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Old 03-04-2013, 07:41   #126
Gallium
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Quote:
Originally Posted by Peace Warrior View Post
Read about this earlier and called someone I know in the field.

Cloudy waters for sure, but there is a "legitimacy" to the do not give CPR rule/policy. Tough phone call for the 911 operator's sense of what was right for sure.

As for me, the least the nurse on scene could have done was clear the airway/make sure it was clear. There is no policy preventing that type of help according to my friend.
(I agree with you.)

Generally a DNR or a corporate policy of no CPR does not mean staff cannot put folks in a position of comfort, and as you say see/check if their airway is clear.

So far nothing in the transcript or news report has been presented to indicate if the deceased had a blocked airway, and /or if such a blockage precipitated respiratory distress/arrest or a cardiac event.

Who knows why she lost consciousness, and then died? If it was my mom I'd be pissed, but my mom would not be in an independent living facility (she has stated this ad naseum!). She wants to live in my house, annoy me for a couple of years, then die in my couch. She says it's the least I could do for her putting up with my teenage years.
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Old 03-04-2013, 07:51   #127
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It was her time to go. There is no guarantee that CPR would have made any difference.
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Old 03-04-2013, 07:53   #128
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Originally Posted by OlliesRevenge View Post
That is one I haven't heard. Thanks for the link, I can use that. It's a great example of how not to do it. Those guys made Alameda Fire look like buffoons due to their inaction.

This kind of thing has more to do with Dept. policy rather than City or State law. Sometimes the "white shirts" don't always make the best decisions.
My point earlier was; that such a dept policy could not exist if state law did not allow it - plain and simple. This incident (current one) occurred in the same state.

Was anyone arrested in that Alameda instance? No. Were any state licenses or certifications revoked? No. The only thing that occurred was 14.5 minutes of outrage, and a policy change.

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Originally Posted by OlliesRevenge View Post
I have run into a similar situation in my Dept. A bunch of us were sent to 'Surface water rescue swimmer' training in '09. In the wake of our 1st water entry that summer (which I was a part of), the Assistant Chief of Ops. sent out a memo stating that "members shall not carry personal water rescue equipment on the apparatus". He didn't say we couldn't enter the water, just that we couldn't carry "personal" gear. He was concerned about City liability in case we got hurt. In subsequent water rescue incidents, our members have entered the water with gear... in spite of the memo... 'cause it's what the public expects.

Here's how the letter to the Chief could read --

"Dear Chief,

Sorry I disregarded the memo. We were dispatched to XXX address, and upon arrival there was a mother and family members frantically urging us to help find their missing child in the water. We had to make a decision, and we chose the course of action that we felt would be most closely aligned with the Dept's mission, and that would spare the Dept from negative publicity...."


Had the Bakersfield staff done CPR and spared themselves the negative press, they could have written a similar letter to their employer, if necessary.
You & your guys done did good. Kudos to you. Each of us has to carefully weigh and balance the potential outcome of our actions. We are at this point mostly due to burdensome lawsuits, often where no justification for such suits exists, or is found.


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Originally Posted by OlliesRevenge View Post
...There is only one way to get really good at doing tubes, and that is to do alot of tubes. Medics just happen to do alot more tubes than most, and like I said their downtown quarters is right there at the hospital.
Missed it the 1st time! That makes sense. Not only does the hospital get help, but it also allows those medics to stay sharp, and work under the eyes of critical care hospital staff (not to say that your EMT-Ps are not also CC rated )




Quote:
Originally Posted by OlliesRevenge View Post
... Since caregivers have the ability to save lives, they should default to doing CPR. Anything less will bring shame, potential liability, and negative publicity to them.
I can tell you there is no faster way to get separated from an agency here, than to go outside of policy, protocol, or to administer care outside the scope of what you are supposed to give, or are authorized by your agency.

There are critical care nurses, nurses, EMT-Is, and paramedics /etc (here) who work a 2nd job or volley as an EMT with another agency. Even if they have their own bag, they cannot do anything outside of the scope of what medical direction for that agency tells them.

Well, they could...
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Old 03-04-2013, 07:56   #129
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Originally Posted by Wake_jumper View Post
It was her time to go. There is no guarantee that CPR would have made any difference.
Uh, then why do we even do CPR or try to save lives?
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Old 03-04-2013, 08:01   #130
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Originally Posted by Gallium View Post
Is this information in the public domain?
Nope.
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Old 03-04-2013, 08:09   #131
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Originally Posted by Wake_jumper View Post
It was her time to go. There is no guarantee that CPR would have made any difference.
Couldn't that be said of anyone at any age that encounters a medical emergency? Had she been 20 years old, would you hold a different opinion?

