OMG! *I* cannot pronounce death but a paramedic can????

[nervousnurse]

Oh wowwww....forgive me for FREAKING OUT, but I know some (or ALL??) of my fellow nurses will understand my stress, shock and amazement!!! I experienced my FIRST death of a resident withOUT a DNR tonight and I still can NOT believe this!!! First, I have to explain, his death was SOOO unexpected, NO warning signs, etc!!!!!!!!

To make a long story short (I'll TRY....LOL!!!)......I knew he was definitely DEAD, and as I called my DON to report it, she said we HAD to begin CPR since there was no DNR. Trust me, I did already (kind of) know this, and I've talked to SOOOO many experienced LTC nurses about this, and many explained the term "slow code", etc.....Co-workers (I wasn't there!) recently had a HORRIBLE experience with an emaciated, cancer-riddled resident who refused to sign a DNR, and a new grad was absolutely traumatized when she heard ribs cracking during the CPR, when the resident was CLEARLY already dead. She said the paramedics wanted to cease the CPR, but she yelled at them and said she was NOT losing her license over it, so I'm pretty sure the paramedics took over.....Why didn't they just pronounce the resident dead like the paramedic who did that for us tonitght?? can EMTs also pronounce?

ANyway, as we waited for the paramedics, the other nurse and I totally agreed that starting CPR was LUDICROUS.....but we started placing the board, setting up suction, etc. Thank Goodness the police officer who arrived WAY before the paramedics totally understood why we were NOT actually going to dishonor this sweet person's body by

starting compressions and breaths. I was SO torn on what the RIGHT thing to do was.....I figured legally, in a courtroom, I / we could get in HUGE trouble if we never actually did CPR.????? (could we?)

The paramedics arrive, and they pronounce him. I had NO idea paramedics could do that!?!"!?!???!!! And not the two of us LICENSED NURSES can do that????? (I'm an RN, my coworker an LPN).........

Aside from all the emotions and my stress level---again, this was my FIRST death, so.....it was kiiiiiinda stressful!!!.......It ticks me OFF that a police officer and THREE Paramedics/ EMTs had to waste their time, wear and tear on their vehichle, gas, etc....when if I or my coworker could've just prounouned him, call the doc, call the fam, do post-mortem care, call the funeral home, etc......WHY make the paramedics/ EMTs come out???? What if someone else needed them WAY more than this resident did?

I'm just blown away....and, hate to say it, but the waste of our time with all the PAPERWORK that the Paramedics need?!!???? They're not even taking him with them......also, legally, if WE had to start CPR, why didn't they have to continue?

My other concern and I'm also so curious........**IF** we had actually done CPR, his body would be so bruised, ribs possibly broken, etc. How on earth does the mortician handle all of that for viewings (if that's what the resident wanted?) What if the ambu bag broke some of the bones on his face? I know they do all kinds of makeup and have prosthetic implants to make the cheeks / neck, etc look nice if they;re traumatized by CPR, etc.....? How do they get the hands to look folded and peaceful if CPR was done and the arms are bent out to the side, etc? Rigor Mortis had already begun in this man's jaw when the paramedic pronounced him----can you imagine what damage the ambu bag would've done???

I appreciate stories/ experiences/ thoughts/ etc.......Also curious ( I know things vary by STATE!!!), where you work, does the doctor require you to tell them WHO pronounced them dead? Does it always have to be a paramedic? What if we'd found him even later and there was more rigor mortus? Do they still require us legally to begin CPR since there's no DNR? Seriously????

Can an LPN/ RN pronounce death where you work and avoid the WASTE of time having the paramedics and poilce come out? Does a police officer always have to be at a death? Thanks! ***oh em gee, wonder if I'll EVER get to sleep!!!****

[noc4senuf]

I agree, each state has their own laws that must be followed. But, if no DNR is in place, then you must treat them as a Full Code. I know of one facility that had a nurse that chose to ignore the report of a CNA that the person had a change of condition. When the nurse finally got around to checking on the person, they had expired. The problem was, they were a Full Code. This nurse was convicted and sitting in prison for 9 years. Do not take it upon yourself to make the wrong decisions just because of your beliefs.

[txnurse01]

Paramedic doesn't technically the physician they are getting orders does after the set numbers of drugs and compressions are done with no affect.

[ellie3]

Wow, you are certainly "nervousnurse" aren't you...and a very dramatic one at that as evidenced in your above diatribe. I think you need to find a way to get a grip before you start complaining about the rules for pronouncing death. I wouldn't want you pronouncing me, that is for darned sure. Maybe you just need to mature.

[Paramedic J Gage]

Hello,

I have been a Paramedic in the State of Maryland for over 25 years. The pronouncement of death has nothing to do with title and everything to do with State law. I have seen arguments reference education level, autonomy, scope, etc. Stop the ego train. If the state you are in believes it is appropriate for Paramedics to discontinue or withhold resuscitation according to certain standards than so be it. If RN/LPN can or cannot do the same, who cares? Bottom line, a death in our society often triggers EMS activation outside of DNR protocols. This is why it is important to the deceased and their family that Paramedics are equipped with the authority to discontinue a futile resuscitation. BTW, those who believe Nurses always have more education need to step into the 21st century and learn a bit more about their EMS system.

Respectfully submitted.

[applesxoranges, BSN, RN]

In my state, they have to have a paramedic verify it with two leads on the monitor and then call it in with the obvious signs of death. Then the MD declares it.