It's a necessary evil in the world of EMS. We see dead people, sometimes we can change that, most times we can't.
Let me give a little backstory first.
A few shifts ago, we responded to a hoarder house where the female is a frequent flier with breathing problems. She has a tendency to wait until she absolutely is in trouble, then call 911. About 2 months ago, she was in cardiac arrest and was one of the "lucky ones" our crews revived. Well, she was given 6 months to live because of her other medical issues.
We responded to a call at her residence because "she couldn't walk". As it turns out, her feet were dying. As in the worse of the 2 was half-dead. The dead parts were textbook, and it's the first time I've seen this outside of the pictures in those books. The dead areas were pitch black and much smaller than the rest of the foot. The skin had split in at least 1 place, and I was shocked to not see maggots.
We tried everything to convince her to be transported to the hospital. We warned her about the impending sepsis, threatened with DFACS, and called to try for orders to hold on a psych evaluation. We even offerred to carry her to a family member's car, but she refused everything and was in too good of a mental capacity to be held on a psych order. Our last resort was to have her sign a refusal of treatment/transport, and have dispatch send a police officer that has a nurse with them to try and see if the nurse would place he under psych orders (our hope was since the nurse could actually see he living conditions an the dr couldn't, that he/she would force the patient to go).
Well, 2 shifts later, we found out that she did have her feet looked at and bandaged. Her body being too weak for the surgery to remove the necrotic tissue. Unfortunately for us, we found this out when we picked her up for being in cardiac arrest.
We did all we could for her, but she was pronounced dead just minutes after arriving at the ER.
Earlier in the same shift, we went to a hospice-at-home arrest. The daughter had medical power of attorney, but couldn't find her form stating it. There was also a DNR, or do not resussitate order, but it was missing the dr's signature, so it wasn't valid.
We had to initiate CPR, and after finally giving enough drugs and attaining both a patent airway and IV, we received orders to terminate CPR from the hospital.
I didn't know it, but apparently because of the DNR (a valid one was brought to the scene by the hospice nurse), the daughter wasn't supposed to have called 911. She just freaked out when she realized the patient stopped breathing. I'd probably do the same to be honest.
Here's something I've noticed recently though, that in a way, really bothers me. Why are ER docs so ready to pronounce without hardly even assessing the patient themselves?
I realize that by the time we get there, the average patient has had 3 rounds of epi, 3 rounds of atropine, and a bicarb, but shouldn't you at least let me get them off my stretcher and get it out of the room before you call them? Is this a new trend/standard I missed another memo on?
What's it like where any of you folks that work EMS are? Do your ER docs work everybody for a few minutes, maybe just the old folks get a rapid termination, do they base it on being asystole or PEA? I'm curious.
4 days ago