AMR crew plays "Return to Sender"

[JPINFV]

EDIT: Title is supposed to be "AMR crew plays "Return to Sender," fails at customer Service," but got cut off for some reason.

Note about title:

Customer service is important for anyone who deals with customers, be those customers patients, tax payers, or the general public at all. While, yes, doing things like changing flats (per previous thread) are rather silly, being able to tactfully deal with situations is still important. A little customer service in a case like this might have saved AMR a lawsuit.

Springfield Man's Body Returned To Family's Door

By Matt DeLucia

Video Watch The Story

Kenia Colon knew something was wrong when her grandmother called and said her grandfather, Luis Suliveres, 71, was feeling sick. They called 911. When crews from American Medical Response arrived at their Fort Pleasant Street home, Suliveres was still alive.

"They took him into the ambulance and they told us he passed away," said Colon.

That is when the family said the EMTs, who were still parked in the street, brought Suliveres' dead body back up the sidewalk, up the porch stairs, and back to the front door.

"They just told us they're going to bring him back in and we have to take care of calling the funeral home," said Colon.

Eventually the funeral home did arrive to pick up Suliveres, who had been suffering from bone cancer for two years. Colon said the EMTs told her they needed the ambulance for "city service" and left. It is something Suliveres' daughter, Carmen says she will never forget.

"That was so disrespectful to me. They didn't respect my father at all," she said.

CBS 3 spoke with a representative from American Medical Response (AMR) Monday afternoon to find out what the protocol is when a patient dies in an ambulance. AMR said local crews are bound to the laws and regulations of the state, but it is ultimately the decision of the "doctor control" at the hospital as far as whether or not to transport the body. A decision it says is universal with all ambulance companies.

Suliveres did have an up-to-date "Do Not Resuscitate" order, which prohibits life-saving measures. It is unclear if that order played a role in the physician's decision, but the family says their frustration lies with how the EMTs handled the situation. AMR could not speculate for the individuals involved, but said its thoughts go out to the family.

The Suliveres' said they are considering legal action against AMR.

http://www.cbs3springfield.com/news/local/17986579.html

[CBEMT]

Follow-Up: State Looking Into Springfield Ambulance Transport Case

By Matt DeLucia

The state is now looking into what happened when an ambulance returned a man to his home shortly after he died. His family says he left home alive, and wanted him to go to the hospital.

The Massachusetts Office of Emergency Medical Services says they are now looking into an incident that culminated with a deceased man declined transportation to the morgue, and was instead returned to his family at his Fort Pleasant Street home.

On April 11, Kenia Colon called 911 because her grandfather, Luis Suliveres, 71, was gravely ill. The family said when EMTs took Suliveres into the ambulance, he went into cardiac arrest. Because he had a "Do Not Resuscitate" order, the EMTs did not make any attempts to revive him.

But that is where things took a turn. The family says the Emergency Medical Technicians from American Medical Response returned the body back to the house instead of the hospital, morgue, or funeral home. The ambulance company said it would have to be a doctor at the hospital, known as a "medical control," who made the call to terminate the transport.

"How they treated him was not correct. I still don't know if bringing him back into the house was the correct thing to do or not," said Colon. She contacted American Medical Response to complain. She said the ambulance company told her it could not speculate why EMTs did what they did because incidents such as this are rare.

The Office of Emergency Medical Services writes the policies for EMTs in Massachusetts. An online version of the policy states that if a patient is in cardiac arrest, EMTs are to "initiate transport as soon as possible." However, if a patient with a "Do Not Resuscitate" order is in cardiac arrest for more than one minute the patient may be pronounced dead, and doctors tell CBS 3 that it is state law that a dead body cannot be transported by ambulance.

CBS 3 contacted several local ambulance companies that agree with AMR, and say it is the emergency room physician (medical control) who makes the call of whether or not to transport the patient.

The Office of Emergency Medical Services could not comment on the incident but sent the following statement to CBS 3 Tuesday:

"In general, EMTs may call their medical control physician to seek advice on patient care decisions if they have a Comfort Care Form (DNR)."

Privacy laws prevent officials from giving CBS 3 the details of the Suliveres case, but it may come out in court if the family sues.

The family said that no dead loved one should ever be returned to the house - out of respect for the patient and the family.

[itku2er]

Well my heart goes out to the family here, and I honestly think out of consideration they should have transported. But I live in a rural area we transport DOA's all the time when family members die at home. But Honestly I think the crew should have showed some compassion, so if they had been almost to the hospital when he died would they have brought him back to the home instead of taking him to the hospital. I just dont get this concept cause its forein to me. 99% of all DOA's are transported by ambulance to the ER for pronouncement. The other 1% is pronounced by hospice and the funeral home comes and picks them up. Crew pick them up at the Nursing Home all the time and transport to the er for pronouncement.

