To work a code or not

[island emt]

Really ????? You don't work dead bodies ?? How many dead infants have you left at home ?

If there is lividity or rigor then yes, we do not work them and put false hope in the family's eyes. The family is now our patient.

We are really good at fixing a lot of things::: DEAD is not one of them.

Now if they are warm & pink with vital signs absent we will make an attempt and see if we get any response and treat appropriately from there. If no changes in status we will call it at the appropriate time.

Age shouldn't matter how we treat our customers.

[scubanurse]

Really ????? You don't work dead bodies ?? How many dead infants have you left at home ?

It could be a crime scene as well, so you much make a decision as to how to proceed based on the individual situation. Some shaken baby cases are played off as SIDS and you should always be analyzing the scene for suspicions and make a decision from there.

[MariB]

Really ????? You don't work dead bodies ?? How many dead infants have you left at home ?

did you read the post? Hours dead, rigor. Not warm, pink and limp.

[runswithneedles]

What is your question, though? Do you really want to know if anyone would work a code like what you described? Or is there something else you want to know? Why did your partner think that this code should have been worked? What good would it have done anyone to work it?

Working a code on someone obviously dead gives the family false hope, is unprofessional and is abusive to the body. I am sure it does not help with their grieving.

she just answered it. Thats what I was wondering

[DwayneEMTP]

Actually, from talking to many of the old timers in EMS it was not uncommon in days gone by to work an obviously dead, cold baby/child...(Even a cold adult if there was no dependent lividity/rigor, for practice in places that saw such people rarely.) I believe that they were called 'compassion codes', with the exact goal of convincing the family that all that could be done, was done.

I don't find this question foolish at all.

We had a long day of death and dying in paramedic school. It was pretty amazing and much of it was counterintuitive for me. Three of the guest speakers were a psychologist, the owner of a funeral home, and a physician.

On compassion codes the thing that stuck with me was that though it was still relatively common with children, according to one or more of them, I don't remember which, but the psychologist claimed that "people know obvious death when they see it", as if it's part of our genetic hard wiring. They were adamant that compassion codes create a major mind fuck with people that have family members in that situation forcing them from the early stages of grieving, to "Wait...I thought they were dead, but I was wrong?!" (logic colliding with intuition which, many of us know, can be pretty painful), pulled from the grieving cycle back into hopefulness, then shocked again to get to the hospital to find that not only isn't their loved one alive, but that they were almost certainly tricked into believing that it might be so in the first place, which makes them very angry.

Though I won't run a code on someone obviously dead, I have made a big show, depending on the people present, of checking carefully for a pulse, running a three lead, looking it over carefully...just dorky stuff that I'm convinced in my little pea brain will remove any lingering thoughts in the family's mind of "are you sure?" before delivering the news, explaining the lack of heroic measures, and beginning to decide what type of care the family will need to cope in the short term.

[Just Plain Ruff]

I've worked many compassion codes for the parents. I dont' have an issue with it.

There are those that do have issues with compassion codes.

But I do remember a medic crew running a code on a decomp patient a number of years ago. The smell was pretty rancid but they worked it anyway because it was in their protocols that all pulseless non-breathing patients got worked no matter how long they had been down. This crew got a total dressing down by the ER doc on duty that day.

But a compassion code can be a good closure mechanism for parents. Like I said, I've worked half a dozen or so.

These are on a case by case basis of course. Depends on down time and other factors. But most of the compassion codes on babies have not been codes at all but the appearance of going through the motions and then calling it. Not many compassion codes that I start have gotten transported.

Edited July 28, 2013 by Captain ToHellWithItAll

[MariB]

I will definitely go through the motion of checking a long pulse, breathing, body temp. I will even listen with my scope, check pupils and put on patches. But at that time my attention will go to the family. I can call in help for them. A pale, cold body with rigor is pretty obvious. And I can't provide false hope.

In the case of an infant, the parents might need treatment, sadly.

[miscusi]

About the old timer: My instructor ( now retired, shes way old ) did say to do CPR on babies no matter how dead, for the parents sake. and I think that makes sense, nothing much worse than losing your own child, very very sad indeed.

[scubanurse]

Actually, from talking to many of the old timers in EMS it was not uncommon in days gone by to work an obviously dead, cold baby/child...(Even a cold adult if there was no dependent lividity/rigor, for practice in places that saw such people rarely.) I believe that they were called 'compassion codes', with the exact goal of convincing the family that all that could be done, was done.

I don't find this question foolish at all.

We had a long day of death and dying in paramedic school. It was pretty amazing and much of it was counterintuitive for me. Three of the guest speakers were a psychologist, the owner of a funeral home, and a physician.

On compassion codes the thing that stuck with me was that though it was still relatively common with children, according to one or more of them, I don't remember which, but the psychologist claimed that "people know obvious death when they see it", as if it's part of our genetic hard wiring. They were adamant that compassion codes create a major mind fuck with people that have family members in that situation forcing them from the early stages of grieving, to "Wait...I thought they were dead, but I was wrong?!" (logic colliding with intuition which, many of us know, can be pretty painful), pulled from the grieving cycle back into hopefulness, then shocked again to get to the hospital to find that not only isn't their loved one alive, but that they were almost certainly tricked into believing that it might be so in the first place, which makes them very angry.

Though I won't run a code on someone obviously dead, I have made a big show, depending on the people present, of checking carefully for a pulse, running a three lead, looking it over carefully...just dorky stuff that I'm convinced in my little pea brain will remove any lingering thoughts in the family's mind of "are you sure?" before delivering the news, explaining the lack of heroic measures, and beginning to decide what type of care the family will need to cope in the short term.

I agree with this. Giving the parents false hope is not good. Just be open and honest. Let them grieve, don't get them worked up thinking they grey, quiet, dead baby has a chance, it does no good.

[ERDoc]

About the old timer: My instructor ( now retired, shes way old ) did say to do CPR on babies no matter how dead, for the parents sake. and I think that makes sense, nothing much worse than losing your own child, very very sad indeed.

Just because something seems to make sense doesn't mean it is the right thing to do (MAST pants, spinal immobilization). Read Dwayne's post and do some research on your own through the current literature and it might make more sense to you.