What would your EMS have done??

  1. Local EMS calls in last night, code 3, cardiac arrest coming to an ER near me...well to me. Lady arrives, intubated, no IV access. Asystole on the monitor...all they got too. Family hasn't seen this person alive for over 2 hours. I pick up her arm to start IV access and her hand stands out, no limpwrist here. Pupils dilated and fixed. Back is bright red/purple to midline. This lady has been dead for a while!! What criteria does your EMS use for calling the ME or heading for the ER?
    •  
  2. 9 Comments

  3. by   2ndCareerRN
    I think the answer to this will vary from crew to crew. If elderly, the chances are they will call in and have the pt pronounced.

    If a younger person, or a sudden death, esp with family present, they may be more inclined to scoop and run. Giving the family a sense that everything possible was done to attempt to resuscitate the person. I can see where that would possibly give more comfort to the family, rather than walk in, take a look, and then pick up the phone to call an MD to pronounce.

    bob
  4. by   ernurse2244
    I agree with what you are saying about the family, but what is the criteria? Rigor mortis had set in. I am ok that we went out and said "we did all we could do". But I am really asking, professional to professional, what criteria is set for when you call the ME and when you go gang busters to the ER.
  5. by   traumaRUs
    I am an ER RN as well as a volunteer prehospital RN and our EMS uses, "Obvious signs of death" to include: rigor mortis, dependent lividity, injuries inconsistent with life (ie decapitation), decomposition. However, I will say it seems like all the places I get called to - none have much lighting and sometimes lividity is hard to see. I use warmth, rigor - which comes and goes depending on time of death and injuries inconsistent with life most of the time. (We see some wild ones on the country roads where I live)
  6. by   New CCU RN
    I once got a post code at home to my unit from the ER who had MAJOR stiffness ---looking like rigor mortis. Unknown time down. We extubated him three days later and he was on a tele unit the next day.
  7. by   Wolfpax
    The last time I worked in an ER and on a medic unit...(long ago) paramedics in NJ were doing pronouncements at the scene, and depending upon the situation either the funeral home or coroner will pick up the deceased... on occasion as a favor EMS will bring the deceased to the funeral home or to the ER to have the body kept in the morgue... all cardiac arrests have a medic unit at the scene, even hospice cases as I recall
  8. by   ITRY2BGOOD
    When I was in EMT class a fellow student did a full arrest for 10 mins in the home because the body was "warm" but once they moved him they saw he was laying on a heating vent OOOOPPPPS
  9. by   teeituptom
    all depends on their departments protocols

    sometimes you do it to help a family out also

    If you want to work ER

    Grin and Bare it

    Goes with the territory
  10. by   Medic946RN
    Quote from teeituptom
    all depends on their departments protocols

    sometimes you do it to help a family out also

    If you want to work ER

    Grin and Bare it

    Goes with the territory
    Like above, it varies from state to state even sometimes from county to county and then even various cities inside their respective counties can have diffrent protocols/criteria. In Delaware where I worked 20 yrs as a paramedic we could pronounce people dead in the field. Where I work now in PA the county I have medical command in doesn't allow that, but the neighboring county does. At one point in DE the State Medical Examiner had a hissy fit becuase he was named in a lawsuit concerning field pronouncement (suit went nowhere) so he ordered that all people be coded and brought to a hospital where a licensed medical doctor could pronounce them dead. We did a lot of useless codes until the State Legislature codified our pronouncement procedure.
  11. by   veetach
    Quote from ernurse2244
    Local EMS calls in last night, code 3, cardiac arrest coming to an ER near me...well to me. Lady arrives, intubated, no IV access. Asystole on the monitor...all they got too. Family hasn't seen this person alive for over 2 hours. I pick up her arm to start IV access and her hand stands out, no limpwrist here. Pupils dilated and fixed. Back is bright red/purple to midline. This lady has been dead for a while!! What criteria does your EMS use for calling the ME or heading for the ER?

    my husband is a paramedic. His answer to this is, that this patient would be called class 4 (obvious death) at the scene. The criteria being, dependant lividity, rigor mortis, and unknown down time. We live in PA also, and we have to call the coroner to the scene as well. At this point there isnt anything we can do for this patient. If this person was brought into our ED, the code would be called at the bedside.

close