I'm CPR and automated external defibrillator (AED) qualified and stand ready to render aid wherever necessary - regardless of the victims age. I hope that others would extend me the same courtesy.
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Old 03-04-2013, 08:22   #132
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Originally Posted by TX OMFS View Post
Uh, then why do we even do CPR or try to save lives?


I hanker if you spend enough time (working) in a hospice, or elderly nursing care facility you would have a better understanding. He is not talking about CPR carte blanche, just CPR for someone LIKE THIS in their mid-late 80s, living in a nursing home.
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Old 03-04-2013, 08:28   #133
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Originally Posted by GVFlyer View Post
Couldn't that be said of anyone at any age that encounters a medical emergency? Had she been 20 years old, would you hold a different opinion?

I'm CPR and automated external defibrillator (AED) qualified and stand ready to render aid wherever necessary - regardless of the victims age. I hope that others would extend me the same courtesy.

'Flyer,

Good on you for having those skills and certifications. Unfortunately, money matters. Work CPR on a 1/2 dozen 87yr olds, resuscitate them, and have to deal with the aftermath of care...and it might jade your perspective.

Not saying right/wrong, just what it is. And yes, it is callous sounding as hell.

If you had very limited resources, and your choices were to work CPR on a 87 yr old, or a 27yr old, and none of them were related to you, and both present with the same symptoms in your presence at the very same time, and you have no help, who do you work?

87 vs a 17yr old?
87 vs a 37yr old?
87 vs a 47yr old?
87 vs a 57 or 67 yr old?

Essentially, this is the decision that many nursing homes and other health care providers are doing. They are saving the dollars for those folks who will benefit from the service.

There are no guarantees of anything - the 37yr old you save can come back to burn your house down, or die in the ER 2 days later...and the 87yr old could tack on another 10 years of decent living.

I don't advocate any of these things...just pointing out to you what "is".
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Old 03-04-2013, 10:16   #134
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Originally Posted by Gallium View Post
I hanker if you spend enough time (working) in a hospice, or elderly nursing care facility you would have a better understanding. He is not talking about CPR carte blanche, just CPR for someone LIKE THIS in their mid-late 80s, living in a nursing home.
I've got plenty of experience.

It was a nice little two line post meant to sound simple and succint. It also made no sense.

Quote:
It was her time to go.
Yes it was. It might be anyone's time to go at anytime. Doesn't stop us from doing CPR on all comers.

Quote:
There is no guarantee that CPR would have made any difference.
Always true no matter the age of the patient or the situation. Doesn't stop us from doing CPR on all comers.
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Old 03-04-2013, 10:41   #135
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Some of the old folks have seen other old folks after they received CPR and they don't want anything to do with the deep bruises and broken bones.

My father lived at a very nice assisted living facility from 2/07 until 8/11 (he was 89) and deciding against CPR was an easy decision for him after he'd been there a while. My mother still lives next door in the full-nursing demetia unit. She chews if someone puts food in her mouth, but otherwise just sits in her wheelchair all day, staring off.

Fwiw, the property also contains a 6 story apartment building and '60s?-era brick garden apartments that are not physically connected like the rest of the buildings. It's VMRC in Harrisonburg VA if anyone is looking for a good outfit.

John

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Old 03-04-2013, 11:15   #136
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If the corporate policy was to just let them die why did they call 911? They should have called the coroner.
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Old 03-04-2013, 11:19   #137
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Originally Posted by 2@low8 View Post
If the corporate policy was to just let them die why did they call 911? They should have called the coroner.
You are so silly someone has to take the blame

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Old 03-04-2013, 11:33   #138
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Quote:
Originally Posted by TX OMFS View Post
...

Always true no matter the age of the patient or the situation. Doesn't stop us from doing CPR on all comers.

If you have the experience then you know CPR is not done on folks with DNRs.
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Old 03-04-2013, 11:46   #139
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Originally Posted by devildog2067 View Post
Do you work for free?

If you don't, why should medical professionals?
Of course, you're right. I need to support myself and my family. Therefore, people with "a negative wallet biopsy" should be just left to die.
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Old 03-04-2013, 11:49   #140
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She was 87 years old. 87! There are no good outcomes for people that age that go into cardiac arrest. It is time to go. Her daughter was ok with it and you should be also.
My grandfather had a quad bypass in his mid-80s and an artificial valve. He passed away at 99 years old, three years after two consecutive silent heart attacks on the same day.

One size does not fit all. Your mileage may vary.
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Old 03-04-2013, 11:50   #141
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Of course, you're right. I need to support myself and my family. Therefore, people with "a negative wallet biopsy" should be just left to die.
Medical care costs money.

