lizard90048

I'm a bit late replying to this topic, but my very first succesful cardioconversion made the news a couple weeks ago: http://www.whittierdailynews.com/news/ci_7947687 Full arrest during the 2008 Rose Bowl game. -Ian, Pasadena CA

Well, in Los Angeles County, all this is outlined in Section 814 of the LA County EMT-I/Paramedic/MICN policy. Basically, it outlines these obvious signs of death: I. Determination of Death: A patient may be determined dead if, in addition to the absence of respiration, cardiac activity, and neurologic reflexes, one or more of the following physical or circumstantial conditions exist: A. Decapitation B. Massive crush injury C. Penetrating or blunt injury with evisceration of the heart, lung or brain D. Decomposition E. Incineration F. Pulseless, non-breathing victims with extrication time greater than fifteen minutes, where no resuscitative measures can be performed prior to extrication G. Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources preclude initiating resuscitative measures H. Drowning victims, when it is reasonably determined that submersion has been greater than one hour I. Rigor Mortis (Requires assessment as described in section II.A.) J. Post-Mortem Lividity (Requires assessment as described in section II.A.) II. Patients Determined to be Dead: A. If the initial assessment reveals rigor mortis and/or post-mortem lividity only, EMT-Is and/or paramedics shall perform the following assessments to determine respiratory, cardiac, and neurologic status: NOTE: Assessment steps may be performed concurrently. 1. Assessment of respiratory status: a. Assure that the patient has an open airway. b. Look, listen and feel for respirations. Auscultate the lungs for a minimum of 30 seconds. 2. Assessment of cardiac status: a. Auscultate the apical pulse for a minimum of 60 seconds. b. Adults and children: Palpate the carotid pulse for a minimum of 60 seconds. Infants: Palpate the brachial pulse for a minimum of 60 seconds. 3. Assessment of neurological reflexes: a. Check for pupil response with a penlight or flashlight. b. Check for a response to painful stimuli. I would assume that you have similar criteria in your area. Check your state's EMT Scope of Practice, and your local County's expanded Scope of Practice. Also, be aware that your scope may change from time to time. I.E.: In LA County it is now recomended to poke all suspected fatilities with a pointed stick. -Ian in LA

Regardless of whether or not you search your patients, be sure to follow your local protocols, and strap your psych patients down (if you can). If nothing else, watch them like a hawk. AMR out here in Southern California is being sued for the death of a psych patient: "Nov 29, 2005. Employees of an ambulance company failed to properly supervise a 13-year-old boy in their care who died after jumping from the moving vehicle, according to a lawsuit. The wrongful death claim was filed Nov. 22 in San Bernardino County Superior Court on behalf of Brian Molina's mother, Delores Gutierrez-Molina. Brian was being transported from Loma Linda University Medical Center to a Chino hospital on Aug. 12 about 2:50 p.m. when he was somehow able to free himself from his gurney restraints. He jumped to his death from the ambulance onto the 10 Freeway west of Waterman Avenue in San Bernardino. According to the lawsuit, ambulance attendees were aware that Brian had behavioral problems that required him to be closely watched and required his wrists and ankles to be tightly secured on the gurney. The lawsuit alleges the employees violated California law by failing to make sure he was safe. A spokesman for American Medical Response said the ambulance company is unaware of the lawsuit and declined comment. Neither Gutierrez-Molina nor her attorney, John Henley, could be reached for comment on Monday. Paul Chaney, Brian's uncle, said the lawsuit reveals what family members have believed all along. "It's obvious to anybody who knows the basic facts of the case (that) if they were doing their job, the kid wouldn't have been able to jump out," he said. Authorities have not revealed whether anyone was in the back of the ambulance with Brian when he jumped, and the lawsuit does not specifically allege Brian was alone. The lawsuit seeks general damages, as well as medical and burial costs, attorney's fees and other related expenses. Chaney said the community has generously donated to help the family with funeral and burial expenses"

Has any tried the "puncture resistant" search gloves for searching patients? Like these: http://www.galls.com/style.html?assort=gen...amp;style=GL168 I'm wondering if they're worth the price and trouble. Or if they even work. -Lizard in Los Angeles