No it's not.
* This is why you don't decide not to start resuscitation without assessing the patient properly
* This is why you don't decide not to start resuscitation, then piss off PD by removing a corpse from a potential crime scene, and piss off the hospital by bringing them a corpse like they're some sort of funeral home.
This situation does present an argument against not initiating futile resucitations when signs of obvious death are present, nor does it argue against calling a resuscitation after 15 minutes of asystole. It argues against not doing your job properly.
Providers (ALS and BLS) are taught that you work the hopeless pediatric code for the parents.
This is not universal. In some areas providers are taught that it's in the parent's best interest not to start a futile resuscitation, and to call it in the home.
Which is the best approach seems to be a matter for debate. Perhaps someone here has a psychology/counselling background and can tell us what the relevant literature states?
Take a moment to think for a second: You're a parent, and your entire world has just come crashing to a screeching halt when you find your child lifeless. You call 911 because, like it or not, we're the people that are supposed to know what to do. How would you feel if a couple of paramedics walked in, looked down at your (dead) child, and said "Sorry, there's nothing we can do.
Pretty much exactly the same as how I would feel if they came in, rushed my kid to the hospital, and I got there to find their lifeless body on a stretcher with a bunch of doctors and nurses around, and some jackass in a white coat told me "Sorry, there just wasn't anything we could do".
I think I'd feel numb, then hungry, then want to get drunk, and probably spend a day or two considering suicide, then I'd remember that my wife is currently pregnant and that I have responsibility to my future unborn second child. I'd probably keep drinking too much for a little while, but then I'd tone it down before the baby was born. I'd also probably pick up my gloves, go down to the gym, hit people and get hit for a little bit, too.
And it would be the worst thing that ever happened to me, and I'd remember it for the rest of my life.
By the way, get ready for a whole bunch of police and the medical examiner to come in to your house, ask you to re-hash the most terrible event that will ever happen to you again and again,
Which is going to happen anyway.
and not even leave you with one physical location that feels safe (since that's going to be where their "baby died")."
Like I would ever walk into that room again, and not be reminded of my dead child.
If you say "sorry, he's dead" that's it. They didn't get to say goodbye,
Calling the code in the home doesn't preclude the parents getting to say goodbye. It just means it's done in a different place. Unless there are clear signs of a violent act, they're going to get to hold the child and have some time if I call it in the house.
the room where their child lived is (probably) also the room where their child died, and nothing is ever going to expunge their guilt and anger.
It's still going to be -- and possibly nothing is. Do you really think they're going to feel less guilty or less angry because you've moved the baby to the hospital, done some CPR and given some drugs? I think you're overestimating the potential impact we have on this situation.
Worse, you (and our entire profession) may become the target of all of that anger - "Why didn't you help our baby? Why did you let him die?".
That's not worse. It's utterly trivial. The parents are going to be angry. They're going to find somewhere to place blame. If they choose to place it on me, that's fine. Nothing is going to make their child come back, and as hard as it might be for you or me to endure, sometimes we get paid to have people dump on us for things we don't deserve.
Regardless of the fact that the child was dead before you got there you're going to be looked at as the monster who "wouldn't save our baby". (Not "couldn't"; "wouldn't").
If that happens, and they actually think I "wouldn't save their baby", not that I was the one who told them "their baby was dead", then I've failed somewhere in explaining to them what's happened, and what's going on, which is a vital part of doing this.
The majority of the time it's not going to happen like this. And when it does, you just have to fall back on the fact that you followed your training and your medical control guidelines.
No parent wants to see their child stuffed full with tubes and wired like a Christmas tree, but no parent wants to see their child sick or dead, either.
Agreed.
If you work the child it a) gets the child out of the house ("The child later died at Rampart General hospital...")
Which saves you and me from having to deal with the parents, but passes that responsibility on to someone else. It draws out the process, and changes where the parents are when they're told the kid's dead, which they probably already suspect.
, b) it looks like you tried everything you could, and
It does. But so does doing a proper examination of the child, finding obvious signs of death, and explaining to the parents that there's nothing you can do.
Running the asystolic arrest for 15' in the child's bedroom then calling OLMC, or d/c'ing based on protocol achieves the same. But we should only do this in the absence of criteria for obvious death.
c) it gets the parents into a physical location (the hospital) that's got the kind of support help they'll need. It won't help every parent but it's a start.
But those resources can be brought to the patient outside of the hospital, just as they are in other out-of-hospital arrest.
By this logic, when I treated a 48 year old man who had a witnessed SCA in front of his wife and 3 kids, I should have run him to the hospital, instead of running the asystole protocol for 20 minutes and calling it. Are we back to transporting all cardiac arrests, or just kids? [I recognise that this borders on a "slippery slope" fallacy, but consider the reasoning]
The reality here, is that some parents are going to be ok with the resuscitation either not being started or being called in the house. If you ask them afterwards, they won't mind. Some are going to wish you'd taken the child to the hospital, even if it was futile. The opposite is true as well -- some parents will be glad you took the child to the hospital, even if futile. Others would wish that you hadn't.
Ultimately what you do in this situation is going to be decided by your regional medical control guidelines, and the reaction of the parents is going to depend on individual circumstances and the personalities involved.
...but hey, remember that 2 week accelerated course meets the national standard, so it must be ok!
