Ethics question

[osiris500mob]

I work for busy metropolitan dept as medic/ff. this day I am riding medic unit. Dispatched for working code to location where we are third due medic unit( all others were busy). Dispatch goes as follows ambulance xx, medic enginexx, and my medic unit. location of code is less then 5 mins from hospital. Arrive on scene and pt is elderly male already packaged in rear of BLS unit with EMT-B's working him. The supposed medic on the engine company did not do any ALS skills on pt, no IV, No cardiac monitor, No Intubation. He stated AED from bls crew advised no shock 3 times. So we jump in rear of unit establish airway and iv enroute to hospital and med administration. We arrived at hospital pt had spontaneous return of respirations and pulse. Doctor seemed new and unsure of what to do next, she leaves room and talks to wife who on phone states she wants no aggressive life saving skills performed on husband(elderly, extensive cardiac history etc.) So I'm in code room when she comes back and tells nurses to take him off of monitor and stop any more treatment. The nurses looked in shock at doctor and followed orders. Doctors rational was that aggressive ALS skills got him to breath and heart beating so if wife did not want that they should just stop.

Sorry for the long story. But what would you have done? I have serious issue with them basically letting him DIE after return of pulses and respsirations. I'm all for persons right to die, but I think this is wrong.

[Farmun]

I don't think that is legal but it is an issue that should be brought to the attention of your medical director. As for the engine company medic not doing anything it sounds like that is something to be brought to the attention of his/her company officer.

[IAMedic]

Did the other ALS squad see a DNR or was told by the wife not to do anything. This has happened to me. That's probably why no ALS care was given and those requests didn't get transferred onto your squad. Could this have been a possibility??

I'm glad the guy making $200,000 had to make the decision, right or wrong he did what he thought was in the best interest of his patient at that time with the information he was given.

[Weruj1]

Unless the medic on the engine saw a DNR then he/she should have been doing more than BLS interventions. Also I dont know how someone that has a pulse and is breathing spontaneously (sp) can then be left for dead. Maybe '77 will share a story here about a hypothermic pt and a simillar situation.

[ladderwell]

Sounds like a case of lack of communication to me. I must assume, having been on similar calls that the first units on scene saw a valid DNR and that the passdown of info was poor to your unit.
In oregon we have a multi level DNR setup: 1. do everything 2. comfort measures only/bls 3. do nothing/call doc and ME. Sometimes this makes life a little tricky when the pt has signed the do nothing portion, and the husband/wife says work him. But hey, we all got into this business because it's not the same every day. Right?

[lexfd5]

Do you know what situation the engine medic encountered before you got to the packaged patient? Was the patient found wedged between the tub and the toilet? Was there an angry mob there interfering with care? Did the hyper ankle biter get in the way? Was the medic with a crew that "Does not do EMS?" Was he on the roof nailing trusses up at a construction site? Without knowing the situation it is hard to point blame on why the medic did nothing.

[osiris500mob]

no angry crowd or ankle biters, good bls unit on scene with him no extraordinary situation presented. just lack of effort on his part to do his job! Wife did not state he had do not resusitate papers and that is reason he was worked.

[RoryEl]

I can see where the doc was coming from but that isn't a call I would honor over the phone, but they're call. About the engine medic's failure to treat, kick it up the chain for investigation. Might be something there or maybe not but your not in the position to gather the facts and make a determination. He's being paid to render a vital service and this isn't a place to retire in place if you know what I mean. Kick it up stairs and let the chips fall.