A few questions: - Page 2

An MD must pronounce them dead. EMS is not allowed to, thus the CPR all the way to the ER.

There is a difference between pronouncing death and signing a death certificate. The coroner/ME may sign the death certificate a day or so later in some states.

It depends on the local EMS protocols and state EMS laws. Even in some states where a death can be declared in the field, the local medical director may not allow it for their particular service.

Remember, they ain't dead till they're warm and dead!

God bless her! I loev me some Nurse K.


Dr. Big Workups are bad enough. Worse still are Dr. BigWorkups who will just look at the CC on the tracking board and order stuff on the pt!!
Yes. You read that right. Doctors who order stuff on pts. without even assessing them!

I feel your pain.

cheers,

That's my favorite blog in the whole world. I live for Dr. Big Workup posts!!

EMS is bound by whatever local policy is in place. It's not the individual medics fault, but...

[rant]
Transporting asystolic patients IS lame. No lesser an authority than the AHA has stated this. The initial 20 minutes of a medical arrest are going to be identical whether they take place in a resucitation bay or the living room floor. In addition a patient who is asystolic after 20 minutes with an ETCO2 value of <10mmHG is dead. No need for cardiac ultrasound, dopplers, or anything else. Two things have been shown to increase survival to discharge in the arrest patient. Transport greatly reduces the effectiveness of one of them (compressions)

As for passing the buck, there is a percentage of my profession that wants nothing resembling responsibility for the decisions they make. Therefore hauling dead folks to the ED is a way to not have to take responsibility. Further, some less than above-board companies (private and public) encourage transport because the reimbursement for transport is higher than working an arrest on-scene.
[/rant]

Want to make a difference? Find out who the local EMS governing body is and present them with the evidence. We've been terminating resuscitations in the field for five years now without any issues. It's better for the patient (better CPR), better for the family (no false hope), better for the EMS providers (no code 3 transport while doing CPR) and better for the ED.