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Riblett

Handling a maternal cardiac arrest situation-rural EMS

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The best choice is to call medical control and get permission to do a C-Section in the field to save the baby.

2. Next best choice is to go to the closest ER and let them deliver the baby. Even though they do not have the NICU or even an OB doctor, any ER doc should be able to perform a delivery and care for a neonate as an emergency (just as a medic would). the child and mother can be transferred to other facilities after stabilization. Driving for 25-30 minutes will most likely result in the death of both, there is a chance to save the baby if it is delivered within 10-15 minutes of arrest.

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Yeah Dwayne I can see what you're saying, but you and I both know that reality will dictate that we consider all patients viable and treat/transport as such. It isn't up to us to "count the baby out," even though it is probably a reasonable conclusion. In addition, there is therapeutic value for the mother to have that baby out of her, so even if we presume the baby dead we can't treat this as a regular cardiac arrest.

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Yeah Dwayne I can see what you're saying, but you and I both know that reality will dictate that we consider all patients viable and treat/transport as such. It isn't up to us to "count the baby out," even though it is probably a reasonable conclusion. In addition, there is therapeutic value for the mother to have that baby out of her, so even if we presume the baby dead we can't treat this as a regular cardiac arrest.

Yeah, I see your point, and that of the Doc as well...I'm a convert. But I certainly would have screwed the pooch on this call had I run it prior to this discussion.

Thanks to all, for your thoughts.

Dwayne

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In that case the fetus is already dead long before I arrive, so I might as well try to save the mother. As to the previous post about the medic who did the C-Section in the field. Lucky for him the baby lived. Had it not no doubt that medic would be penniless from all of the court cases for conducting a procedure out of his scope of practice. Not even medical control can authorize something like that. If loading and running like hell was the best practice for cardiac arrest we would be doing that every time rather than sitting on scene running a code.

I stand by my treatment

Your treatment is correct.

But as for your comment about the medic going outside his scope of practice. the mother's head was trapped under the car, no fire department on scene yet to get her out. There was a physician on the scene but he was not prepared to cut the baby out but this was a very seasoned medic. The physician and the medic both did this but the medic was the one who cut and delivered.

The state of missouri came in after this (remember this was over 25 years ago) and did an investigation and found that while this was out of the paramedic scope of practice they found that the benefit of doing this (live baby) versus not (dead baby and dead mom) outweighed the situation at hand. He was actually recognized for heroic measures and the director of the state of Mo EMS was in attendance.

So even if he was out of his scope of practice it seemed that not many people had an issue with it.

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Remember, folks... this is simple, first day of CPR class stuff.

You cannot hurt a dead person. No harm = no liability.

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Yeah they said that at my CPR class too. I remember the quote exactly: "do whatever you want to these patients because since they are in cardiac arrest no damage can be done to them. You are in the clear because, hey, they're already dead so what the hell." I remember it kinda spoiling my interest in the rest of the class. They should have saved that kind of advice for graduation day, huh?

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Remember, folks... this is simple, first day of CPR class stuff.

You cannot hurt a dead person. No harm = no liability.

Somehow I doubt the instructors are thinking the student will be slicing a pregnant woman from xyphoid to pubis though. There is a big difference between trying to save a life and making an error compared to trying to save a life while at the same time causing a mortal injury that will completely prevent the possibility, faint as it might be, of resuscitation. Sure, if they fit within the criteria of my protocol for pronouncing death in the field, my position may change, but if there is a potential for ROSC, I'm all over it. I also suspect that one without the training or skills will survive a legal fight in this day and age. 25 years ago was a different era. Fortunately for that baby, the medic didn't put his brain into gear before grabbing the scalpel.

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Somehow I doubt the instructors are thinking the student will be slicing a pregnant woman from xyphoid to pubis though. There is a big difference between trying to save a life and making an error compared to trying to save a life while at the same time causing a mortal injury that will completely prevent the possibility, faint as it might be, of resuscitation. Sure, if they fit within the criteria of my protocol for pronouncing death in the field, my position may change, but if there is a potential for ROSC, I'm all over it. I also suspect that one without the training or skills will survive a legal fight in this day and age. 25 years ago was a different era. Fortunately for that baby, the medic didn't put his brain into gear before grabbing the scalpel.

ArcticCat, you are missing the point. There was a physician on scene and also a physician on medical control What part of the medic not putting his brain in gear do you have an issue with?

plus the mothers injuries were so severe, her head was about 3 inches thick after being crushed by the car. I think her injuries were fatal don't you?

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And if he'd screwed up the defense attorney trying to use the old story that "It's okay! The doctor told him to do it." will stand up for about 30 seconds. As I had stated, he is fortunate it was 25 years ago and not today's court happy world. It is the responsibility of the paramedic to ensure that he/she functions within the scope of practice and does not allow pressure from other sources to compromise that, because the medic will be the one held accountable, not the physician who told him/her to do it. If the doctor was too scared to actually attempt it, the only reason the paramedic did was because he was too ignorant of the risk he was taking. BTW, I know he's your hero and everything, so don't confuse the term ignorant with stupid. They are totally different.

You will also note in the post you quoted that I mentioned my position would change if the patient met my death in the field protocol. A head three inches thick would qualify as such. I still wouldn't slice her open, but I'd makes sure to drive her as fast as hell to my doc...who also wouldn't slice her open.

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And if he'd screwed up the defense attorney trying to use the old story that "It's okay! The doctor told him to do it." will stand up for about 30 seconds. As I had stated, he is fortunate it was 25 years ago and not today's court happy world. It is the responsibility of the paramedic to ensure that he/she functions within the scope of practice and does not allow pressure from other sources to compromise that, because the medic will be the one held accountable, not the physician who told him/her to do it. If the doctor was too scared to actually attempt it, the only reason the paramedic did was because he was too ignorant of the risk he was taking. BTW, I know he's your hero and everything, so don't confuse the term ignorant with stupid. They are totally different.

You will also note in the post you quoted that I mentioned my position would change if the patient met my death in the field protocol. A head three inches thick would qualify as such. I still wouldn't slice her open, but I'd makes sure to drive her as fast as hell to my doc...who also wouldn't slice her open.

sorry to burst your bubble but he's not my hero. Far from it, he's done some stupid things but in this I believe he did the right thing. Please don't make assumptions on my behalf. It just makes you look silly.

I also never said that the doctor was scared to do it. My friend was in the ditch with the patient and the doctor talked him through it.

Maybe I didn't give you all the particulars but please refrain from putting words in my mouth. You don't even know me so you have no idea who my heroes are.

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