Handling a maternal cardiac arrest situation-rural EMS

[crotchitymedic1986]

Yes i am comparing the two, both kids will die if there is inaction over a perceived FEAR that is a maybe. But i can make it more apples to apples for you. Lets say that the guy at the pool was trained in CPR but it expired years ago. Maybe he is afraid that the child in the pool will require CPR, and he will perform it incorrectly, and maybe get sued.

[Eydawn]

I don't know of any paramedics who were licensed in field OB surgery but who just kinda let it lapse and aren't sure they know how to do it anymore. They never knew how to do it in the first place, unless they were a Vietnam type doctor who decided to let the MD go away once they got back to the States!

Never learning how to do it in the first place and learning it once and being outdated are apples and oranges. It's relatively hard to screw up CPR. Push on the chest until someone else gets there. All you gotta remember as a lay-person. It's VERY easy to screw up a field C-section. What if you cut too deep? What if you cut the umbilical cord while trying to get access to the uterus and the infant exsanguinates? Then you just killed the kid for certain! I'm sure there's more complications involved in that, and I would have no idea where to start because IT IS OUT OF MY ARENA.

Wendy

CO EMT-B

[crotchitymedic1986]

You cant screw up a c-section on a dead person. And yes if you are using all the sensitivity of freddy kreueger, you could cut the infant --- but the infant dies if you dont cut it out. No one is advocating that medics start doing c-sections on normal patients, this patient has a crushed head, and fetal heart tones are present, with a Doctor on the scene (although that wouldnt matter to me). Note that I also said call Medical Control for the order to do it (which would also provide doctor communication/instruction over the phone or radio), which is not guaranteed -- my guess is that most doctors would deny the order today.

It's a good thing Roy and Gage arent working today, I remember all those times they had to do an emergency trach in the field, with Dr. Brackett walking them through it, followed by some D5W TKO.

I am not certified in wilderness rescue, rope rescue, water rescue, extrication, or firefighting, but I cant imagine not going in after those patients while they are dying, to wait on someone who was certified to get there 20 minutes later.

[crotchitymedic1986]

I cant believe you guys feel ok about letting a patient die that you could save. I guess I, dust, and spenac are in the minority, but I couldnt let a child die just because I might get sued.

[akroeze]

That's an interesting point Dust.

You have a patient who is obvious traumatic death whom you deem is not a candidate for resuscitation. You have another patient trapped under them and alive but critical. The only way for patient two to be removed from the wreckage is to amputate above the knee the leg of patient one. Amputation isn't in your 'scope'. Do you do it?

Anyone?

[crotchitymedic1986]

good point !

[Arctickat]

I don't see how a comparison can be made between the two. Regardless, people can throw "What if's' around until the cows come home all they want, I'm not gonna play that game.

[Eydawn]

It isn't about getting sued! It's about practicing medicine outside of your educational scope! I'm not advocating doing it or not doing it, I'm saying to be cavalier about it is akin to the "I'll rush into the burning building to save the children" mentality that we criticize so often in our firefighting brethren! It is a personal choice. Do you sacrifice your cert (not because you got sued, but because you obviously and intentionally acted outside of your legal purview) for one pediatric patient that has a low survivability chance? Your call.

I say if your OWN medical director, your top kahuna, the doctor directly signing off on every action you do every day is on the cell phone with you and says you know, I fully back this, I hereby give you a temporary clearance to perform this surgery under my direction, then you should be ok or at least have some backing legally and it is up to you. If you can't get authorization, you should realize that you are risking your entire career and your future in medicine by taking this action.

I say if you get positive fetal heart tones with your doppler, you have more of a case for doing it. If you can't find them, then you can pretty much figure that the fetus is already deceased and avoid surgery that is outside of your scope.

Akroeze: I think that's more of an extrication consideration than a "medical procedure" consideration. The difference is that the person who's trapped isn't necessarily going to die if one waits for a surgeon to be brought to scene to amputate the leg of the deceased person who is entrapping the living person. And the living person isn't inside the dead person- just behind them. You may not be able to extricate them and get them moving, but you may be able to do interventions that will increase their survivability. And it's less scary to consider using a power tool to remove a leg from a cadaver than it is to consider using a scalpel to open a dead woman's abdomen in an attempt to save a fetus that is directly inside where you will be cutting...

I tried *shrugs* not sure where you were going with it, but that's my response.

Wendy

CO EMT-B

[fiznat]

I cant believe you guys feel ok about letting a patient die that you could save. I guess I, dust, and spenac are in the minority, but I couldnt let a child die just because I might get sued.

The "how far would you go to save one life" is a hypothetical that nobody can win. The prudent person who wants to protect his license (and possibly the patient) is regarded as cold and uncaring, while the "hero" who is willing to bend the law is scoffed at as a cowboy who's time on the street will be short lived.

My personal opinion is that we providers have a responsibility to protect our licenses and jobs so that we can continue to work as long as possible. We are more valuable to the community over the long run than we are on any single call. Throwing all of that away for the sake of heroically "saving" one patient is, in my opinion, a huge mistake.

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.

This is not the attitude of someone who believes in the value of what he does. Have a little respect for yourself. Have a little respect for your profession. We do more good in aggregate than we could ever do on this one scene. It doesn't make any sense to trade it out in some blaze of glory.

[mobey]

The "how far would you go to save one life" is a hypothetical that nobody can win. The prudent person who wants to protect his license (and possibly the patient) is regarded as cold and uncaring, while the "hero" who is willing to bend the law is scoffed at as a cowboy who's time on the street will be short lived.

My personal opinion is that we providers have a responsibility to protect our licenses and jobs so that we can continue to work as long as possible. We are more valuable to the community over the long run than we are on any single call. Throwing all of that away for the sake of heroically "saving" one patient is, in my opinion, a huge mistake.

I completely agree.

The reality is, alot of what I do does not "feel good". I work BLS (for now), that means there is not many patients I can do any good for. I don't feel "OK" with it, but it is the way it is. Really this is no different than me having a patient with a tension pneumo, should I decompress? How about when I clearly see fine V-Fib on my motitor but the AED says "no shock", should I switch it to manual (out of scope)?

I am far from a "protocol junkie" but I do have a limit. I am not a "Hero" I am a medical professional, therefor I am not willing to "risk it all" for one patient.

Seriously. So you lose your cert. So what. Who cares?

Me, my wife, my kids, my parents, my instructors, my co-workers, and anyone else who has assisted/supported my careerchoice.