If you don't have money and need medical care, one of two things can happen:

1) You don't get it.
2) You get it and someone else pays.

I agree that it's wrong for a first world nation to let people die who could be saved--morally wrong. But it's just as morally wrong to demand that someone else pay for something that you need.
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Old 03-04-2013, 12:31   #142
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Had the Nurse not been state certified to do CPR and did it anyway and the patient died, she would face criminal charges. Its messed up that STNAs arent required to be certified in some places,It would possibly save more lives if they were required.
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Old 03-04-2013, 12:40   #143
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Originally Posted by Gallium View Post
If you have the experience then you know CPR is not done on folks with DNRs.
FWIW, TX OMFS is a physician. From his screen name, I would assume that he is a Oral and Maxillofacial Surgeon.
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Old 03-04-2013, 13:04   #144
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Originally Posted by Gallium View Post
Thank you for riding a bus. Society needs every volley and paid 1st responder it can get.

Based on your sterling history in this thread of incorrect inferences, you've not made a positive impression that you are reading and interpreting data as it is being presented.

If you are so inclined , I can carefully deconstruct your hypotheses, starting with where I 1st quoted you, backed up by statistics. It's not very hard.

I have not provided anything constructive to the dialogue because you have nothing to learn. You already know everything.
Yeah, go ahead and do that. Tell us all how there is no possible way this lady could have arrested due to an airway obstruction, and the statistical improbability of that occurring at a dinner table. I never said that was what happened, only that it was entirely plausible. I stated that we can assume that she was ambulatory and free of diagnosed psychiatric disorder based on the information that she was a resident of the assisted living side of this facility. This does not mean those statements are fact, and they were never presented as such. I posed a question of the policy and if this nurse would refrain from assisting a non-resident of the facility. You cannot refute any of this because none of it was presented as fact.

You sir, are an arrogant fool who has aptly displayed an ability to do nothing but seek to glorify your own inflated opinion of yourself at the expense of others. Hell, you still can't even tell us what your qualification is that makes you such an expert on this topic, other than a "Glocktalk PhD."

No, I don't know everything. There's a lot I still have to learn. Doesn't mean there isn't a thing or two I do know. Seems to me you comment on nearly everything. I've been here for years and commented very little. I suppose society needs its share of know-it-alls too.
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Old 03-04-2013, 13:05   #145
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Originally Posted by GVFlyer View Post
FWIW, TX OMFS is a physician. From his screen name, I would assume that he is a Oral and Maxillofacial Surgeon.

That may be the case. If so, he should refrain from asking really dumb questions about refraining from giving CPR, when the respondent was talking about CPR to the elderly, not CPR for "everyone".

Talk about taking something almost completely out of context...


Quote:
Originally Posted by TX OMFS The Okie Corral
Uh, then why do we even do CPR or try to save lives?

Originally Posted by Wake_jumper The Okie Corral
It was her time to go. There is no guarantee that CPR would have made any difference.
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Old 03-04-2013, 13:30   #146
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That may be the case. If so, he should refrain from asking really dumb questions about refraining from giving CPR, when the respondent was talking about CPR to the elderly, not CPR for "everyone".

Talk about taking something almost completely out of context...
Wake_jumper said there was no guaranteed CPR would have made a difference.

That statement is true for all patients at all times.

Following Wake_jumper's line of thinking we would NEVER do CPR.
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Old 03-04-2013, 13:33   #147
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Originally Posted by TX OMFS View Post
Wake_jumper said there was no guaranteed CPR would have made a difference.

That statement is true for all patients at all times.

Following Wake_jumper's line of thinking we would NEVER do CPR.
Well I did not take that from his statement. It is clearly only true in the narrowest of windows (CPR not making a difference), and even when there have been times when things look iffy, the resilency of humans surprise us.

Which is why in virtually all of the USA - someone keeps getting worked until or unless signs of death are obvious.

I cannot fathom how you arrived at that conclusion from his statement. I did not. Maybe you should ask him what he meant.

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Old 03-04-2013, 13:35   #148
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You sir, are an arrogant fool who has aptly displayed an ability to do nothing but seek to glorify your own inflated opinion of yourself at the expense of others. Hell, you still can't even tell us what your qualification is that makes you such an expert on this topic, other than a "Glocktalk PhD."
That was funny.

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Old 03-04-2013, 13:40   #149
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Dnar?

If the patient was DNR or DNAR (do not attempt resuscitation) then the staff would have been prohibited by law. It's a tough situation, but I've met a few nurses/nurse's aides who have been fired/had their license revoked for not seeing a DNR and providing CPR, breaking ribs in the process and prolonging a patients life. What's more they were sued...but as there is no mention, speculation would be pointless.
(a little info, a DNR is not cause for not administering first aid to anything but a cardiac emergency)
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Old 03-04-2013, 13:46   #150
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Yeah,...blah blah blah blah....
From the minute you inserted yourself in the thread you've make more wrong turns and driving up the wrong way of traffic than anyone else. You need to take a deep breath, and re-read what you've read.

