When does a Paramedic not resuscitate a patient?

Veneficus

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Think what you want. I do what I do based upon my experiences in the area I'm in.
I've been attacked while working the code, so I am guessing if the people are going to attack, it won't really matter what is being done or not.
 

usalsfyre

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Think what you want. I do what I do based upon my experiences in the area I'm in.
We'll agree to disagree then. I don't know your specific circumstances. I can say in my area I've done death notifications(either ceasing resuscitation or not starting it at all) a few times a month for all age, socioeconomic and common racial groups and never run into a problem
 

HotelCo

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I've been attacked while working the code, so I am guessing if the people are going to attack, it won't really matter what is being done or not.
We've had medics here attacked while helping patients as well. Why give them more reason to be upset? Throw em in the ambulance, call the hospital en route, and tell them what's going on. At that point, it's the doc's choice whether we continue working it, or not.

We'll agree to disagree then. I don't know your specific circumstances. I can say in my area I've done death notifications(either ceasing resuscitation or not starting it at all) a few times a month for all age, socioeconomic and common racial groups and never run into a problem
I've done the same, but I choose not to when I don't feel it'd be safe for me to do so. So, like you said, I suppose we'll agree to disagree.
 

Veneficus

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We've had medics here attacked while helping patients as well. Why give them more reason to be upset? Throw em in the ambulance, call the hospital en route, and tell them what's going on. At that point, it's the doc's choice whether we continue working it, or not.
Sounds like a great plan to me.

I have had the experience to throw people in the rig, drive a few blocks and then terminate efforts for the reason you described.

When in Rome, do as the Romans do.
 

DrParasite

The fire extinguisher is not just for show
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I transport most codes from a private residence with family on scene around here. I don't want to be left on scene with family who saw me stop doing CPR, with no PD. More of a 'scene safety' thing than anything. :p
seriously? don't PD go to your possible DOAs? it's an unattended death, it needs to be investigated by the police. it's a law enforcement matter, PD needs to be there. If nothing else, PD should be there to make sure the scene isn't disturbed until the detective can arrive.
You come deal with the people around here for a bit, and then we'll see if you still think that way. We've had medics attacked while helping the patient. I'm not about to have them see me stop helping, tell them that's that, and hope the gangbanger is calm enough to be rational. ;)
you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER? wow.

We have had EMTs and medics attacked. usually it's by EDPs, people under the influence, or people who don't want EMS there. rarely is it by a bystander who doesn't like the way you are treating the patient (unless you are disrespecting them, which is why you should treat everyone with respect, especially in the public eye).

If you have a reason to transport a dead body (homie pulls out a gun and says "you will save my momma!!!"), then by all means do so.

but in my experience, even in the ghetto, if the person is dead, and you treat them and the scene with respect, not even the homies will give you a problem.
 

HotelCo

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seriously? don't PD go to your possible DOAs? it's an unattended death, it needs to be investigated by the police. it's a law enforcement matter, PD needs to be there. If nothing else, PD should be there to make sure the scene isn't disturbed until the detective can arrive.
you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER? wow.
You've never been to Detroit, have you? PD barely responds to 911 calls...

you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER? wow.
Where did I say that? I'd rather they find out in a well-lit ER with PD, then them seeing me suddenly stop doing CPR in a back room, at night.

We have had EMTs and medics attacked. usually it's by EDPs, people under the influence, or people who don't want EMS there. rarely is it by a bystander who doesn't like the way you are treating the patient (unless you are disrespecting them, which is why you should treat everyone with respect, especially in the public eye).
Glad it doesn't happen in your area.

If you have a reason to transport a dead body (homie pulls out a gun and says "you will save my momma!!!"), then by all means do so.

but in my experience, even in the ghetto, if the person is dead, and you treat them and the scene with respect, not even the homies will give you a problem.
In your experience.
 

