Death in EMS

[Kiwiology]

I feel empathetic toward the people affected when somebody else dies but I don't sit up at night worrying about it.

One of the main reasons I dislike cardiac arrest resuscitation is many people begin resuscitation that is either clinically futile or not in the best interest of the patient and I find it quite undignified, particularly for the family.

In NZ a Doctor must sign the death certificate stating cause of death however Ambulance Officers (at all practice levels) may pronounce life extinct and an Intensive Care Paramedic may complete a Deceased Person Certificate for the Police or Coroner. Once there is national agreement between the various Coroners it is expected that this ability will be extended to Paramedic and ICP.

Death is just a fact of life I guess.

[island emt]

Funny thing about that: We all will die someday.

We can make a determination of death here by several methods. Obvious injuries incompatible with life, Rigor, dependent lividity, Pulseless and asystole in 3 leads for more than 20 minutes after resus attempts or not. They do not want us to transport a "working code" to the hospital.

The current protocol is to work a fresh arrest for 20 minutes and 3 rounds of acls protocol. If no ROSC then call it and notify Medical control Dr that you have ceased efforts and time of death. We can get approval on the phone from Pt's physician to have them sign the death certificate.

We do have the ability to transport any pt that is hypothermic and children, or anyone with near drownings.

[DFIB]

I read an article a while back that has changed my thoughts about the duration of CPR but not the practice. We don't have the luxury of ALS so all codes are actively transported. Most are declared DOA at the hospital..

Here is the article. http://www.nytimes.com/2012/09/05/health/research/doctors-may-be-ending-cpr-efforts-too-soon-study-says.html?_r=0

Funny thing about that: We all will die someday.

We can make a determination of death here by several methods. Obvious injuries incompatible with life, Rigor, dependent lividity, Pulseless and asystole in 3 leads for more than 20 minutes after resus attempts or not. They do not want us to transport a "working code" to the hospital.

The current protocol is to work a fresh arrest for 20 minutes and 3 rounds of acls protocol. If no ROSC then call it and notify Medical control Dr that you have ceased efforts and time of death. We can get approval on the phone from Pt's physician to have them sign the death certificate.

We do have the ability to transport any pt that is hypothermic and children, or anyone with near drownings.

I read an article a while back that has changed my thoughts about the duration of CPR but not the practice. We don't have the luxury of ALS so all codes are actively transported. Most are declared DOA at the hospital..

Here is the article. http://www.nytimes.com/2012/09/05/health/research/doctors-may-be-ending-cpr-efforts-too-soon-study-says.html?_r=0

[island emt]

Defib: I have worked for upwards of three hours on a code where we did get return of pulses, then lost them , then got them back a total of 8 different times.

We shocked over a dozen rounds of V-Fib over the course of the code. We did transport and worked alongside the hospital code team for an 1 1/2 hrs in the ER.

Finally the decision was made that she had been down long enough without good perfusion to have suffered life ending brain activity. We stopped and she held on for thirty minutes more then finally her heart gave up.

She Was a good friend who's husband had died 6 months earlier from cancer.

We believe she died of a broken heart , and just wanted to be with him.

[DFIB]

Defib: I have worked for upwards of three hours on a code where we did get return of pulses, then lost them , then got them back a total of 8 different times.

We shocked over a dozen rounds of V-Fib over the course of the code. We did transport and worked alongside the hospital code team for an 1 1/2 hrs in the ER.

Finally the decision was made that she had been down long enough without good perfusion to have suffered life ending brain activity. We stopped and she held on for thirty minutes more then finally her heart gave up.

She Was a good friend who's husband had died 6 months earlier from cancer.

We believe she died of a broken heart , and just wanted to be with him.

I am sorry that you had to resuscitate your friend. That must have been very hard for you. She was fortunate to have people that loved her around in her final moments.

[island emt]

Thank you. The joys of small town rural EMS.

We know the majority of our customers as neighbors and acquaintances.

Even the summercators get to know us after a few years visits.

towards the end of her fight , we held her hands & told her it was okay to let go and join her husband.

It was hard to do and it was also the right thing to do.

[ClutzyEMT]

Being from a small town myself where I also volunteer on the squad I can understand completely 'working a code' longer than normal. We've done it here too in special circumstances Ed.

Sometimes in small town EMS, what I find affects me most is not the code itself....but seeing the family a few days later. Especially if it's a ped or totally unexpected event...that is what gets to me sometimes.

[Trm90]

None? None at all?

Perhaps it's time for you to consider another line of work.

Well, that doesn't mean that I wouldn't do my job to try to save a person...

[Just Plain Ruff]

Well, that doesn't mean that I wouldn't do my job to try to save a person...

We are not saying that you would do anything to save that person. What were are questioning is your empathy and your apparant lack of any feelings towards a persons death.

You said that no death affects you and I say that you aren't being truthful. You may say it doesn't affect you at all but I'm not buying it. YOu might think it doesn't but down the road maybe not now or today or tomorrow but one of these days it will and you better have a good support system to help you through it because I'm fearful that the ramifications of your callous(I don't mean that negatively) attitude will really hit you hard.

I'd urge you to consider and think about why death doesn't affect you even a little bit.

[Emergency Laughter]

That article hit home very very close, I have two daughters. But on a side note, that article took forever to load. And it was a beautiful article but very very sad and really tough to read.

Remember, death happens, it comes quickly, you have no control over it and all you can do is be there. If you try to fight it, you will not win.

And then theres the Cottage Cheese story on the same page as the story on death. I urge you to read that story after you read the story about the kids. It will make you cry even more. http://home.earthlink.net/~medicalhumor/mikecyra/id20.html

Hey to hell with it all, Thanks for taking the time to read it. I can imagine that it hits home with two girls. I'd be a basket case if I had daughters. I'm glad it was tough to read, means that I know you a little better now. Hey thank you for letting me know that it loads slow....would you know how I might rectify that problem?? Obviously it's file size, but beyond that I'm not too sure what I can do. I appreciate that feedback. Glad you liked cottage cheese, I'm all better now, I can eat it by the spoonful now.

I wish I could get across to teenage drivers (I'm teaching my 15 yo nephew) how fast death happens.

I've been reading the post's here...you're all good people...I know I've probably taken SOMETHING away from most of the deaths I've seen, could be as little as it's clinically interesting or "that was the biggest son of a bitch I've ever done CPR on" or I remember a neonat that we lost that was so small I was doing cpr with just my thumb and indexfinger. The ones I remember are always the ones I don't want to remember. But, such is life. I second anyone who says that the survivors - family effect you...

Here today-gone to Maui...