interesting case, what would you do?

[island emt]

you did exactly as I would have done .

quote"were transporting a pt from a extended care facitlity to home for hospice care and to die at home. "

this patient kept himself alive until he arrived home and then let himself go. exactly as he wanted it to be. To have started a "code drill " on this patient would have been nothing more than flogging a corpse without reason.

We recently [last month ] were asked to provide a members last ride home from the hospital to allow him to pass away at home with family and friends at his side. he had terminal cancer and did not want to go in the sterile confines of a hospital. I went to visit him last monday and he said to me " this is it , it's time for me to say goodbye. He passed in his sleep a few hours later. Just as he wanted , pain free and in the comfort of his home.

Also thank you for staying and assisting the family make arrangements. this is the difference in how they will remember you & your service. They will remember the compassion you showed them in their time of need. Too many times I have seen this scenario and the medic says to the family they're gone and so are we.

P.S. take an atta boy out of petty cash

[ManchesterEMT]

You did everything I would have done. In my area I probably would have got my butt chewed for transporting w/o a valid DNR. It's a requirement by my company, if we are transporting a hospice pt. I don't know why anyone would tell you that you did the wrong thing!

[hammerpcp]

I had a very similar situation recently. We were called to the residence of an elderly couple for the husband (81 y/o male) who had collapsed after returning from the bathroom. He is on home O2 and has quite severe COPD for 20+ years. Essentially his quality of life is non-existent. He is attached by a ten foot leash to his O2 compressor.

So we arrive scene and the pt is quite hypotensive and is feeling dizzy, weak and SOB. He is sitting on the floor being supported by a fire fighter, otherwise he could probably not sit up on his own. My partner and I began treatment on this pt and were getting ready to transport him, when he told us that he did not want to go to the hospital. His wife was also there and she was in agreement. We of course inquired why, if he did not want treatment or transport, did he phone us? Apparently all he wanted was to be assisted back to bed.

I told him that he could and probalby would die without treatment. He said that he wanted to die at home. The wife was in agreement. We assisted this pt back into bed after repeating the risks to him and ensuring that he understood and that she understood. We then contacted our supervisor and our base hospital doctor and both concurred that this pt was of decision making capacity and that he had every right to refuse.

The couple had a living will in place but there was no DNR order. I advised the wife that she must contact the family physician and arrange a DNR order, and that of course if he changed his mind about treatment that they should call us back (911), but otherwise, if and when he does die they should not call 911 because we are obligated to start resuscitation. They both assured me that they understood the role of EMS and our legal obligations, etc.

The following night when I reported to work to relieve the day crew, they informed me that approx 5 hours after we had been there, they had returned to the same address for the same man who was now vital signs absent. They were obligated (as EMS is here) to start resuscitation -although we can begin BLS resuscitation only- while they contacted the base hospital doctor for a field pronouncement.

This situation seems to arise far too frequently. The big issue here is that family physicians rarely, if ever, will make a house call for any reason, even to pronounce death. A person is almost obligated to die in hospital, even if it is an expected and inevitable death, if only to save their family the hassle of dealing with the body, etc. Of course a funeral home will not take a body that death has not been pronounced upon by a physician or delegate.

Anyway, I am glad that your system allows for you to make a call to your doc without having to take the unnecessary step of attempting resuscitation.

Good work.

[scratrat]

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!

I have to agree with what the original poster did. I would have called and got the order too.

However I have to disagree c/ Connie slightly.

Now, just for talking, (because maybe I can learn something too), I was told by a laywer who was also a medic, if you HAVE a valid DNR, you must honor it. The only exception is if the family member who wants CPR done is the MEDICAL POA. Otherwise, their vote doesn't count. Same thing for stopping CPR, if the family tells you he wanted nothing done, too bad. You HAVE to work it unless you have a signed copy of a DNR or medical control tells you otherwise.

I don't want to sound like I'm being a prick, I wouldn't want to work someone who the family states didn't want anything done. But I'm going to start CPR and call my doctor and make damn sure he's okay with taking responsibility for not working the code. I know that doesn't clear me legally, but at least I'll know if he's going to back me up or not.