DesertMedic66

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seriously? don't PD go to your possible DOAs? it's an unattended death, it needs to be investigated by the police. it's a law enforcement matter, PD needs to be there. If nothing else, PD should be there to make sure the scene isn't disturbed until the detective can arrive.
you want to transport an obviously dead body, just so you can put the blame of the person dying on the ER? wow.

We have had EMTs and medics attacked. usually it's by EDPs, people under the influence, or people who don't want EMS there. rarely is it by a bystander who doesn't like the way you are treating the patient (unless you are disrespecting them, which is why you should treat everyone with respect, especially in the public eye).

If you have a reason to transport a dead body (homie pulls out a gun and says "you will save my momma!!!"), then by all means do so.

but in my experience, even in the ghetto, if the person is dead, and you treat them and the scene with respect, not even the homies will give you a problem.
For DOA's we arrive first because it comes in as a medical call. Then once say time of death we call PD so they can do their investigation.

Quiet a few people in this area don't want you to just arrive and say "we cant do anything" or start CPR and then stop. So it's just safer to transport and contact the ED and have them say what they want you to do. If there is odvious signs of death then I'll just call it on scene.
 

mycrofft

Still crazy but elsewhere
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Dear OP,

When he is the Spawn of Satan.
 

abckidsmom

Dances with Patients
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For DOA's we arrive first because it comes in as a medical call. Then once say time of death we call PD so they can do their investigation.

Quiet a few people in this area don't want you to just arrive and say "we cant do anything" or start CPR and then stop. So it's just safer to transport and contact the ED and have them say what they want you to do. If there is odvious signs of death then I'll just call it on scene.
Just wondering...if you're working it just for the people, do you intubate and give all the drugs and everything?

I've been in a situation like you describe just a few times. Our ghettos weren't quite as unfriendly, and our PD were all over the place. I get it, but I wish people didn't have to live such lives of ignorance.
 

DesertMedic66

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Just wondering...if you're working it just for the people, do you intubate and give all the drugs and everything?

I've been in a situation like you describe just a few times. Our ghettos weren't quite as unfriendly, and our PD were all over the place. I get it, but I wish people didn't have to live such lives of ignorance.
PD doesn't come unless we request them. After we call for them they can take up to 5 mins or over to arrive on scene. On those calls we arrive on scene and load them up quickly into the rig then call the ED and see if they want us to intubate, push meds, just do CPR, or nothing at all. From what I've seen basically everyone gets transported unless it's completely odvious they are dead.
 

DrParasite

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You've never been to Detroit, have you? PD barely responds to 911 calls...
your right, I never have been. I would imagine that PD still investigates possible homicides (which every unconscious is until proven otherwise). I mean, they do respond to shootings right? what about unsafe scenes, PD goes to them right? I mean, you got a guy running around attacking people with a baseball bat, PD gets sent, not an ambulance right? and if the scene isn't safe, than wait for PD, that's why units are supposed to stage.
Where did I say that? I'd rather they find out in a well-lit ER with PD, then them seeing me suddenly stop doing CPR in a back room, at night.
so you would rather tie up an ambulance on an over burdened system (you do still get Detroit FD responding to cardiac arrests, right?), instead of leaving the dead body for the ME/funeral home to take away?

Don't get me wrong, I know you guys don't have enough units to handle the volume, but transporting dead bodies because you are afraid of what the family would do (especially when you have all those FF's on scene with you) makes me think maybe they are unsafe scenes that PD should be sent to first.
Glad it doesn't happen in your area.
your right, your agency does EMS in the most dangerous city in the US, my agency only does EMS in the 3rd most dangerous, two completely different places.

And learn something new every day, I though it was a standard practice to send a PD unit on any cardiac arrest because an unattended death needs to be investigated to rule out foul play. I guess it's not in some parts of the US.
 

