Guest guest Posted December 25, 2003 Report Share Posted December 25, 2003 Kathi, Dead is dead. Period. There's no need to " assess " an obvious corpse. The sort of assessment that needs to be done will be by the Medical Examiner and her minions and the crime scene investigators. There's no reason legally or medically to describe the mechanism of death in an EMS patient care form. Further, there's widespread misunderstanding about what is necessary to confirm death. Many agencies insist on running a strip to demonstrate asystole. When you stop to think about it, this makes no sense whatsoever because asystole is a treatable dysrhythmia; so if you confirm that your patient is in asystole you really ought to work it. People were confirmed to be dead and pronounced as such for centuries before the portable cardiac monitor was invented. I know that seems extreme, but it's nontheless true. Nothing is gained legally nor medically by running a strip on a dead person to prove they're dead. A simple check of the ABCs will do nicely. If you're not sure whether or not they're dead, or if you're going to attempt resuscitation, then by all means apply the monitor, but if you see a workable dysrhythmia, then you'd better work it. And asystole is a workable rhythm. Otherwise, leave DRTs RT. Happy Holidays and don't forget that tomorrow is Boxing Day. Best, Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 I would defer to what your current practice or past practice has been. Documentation of what you did while on scene (whether you did anything or not) is of essential importance. For the sake of argument this is a crime scene. You will be called into court to testify as to what you did or did not do. Law Enforcement may need your testimony for evidence gathering purposes (whether you touched a piece of evidence or not). Defense may call you to dispute a piece of evidence (did you touch a piece of evidence thereby rendering it unusable due to contamination) Hope this helps. Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 In a message dated 12/26/2003 8:30:59 AM Central Standard Time, bwiseman@... writes: > My question is why is the crew there in the first place? > dispatched to a shooting....... following staging, notified 1 dos, 1 pt. we dont run strips on dos's.....however, other depts local here do....and LE takes a copy of their strip. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 My question is why is the crew there in the first place? Were they requested to come run a strip? Our practice would be just to document what you see and clear. If they were called specifically for a strip, then the crew would be canceled, we don't go just for that! DOS/Assessment > Can some of you legal types attempt to resolve an ongoing difference in > philosophy, at least from the legal point of view. > > DOS on scene, obvious crime scene. Long down time--pt. ice cold, lividity, > cyanotic. Bloody scene. Pt. covered to neck with blanket, flowers on chest. > > Documented as such(with a little more detail). > Here's the difference in opinion---crime scene, obvious dos. EMS isnt going > to be doing anything for her. Leave pt as is, with adequate documentation due > to crime scene, or remove blankets etc to do complete assessment including > search for any obvious cause of death--ie shooting/stabbing etc. > > Thanks! > Kathi > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 please update me with this issue about not running strips on a DOS? Are we just suppose to go with the s/s of death? We go with signs/symptoms/absence of heart tones etc and do not rely on strips to " confirm " death(see prior discussions of asystole as a treatable rhythm). Nor do we run strips for LE. We do get called on most, if not all, DOS with LE. Kathi Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 Why do you think medical examiners call EMTs " Evidence Mangling Technicians " ? Bledsoe, DO, FACEP Midlothian, TX [http://www.bryanbledsoe.com] Re: DOS/Assessment My question is why is the crew there in the first place? Were they requested to come run a strip? Our practice would be just to document what you see and clear. If they were called specifically for a strip, then the crew would be canceled, we don't go just for that! DOS/Assessment > Can some of you legal types attempt to resolve an ongoing difference in > philosophy, at least from the legal point of view. > > DOS on scene, obvious crime scene. Long down time--pt. ice cold, lividity, > cyanotic. Bloody scene. Pt. covered to neck with blanket, flowers on chest. > > Documented as such(with a little more detail). > Here's the difference in opinion---crime scene, obvious dos. EMS isnt going > to be doing anything for her. Leave pt as is, with adequate documentation due > to crime scene, or remove blankets etc to do complete assessment including > search for any obvious cause of death--ie shooting/stabbing etc. > > Thanks! > Kathi > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 The fact of the matter is that there are a hell of a lot better ways to document death than with an EKG strip. n a message dated 12/26/03 1:40:24 PM Central Standard Time, EMSRECRUITER@... writes: > please update me with this issue about not running strips on a DOS? Are we > just suppose to go with the s/s of death? