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

[paramedicmike]

I'm just simply stating what my instructor drilled into our heads over and over again.

Fair enough. But don't you have the capacity to think for yourself? This may be a legally protective act for you. But seriously, think about what you're saying.

He is and has been a medic for 30 yrs in this state.

That doesn't mean he know's what he's talking about. You'll learn this as you gain experience in the field.

He said without a proper DNR we have got to start CPR. It may be that we are told to stop but we must, without question, start CPR if the family cannot provide a proper DNR.

So think about this for a moment. You're going to start CPR on a patient who's obviously been dead? Rigor has set in? Lividity is present? By what you've said (despite your contradictions) you have to, right? Are you really going to do that?

I'm trying to give you the benefit of the doubt here. I realize you're a new provider and your instructor has probably drilled a lot of things into your head. However, you are NOT a trained monkey. You are a living, breathing, THINKING individual. Use that brain of yours.

I am not suggesting you violate local protocols. What I am suggesting is that once you get out on the street and gain some experience you'll find that much of what your "instructor" has told you "must take place without question" isn't really what happens or what's best for people involved.

At the same time, though, that's why you're here. Right? Because you want to learn? Which I think speaks more positively about you than you might realize.

Good luck.

-be safe

[ittybitty1313]

"So think about this for a moment. You're going to start CPR on a patient who's obviously been dead? Rigor has set in? Lividity is present? By what you've said (despite your contradictions) you have to, right? Are you really going to do that?

Last I checked that was not the case here. Of course your not going to do CPR on someone who is in rigor or where lividity is present. Dead is dead. We were talking about a case where someone is crashing without a proper DNR. Not someone who is obviously dead.

Yes, I'm new and admit I have a lot to learn and as you said that's why I'm here. And yes, we have had a ton of stuff pounded into our brains. Even more importantly I know that nothing makes up for experience.

I can tell ya that this newbie is going back to lurking!

[brentoli]

No one is trying to scare you away.

They are trying to make the point, if you are the only provider on the scene and the online Doc tells you he is issuing a DNR for this pt, you stop efforts. If ALS is on the scene then it is their call. Until they are there, it is your scene, and if you refuse an order from your doc that falls in the standard of care (I know there is a word for it but im in hour 13 of a 16 hour dispatch shift) then YOU will be held negligent for that.

If a doctor issues an order, and you refuse it, you must have just cause. Trust me, sitting in front of the jury saying "my EMT instructor taught it to us" will not be just cause.

POST POST and POST some more. But realize that being new there are people here with more experience and knowledge then what you have right now. Maybe everyone doesn't use the most tactful approach here.... but everyone wants you to LEARN, thats what this site is for.

[Dustdevil]

This is not a cut-and-dried issue that can be taught out of the book. This is an issue that will vary greatly from location to location. Ultimately, it is up to your medical control. And if you aren't going to listen to your medical control, then why would you even call them in the first place? That just doesn't make any sense. And, of course, as previously stated, if you choose to defy a physicians order, you indeed best have some better rationale than "it's what my EMT instructor told me." In fact, right off the bat, I can't think of any rationale that will save your job.

This is the point that Mike was trying to impress upon you. To be successful as a professional in this job, you have to use your brain as more than a mere recepticle for memorised bits of information, like protocols. You have to use it as a device for analysing those bits of information to reach reasoned conclusions. You have to think for yourself. And this is what we mean when we talk about the differences between training and education. EMT school (and far too many paramedic schools too) trains you to act upon specific criteria with specific actions in a flow-chart, cookbook fashion without the need for intelligent reasoning. Education lays a foundation of knowledge and information for you, then exercises your ability to put all that information together and use critical thinking skills to come up with a logical solution that considers all the facts pertinent to your specific patient, not just those in the cookbook.

If you stop posting, you stop challenging yourself. If you stop laying your knowledge out there for review and critique, you are doomed to professional stagnation. And remember, every mistake you make on this forum is one less mistake you will make on a real, live patient. It's worth the occasional humiliation. Especially to your patients.