DesertMedic66

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your right, I never have been. I would imagine that PD still investigates possible homicides (which every unconscious is until proven otherwise). I mean, they do respond to shootings right? what about unsafe scenes, PD goes to them right? I mean, you got a guy running around attacking people with a baseball bat, PD gets sent, not an ambulance right? and if the scene isn't safe, than wait for PD, that's why units are supposed to stage.
so you would rather tie up an ambulance on an over burdened system (you do still get Detroit FD responding to cardiac arrests, right?), instead of leaving the dead body for the ME/funeral home to take away?

Don't get me wrong, I know you guys don't have enough units to handle the volume, but transporting dead bodies because you are afraid of what the family would do (especially when you have all those FF's on scene with you) makes me think maybe they are unsafe scenes that PD should be sent to first.
your right, your agency does EMS in the most dangerous city in the US, my agency only does EMS in the 3rd most dangerous, two completely different places.

And learn something new every day, I though it was a standard practice to send a PD unit on any cardiac arrest because an unattended death needs to be investigated to rule out foul play. I guess it's not in some parts of the US.
So you have never had a call where someone doesn't mention there is a gun in the house? What if someone starts getting aggressive while you are on scene of a Dif breather that goes into arrest. The police aren't going to be there.

Firefighters are no good when someone pulls a gun or a knife or any weapon.

For my area PD does not respond to deaths until we call then except for shooting and stabbings.

We are famous for getting the "unknown medical aid". So we won't be able to tell if the scene is safe until we pull up.
 

the_negro_puppy

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We may declare life extinct:

After 20 minutes of resus effort with no ROSC
Patient presentation of at least ten minutes of pulseless and unresponsiveness with no CPR w/ asystole 2 leads.
Obvious death (rigor, lividity)
Inevitable death/injuries decapitated, cerebral destruction etc


I think it is poor practice to transport patients in cardiac arrest (unless extenuating circumstances) Not only is it difficult to attempt resus on a patient in the back of a moving vehicle, the public is also endangered by a lights and sirens drive that has a very poor prognosis.

Here we only transport if we have a ROSC or patient arrest enroute close to hospital.
 

DrParasite

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So you have never had a call where someone doesn't mention there is a gun in the house?
well, if it's not mentioned, how would I know??? and I'm sure people have had guns in their house, but as long as you don't disrespect them, and do what you are supposed to do, 99% of the time they will not only let you do your job, but make sure no one else messes with you. and how many times has a gun been pulled on me? 0. I've also never been shot or shot at, something I am pretty happy with.
What if someone starts getting aggressive while you are on scene of a Dif breather that goes into arrest. The police aren't going to be there.
two things will happen. #1, as a general rule, any arrest that I witness gets worked all the way to the hospital. hell, I work most witnessesed arrests, unless they show signs that they aren't coming back no matter what I do. #2, if someone starts getting aggressive, you either request police to respond immediately (if we do it, it is a city wide request for all available police officers, and they won't stop until they are advised that the situation is under control), or say screw the patient, take you and your partner out the door you came in, leave all your equipment (or use it as more stuff to throw in between the aggressor and yourself), run to the ambulance and drive away, and wait for PD to get there to make sure everyone behaves. remember the whole scene safety thing? taught day 2 of EMT class? if it's not safe, leave and call for help. not exactly rocket science.
Firefighters are no good when someone pulls a gun or a knife or any weapon.
having 4 firefighting around you is a great deterant to having a knife or gun pulled on you. once it's pulled, yeah, you are in a jam, but someone is much more likely to start something when it's just two EMTs who he or she can take easily, vs 2 EMTs and 4 firefighters, esp when the 4 firefighters are watching your back while you two are working on the patient.
For my area PD does not respond to deaths until we call then except for shooting and stabbings.
interesting, maybe you should propose changes, for your own safety?
We are famous for getting the "unknown medical aid". So we won't be able to tell if the scene is safe until we pull up.
yeah, we get them too. you pull up find the scene is not safe, you leave until PD makes it safe. not exactly rocket science here...:rolleyes:
 

Smash

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I've ceased resus in pubs (bars for you lot) where these types of chaps drink


And never had a problem.
 

