion.

As for the crew and the sup that handled the call? I was not there so I will try to keep my mouth resonably well shut. Just my 2 cents.
 
dhpd9807 said:
Captainpanic....hmmm. Have you ever worked the street? Going by your age, if you have, I think maybe not enough to be a Monday morning quarterback. I'd be willing to bet there are alot of natures/scenes and so on that would cause you to vapor lock. Hardly a soul deals well with sick kids and your harsh response indicates a gross lack of experience if not compassion.
Click to expand...

:rolleyes: How long have you been working, dhp?
 
Just wondering if your doing for the parents or for yourself ?..... Will you also pay for the expenses as well?...hmm EMS bill about $800.00 .. ER Bill (dependent) at least $400.00 .. if you are going to do it for the family when there was no need, think and look at the whole picture. Don't involve YOUR emotions...

Be safe,
R/R 911
 
This will probably show how green I am, but don't you leave and call the coroner if the pt (whatever age) has passed? Or does your service(s) require you to take care of the body? I don't know what mine are I really should find out.
 
In my area, LEO (police) is automatically notified. After, I declare death.. my job is done for the infant, I will assist the parents and assist anyway I can. The State M.E. field investigator is notified and handles the remainder of the case.

Be safe,
R/R 911
 
You must log in or register to reply here.
Back
Top