What in the heck were these rocket scientists thinking

[Dustdevil]

They should kill the lawyers.

[Andrewtx]

They should kill the lawyers.

Nice and concise

[JPINFV]

They should kill the lawyers.

Naw, we should let baiscs play "paramedic" with them.

([think Tootsie Pop commercial] So, how many [iV] sticks does it take to get to the center of a vein? 1, 2, 3...)

[SSaint]

Naw, we should let baiscs play "paramedic" with them.

([think Tootsie Pop commercial] So, how many [iV] sticks does it take to get to the center of a vein? 1, 2, 3...)

Ouch...

[Ace844]

If this truly is what happened then shame on them but let's take a step back from the article and think about what was happening

1. you have 3 patients who obviously could not be moved

2. You have a major storm coming and after it hit the hospital if I remember correctly was nearly destroyed. By the time that the three of them realized that this was a hopeless situation there were no ambulances to transport the patients cause I believe the hospital was also under water.

3. No utilities which if the patients were on drips or pumps or ventillator then what the heck was powering the equipment

4. Without utilities running how can they get the patient with all the ancillary stuff on them down or up to a level that they could evac them out. it's impossible to move these types of people down stairs or upstairs.

5. What was the survivability of these patients in the end run?

6. Was it more humane to "put them to sleep" or let them suffocate because their vent didn't work or the pumps that were keeping the lifesaving drugs going in had run out of batteries.

Before we chastise these providers we need the whole story. They are still SCREWED BIG TIME IN MY OPINION, BUT we need to step back and find out the entire story.

"Ruff,"

Well said, but I disagree with your statement of

They are still SCREWED BIG TIME IN MY OPINION,

I will preface that with the following points.

1.) Uneven application of these laws in this situation. How much do you want to bet that this happened many times in this area and at this time. Where are the investigations and prosecutions for those situations?

2.) If these clinicians are guilty of murder as soem here are implying, why weren't the hospital and gvt officals charged as accessories for failure to follow or provide the menas for these patients to be evacuated before the hurricane struck. Are you going to try to tell me that they had time and resources to evactuate prisons but not a hospital and ICU???!!! Where is the blame there? By the standards being applied here agianst these 4, the others are at least 'conspirators,' or 'accessories'... :!: :!: in this and belong right next to the others with charges being filed as well.!!! !!

3.) What are the teachings on this type of situation WHICH EVERY MEDICAL PROVIDER OF EVERY LEVEL GETS TAUGHT!?!?!?.. It's rhetorical. The fact is that we are ALL told that in an extreme MCI-Extremis situation you need to rise above and make tough decisions like these clinicians did and do the best you can for everyone. Also, we are taught that THE RULES DON'T APPLY HERE AND YOU WILL BE BACKED UP AND SUPPORTED ON YOUR REASONABLE ACTIONS..!!! Where is the MEDICAL PROVIDER COMMUNITIES SUPPORT FOR THESE INDIVIDUALS???? Is there really any question that this is an extremis MCI-battlefield type situation. We all make these types of 'tough' decisions in these situations in different ways but with similar consequences...THINK ABOUT IT!!

4.) As said previously there is a lot more to this story, a few are being made scapegoats for the many, this is a distraction from something else major we all are missing, there is a personal vendetta-agenda involved..

5.) As "dust," pointed out... to the lawyers!!!

Out Here,

ACE844

[paramedicmike]

I agree there is more to this story. I'll withhold any decision until more details come to life.

Ace:

I'm going to play devil's advocate with some of what you posted. Not necessarily because I disagree, mind you. Simply for furthering a discussion on ethics and exploring the topic a bit.

Don't you think there's a big difference between an MCI situation where you triage a patient, realize that there's nothing that can be done and moving on versus triaging a patient, realizing that nothing can be done, and actively taking a roll in terminating that life? It's one thing to withhold treatment in an MCI situation while moving on to someone you really can help. It's quite another to actively take a roll in eliminating the need for further treatment despite the circumstances.

If it had been an issue of batteries dying and equipment failing leading to these deaths that would be one thing. But active euthanasia is quite a different story (if that is, in fact, what happened here. Like I said, I'm withholding any decision on this particular topic until all the facts are known.).

Overall, I understand the point that you're making. It was a tough situation. Events demanded an atypical response. There was no sense in thinking outside the box as this situation provided no box in which to think. By all accounts, the environment was horrible. This lead to a situation where decisions that shouldn't have to be made were needed.

And Dust, you now have the high esteem of being regarded in the same company as Shakespeare. You were both right... "The first thing we do, let's kill all the lawyers".

-be safe.

[SC MedicMike]

Naw, we should let basics play "paramedic" with them.

([think Tootsie Pop commercial] So, how many [iV] sticks does it take to get to the center of a vein? 1, 2, 3...)

Cool! Can we get CE credits for this? After we're done with the lawyers (most are bloodless, anyway), we can move on to the folks at Faux News... :twisted:

[Ace844]

I agree there is more to this story. I'll withhold any decision until more details come to life.

Ace:

I'm going to play devil's advocate with some of what you posted. Not necessarily because I disagree, mind you. Simply for furthering a discussion on ethics and exploring the topic a bit.

