Handling a maternal cardiac arrest situation-rural EMS

[DwayneEMTP]

If the question posed is would I do the extrication if I would not lose my cert? then hell Ya. I am not "scared" to do anything if the only other outcome is death!

Let's try again. Your previous statements and those that follow contradict what is in bold above. That was what I was commenting on.

WTF was that??

An opinion. Reread it and I think you'll find your tantrum is unwarranted.

Of course I am scared to lose my certs!!

As we all are.

Are you actually suggesting I become a renegade EMT doing what ever I "feel" I should do as long as I logically and intellectually believe to be the best interventions?

I'm not suggesting "you" do anything. It's obvious you don't have the education to make any of those type decisions. I was simply giving my opinion, about my decisions, based on my experience. You extrapolated it to yourself and then decided to cry about it....That's not on me brother.

Just because I am not willing to "Risk it all" for one patient I am suddenly some inferior EMT and my patients are getting poor care?

Did you actually take that away from my post? Ridiculous. I'm unwilling to explain my comment at the 3rd grade level simply because you decided to post in a fit wihout making at least a minimum effort to think first.

Really.... how about you answer my question about me (Bls) doing a cric??

If your logic and intelligence are to be judged by your statements here and your inability to follow this simple conversation I wouldn't allow you to run a BVM, of course the idea of you doing a cric is ridiculous.

I am NOT willing to perform an intervention that I KNOW will end my career in EMS if that makes me a poor provider then so be it. Perhaps it is common practice in your area for bls crews to do whatever they "Feel" is appropriate, but around here "Big Brother" would hang us pretty quick.

Again, reread my post. Perhaps more slowly this time. At no point did I suggest that you should do anything. I gave my opinion of me. If that's got you feeling like a pussy, not my fault brother. My way is not everyone's way. Since being in Afghanistan I've made three decisions that I felt were necessary, but had a significant risk of getting me sent home. Each time I got my ass chewed by management, but was reassured by the doctors that I had performed competent, necessary interventions. That's MY way, I can't figure out why you keep insisting that it has anything to do with YOU?

So to clarify my stance on this subject

Do the extrication and lose certs but save one life = NO

Do the extrication and keep certs to stay in same career justifying all my hard work over the last 5 years = YES

Outstanding...you actually used 3 sentences to say absolutely nothing. So you've decided that if you ever live in a perfect world that you'll know exactly what to do when you don't have any idea what to do? Silly.

Am I the only BLS provider out there who has had patients die under thier care because the law/cert ties thier hands??

No, but hopefully you're the only one that keeps blaming certifications for personal decisions. Your hand aren't really "tied' man, you've just chosen not to act under a certain set of circumstances. Good for you.

Good luck brother....

Dwayne

[DwayneEMTP]

Honestly I don't know what I'd do in that situation. I would have to be in it before I knew.

Kind of a cop out I know but it is what it is.

You could throw in so many variables it is hard to say.

No man, I don't think it's a cop out. I think it’s one of the few no bullshit answers in this thread.

This scenario, though incredibly unlikely of course, for some reason seesaws my brain back and forth. It seems there is an obvious "right" answer, to save the baby by whatever means available, and another obviously ‘right’ answer, don’t risk your livelihood when it’s not your emergency, but for some reason it just doesn't sit right still...know what I mean?

I've made the decision for myself, (though I've been around a few days longer than you, so have no issues that you haven't done so yet), but can't find a solid argument to make for what's right for others to do in this situation.

Maybe it’s like quantum mechanics, there truly are several absolutely correct, though opposing answers to the same question.

Thanks for your response.

Dwayne

[reaper]

I think this is a decision that can only be made at the time.

Would I do this? Probably, if the MD was backing me and I thought that the fetus could be saved.

Some of the excuses being used, don't hold water for me.

1. "If I do this I will lose my cert!"

If I have made the decision to go ahead with this, I would not be worried about my cert. If I lose it, then I would find another line of work. At least I know I could live with the decision I made.

2. "What about all the future Pt's you can't help, if you lose your cert!"

I never worry about future Pt's, I worry about the one in front of me! Do you honestly think if I don't show up tomorrow, that there is Pts not getting care because of it? If I am not there, the next medic in line will cover those pts.

These as just my opinions on this scenario and how I would justify my decision, to myself and my family!

[mobey]

I simply think that there is little time to think about politics when hinky situations arise, at least I'm not smart enough to do so. I think that too many of your patients are getting poor care if you have to do the cost/benefit of your certs vs treatment each time you come to a situation you're not sure of. Perhaps you don't have those situations, but I'm practically a factory for them.

I can't figure out why you keep insisting that it has anything to do with YOU?

:-k

For me, I had to decide early on that I will perf......

This would be when you started talking about you

Outstanding...you actually used 3 sentences to say absolutely nothing.

Just because you cannot understand what I am saying does not mean I am saying nothing.

So you've decided that if you ever live in a perfect world that you'll know exactly what to do when you don't have any idea what to do? Silly.

That is possibly one of the dumbest things I have ever read from you. Seriously, your posts are always well thought out, and make perfect sence to me, this is just well.... silly

No, but hopefully you're the only one that keeps blaming certifications for personal decisions. Your hand aren't really "tied' man, you've just chosenunder a certain set of circumstances. Good for you.

Perhaps I am too thick to understand what you are trying to say.....

I take the above statement to mean that you believe I SHOULD act under a certain set of circumstances? Sooo.... Hmmm anyone else help me out here?

I do not blame anything/one for anything. It takes 3 full years to get my medic, during that time I cannot do alot of procedures (or even act as an independant) without losing my career, no one is to blame except the lame-ass shcools for requiring experience.