[JPINFV]

^

The true answer regarding valid vs invalid DNRs and who can request one is going to fall on local DNR procedures. Locally for me, any immediate family member can request that a patient gets worked or not. Any disagreements or questions about who family is means the patient gets worked pending base hospital contact.

[Dustdevil]

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

Minus ten.

Do not post the same topic on several forums. Pick the most appropriate forum for your topic and post it there. Do not open the same discussion in multiple forums or threads. If you believe that your topic is so universally important that it needs to be in more than one forum, contact a moderator for assistance.

and...

Choose a subject that describes your topic. When starting a new topic, it is important that you choose a subject title that accurately reflects the content of the thread. Do not make people guess what is in your topic. Threads posted with teaser titles like, "Guess what!," "I need help!," "What do you think?," "What would you do?," "What should be done?" or simply "Question!" will be deleted with extreme prejudice.

[brock8024]

I have seen this one time. Me and my partner walking in a house on xmas day at noon for a person down. When we got there he was in full arrest and both daughters asked us no to do anything. We had already called them from the ambulance and asked them to call the family doctor since he did not have a DNR. The doctor they had called was being a prick and told us to transport him and let the ER doctor call him there. We looked confussed because this man wanted us to drive a dead man to ther ER so another doctor could call him. We both called our ER doctor told him what was going on and was like give me five mins and do not start treatment. He called us back and told us that he talked to the family doctor and that he was calling it over the phone. We chose to help the family out a little by taking him down the road to meet the funeral home. Seeing it was xmas day and we backed our vech to eachother it worked well. The family was greatful he did not have to stay in the floor and that we followed the wishes. The grandkids were there and I am sure it helped since they was all out of the house until we removed him.

[johnrsemtp]

Dust;

I apologize; It has been approx 2 years since I joined and I don't remember the rules, and can't figure out how to find them.

I posted this on both ALS and BLS since BLS crews have a larger chance of running into this than ALS crews and may be able to learn from it. Also just to see if anyone had seen this before.

thank you

john

[OzMedic]

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.

You need to be careful in these situations, being a family member alone does not give people the right to make life and death decisions about a person. Think about the possibilities!!! Are you going to make this kind of critical decision within a few minutes based upon what someone who you have no idea about their real identity or motives has told you? What if they murdered the patient? What if they stand to benefit from the will? What if the patient had changed their mind about the will prior to the person who is telling you not to resus placed a pillow over their head? Family members have not legal right to make these decisions unless they are enabled to do so by the patient via the appropriate legal documentation even then they still have to abide by the patients wishes contained within that documentation (ie. patient requests no resus then the medical attorney must abide by this and cannot request resus be commenced). In my state I am not expected to verify if a person is the actual health attorney if they state they are. If someone identifies themselves as the health attorney and give me directions and it turns out they were not then they will be dealt with by the law and there is no comeback on me (by the way, I always point this out to people when they make these claims. It's tends to sort out the do-gooders from the real thing).

While I'm on this how many people out there have family members that they would not want making medical decisions on their behalf? .............I rest my case

[OzMedic]

We chose to help the family out a little by taking him down the road to meet the funeral home. Seeing it was xmas day and we backed our vech to eachother it worked well. The family was greatful he did not have to stay in the floor and that we followed the wishes. The grandkids were there and I am sure it helped since they was all out of the house until we removed him.

I hope there were plenty of other resources available in your area while you guys were playing mister humanitarian. Sorry not trying to be harsh but the family of the kid who was knocked off their new bike that santa bought them while you were transporting a dead body would not be as appreciative I'm sure. I've seen this type of thing happen all to often, crews take themselves out of service playing Mr nice guy and Murphy steps in. There is always a way to handle these situations that maintains the ability to respond. Once again sorry, and if there were sufficient other resources available then I take my hat off to you for your kindness. Personally I think my back/knees have a finite number of lifts in them and I don't waste them on dead people.