interesting case, what would you do?

[johnrsemtp]

I am also posting this on BLS to get more input.

I work both private EMS and 911 this happened on the private service

2 weeks ago my EMT-B partner and I (paramedic * 2 years); were transporting a pt from a extended care facitlity to home for hospice care and to die at home.

At the ECF we found out that the DNR (Do Not Resucitate) order was invalid due to not being signed by a Doctor. Family wanted him transported and we did.

His BP in the parking lot of the ECF was 131/83. 12 minutes later as I was backing into the driveway it was 42/19.

We got him into the bed, my partner was getting signatures from the wife, and I was talking to the daughter about how to get a valid DNR; get family Dr to sign one. Also telling her what needs to happen when he dies. about 3 minutes after getting pt into his bed, a 20+ y/o grandson comes running out to say that grandpa was dead.

great, invalid DNR and we were still in the house. partner grabbed the monitor and I called there ER. pt was showing asystole in all leads. I talked to the ER doc, and explained the situation and he gave me verbal orders not to work the code. so then we stayed there and helped them to call family dr for death certificate and the funeral home for picking up the body.

what would you do and what could you do per your protocols?

I shared this at both jobs, and got all sorts of answers. also got told by more senior medics that I can't do that, and others said I did too much, and others said that I did right. Most of the Basic EMT's just stated they were glad they weren't there.

[Just Plain Ruff]

Hospice - dying with dignity

Good call not working that code. Good call calling the ER doc and explaining the situation.

The family knew he was dying, the patient knew he was dying and they did the humane thing and brought hospice into the situation.

Hospice is a great resource - my grandfather died comfortably in his sleep at a hospice care facility. One minute he was breathing and the next he was gone. This sounds like what your patient did.

Patients go into hospice for mainly one thing - to die with dignity.

-15 for the invalid DNR, bad bad mojo for the paper shufflers.

+15 for not working the code.

I would not have worked the code, I'd have called the ER and explained the situation.

Sounds like you did a good and ethical job on this case.

[medic001918]

You did the right thing. I've been in the same situation before where they said the patient was a DNR but didn't have the paperwork at the location (it was on it's way from about 30 mintues). I called medical control and explained what happened and what the family's wishes were and they gave me the order to presume the code in the field w/o hesitation. You did the right thing. Strong work and I'm sure the family appreciates it.

Shane

NREMT-P

[Ridryder 911]

Whom ever told you did the wrong thing obviously is after their own ego in this business, and not the wishes of the patient and have no busines in this profession. You did the right thing, you used your gray matter and thought out the process both logically, legally, and morally.

Too many medics these days are "cookie cutter" prepared that they only know to "follow protocols" and not able to think with their brain. The main intent and purpose of the patient was for the patient to die among loved ones. Probably why he lasted long enough to get home, and when he did, was able to "sense" and quit trying to live.

Good going, using your noodle... you will go far ! However; I forewarn you many will criticize you for trying to "think"... just ignore them and know what you did was right. You placed the patient first.

R/r 911

[Connie31079]

Please correct me if I'm wrong, but I was always under the impression that, if a person codes @ home, in front of you, and the family wishes no resusication be done, then you don't work the code.......doesn't matter if there is a legal DNR in place or not? Same thing goes if there IS a legal DNR in place, and the family wishes you to work the code, then you work the code.

That's what I was always taught anyway.....maybe I was taught wrong???? The DNR, as far as I'm concerned, is only in place for me to make the decision to work the code(or not) if there is no family present....if family wants us to work it, then we work it, If they don't, then we don't.

Hmmm, maybe I should look that one up, for future reference, just incase.... sometimes family call 911 when a person arrests, even though they know they don't want us to work the arrest. :?: I could never quite figure that one out....call 911 for a person who's dead, but once we arrive, they don't want us to do anything to try and help the patient. In that case, why call 911???? Just to make sure they're dead???

Anyway, yes, you did the right thing.....the patient wished to die at home with dignity, and you allowed that to happen. Good job!

[1EMT-P]

I think you did the right thing in this case, especially if the patient had already expressed his wishes.

[fiznat]

Please correct me if I'm wrong, but I was always under the impression that, if a person codes @ home, in front of you, and the family wishes no resusication be done, then you don't work the code.......doesn't matter if there is a legal DNR in place or not? Same thing goes if there IS a legal DNR in place, and the family wishes you to work the code, then you work the code.

It is a grey area. What you are supposed to do is what the original poster did: call medical control and explain the situation. In the meantime, you are supposed to start working the patient until you get confirmed orders.

By law, you need to work that code unless there are obvious signs of death (rigor/lividity/asystole x 3 leads/etc etc), you have a valid DNR, or medical control orders you to do something otherwise (you are passing the buck to them in this case).

To the OP: well done. Like others have said, you did the right thing for yourself, the patient, and the family. I, and I think any other responsible member here, would do the same thing.

[ERDoc]

You also need to find out who the health care proxy/DPOA is and see what there wishes are.

[Medic26]

Hospice - dying with dignity

Good call not working that code. Good call calling the ER doc and explaining the situation.

Ditto

[emt322632]

I would have done the same thing in your situation. Sad situation, but in the end like everyone has said you put the patient above your own ego. Too many people that I know would be unwilling to "give up", and would have ran it despite there having been a previously valid DNR. Hard situation to be in, but you did well.