Don't you think there's a big difference between an MCI situation where you triage a patient, realize that there's nothing that can be done and moving on versus triaging a patient, realizing that nothing can be done, and actively taking a roll in terminating that life? It's one thing to withhold treatment in an MCI situation while moving on to someone you really can help. It's quite another to actively take a roll in eliminating the need for further treatment despite the circumstances.

If it had been an issue of batteries dying and equipment failing leading to these deaths that would be one thing. But active euthanasia is quite a different story (if that is, in fact, what happened here. Like I said, I'm withholding any decision on this particular topic until all the facts are known.).

Overall, I understand the point that you're making. It was a tough situation. Events demanded an atypical response. There was no sense in thinking outside the box as this situation provided no box in which to think. By all accounts, the environment was horrible. This lead to a situation where decisions that shouldn't have to be made were needed.

And Dust, you now have the high esteem of being regarded in the same company as Shakespeare. You were both right... "The first thing we do, let's kill all the lawyers".

-be safe.

"Scarmedic,"

I don't see all that much of a difference in that the rules and precedence of survival as well as the clinician trianing and STANDRDS OF CARE in this situation are THE SAME. Fact of the matter is, in a 'LARGE' MCI type situation like the one in which we are talking about, or a battlefield, or even a protracted amount of patient care in an adverse environment dictate a different view of the patients management and outcomes. Also, we rae all taught...'DON'T WORRY, ALL THE RULES ARE OUT THE WINDOW, YOU DO WHAT YOU HAVE TO DO AND NO ONE WILL COME AFTER YOU AS LONG AS IT WAS IN THE BEST INTERESTS OF THE PATIENTS AND TO THE BEST OF YOUR ABILITY'!! Furthermore, they treated the patient and both conditions and their ilnness-injuries progressed to the point where adequate care was no longer working or warranted.

I guess what I am saying is that if they did NOTHING, or were deliberately trying to cause harm, pain, discomfort, etc... That would be one thing, but they did all they could and then did their best to be humane about it when they could do no more and were forced to make a tough call. They DESERVE OUR SUPPORT!! This is no different than when in your analogy when you work a critical 'RED TAG' patient and their illness progresses to the point where ressus, is futile and the end point will remain unchanged.

It is actually the same mindset of 'START' or rapid triage just over a longer time. You do what you can for as many patients as you can until it becomes unteneable for the group and you to continue their care at the same standard level especially with or in the case of physiologic decompensation and or non-response to this treatment. Conversely, what 'discussion' and 'charges' do you think these clinicians would have faced if they did the opposite and dedicated all available resources and care to these patients only later to have a suplly issue or have the other patients sufferr and recieve no to negligent lacking care? It was and is a no-win situation. If they had the intent to 'murder' no care would have been given, and many more patients would have been killed, and or they would have fled for their own safety as oppossed to 'sticking it out like they did.

Out Here,

ACE844

[paramedicmike]

I think I see what you're saying. But let me make sure so I don't go and mess anything up down the road.

What I think you're saying is that so long as the intent of their action was good then it's ok to proceed. So if they gave something obscene like 5mg of fentanyl for sedation to keep the patient's mind off the heat, humidity, trouble breathing, pain, or whatever, but not to kill them, then it's ok. Even if the patient "accidentally" wound up dead because we all know that respiratory depression is a side effect of that much of the drug.

But if they specifically went out with the intent to terminate the life of the patient by administering that much fentanyl (or morphine or whatever) then it's not ok and should be punished.

Am I reading you correctly? If not, let me know. Just trying to get a better handle on your line of thinking.

And again, I'm not agreeing or disagreeing with anyone on this. There's more information to this story that none of us have. I'm withholding a decision on a position until all the facts come to light and we're able to better assess what went on in such dire circumstances.

-be safe.

[Ace844]

I think I see what you're saying. But let me make sure so I don't go and mess anything up down the road.

What I think you're saying is that so long as the intent of their action was good then it's ok to proceed. So if they gave something obscene like 5mg of fentanyl for sedation to keep the patient's mind off the heat, humidity, trouble breathing, pain, or whatever, but not to kill them, then it's ok. Even if the patient "accidentally" wound up dead because we all know that respiratory depression is a side effect of that much of the drug.

But if they specifically went out with the intent to terminate the life of the patient by administering that much fentanyl (or morphine or whatever) then it's not ok and should be punished.

Am I reading you correctly? If not, let me know. Just trying to get a better handle on your line of thinking.

And again, I'm not agreeing or disagreeing with anyone on this. There's more information to this story that none of us have. I'm withholding a decision on a position until all the facts come to light and we're able to better assess what went on in such dire circumstances.

-be safe.

You are correct. It is a fine line and one which MANY MD'S walk every day just BECAUSE of these types of laws which prevent them from (although in a very different environment-situation than the one being discussed) from following a patients or families wishes not to continue futile efforts or sustain a patient to an outcome which is undesirable, or leads to no-poor quality of life.. Another example would be an order written as follows; "Pt to recieve increasing and or escalating doses of XYZ medication for percieved discomfort, distress and pain as needed PRN".

Out Here,

ACE844