1. #1
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    Default What Would You Have Done?

    Not the most appropiate location for this topic but by looking at the First Responder section's lack of posts, I doubt I would receive any responses.

    Got toned out to a possible cardiac arrest/109-D (our 10-code for deceased individual, yes I know we shouldn't be using 10 codes, but tell that to dispatch) a few weeks ago.

    I was the first responder to arrive on-scene (I am a certified FR). I introduced my self as a responder to the family members (who were in obivious signs of emotional distress), assured them we would do everything we could do, and donned my BSI PPE.

    I then proceeded to establish the victim's LOC by gently shaking and talking to the victim. After no response, I proceeded to check for obivious signs of life to which I found he was not breathing, had no pulse, and was ice cold to the touch. It was quite apparent that the victim had been deceased for an extended period of time, for rigamortis (spell?) had also already set in, but as a FR I know we cannot declare an individual deceased. Clearly my next step would have been to proceed into CPR, but the medics had arrived by this time and pronounced the victim dead (note: the medics arrived less than two minutes after I first pulled up on-scene).

    Clearly I did everything by the book, but the one kicker I have to this situation is the fact the individual was lying on his bed and weighed 350+ lbs. If the medics had been delayed any longer, I would have obiviously had to attempted CPR. However with my small frame (5'9" and 140 lbs.), moving this large victim to the floor in an "appropiate" manner would have been hard to say the least.

    My question is how would you have handled the situation based on these facts?
    Last edited by JR3115; 10-04-2009 at 11:48 AM.
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    in nys as an emt with the same conditions as stated you cant pronounce the patient but you dont need to start cpr. as long as it is an obvious death with the patient being ice cold and rigor set in. as far as moving the patient, if the family is there and are able you could ask them to help if you think they are capable, but that is something that would have to be a case by case call.

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    So a First Responder has to work someone with obvious signs of death in you State?


    Do CPR while hes on the bed. The family won't know the diffrence, and if they do they would be helping you move him.


    OR

    Stage until the medics get there and assisst them.
    FF/Paramedic

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    Not sure about First Responders but EMT do not have to work Patients that show obvious signs of death. Such as Rigor, Dependant Lividity, Decapitation, Decomposition, Incineration, Removal of a vital bodily organ ECT... I would assume that it would be the same for First Responders.

    If you can't move him do CPR on the Bed, compressions will be less effective but its better then nothing. If you are worried about pronouncing someone dead (Be sure 1 or more of the obvious signs of death are present), do CPR til the paramedics arrive. It shows the family that you tried and will save you from any legal actions taken by the family

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    Why would you abuse a corpse thats cold & in Rigor ????
    Check your state protocols for required disposition of deceased bodies.
    Do not give the family false hope by telling them it will be fine, you will do everything you can. Do a proper assessment of the pt and then tell them the truth. "Bubba stopped being with us a long time ago".

    Was this your first corpse call by any chance?.
    If so don't let it get to you, it's something we have to deal with. We can fix a lot of health problems: DEAD isn't one of them!

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    I would check your state & local protocols. In Virginia, we do not have to work patients who have signs of obvious death, so this would be a moot point.

    However, to answer your question, I would first tried to get some of the family members to assist me. In times of crisis, you can often (but not always) get them to help you with whatever you need. I have done this before with success. After they help you, send them on a mission - go find the patient's meds, go flag down the ambulance - anything to give you the room that you need to work.
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    I agree with the others. With the signs you described this is no longer a viable patient. You would have been correct not to begin CPR in this case. I would gently inform the family, "I'm sorry, but he passed away some time ago" or something to that effect. Spend the intervening time while waiting for the medics to arrive gathering patient info...When was the last time someone spoke to the victim? What kind of medical history did he have? Are there DNR orders? and so on, so that when the medics arrive you can provide them with the relevant history. They would then confirm your assessment and more than likely also elect not to begin resuscitation.

    You assured the family when you arrived that you would do what you could for the victim, and this is also proper. You made no promises that "everything is going to be alright". Then, you proceeded to do what you could do for the victim, which was to assess his condition and determine (correctly) that the victim was beyond saving. That's reality.

