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engine173351

Refusing To Assist With CPR Because of No Gloves?

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We hooked him up to our monitor, which advised "no shock" because he was in asystole.

What's your equipment? The monitors that we use don't advise the shock, we have to interpret that stuff. We might be old school, though. Not that's it's really a big deal or anything.

In response to everyone giving shit for recruiting help out of the lobby, it's happens. In rural areas it's somewhat common. I've seen it happen a few times, but usually to people on duty.

The compressions sounded futile. You had a patient who was in asystole for who knows how long. Pump him with some Epinephrine, do a few rounds of CPR, but he's probably not coming back. I'm surprised a doctor didn't call it over sooner that he did. Maybe the medic was simply saying, "I'm not getting involved compressing a corpse." That would explain why he initially accompanied you, then left when he saw the patient.

All this being said, I've done CPR without gloves before. Unless the patient's bleeding, the risks are pretty low of contracting anything. I'm all for universal BSI precautions, but you shake hands without using gloves, how's this any different?

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So we're working on a patient in the ED's "Trauma Room". The patient, a male in his mid-40's, was pulseless and nonbreathing when we arrived on scene. According to his family, they came home and found him on the floor, so it was an unwitnessed arrest. We hooked him up to our monitor, which advised "no shock" because he was in asystole.

For those who are questioning why the OP was using an AED or had their monitor set to AED, look at his profile – first responder… that does make sense.

The paramedics get him intubated on scene and we deploy the AutoPulse, which eventually stops for whatever reason. So we begin manual compressions.

I am assuming that the medics got there after you did…

I am curious – what are the protocols for a medic to say a patient is a non-workable code? Here, if the arrest was not witnessed, and the patient has obvious signs of death (lividity, rigor, cool temp) we can call it on scene, and do not have to work the code. This may have been a situation where working this patient may not have been the best option; I was not there, so I won’t say that this is an absolute. And, not knowing what your protocols are, you may not have the option to not work a code.

When we get to the ED, there's an off-duty paramedic there who assists us with unloading the patient. We get him into the Trauma Room and the staff continues resuscitative efforts. The two paramedics who I was riding with are assisting the ED staff, so it's me and an EMT-I who perform chest compressions. After about six or seven minutes, the both of us are becoming exhausted, having switched out several times. So as the EMT-I continues compressions, I go out into the open area of the ED and ask for two people to come and assist. I get two people, the off-duty paramedic and another person (who has to leave when called out of the room). When the EMT-I signals for me to take over, I ask the off-duty paramedic to do compressions, as I feel like I'm too exhausted. But he says "Nah, I don't have any gloves," and proceeds to leave the room. So I go ahead and relieve the EMT-I before two nurses eventually assist with compressions. Unfortunately, our patient didn't make it, which was evident considering the fact that he could have went down four hours or four minutes before we got to him.

I agree with others here – the “no gloves” excuse is an excuse, and he could have come up with a better one.

It does sound like your ER and EMS staff do need to review codes though… between you, your EMT-I partner, 2 medics, and the ED staff, you didn’t have enough people to rotate through doing compressions?

Drawing up the meds and getting the IV line in place (or IO) doesn’t take very long, and I am assuming it was done on scene (it should have been, since the patient was tubed on scene). Epi and atropine should be in pre-dose syringes… The patient was tubed on scene, so that was taken care of… At the ER, one person should be on airway, one recording, one on the chest, and the others should be stepping in to spell someone off as needed. Your medics should have been able to instruct you to stop compressions for a few seconds, look at the monitor, say “asystole, continue compressions” and advise their partner to give the appropriate med…. Other than during transport, you shouldn’t have had to be on the chest for extended periods.

Here's my question. Was it in some way "wrong" for the off-duty paramedic to refuse to assist and leave? No gloves? I can guarantee you that there's at least eight, if not more, boxes of gloves mounted on the walls of the Trauma Room. I can understand if a person doesn't want to help, but it was clear that we needed assistance for compressions. To me, that was a cheap excuse. The real question is, should I mention it to someone at my service?

Nope – don’t report him… what good would it do? He was off duty – he really didn’t have to assist at all. His excuse was lame, but, he really had no obligation.

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What's your equipment? The monitors that we use don't advise the shock, we have to interpret that stuff. We might be old school, though. Not that's it's really a big deal or anything.

Perhaps their equipment is more modern than yours?

I dont know of any monitor that doesnt say "no shock advised" when in AED mode

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Perhaps their equipment is more modern than yours?

I dont know of any monitor that doesnt say "no shock advised" when in AED mode

I think that they all do, at least as of LP12s or so?...I've just, like most I think, never used it in AED mode.

Dwayne

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I think that they all do, at least as of LP12s or so?...I've just, like most I think, never used it in AED mode.

Dwayne

I hear ya bro, but it pays to know all of your equipments modes, uses and limitations methinks.

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I'd say no gloves is an excuse well with in his right, to protect himself... But more of an excuse to be used while on a trip to the mall, and silently to yourself, unless you're wearing something that says what you are.. The way you describe it, I'd say he's probably an asshole with an ego problem.

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What gets me is that he walked into the room. If you're opting out because you're not on the clock and not covered by your employer's insurance, why did you walk into the room in the first place?

However, I do like Dwayne's assessment of "Man, I want no part of that mess... quick, think of an excuse!" I could see that happening. Methinks, though, what would it hurt to help do compressions until the doc says "no mas."

It's not like he killed the patient by refusing, though. It's not like they asked him to help get a difficult airway that nobody had been successful with... he just didn't feel like pounding on a dead guy's chest. Guy was still gonna be dead, help or no... so no harm done. Especially if he was in asystole. Does your AED tell you the rhythm when it advises "no shock"? And yeah, I'm talking JUST the AED, which is what I think may have been used here... not the fancy 10k Lifepaks that let you actually LOOK at what's happening...

Wendy

CO EMT-B

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As for what we were using, we had a Zoll E-Series with us (You know, the one that can be thrown off a building or run over with a truck and still work? That one.). As for what "mode" it was in, I have no idea. Like everyone says, the guy was deader than dead (without any obvious signs of death). But the two paramedics I rode with decided to work it.

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engine173351 - sounds like a small town or something. The ER should have had plenty of staff ready and willing to take over for you. I don't think I've ever run into a situation where the techs didn't jump right in. So this guy was off duty, what was he doing in the ER?

I'll be perfectly honest, I am SOOO over the glory part of this job and I'm the first one to not get involved when it doesn't pertain to me. I'm not going to "jump" calls or show up on scene just to "see" if you need help. HOWEVER, if help is needed, I'll jump right in, duty status aside. I can't just sit idly by when you are asking for help. I think that was a shitty attitude to have on his part.

But like someone else said, he's not covered by malpractice, but more importantly he's not covered by workers compensation. If he's got mouths to feed, that could be VERY important to him. I work be thinking of that. I've got four other mouths to feed and I don't need an injury that's not going to be covered.

Oh, and P.S.....you with IN A HOSPITAL!!!!! How hard is it to find a pair of gloves?????

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