[Cookie]

We transport all the time when a person passes away, it would not cross our minds to take the body back to the home. If we are call because the person passed away, we, all of the crew waits with the family until the funeral home or the coroner arrives. Ours is a rural community and we know most everyone, so being there with the family is comfort measures. Things are a little easier now then years back. People are allowed to pass at home. Years ago we had an elderly woman who passed away at home, we knew it, so did her sister, but we were unable to pronounce death, so we put a b p cuff on her and a nasal canula and transported her to the hospital where the Dr. did the necessary. It saved the family from waiting hours for the coroner to show up.

I think the crew needs a lesson in compassion.

[JakeEMTP]

I think the crew needs a lesson in compassion.

If they did transport the pt. wouldn't they be in violation of MA state law? I think it is a little bit of a grey area. Did the crew contact Medical Direction for advice? It seems to me, if a person is alive when you begin patient care, then you are obligated to transport if they are loaded into the ambulance. If they are alive when place them in your ambulance, it's pretty weak to take them back into the residence if they then code.

[fallout]

Returning the patient to the residence is a bit harsh. I was in that situation, had a swirling the drain patient with a DNR that the family wanted transported to the ER. I tried to explain the only treatment option we had was intubation, which was not possible because of the DNR. The family still wanted transport. Regardless, the patient went into cardiac arrest three minutes into the transport. I took that patient to the ER.

As a general rule though, I don't transport cardiac arrests that have not resuscitated if I can avoid it. If they are dead on scene, I break the news to the family and leave it at that. I help them get in touch with a funeral home, chaplain, etc. but under no circumstances is that body going to the ER in my ambulance. Frankly, it is another bill on a family that is about to take a huge expense financially.

For reasons of protocol, I do get stuck into transporting cardiac arrests if they do not fit our field termination guidelines. However, when I transport a cardiac arrest, everyone at the ER knows the patient is not going to resuscitate and that I am bound by medical control to transport.

[jmp6753]

I would not take a body back into the house. I would wait on-scene with the pt in the back of my rig until the coroner or funeral home arrives. As I have done several times before.

Here we have a pretty liberal death in the field protocol. It goes as far as in trauma if a pt is apneaic, no blood pressure and a pulse of less than 80, that person is pronounced dead.

If you are transporting a known dead body just for the ER to pronounce, can you imagine the liability if you seriously injure or kill another person while transporting? After all, the motoring public isn't watching out for you and the driver of the emergency vehicle is almost always at fault. I have no desire to lose my house, car and everything that I have worked for lost in a lawsuit. Do you really believe that the city or county or your private company is going to have your back when it happens? I really doubt they will.

[p3medic]

Interesting. I suppose if I were in that situation I'd transport, give the hospital a heads up that we were coming in with a patient that arrested in our ambulance with a valid DNR, and need a room out of the way. I couldn't imagine bringing a corpse back into a home, but thats just me, and I wasn't there.

As far as state law is concerned, not particularly worried about it, I took a burned 5yo to the morgue once a long time ago, was brought out of a house fire at 3 am, non viable, we put it on the bench in the truck, ME didn't show up after waiting a couple of hrs, and then a decision was made to bring the kid to them. No one seemed to mind.

[triemal04]

So, other than lacking some compassion and tact (maybe, I wasn't there and the article doesn't give many details) the AMR employees really didn't do a whole lot wrong. This wasn't a pt that had a chance at resucitation; hell, it wasn't even going to be tried, so why take him to a hospital? Mass laws prohibits carrying dead bodies around, so why take him to a hospital?

I can get behind leaving him in the ambulance and waiting for a funeral home to arrive, but that may not have been possible or event thought of. Really, that would have been the best course of events; allow the family to see the body, say goodbye and do what they need to. And there would have been nothing wrong with explaining to the family what had happened and asking if they wanted their loved one brought back into the house to wait.

This has happened before and it seems to get a bit overblown each time. While I'm happy to help someone start the arrangements when a family member dies, I'm not (and I doubt any paramedic is) required to get ahold of the funeral home. I damn sure am not required to take the person there, or to the morgue at the hospital. Like I said, the employees may need to work on their compassion and how they interact with the family of the newly dead, but other than that, don't think they did much of anything wrong.

99% of all DOA's are transported by ambulance to the ER for pronouncement.

Dear god why? Are you saying that you actually transport dead people, not workable codes, but dead people to the ER? Why?

[spenac]

We do not transport the body. We call the justice of peace and the funeral home. If we have no other calls we will wait with the family. Why are so many appalled about the body being in their home? It was not that many decades ago that the body would be viewed in the family home, sometimes layed on the the dining room table. Honestly I think people used to deal with death better because they saw the body, they had closure.