what would you do in this situation as a EMT-B

[courageheartx]

I will probably get lambasted for this but in the end, Grandpa died peacefully, and nice and warm in his own bed. Forget protocols and all the official crap. The situation took care of itself. Good for him he was able to die in the fashion he desired. Many aren't that lucky.

Yeah,forget protocols and "official crap." I hope you don't make it into Paramedicine.

[courageheartx]

I also posted this on the ALS site.

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

2 weeks ago my EMT-B partner (1 year experience) 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.

No valid DNR? Then the code gets worked. Grandson?What kinds of medical qualifications does he have to be making calls on who's dead and who isn't? Family wants the pt transported?Is that all?Bottom line,DNR isn't signed by the physcian. Assess ABCDE.neurological response,blood pressure. Agressive airway management. lights and sirens. call for an ALS intercept. Asystole on the monitor?hmmm. Was a shock advised?Continue CPR?possibly?no?yes?....hmmm

[captainstandup]

In North Carolina the ER's would stroke if we brought this patient back to them having intubated and medicated. Eight hour waits for care are common as it is. The real problem is vultures in our own midst that are waiting for a reason to get you in a jam. I agree with the folks in this thread that you call medical control for direction after having completely explaining the situation. Of the thirty ER doc's I know personnaly there isnt one of them that would have you work this patient. If you have no medical control (cant imagine that!) I think the best option is to ensure the discharge planners have done their job in terms of COMPLETING all of the paperwork including the DNR before you load the patient onto your stretcher. In absence of the proper documents simply deny transport as you are accepting care of a patient likely to be in need of ALS services and are unable to provide it to them. All things considered I wonder if this could be considered an EMTALA violation on the sending facilitys part?

[emtrjs]

Being an EMT for 10 years and seeing alot of this, i would have done and have done the same exact thing you did. Calling command is your best source of CYA. That is a tough call, but the right thing was done. Congrats on doing what you did.

[AnthonyM83]

Nope, there is no method in Orange County, CA to obtain online medical control at the BLS level. The reality, though, is that 99.99% of the patients can either be handled via acceptable protocols/SOP [note: That requires that the basics actually READ them instead of relying on a friend of a friend of an instructor's word for it], or the call requires ALS [which is easily available by transport to the 17 or so hospitals with emergency services or by requesting a paramedic response via the 911 system].

You're pretty much like us in LA. No online medical control and I'd be surprised if more than 3% of the EMTs in our system have read the medical protocols. It's not even addressed when you get hired...

[JPINFV]

^

Of course. Simple rules for EMTs from the company.

911=Do what the firemedic says, no questions asked.

BLS=Do what the facility says, no questions asked.