Arizona Victim Thought Dead, Not

[FireMedic65]

Don't have to be there to know if a proper assessment was done or not... Doesn't take long to check for signs of life.

[joesph]

Here we go again with the assumptions.

We assume that they didn't do an adequate assessment. Were any of us there?

If indeed a poor assessment was done then by all means, remediation and discipline but if there were 7 people in the wreck and this one guy met the black criteria then there you go.

Unless any of us were there then we need to stop being so freakin judgmental and shut the hell up.

Yippee my new hero

[ncmedic309]

Here we go again with the assumptions.

We assume that they didn't do an adequate assessment. Were any of us there?

If indeed a poor assessment was done then by all means, remediation and discipline but if there were 7 people in the wreck and this one guy met the black criteria then there you go.

Unless any of us were there then we need to stop being so freakin judgmental and shut the hell up.

I'm not assuming anything - they obviously wouldn't have declared this patient dead had they done a thorough assessment. The ME on scene detected signs of life and I highly doubt he used a monitor or any other tool besides his own common sense. It's highly unlikely that the patient was ever pulseless or apneic. The article states that he was in the vehicle for at least an hour before it was realized that he was still alive and also that the accident occured over the weekend and he later died on a late Tuesday evening. This paints the picture to me that they had an obviously viable patient - just failed to recognize it.

It doesn't take much effort to do a thorough assessment to determine death. It can be done rather rapidly if your effective and competent in your assessments. You attempt to palpate both radial and carotid pulses - you place the patient on the monitor (unless it's obvious death such as injuries incompatible with life), you do a thorough examination of the chest including observing for chest rise and fall, auscultating for lung sounds as well as heart sounds. It's also a good idea to do a quick pupillary exam as well. I know this can be done quickly and effectively because I do it on every patient before they get declared dead, regardless if it's medical or traumatic etiology (again providing the death is not completely obvious).

I'll be judgmental on anything I choose to be with the information I'm provided with - it's not hard to realize that somebody really fucked up on this one.

[JakeEMTP]

If they had performed an adequate assessment on the patient, even during triage - they would have realized that this patient was an immediate priority and should have likely went before any of the others - providing care wasn't delayed by extrication. But even then, as soon as the patient is free, he's high-priority and off the scene. He definitely wouldn't have been last, not until he's really, truly, no doubt about it - DEAD!

Exactly. Patients Triage status can change. It is important to continuously reassess your pt.'s.

[Dustdevil]

Didn't we already have a threat about traumatic PEA? I think the consensus is that it gets worked. Now the question is, if you check a pulse and find none, do you really need to put the monitor on the pt?

Possibly. Pulse is only one facet of an assessment. I think we've all had a few perfectly living patients who did not, on first exam, have a palpable pulse. Sometimes you have to really look for it. But, of course, sometimes it is painfully obvious that there is no need to look for it. There are a lot of other signs that will contribute to the body of evidence for life or death. If any of those signs are positive, then obviously an EKG is going to be indicated. But no, I do not believe that an EKG is indicated strictly for the purpose of proving obvious death.

Although, every time I read another one of these stories, I begin to rethink that position.

[chbare]

Didn't we already have a threat about traumatic PEA? I think the consensus is that it gets worked. Now the question is, if you check a pulse and find none, do you really need to put the monitor on the pt?

I have seen a few patients with VAD's who walking around without a pulse. This is actually something that I consider. MVC, patient scrambled the noggin and unconscious, VAD in place, no pulse, EMS on scene, wonder what would happen?

Take care,

chbare.

[FireMedic65]

I have seen a few patients with VAD's who walking around without a pulse. This is actually something that I consider. MVC, patient scrambled the noggin and unconscious, VAD in place, no pulse, EMS on scene, wonder what would happen?

Take care,

chbare.

wait what? I would definitely like to read more about this.

[Just Plain Ruff]

I'm not assuming anything - they obviously wouldn't have declared this patient dead had they done a thorough assessment. The ME on scene detected signs of life and I highly doubt he used a monitor or any other tool besides his own common sense. It's highly unlikely that the patient was ever pulseless or apneic. The article states that he was in the vehicle for at least an hour before it was realized that he was still alive and also that the accident occured over the weekend and he later died on a late Tuesday evening. This paints the picture to me that they had an obviously viable patient - just failed to recognize it.

