When does a Paramedic not resuscitate a patient?

[RickVS]

I'm not in the field, but have a couple questions. If a paramedic goes to a scene where a victim just collapsed due to a coronary/choking/stroke, the paramedic I assume will attempt to bring the victim back. If a paramedic is called to a scene where the victim was decapitated by a piece of equipment, obviously there will be no attempt to resuscitate. So here are my questions: 1) where is the line drawn between the two above extremes as to when a paramedic needs to resuscitate a victim and when it is not necessary 2) can a paramedic declare somebody dead when it is obvious that they are truly dead and 3) does the paramedic have to keep resuscitating the victim all the way to the hospital or can they quit on scene at some point?

Thanks. I used to be a EMT-P 30 years ago, but I suppose a lot has changed.

Rick

 

[NomadicMedic]

1) where is the line drawn between the two above extremes as to when a paramedic needs to resuscitate a victim and when it is not necessary 2) can a paramedic declare somebody dead when it is obvious that they are truly dead and 3) does the paramedic have to keep resuscitating the victim all the way to the hospital or can they quit on scene at some point?

1) When the death is obvious. Any condition incompatible with life, such as decapitation.

2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.

3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.

 

[MrBrown]

Our Ambulance Officers can decline commencment of resuscitation when it is either futile or not in the besr interests of the patient. eg end stage cancers, unwittnessed arrest with asystole as initial rhythm

Sent from Brown's smartypants GTI-5580 Android using Tapatalk

 

[IrightI]

1) When the death is obvious. Any condition incompatible with life, such as decapitation.

2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.

3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.

Couldnt have said it better myself.

 

[DesertMedic66]

1) When the death is obvious. Any condition incompatible with life, such as decapitation.

2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.

3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.

Same as #1.
#2 EMTs and medics can declare death (at least in this area)
#3 It varies. Some codes we will transport and some we won't. It's a case by case thing

 

[RickVS]

Thanks for the info.

Very helpful, everyone.

Rick

 

[firecoins]

I won't resusitate anyone who has a perfusing pulse and is breathing on their own. Just won't do it. Its not worth it.

 

[ihalterman]

I won't resusitate anyone who has a perfusing pulse and is breathing on their own. Just won't do it. Its not worth it.

Funny as hell, but I'm not sure it will help the OP.

 

[MrBrown]

Ambulance Officers can choose not to resuscitate a patient when it is clinically futile (eg asystolic unwitnessed arrest) or not in the best interests of the patient, e.g. somebody dying from end stage cancer or with a clearly described directive.

 

[medic417]

So what law firm are you with and who are you trying to hang by getting blanket statements from people?

 

[HotelCo]

We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.

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.

 

[HotelCo]

So what law firm are you with and who are you trying to hang by getting blanket statements from people?

Also... this.

 

[Sasha]

So what law firm are you with and who are you trying to hang by getting blanket statements from people?

My thought exactly!

 

[Sasha]

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.

Man up and explain there's nothing that you can do. People will be grateful they can say their goodbyes in the comfort of home instead of the cold hospital room with the thought of a ridiculous, pointless bill in the back of their minds.

 

[HotelCo]

Man up and explain there's nothing that you can do. People will be grateful they can say their goodbyes in the comfort of home instead of the cold hospital room with the thought of a ridiculous, pointless bill in the back of their minds.

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.

 

[DesertMedic66]

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.

Same here.

 

[usafmedic45]

So what law firm are you with and who are you trying to hang by getting blanket statements from people?

LOL Nah, they'd go get the protocols of the service, the medical literature and an expert witness such as myself to hang the person(s) in question.

 

[usalsfyre]

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.

I'm sorry, but this sounds like a copout. I've ceased efforts in the ghetto, and in the rural, rural backwoods. Never had a problem either way. As long as it's handled with compassion and discrestion most people understand.

 

[HotelCo]

I'm sorry, but this sounds like a copout. I've ceased efforts in the ghetto, and in the rural, rural backwoods. Never had a problem either way. As long as it's handled with compassion and discrestion most people understand.

Think what you want. I do what I do based upon my experiences in the area I'm in.

 

[Shishkabob]

1) When the death is obvious. Any condition incompatible with life, such as decapitation.

2) We don't "declare" death, but we may "cease efforts" or simply not start a resuscitation.

3) If we're en route with a viable patient, we'll work it all the way in. We don't as a rule transport CPR in progress unless it's a hypothermia or person who has ROSC and then arrests again while transporting.

You may not, but I pronounce death, just the same as I make a diagnosis. Now, I don't sign the death certificate... but that doesn't mean I'm not pronouncing. In the end, it's my decision if a patient is worked or not, not some person elected to the position of JP who has no medical background whatsoever.


As for the OP, a Paramedic (or in some places, EMTs) can make the determination, aside from obvious injuries incompatible with life (such as decapitation), along with other signs not generally compatible with life, such as rigor mortis or dependent lividity.

Sometimes it's a judgement call. If you get called for a difficulty breathing and arrive to find the patient in cardiac arrest, you might work it. If you get called for an auto-accident and find the patient in cardiac arrest, chances are you won't work it.