Why do we transport dead people?

[Just Plain Ruff]

I absolutely think that many medics out there have a problem or aversion to doing what you are discussing.  In my first year of working I was apprehensive to do it but after a close friend was killed when I was working and I had to call him in the field.  I spent time with his family a couple of weeks after his death and they told me that my discussing what we were doing and stopping it when we did made it much easier for them to accept his death.  I then began to push myself to be more "out there" in working with the families of patients who we worked who were dying or we were coding.  After time, it got easier(it never gets easier but you know what I"m saying).  After you do it for a couple of times you get a flow and process. 

I will also say that I had a great mentor in medic school who worked with me during the codes we worked to tell patients families of their impending deaths and non transports.  I learned from a GREAT GREAT GREAT mentor.  I tried to mentor with the same kindness that my mentor gave to me.  

If I was still actively doing this line of work, I'd write a book about it and other things.  

I think with all things, the more that you do it, the better (or more empathetic) you become. 

[Off Label]

I think it's far more likely that the "discussion" occurs in very busy, urban type systems that are very "deep" with experienced personnel than not. Folks who don't 'need' to manage full arrest patients and/or no longer derive professional satisfaction from them, successful or not.

Edited December 29, 2015 by Off Label

[paramedicmike]

Locally I've recently seen two cardiac arrest transports that were, on their face, questionable.  One turned out to be a hunter, questionable hypothermia, and the crew kept getting a shockable rhythm.  The other turned out to be a scene safety issue.  It was reported that the family was less than reasonable and the situation deteriorated quickly.  From a safety perspective they chose to grab and go and work en route.  Otherwise, locally, which is an area that covers both rural and urban settings, the vast majority of cardiac arrest patients found on scene in cardiac arrest are not transported.  Patients are worked on scene.  If ROSC occurs then they're transported.  If not a quick phone call for request to terminate resuscitation attempts is made and usually granted.

There are occasions where transporting someone in cardiac arrest could be warranted.  The hypothermia patient as previously discussed would be a good example.  These exceptions, however, aren't particularly common no matter how often we tend to talk about them.  I think the vast majority of cardiac arrest patients we see are dead well before we get there.  Even if resuscitation is attempted on scene there is little value in transporting the vast majority of cardiac arrest patients we encounter.  To be fair we need to talk about those zebras that might otherwise require we transport.  But how often are those situations realistically encountered?

Of course, this says nothing of the multiple safety considerations and interventional efficacy issues of working a cardiac arrest in the back of a moving ambulance.

I have worked in rural, suburban and urban environments.  Personally, I have no problem, if given the right circumstances, with working and terminating attempts in the field without transport regardless of the environment.

[Just Plain Ruff]

ok, let me ask this question,  for the one off patients, the ones who you work (hypothermic, drug overdoses, etc) and you get ROSC, should those examples be used to guide our overall treatment and transport of all Codes?  There would be some in the field who would say that if the possibility to bring back even one code patient then the benefits outweigh the risks.  

Do we let anecdotal evidence trump otherwise valid evidence in this discussion?

9/10 or more outcomes are dismal at best, horrible at worst.  We all have our stories of codes we've worked or know of worked and brought back and now we get to cart them back and forth to the hospital for their monthly admissions because they are alive but not, if that makes sense.  

[ERDoc]

No, because if we did that we would be working/transporting all arrests.  Every so often we hear a story on the news where someone was down for some unreasonable amount of time but gets resuscitated and makes a full recovery.  It makes the news because it is so rare.  I think the biggest reason that codes make it to the ER that shouldn't have is because providers don't feel comfortable having the talk.  I doubt there are many classes that teach this, especially at the EMT level.

[Just Plain Ruff]

hey Doc,  let's you and I begin the negotiations with your publisher and write up a book on how to have those and other tough discussions for the new as well as the experienced provider.  

[Off Label]

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6008a1.htm

This is the reality according to the CDC. If  (very) roughly 10% of out of hospital arrests survive to discharge, neuro deficits not withstanding, convincing a young or not so young paramedic or physician to choose one out of the next ten they'll see to call might be a tall order.

[scubanurse]

hey Doc,  let's you and I begin the negotiations with your publisher and write up a book on how to have those and other tough discussions for the new as well as the experienced provider.  

Count me in!

[Just Plain Ruff]

Count me in!

I was semi-serious.  I've been looking for a project and a writing project to boot.  I've been doing a life lesson/partially religious/partially secular short story style writing when time allows over the past couple of weeks and I gotta say they are rough but pretty good.  I need a project right now and maybe this might be something to think about doing. 

sort of a compilation of tips/tricks in short 1000 words or less from seasoned providers in the field who want to provide their expertise to new providers and old.  Not a new intubation or EKG skills essay type but a "this happened to me" or a "what to do when this happens"  

ER doc, Dwayne, Mike, Scuba?  Any thoughts?

Edited December 31, 2015 by Ruffmeister Paramedic

[scubanurse]

I like the idea a lot.  I don't have a whole lot of free time with an infant, school, and work, but I'm happy to help out in any way you need.  I imagine maybe each chapter being a different topic, like "Field Pronouncement" and then the chapter discusses our experiences pronouncing patients in the field and tips for talking with the families?