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Riblett

Handling a maternal cardiac arrest situation-rural EMS

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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 don't understand what makes you think that any of us are discussing a scenario different from that one. Of course that is what we are talking about. Not sure where you got the idea that this was theoretical discussion of choosing the life of the baby over the mother. This is strictly a decision to either choose life for the baby, or to let it die. It has nothing to do with the mother. The mother is obviously, verifiably, and pronounceably dead.

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I am sorry, i got into this business to save lives. If i came across this situation today, and I knew the mother had taken her last breath just a few minutes ago, I would be on the phone with medical control to get orders to cut the baby out. If I lost my paramedic certification because I saved the baby's life, then so be it. I couldnt live with myself knowing that I didnt give that infant every chance to survive. Do you know a firemen that wouldnt run into a burning house to save 3 kids he could hear screaming ? If he can risk his life to save lives, the least I can do is run the risk of a lawsuit to save one. To the contrary, if i were the family and i knew all those medical professionals were on scene, and did nothing, i would sue in a heartbeat

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Seriously. So you lose your cert. So what. Who cares? About one in ten-thousand of us will ever stay in EMS long enough to retire anyhow. So you lose a year or two off of your total time. Big deal. Move on with the satisfaction of knowing that you did the right thing.

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You can lose a lot more than your "cert," but hey whatever in the end it will be up to the paramedic on scene to decide what he wants to do. Personally I think it would reckless to start performing out of scope, untrained amateur surgery in the field but ego always seems to prevail. What exactly makes this the "right" thing to do? We don't know how to perform this procedure correctly. Are hopes and dreams going to save this baby's life out of the mess that you will inevitably make? If that's the case then why don't we start cracking chests on traumatic arrests too. Cutting the chest open and squeezing the heart cant be that hard right?

If you're "in this business to save lives" you should understand that you will save more by doing what you're supposed to rather than going out on a limb with these supposedly heroic efforts. How many lives will you be able to save when you're in court and losing your license is a foregone conclusion?

People need to understand their limitations in this job.

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If you're in this business to "save lives" you should understand that you will save more by doing what you're supposed to rather than going out on a limb with these supposedly heroic efforts.

Being an extension of my Medical Director's practice is exactly what I am "supposed to" do. Following his orders is not heroic. It is my job description.

How many lives will you be able to save when you're in court and losing your license is a foregone conclusion?

You will save none if you don't have the guts to try. The mother is dead. Whether or not the baby survives is entirely up to you.

That is a foregone conclusion.

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No medical control doctor can instruct you to perform a procedure that you simply do not know how to do. It isn't in anybody's "job description" to risk themselves or their patient in that way.

And we wonder why so many of our medical control physicians don't trust us. We walk such a thin line, performing the procedures we do with the limited education we've got, and all the while there are those out there who believe all it takes is a little more GUTS to go way above and beyond.

In my experience, competent, educated providers don't relegate themselves to going down in a bloody blaze of glory. They've put too much work and effort into this to throw it all away on a decision built on balls instead of brains.

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Save the baby, deal with the legal later. Get jury full of mothers and get off scott free.

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No medical control doctor can instruct you to perform a procedure that you simply do not know how to do. It isn't in anybody's "job description" to risk themselves or their patient in that way.

This thread isn't about doing something you do not feel confident and competent enough to perform. If you do not, then you are correct; you should refuse the order. It is not my intent to tell anyone to do otherwise. But there are quite a few medics who are well educated and intelligent enough to feel confident with the order. Not everyone here is limited to a 13 week tech school education.

And we wonder why so many of our medical control physicians don't trust us.

If my Medical Control Physician didn't trust me, he wouldn't be giving me the order in the first place, would he?

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I'm going to assume in all these hypotheticals that online medical direction would continue throughout the whole procedure and not just be a "Ya, go ahead and cut that baby out and then give me a call and let me know how it turns out." Right? Either way I'll admit I'm still very much of two minds about this one and I think my inexperience is going to leave me sitting on the fence on this one. I'm not comfortable enough with myself as a provider yet to consider going that far out of my scope. Especially since I'm only BLS. I'll return to being a fly on the way on this one now.

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But there are quite a few medics who are well educated and intelligent enough to feel confident with the order. Not everyone here is limited to a 13 week tech school education

I guess we're just going to have to disagree on this one Dust. I don't see how any paramedic can possibly feel confident with performing this kind of surgery in the field. The percentage of medics out there who have experience enough to feel genuinely confident with this has got to be so infinitesimally small as to not even be worth discussing. Is there a one in million provider out there that has some sort of unique experience that might enable him to do this? Sure. Should the VAST majority of EMS providers even think about this route? Hell no. I don't care how many CME lectures you've been to or books you've read, its out of our scope.

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