STXmedic

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I've got to agree with that being a horrible excuse to transport an arrest. I work in the "getto" in a major city also, and I've worked and called plenty of arrests in not-so-nice parts of town. Worked on family of Mexican Mafia and Latin Kings and never once had a problem. Quite the opposite, they are usually very grateful you tried and understanding when you tell them their friend or family member didn't make it. If things do start escalating; talk them down or leave. And that pretty red button on top of the radio is a wonderful help in a tough spot ;) As far as guns, near every house we go into has guns, no matter what the socio-economic state of the area. I'm in Texas, I'd be worried if they DIDNT have a gun :p
 

HotelCo

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I've got to agree with that being a horrible excuse to transport an arrest. I work in the "getto" in a major city also, and I've worked and called plenty of arrests in not-so-nice parts of town. Worked on family of Mexican Mafia and Latin Kings and never once had a problem. Quite the opposite, they are usually very grateful you tried and understanding when you tell them their friend or family member didn't make it. If things do start escalating; talk them down or leave. And that pretty red button on top of the radio is a wonderful help in a tough spot ;) As far as guns, near every house we go into has guns, no matter what the socio-economic state of the area. I'm in Texas, I'd be worried if they DIDNT have a gun :p
Once again, I've explained my choice is based upon experiences in the area I work, and events that have occurred to other Paramedics in the area. I see no need to repeat myself after this post.

Also: Your red buttons work?
 

DesertMedic66

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well, if it's not mentioned, how would I know??? and I'm sure people have had guns in their house, but as long as you don't disrespect them, and do what you are supposed to do, 99% of the time they will not only let you do your job, but make sure no one else messes with you. and how many times has a gun been pulled on me? 0. I've also never been shot or shot at, something I am pretty happy with.
My point being that a scene can be more then it seems. Obviously your town is different then mine because people here don't say gun shot to the dispatcher. so PD has no reason to respond to a medical call (at least in this area unless we request them). Refusing to do CPR is a form of disrespect in some peoples eyes. I have been threated on scene with "save my momma or else you are the one thats gonna need to be saved".

two things will happen. #1, as a general rule, any arrest that I witness gets worked all the way to the hospital. hell, I work most witnessesed arrests, unless they show signs that they aren't coming back no matter what I do. #2, if someone starts getting aggressive, you either request police to respond immediately (if we do it, it is a city wide request for all available police officers, and they won't stop until they are advised that the situation is under control), or say screw the patient, take you and your partner out the door you came in, leave all your equipment (or use it as more stuff to throw in between the aggressor and yourself), run to the ambulance and drive away, and wait for PD to get there to make sure everyone behaves. remember the whole scene safety thing? taught day 2 of EMT class? if it's not safe, leave and call for help. not exactly rocket science.
Yes that was taught in EMT class. But its not exactly easy to slip out of the house without anyone noticing you. let alone someone asking you what you are grabbing from your bag. and calling for PD while on scene???? down here that is asking for someone to try to kill you. (if we ask for assistance from police we normally get one or two units. we only have a total of 33 officers for a population of 40,000+).

having 4 firefighting around you is a great deterant to having a knife or gun pulled on you. once it's pulled, yeah, you are in a jam, but someone is much more likely to start something when it's just two EMTs who he or she can take easily, vs 2 EMTs and 4 firefighters, esp when the 4 firefighters are watching your back while you two are working on the patient.
In an ideal world thats how it works. sometimes we cancel fire because they will have another call. and once again if someone wants to pull out a gun they will.

interesting, maybe you should propose changes, for your own safety?
yeah, we get them too. you pull up find the scene is not safe, you leave until PD makes it safe. not exactly rocket science here...:rolleyes:
uhhh im confused here. i said you wont know until you arrive on scene. and yeah i know its not rocket science.... i never said it was. You do things how you do them in your area and i will do them how we do them over here................... its not rocket science that our two areas are vastly different :rolleyes:
 
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