    Also, paramedics do not pronounce people dead. A doctor needs to do that. Paramedics, like you, can only assess the situation and determine whether or not to proceed with interventions.

    Sounds like you handled the situation just fine.

    Just a guess here...was this early in the morning? That's when we get most of our calls like you're describing. Passed away during the night, they went in to wake him and found him like this. Pretty common scenario.
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    It has been said numerous times that FRs and EMTs cannot pronounce someone dead. If placed in the situation as the OP described where obvious death is present, what is the next step?
    Kyle
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    Also, paramedics do not pronounce people dead. A doctor needs to do that. Paramedics, like you, can only assess the situation and determine whether or not to proceed with interventions.
    I think that police officer or medics CAN pronounce death in Florida ... sort of .... they determine that an ME is called rather than an ambulance. Medical Examiner or Doctor does have to fill out cert. of death ..

    pronounce / issue cert maybe two different things ... down here .... again ... just trying to show the difference between states.

    In NYS a Dr or coroner .. (M.E. also but then i think they are all doctors anyways) can pronounce death .... in NY state NOT ALL coroners are doctors either as coroners are elected positions .... again .. unsure if you are speaking about pronouncing death or issuing a death cert.

    Did that just confuse the situation?

    It has been said numerous times that FRs and EMTs cannot pronounce someone dead. If placed in the situation as the OP described where obvious death is present, what is the next step?
    You do not have to work an obvious death (as taught to me). Just be SURE they are dead tho ... usually an unattended death is considered a crime scene .... if they are dead and you work them you might be messing up the evidence.
    Last edited by owenscott; 10-11-2009 at 09:18 PM.

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    Quote Originally Posted by ScooterUMT56 View Post
    It has been said numerous times that FRs and EMTs cannot pronounce someone dead. If placed in the situation as the OP described where obvious death is present, what is the next step?
    In Virginia, law enforcement must be notified of any non-witnessed (by EMS) death, and the body must have an autopsy performed. Therefore, we would turn the scene over to law enforcement, who is responsible for making arrangements to have the body moved from the scene to the morgue. Often times, FD/EMS will work with both LE and the patient's family since the scene came often be stressful for the family members, especially when they're informed that the autopsy must be performed.

    Now, with that being said, we (FD/LE/EMS) can contact the family's primary physician, and if they agree to to sign the death certificate, then it waives the need for the autopsy.

    On a related note, I went and checked my protocols for the specific instances that CPR does not need to be started by ANY pre-hospital provider (FR/EMT/ALS) in my region:
    • Decapitation
    • 100% full thickness burn (incineration)
    • Putrefied, decayed, or decomposed body
    • Advanced lividity
    • Rigor mortis
    • Obvious mortal wounds, i.e. crushing injuries to head and/or chest
    • A valid state of Virginia EMS-DDNR order
    • Asystole as a presenting rhythm in an unwitnessed arrest

    In the past, I have called medical control for cease resuscitation orders as a BLS provider based on the patient's lack of response to BLS intervention including a King airway, shocks delivered, and CPR, and (most importantly), a severely delayed availability of an ALS provider to the scene.
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    Quote Originally Posted by ScooterUMT56 View Post
    It has been said numerous times that FRs and EMTs cannot pronounce someone dead. If placed in the situation as the OP described where obvious death is present, what is the next step?
    think about what you are saying. Look at the list boxalarm posted, do you think the state wants you doing CPR on those people and doing other "heroic measures" in an attempt to resuscitate. How am I even supposed to ventilate a decapitation? Do I do CPR on the body and vent down whatever is left of the neck. What do I do with the head?

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    Quote Originally Posted by nameless View Post
    think about what you are saying. Look at the list boxalarm posted, do you think the state wants you doing CPR on those people and doing other "heroic measures" in an attempt to resuscitate. How am I even supposed to ventilate a decapitation? Do I do CPR on the body and vent down whatever is left of the neck. What do I do with the head?
    Obviously I realize CPR cannot be performed on a decapitation. I was curious as to what we should do in the next step. Thank you for all of those answers, they answered my question fully.
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