If you reread the post you have bolded, you will see that I explicitly say "If the question posed is would I do the extrication if I would not lose my cert?" Sooo, another way to put this would be, "The only thing I am scared of is ending my career, not cutting some corpse open to save a life"

I don't have a clue where you get the idea I am having a tantrum, or in the least bit deserve any of the condescending remarks you have made but if you are unable to carry on a decent debate without belittling me than you can finish this thread with someone else.

decided to cry about

at the 3rd grade level

wihout making at least a minimum effort to think first

Outstanding...you actually used 3 sente.....

...not to act under a certain set of circumstances. Good for you.

I guess I just got used to your insightful, non judgemental, educational posts of the past. I am actually a little caught off guard that someone I look up to would be so harsh at the drop of a hat?

[DwayneEMTP]

Yeah man, though I still disagree on the context of a few points, you're correct on nearly every other one.

I was at the PX just now running this post through my head, and thinking, "Jesus Christ, when did I become such a self rightous asshole?" I would delete it if it wouldn't make your post that followed look bad.

My appologies to all. I got a little tired and a little homesick and seem to have developed a near terminal case of 'self rightous stupid' the last couple of days, I shouldn't have let it splatter onto you all...

I'll reply again to your post Moby when I've had some sleep man...Sorry for the nonesense.

Dwayne

[mobey]

No harm done my friend. I am somewhat aware of the stress you are under out there..... although I cannot get a full grasp of it.

The respect remains intact. My appoligies if I have offended you as well.

Mobey

[crotchitymedic1986]

Has anyone else noticed a trend here ? It seems to me that the ones willing to do the procedure seem to all be old veteran medics, whereas the ones who are most vocal against the procedure seem to be fairly new to EMS (atleast less than 6-8 years of experience).

Could this simply be due to the fact that we older medics know that for all the lecturing we have received about lawsuits if you make a mistake or fail to document something, the reality is that you will rarely be in a courtroom, and when you are it is usually about what you witnessed, not what you did. The new guys may not know that reality yet. So they may not be as comfortable to make such a quick decision.

If you do not agree, what do you attribute this difference too ?

[Arctickat]

I've been in EMS for 30 years.

It seems to me that those who would do it have some sort of military background from what I can tell.

[DwayneEMTP]

And hell, I don't fit either category. I've not been a medic long, and have never been in the military. But I have been on the planet a few days longer than some.

For me this isn't specifically a medical question, it's a general question of "what do you need to do to feel valuable?" For me, I need to do what I feel is right, regardless of the applicable rules. Unfortunately it seems this attitude keeps getting confused with "Do whatever I want and damn the rules." Not the same, to me at least. Rules are a valuable resource, as are protocols and SOPs. But they are not foolproof.

I feel that, as a medic, I'm tasked with preserving life and mediating suffering to the very best of my tiny ability. To decide that I will choose not to do so, despite having the tools necessary, because someone forgot to write a rule that applies perfectly to my current situation means that I fail in my moral and ethical responsibilities. I've often done that on accident and on purpose in the past, but make every effort at this time in my life not to do so again when I can help it.

I once pounded on some gang bangers with a baseball bat that were attacking a young kid. Some were minors I'm sure, the 'rules' say I shouldn't have done so, as none of them produced a weapon (I think that’s what it says), the rules say (I think) I shouldn't hit kids with baseball bats, The rules say I should have stayed away from them as I have a family to support, the rules say (I think) that I'm opening myself up to a lawsuit.

But see, I'm not smart enough to figure all of that out in a moment. If someone had told me I would have to deal with that situation tomorrow, I would have looked into it, but, in the moment, I chose to act, as opposed to not act, and do what I felt was right, because that’s what I can live with at the end of the day. Do I think the person that makes different choices is less of a person than I am? Of course not.

Sit a while with ak. He can talk medicine, politics, download porn, run an arrest, all at the same time and still have brain cells left over. I'm not like that. I have to hold my breath when treating a pt, because if I shift the mental resources to breathe I'm likely to lose focus and fall out of the ambulance.

If life has brought you to a place where your cert is more important than those things we've discussed here, ok. If you're smarter than I am and can figure out all of the political/legal ramifications of each action you take before taking them? Ok again. I can't. Not because I'm better, but because I'm different. And my differences have brought me and my family a lot of pain at times, and may bring us more in the future.

I don’t believe I have the answer, I simply have my answer, which of course is subject to change given different circumstances and new information.

Dwayne

[VentMedic]

Back in the early 1980s there was a case in rural Alabama where a logging truck hit a car containing a woman who was on the way to the hospital to deliver her baby. Full term and obvious death to the mother made that decision relatively easy and it helped put a few laws on the books in some states that can be brought up.

However, obvious death should be reasonably obvious.

In the situation of the OP, this is a gray area. Did you do all you could for the mother? All Hs and Ts considered? Or, as evidenced by the many emotional posts, would your reasoning be skewed by the need to save a baby that may or may not be viable and forgo covering your bases with the mother? If you can without any doubt argue before any board that you did everything possible for the mother and can demonstrate further resuscitative efforts were futile, the next call would be yours and your medical control. But, in your haste to save the baby or lack of training to perform a field C-section, you damaged the baby which resulted in its death, you may have other issues to answer for. The charges for either could mean more than loss of license. Luckily, there may be some "done in good faith" protection under some state statutes that will protect you although not entirely.

Know your state statutes, pose this question to your EMS board and your medical director. Don't be shy. Too many fail to even read all of their P&Ps and are even more clueless about all the information in their statutes. Members from an anonymous forum will not be protecting your license or writing your protocols.