CPR or Not?

[paramedicmike]

Mike, I think you stand a bigger threat to your certification and your job if you attempt resuscitation after the physician has pronounced this patient than you do from any potential lawsuit you may or may not face five years down the road. ERDoc's comments about pursuing a complaint with your medical director are not his alone. I've heard similar comments from other physicians on this topic. Past medical command physicians have even said to me that were any of his medics to engage in any activity similar to what was outlined in the OP articles we'd be out of a job AND a certification.

If your documentation is solid it doesn't matter what they show you or present to you down the road in any potential lawsuit. Your documentation should clearly state that the on scene physician pronounced this patient before you got there. Want to back that up with a call to your command doc? More power to you and, ultimately, probably not a bad idea.

Bottom line here is that a physician out ranks an EMT or paramedic in this particular case.

[ERDoc]

I agree with the CYA of calling your command doc/medical control but DO NOT start CPR.

[MikeEMT]

Why are we calling the doctor a "doctor"? Did I miss somewhere where his credentials were questioned? A doctor does have the authority to pronounce death and they are certainly not required to following any ambulance services protocol for how they do this for their patients.

I am referring to him as a "doctor" because I don't know his qualifications. How many people have Doctor in front of their names? What is he a Doctor of? I have had people tell me they were doctors only to find out later they were not MD's. Not every doctor has the authority to pronounce a death.

Doctors don't work under protocols, they use medical judgement. I would have a huge problem with anyone starting CPR in this case if I had already pronounced the pt. It becomes assault/decimating a corpse/whatever your state law calls it at that point and I sure as hell would push the point with your medical director and/or state medical director. It has nothing to do with ego and is all about dignity for the pt and family.

While Doctors do not work under protocols in the sense that we do, they still have guidelines they must follow. One of which is pronouncing death.

You might want to look up decimating a corpse laws before you go tossing that around, especially to someone who spent the majority of his career in law enforcement and criminal justice. I would have a HUGE problem with a medical professional interfering with this. If you took this to a medical director they would probably laugh you right out of the office. You claim it is about dignity. The most recent "OFFICIAL" wishes from the patient is FOR CPR to be initiated. That sounds to me like you are doing what the patient wants.

When I am on scene it is my call, period. I am not relying on the word of anyone claiming to be a doctor, especially if I don't know them. Its not like a SNF would ever make shortcuts or anything. Now if it was the personal physician of the patient then I would give them more credit. That said, when was the last time a personal physician pronounced a death? Most physicians I know would be uncomfortable performing CPR yet alone pronouncing a death. There is a reason they work private practice and not in the ER.

Fortunately for me State Law would be on my side in this case. If I performed CPR while getting Medical Control authorization I would be protected. The bottom line is what can be presented in court. The patient has signed a document a couple days prior to this event that expressed their desire to have CPR performed. Advanced Directives hold a lot of weight in court.

Bottom line, every situation is different. Based on this call with these circumstances and the information presented to me, I would perform CPR. I am unaware of any court that would accept phone authorization from family to override the patients wishes. You are entitled to have your own opinion. Since I am going back to work for my long week it is doubtful that I will respond further in this topic.

[MariB]

Actually, the document was signed by the doctor on scene and the patients daughter. Not the patient.

So, was the patient terminally Ill where the daughter didn't want to accept it and signed the paper? Lots of unanswered questions here.

Advanced directive or not, if someone is decapitated , you don't start CPR. This man may have been dead hours. I wouldn't go against his own doctor.

[HellsBells]

Well. I think that Mike EMT has officially settled this argument, as he has noted that he spent most of his career in law enforcement, and criminal justice, so... full stop, continue CPR, and ignore the doctor. Clearly, this doctor must be an incompetent fool, as he works for a nursing home facility care must be determined by the highest level of care on scene, which in this case is a basic EMT employed by the local FD.

Seriously though, what was the nurse thinking when she called back stating that the pt was now alive and no longer required EMS?

[Arctickat]

But CPR WAS started prior to the arrival of the fire truck drivers

ECC Dispatcher: "And who is with the patient right now?"

911 Caller: "We have RN, LVN, and another staff."

ECC Dispatcher : "So RN with patient with CPR in progress?"

911 Caller: "Yes, it's in progress."

The Doc simply called the code prior to their arrival, which is his prerogative. The communication that the patient has a pulse could be a simple miscommunication, but that never happens when someone calls 911.

The most recent "OFFICIAL" wishes from the patient is FOR CPR to be initiated. That sounds to me like you are doing what the patient wants.

Or not

The fire department said that order was signed by the patient's daughter and the same doctor who was on scene.

Edited March 21, 2013 by Arctickat

[ERDoc]

Mike, you can nipick over the term I used but it is irrelevant, which is why I added the comment about state law. I'm glad it is your scene, but it is the doctor's patient so you have no right touching him. You seem to forget who is the higher medical authority. I'm also glad that you have so much experience in law/criminal justice, it will come in handy when you need to arrest the dead guy. Is it really that difficult to identify what kind of doctor the guy is? "Excuse me doc, but are you an MD/DO?" Pretty simple. You are making this much more difficult than it needs to be. A physician at the scene (the highest medical authority) has pronounced the pt. There is nothing for you to do here, finish your paperwork, clear the scene and be available to help someone that may benefit from your assistance. In the end it does not matter what the paperwork says, a licensed physician has pronounced the pt, it's a done deal.

As for the second call saying that the pt was fine, it could be possible that the doctor didn't want the firemonkies coming in an starting CPR on a dead person that has been pronounced(although a situation like that might be rare...oh, wait a minute...)

[HellsBells]

As for the second call saying that the pt was fine, it could be possible that the doctor didn't want the firemonkies coming in an starting CPR on a dead person that has been pronounced(although a situation like that might be rare...oh, wait a minute...)

The fact that the media got hold of this at all is somewhat suspect, what grounds does dispatch, FD have to release this information at all. I am not familiar with privacy laws of this particular jurisdiction, but a would assume there is statute prohibiting this info to be leaked to the media.

Perhaps Mike can in enlighten me on that point, as he is the resident legal expert here.

[Bieber]

If the physician has a preexisting relationship with the patient (as seems to be the case in this scenario), then we follow their orders. We no longer accept orders from random on-scene physicians with no prior relationship to the patient, however; if they push the issue then we're supposed to connect them with our medical director and they can hash it out... but most likely I think she would just tell them thanks and have us follow our established protocols.

[mobey]

I am referring to him as a "doctor" because I don't know his qualifications. How many people have Doctor in front of their names? What is he a Doctor of? I have had people tell me they were doctors only to find out later they were not MD's. Not every doctor has the authority to pronounce a death.

I promise you.... a podiatrist will never interfere on a code. Don't even try this sh*t here.

While Doctors do not work under protocols in the sense that we do, they still have guidelines they must follow. One of which is pronouncing death.

You do realize you are talking to an experienced emergency physician? Don't be condescending. Know your role, and show some respect!

When I am on scene it is my call, period.

Ya........ about that........

The bottom line is what can be presented in court.

Time for you to wake the hell up bucko. The bottom line is Whatever is in the best interest of the patient, and healthcare overall