[BEorP]

Per my state and local protocols, I have no choice but to work the code. As an EMT-B in Michigan, I cannot honor a DNR order, whether valid or invalid.

Since the DNR order was not valid (missing the physician's signature), legally, one would think that it's as good as not having one at all.

Would I have felt bad for Grandpa? Of course! But at the end of the day, I either follow protocols or lose my license. I'm sorry, but its no contest. Granpa gets worked.

You could still find a way to follow your protocols. Don't you remember, you were actually out of the house when he died and the family did not tell you?

I'm not saying for sure that that is what I would do if I were stuck working in a system like that, but I think it's worth considering. Regardless of the legal validity of the DNR, they didn't want a resus attempt so why do it? And don't say because your protocols say so.

[katbemeEMT-B]

This is not a cut-and-dried issue that can be taught out of the book. This is an issue that will vary greatly from location to location. Ultimately, it is up to your medical control. And if you aren't going to listen to your medical control, then why would you even call them in the first place? That just doesn't make any sense. And, of course, as previously stated, if you choose to defy a physicians order, you indeed best have some better rationale than "it's what my EMT instructor told me." In fact, right off the bat, I can't think of any rationale that will save your job.

This is the point that Mike was trying to impress upon you. To be successful as a professional in this job, you have to use your brain as more than a mere recepticle for memorised bits of information, like protocols. You have to use it as a device for analysing those bits of information to reach reasoned conclusions. You have to think for yourself. And this is what we mean when we talk about the differences between training and education. EMT school (and far too many paramedic schools too) trains you to act upon specific criteria with specific actions in a flow-chart, cookbook fashion without the need for intelligent reasoning. Education lays a foundation of knowledge and information for you, then exercises your ability to put all that information together and use critical thinking skills to come up with a logical solution that considers all the facts pertinent to your specific patient, not just those in the cookbook.

If you stop posting, you stop challenging yourself. If you stop laying your knowledge out there for review and critique, you are doomed to professional stagnation. And remember, every mistake you make on this forum is one less mistake you will make on a real, live patient. It's worth the occasional humiliation. Especially to your patients.

You know, Dust has beat me up on other posts I have put out there, but he has definite validation for his statements here. In class I was a straight A student, top of my class. When I got out into the real world of EMS, I quickly learned just how dumb I was. I was able to take what I learned along with what my fellow co-workers were willing to teach me and am striving to be the best damn EMT I can be. The key is to continue learning by always having an open mind and thinking things through. You may get called out for fifteen diabetic reactions but you won't treat them the same because your patients aren't the same and neither are their symptoms.

The other thing you have to keep in mind is when it comes to the legal end, if medical control tells you to stop CPR and you continue, the family can have you charged with battery for causing undue harm to their loved one. At the point that you continued CPR you began to work outside your scope of practice via orders of medical control. It's a lot to consider.

[emtd29]

Per my state and local protocols, I have no choice but to work the code. As an EMT-B in Michigan, I cannot honor a DNR order, whether valid or invalid.

Invalid... OK

Valid... WHAT?

[Bakerma]

That's ridiculous. I'm an EMT-B in Michigan, and if we have a valid DNR order, we sure as hell better not begin CPR. I don't know who told you that basics can't honor DNR orders, but that's wrong.

[Lone Star]

That's ridiculous. I'm an EMT-B in Michigan, and if we have a valid DNR order, we sure as hell better not begin CPR. I don't know who told you that basics can't honor DNR orders, but that's wrong.

I'd hate to think that Genesee County Medical Control was 'wrong' about anything!

[sassy_emt]

I maybe new to this field but I undertstood the protocols is my state to say that if there is a signed DNR then yo follow it but if it is not signed you start CPR unless directed by medical command to do other wise.......so he was right in how he responded on this call.......at least that's how I see it.....

cheryl