what would you do in this situation as a EMT-B

[NREMT-Basic]

Code with no valid DNR:

1. Initiate "Code Protocol" and work the code

2. Contact MedCon

3. If advised to cease working code, do so. Offer condolences to family.

4. Write PCR

5. Purchase double espresso and smoke a cowboy killer

[JPINFV]

:shock: Isn't that an EMS requirement? I understand that in some desolate areas there are communication problems where you can't get someone online, but that's the only exception.

Nope, there is no method in Orange County, CA to obtain online medical control at the BLS level. The reality, though, is that 99.99% of the patients can either be handled via acceptable protocols/SOP [note: That requires that the basics actually READ them instead of relying on a friend of a friend of an instructor's word for it], or the call requires ALS [which is easily available by transport to the 17 or so hospitals with emergency services or by requesting a paramedic response via the 911 system]. The drugs available at the BLS level is limited to oxygen. Thus, the treatment options are very limited, ALS is never far away, and the only other problem is generally when the basics are either too dumb or arrogant to do the right thing [you'd be surprised at how many basics have said that they would refuse to follow the DNR guidelines because of legal concerns].

Of course, this is really only a concern on interfacility calls since all 911 calls have an ALS response. You might argue that this is exactly the reason why basics should have online medical control, but I think it's pretty obvious that the county doesn't care since paramedics are limited to the fire departments anyways.

[WendyT]

If there was NO valid DNR, I wouldnt touch him or transported him till you had one in your hand, families should have this on the table before you do anything. What happened if he died enroute to the place he was supposed to go. Negligence seems harshly but you could of done something to him and that family could of sued, regardless of what was wrong with him.

[johnhays110966]

according to what i have learned in my basic class, i would have worked the code since the dnr was not signed, it would alleviate some trouble if the family where to sue for not working it.

[JPINFV]

If there was NO valid DNR, I wouldnt touch him or transported him till you had one in your hand, families should have this on the table before you do anything. What happened if he died enroute to the place he was supposed to go. Negligence seems harshly but you could of done something to him and that family could of sued, regardless of what was wrong with him.

I hope I read this wrong, but are you saying that you wouldn't treat a patient that don't have a valid DNR? What about if you work in a system, as outlined above, that don't require a DNR form if certain procedures were followed?

[tator55]

as an emtb, i would work the code until arrival of ALS, its then their decision to continue working it. I cannot see not working a code unless their is a valid DNR or obvious death (beheading, onset of rigor mortis ... etc.)

[spenac]

as an emtb, i would work the code until arrival of ALS, its then their decision to continue working it. I cannot see not working a code unless their is a valid DNR or obvious death (beheading, onset of rigor mortis ... etc.)

Good text book answer. Did you know one of the northern states, can't remember which one, had the rule that to be decapitated head must be at least 6" from body. Any closer you still had to do CPR.

[brentoli]

Good text book answer. Did you know one of the northern states, can't remember which one, had the rule that to be decapitated head must be at least 6" from body. Any closer you still had to do CPR.

Sounds like a good game of soccer could be had.

That was wrong.

I hate DOA's and DNR's. Personally, I always second guess myself. But I think that is just my lack of experience.

[spenac]

I hate DOA's and DNR's. Personally, I always second guess myself. But I think that is just my lack of experience.

Better to second and third check than to send a live person for the funeral home like so many "experienced" medics have done last few years. I'm guilty of saying dead, then while waiting for JP, LE, and funeral home going back and rechecking the patient. I just make it like I'm consoling the family or if wreck making sure ants and bugs are staying off body.

[JPINFV]

Better to second and third check than to send a live person for the funeral home like so many "experienced" medics have done last few years. I'm guilty of saying dead, then while waiting for JP, LE, and funeral home going back and rechecking the patient. I just make it like I'm consoling the family or if wreck making sure ants and bugs are staying off body.

Woa, wait, what? How did I end up in that post?