ibemt31 Posted April 9, 2008 Share Posted April 9, 2008 I was browsing the forums and suddenly thought of an article presenting an ethical dilemma that I read in a magazine once, I think it was in JEMS. I don`t remember every little detail, but it went something like this. You are dispatched to an unconscious 3 y/o male. Upon arrival you find a frantic father, flipping out, begging you to help his son. The father informs you that the child suffers from a terminal illness. The child is unconscious and is in respiratory arrest.You begin to work the child up, prepare him for transport, and place him in the ambulance. As you place him in your ambulance, he codes. The father, even more frantic now is near tears as you initiate CPR. After a round of CPR, you are interrupted by a knock on the back door of your ambulance. It opens and you are greeted by the pt`s mother, who orders you to stop CPR immediately, as her child has suffered enough, holding in your face a valid DNR signed by both parents. Both parents are the pt`s natural parents and both have legal custody of the child. What would you do? IBEMT31 Link to comment Share on other sites More sharing options...
Timmy Posted April 9, 2008 Share Posted April 9, 2008 holding in your face a valid DNR signed by both parents.IBEMT31 There's your answer, stop. Link to comment Share on other sites More sharing options...
itku2er Posted April 9, 2008 Share Posted April 9, 2008 Good topic, Where was the mother at when you first arrived and why didnt she produce the DNR before you left with the child? Here most DNR's are post in a visible spot where EMS workers can see them, notice I said most not all. I would call the hospital and let them know what was going on and if you are in doubt as to what to do call a supervisor and pass that buck to him. (personally I would stop CPR even though once started you are not suspose to I would feel like the mother the poor child has suffered enough and if they had a terminal illness to begin with chances are if you did successfully save t them you would just be prolonging the enevitable and causing the child to suffer more. As heart breaking as it is to loose a child.) Link to comment Share on other sites More sharing options...
JPINFV Posted April 9, 2008 Share Posted April 9, 2008 Valid DNR, stop resuscitation. Side note: My county allowed verbal requests from immediate family, so it still wouldn't have been worked in the first place. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted April 9, 2008 Share Posted April 9, 2008 Same here (as what JP said). Link to comment Share on other sites More sharing options...
Ecnalubma08 Posted April 9, 2008 Share Posted April 9, 2008 DNR = Final answer. Good topic by the way. Link to comment Share on other sites More sharing options...
emt322632 Posted April 9, 2008 Share Posted April 9, 2008 What does the father say when you're presented with the DNR? I don't think the scenario is that simple. In my region we're allowed to ignore the DNR if it looks as if there will be a confrontation with family members. The DNR is valid and signed by both parents, but I don't agree that it is always the "Final Answer". Once in a great while you may pull up to a scene where a DNR has been signed and is valid, but the family may want you to begin CPR and try to save them anyway. People do change their minds. Personally I would contact medical control while continuing to work the child, telling them one parent agrees, one disagrees, however there is a valid DNR. See what they say, and if they agree I should stop, I'll stop. Nice scenario. Link to comment Share on other sites More sharing options...
Eydawn Posted April 9, 2008 Share Posted April 9, 2008 Call medical direction. The people who have signed the legal document (DNR) are present and presenting conflicting responses. I was taught that anyone who signs the DNR can rescind that decision as long as they are physically present at the scene, and that someone who signs a DNR for themselves can void it if they are talking to you and say "I know I signed that, but I changed my mind. If I code, work me" or some variation thereof. Since the parents appear to *both* be legal guardians, you have a problem! Definitely a tricky scenario! I'd think that there's more precedent for following the wishes of the parent wishing to provide care for the child... consent for care and all that... but the fact that the kid has a terminal illness complicates things. Put it in the doctor's hands. Hopefully he or she has a nice lawyer they can grab real fast to help sort out the mess. Keep working the kid until informed otherwise. Wendy CO EMT-B Link to comment Share on other sites More sharing options...
AZCEP Posted April 9, 2008 Share Posted April 9, 2008 There's your answer, stop. Wrong-O my friend. Once the father has requested your help, you have to carry it through. They can tell you to start, not stop. In this case a call to medical control is necessary. Perform good basic resuscitation until you receive an order to terminate. Link to comment Share on other sites More sharing options...
JPINFV Posted April 9, 2008 Share Posted April 9, 2008 Note to self: Read scenarios all the way through. Don't scan. Call medical control. Conflicting requests get worked up pending base hospital contact since any parent can rescind a DNR. Link to comment Share on other sites More sharing options...
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