  • Made assumptions to support a position
  • Claim you didn't make the assumptions
  • Claim you made the assumptions
  • Claimed you made the assumptions, but we should have clearly seen they were assumptions
  • Claimed I inferred I was a physician (I did not)




Here is your original post, and you've not made any effort to "man up" to your errors:
[quote=slathrum;20050603]


  • Hmm...so grandma was in an assisted living facility,
It is not being reported that she lived in an assisted living facility.

  • and her arrest was witnessed in a dining hall.
There is nothing in the call or the media that says she had an "arrest" or that it was witnessed. If you have that information, please point it out, and I will retract my comment.

  • What do you suppose the chances of her arrest being caused by an airway obstruction are? I'd say about 50/50.
Since we don't know WHAT happened, it would really be remiss of us to assume she had an arrest. Particularly because the nurse reports she tooks "3 breaths".

  • I don't know the transport protocols there, but I would imagine that the reason she was transported instead of being pronounced on scene, was due to the crews finding a reversible cause of death and being able to return circulation, for the time being anyway.
I don't know about where you live, but I do know no where I have made contact with other health care professionals - or the NREMT operates like you have outlined, which is why I asked WHERE DO YOU LIVE. So yes, until you tell us what state you are in that has this as protocol I am calling bull-hockey. When you post your state or local protocols I will stand corrected, and apologize on this point.



  • We can assume that she was reasonably ambulatory, able to function independently and free of diagnosed psychiatric disorder since she was in such a facility.
No, we cannot reasonably assume anything. The good medical professional is trained to not make assumptions if there is a body of information to draw on.

  • Grandma had an ok life still. Hypothetically, let's say this nurse witnessed her choking prior to the code.
Seriously, unless you knew this woman personally, or have access to her medical records, it is a ludicrous claim to make. She may have been in the best of health, she could have been a former Olympian...and she could have been one of the lucky ones with Down Syndrome or MS or Parkinsons to live in her 80s. The point here is you are packaging your opinions to make your argument.


  • Granted, we're assuming a nursing home staff member could recognize choking, but still...by their policy, all she can do is stand there and watch while waiting for EMS.
More bull hockey, as you do not know what the nursing home policy is on "choking". Yes, someone can choke, and initiate a string of events that lead to a cardiac event, but we don't know what happened.


  • Meanwhile, grandma dies when chest compressions would have likely cleared the obstruction. That may or may not have been what happened, but it's entirely plausible.
You don't know that. I don't know that. There is no MD, PA, nurse, EMT-P/I/A, NP or any other sort of medical professional in the world that does not have access to what happened there who could possibly know this. Again, you are creating a scenario to support your position. What does your agency and/or state offer in training if you are ever to testify in a trial?





  • It's beyond me why anyone would want to live in such a place, or how anyone could work under such policies. Kind of makes you wonder what the policy is when fellow staff members or non-residents experience medical emergencies that a bystander could reasonably assist with, let alone someone trained to help.
I can completely agree with you on this point. I would not want my mother, or wife, or self to live in such a place. BUT, if I am at the last mile of my life, maybe I would change my mind.


and for this last gem:


Quote:
Tell us all how there is no possible way this lady could have arrested due to an airway obstruction, and the statistical improbability of that occurring at a dinner table.


Ah, see, I did not say that. See below for what I said. There you go again with assumptions and distorting what you read/see. If I DID say what you are claiming...my apologies, this thread is extended, and I talk too much.







Quote:
Is it possible that a EMS crew with a EMT-P/CC and another EMT-P/CC/driver can offer a higher level of care than a L3 or L4 trauma center? Yes, it is REMOTELY possible, but statistically improbable, and very unlikely.

It is very difficult for an ambulance - the exception being those vehicles that approach the size of 42ft "tour buses" (which are more like a small, compact clinic on wheels) to have the equipment & amenities that a L3 center is going to have. I implore you to find the link in this thread (here it is: http://en.wikipedia.org/wiki/Trauma_center) and read on the minimum requirements for what a trauma center of a specific designation is required to have.




I've constantly hammered on you because you have spouted a lot of 1/2 truths mixed with nonsense, mixed with your opinion. When I teach (please note I did not say I was a teacher at a medical facility), you are exactly the kind of person I hammer away at, because you come to the table with arguments which, to the unsuspecting (those who don't know better) it may make a lot of sense.
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