It doesn't take much effort to do a thorough assessment to determine death. It can be done rather rapidly if your effective and competent in your assessments. You attempt to palpate both radial and carotid pulses - you place the patient on the monitor (unless it's obvious death such as injuries incompatible with life), you do a thorough examination of the chest including observing for chest rise and fall, auscultating for lung sounds as well as heart sounds. It's also a good idea to do a quick pupillary exam as well. I know this can be done quickly and effectively because I do it on every patient before they get declared dead, regardless if it's medical or traumatic etiology (again providing the death is not completely obvious).

I'll be judgmental on anything I choose to be with the information I'm provided with - it's not hard to realize that somebody really fucked up on this one.

So NC, if you are ever accused of stealing from a patient or god forbid inappropriate conduct and the newspaper gives your story only 8 lines in the paper are you going to be happy with people judging your actions? Remember, there is more to this story.

I agree that someone screwed up on this one but be seriously, how often on this board do we jump to conclusions like dust did on the emt who had sex with his cousin. It appears she isn't a fire explorer.

But we tend on this board to be higher than mighty and we prove the guy guilty or the person involved guilty until proven otherwise.

Someone messed up but the immediate tone of this board on this particular thread was "JUDGE JUDGE JUDGE" and that is what distresses me with this particular forum.

I'm all for hanging those who truly screwed up out to dry but let's make sure we have all the info first rather than a news article.

Just my 2 cents.

[chbare]

wait what? I would definitely like to read more about this.

Scary stuff. This is a subject where many EMS providers lack even basic knowledge. A VAD (ventricular assist device) is a device implanted into the body that diverts blood from the ventricle into either the aorta or pulmonary artery depending on the device specifics. (LVAD left ventricular assist device, RVAD, right ventricular assist, or both BIVAD)

Several types exist and many people are going home on destination therapy with these devices. Meaning that will live with the VAD for the rest of their life. In addition, the days of manual hand pumps and pump shut down for defibrillation and cardioversion are over. New devices such as the heart mate II have not manual back up. Additionally, these new devices create non-pulsatile blood flow as they tend to significantly dampen the underlying arterial waveform.

Many concepts such as the patients underlying problems, medications such as anticoagulants, equipment, batteries, patient education, and the dynamics of the environment created by this device.

In addition, these are not just for "old" people. Recently went to a workshop where a teenager with non-ischemic cardiomyopathy and a left ventricular ejection fraction of less than 10% is now at home in their community with a LVAD. It is likely this patient will be on destination therapy with this device.

Take care,

chbare.

[FireMedic65]

Scary stuff. This is a subject where many EMS providers lack even basic knowledge. A VAD (ventricular assist device) is a device implanted into the body that diverts blood from the ventricle into either the aorta or pulmonary artery depending on the device specifics. (LVAD left ventricular assist device, RVAD, right ventricular assist, or both BIVAD)

Several types exist and many people are going home on destination therapy with these devices. Meaning that will live with the VAD for the rest of their life. In addition, the days of manual hand pumps and pump shut down for defibrillation and cardioversion are over. New devices such as the heart mate II have not manual back up. Additionally, these new devices create non-pulsatile blood flow as they tend to significantly dampen the underlying arterial waveform.

Many concepts such as the patients underlying problems, medications such as anticoagulants, equipment, batteries, patient education, and the dynamics of the environment created by this device.

In addition, these are not just for "old" people. Recently went to a workshop where a teenager with non-ischemic cardiomyopathy and a left ventricular ejection fraction of less than 10% is now at home in their community with a LVAD. It is likely this patient will be on destination therapy with this device.

Take care,

chbare.

Thanks chbare, I appreciate all that. I will look into this more in depth since I knew nothing more of what a VAD was and what it was for. That was the except of the lecture about them. Seems to be a lot more to it that EMS needs to be aware of.