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 So, my question is: What on earth does LE do with this strip? Is that the only way they can tell the person is dead? Things that make you go Hmmmmmmmm. Gene In a message dated 12/26/2003 9:36:49 AM Central Standard Time, T68b@... writes: > > > > > In a message dated 12/26/2003 8:30:59 AM Central Standard Time, > bwiseman@... writes: > > > My question is why is the crew there in the first place? > > > > dispatched to a shooting....... > following staging, notified 1 dos, 1 pt. > > we dont run strips on dos's.....however, other depts local here do....and LE > > takes a copy of their strip. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 It seems that LE in County needs some edumacation in basic Texas law. The only people in Texas who can pronounce a patient are physicians, Medical Examiners in counties where they have them, Justices of the Peace, and certain nurses (hospice, et cetera) who have been delegated the ability to do so, and only within their institutions. Where is the Medical Examiner in Austin/ County? S/He or her deputies is/are the one who should be pronouncing these DRT patients, not base station physicians. Ed? Do you know something that I don't? Are you allowing your paramedics to function as deputy medical examiners? Best, Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 It seems that LE in County needs some edumacation in basic Texas law. The only people in Texas who can pronounce a patient are physicians, Medical Examiners in counties where they have them, Justices of the Peace, and certain nurses (hospice, et cetera) who have been delegated the ability to do so, and only within their institutions. Where is the Medical Examiner in Austin/ County? S/He or her deputies is/are the one who should be pronouncing these DRT patients, not base station physicians. Ed? Do you know something that I don't? Are you allowing your paramedics to function as deputy medical examiners? Best, Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 I'm glad Jane is with me on this, because she is 100% correct. In this day of maddog lawyers and nitwits galore, I don't intend to have to explain why I didn't Code the patient whose strip showed asystole. I also don't want to be subpoened to trial in a criminal case and sit on the hard bench outside the courtroom waiting to be called till I have decubitus ulcers on my butt. For LE to call EMS to crimescenes where there are no live persons needing treatment and transport is dumb. " So, officer, you're telling this Court and jury that in order to find out that Mr. was dead, even though the top of his head was shot off, you had to call a Paramedic to let you know? And now you want this jury to believe that you're an expert in crime scene evidence gathering? " DUH! GG In a message dated 12/26/2003 1:36:52 PM Central Standard Time, je.hill@... writes: > > I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a > non- > issue because you really shouldn't be running an asystole strip to prove > death. Asystole is a potentially " treatable " rhythm based on the AHA > guidelines, which could be used against you in a courtroom when they ask > you, " So, Mr. , what IS the interpretation of this strip? And isn't it > > true that you have a protocol to treat asystole? So why didn't you follow > it? Why did you leave this person to die with a treatable rhythm by your > own > protocols?? " That is NOT a position I want to be in.... > > Jane Hill > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 I'm glad Jane is with me on this, because she is 100% correct. In this day of maddog lawyers and nitwits galore, I don't intend to have to explain why I didn't Code the patient whose strip showed asystole. I also don't want to be subpoened to trial in a criminal case and sit on the hard bench outside the courtroom waiting to be called till I have decubitus ulcers on my butt. For LE to call EMS to crimescenes where there are no live persons needing treatment and transport is dumb. " So, officer, you're telling this Court and jury that in order to find out that Mr. was dead, even though the top of his head was shot off, you had to call a Paramedic to let you know? And now you want this jury to believe that you're an expert in crime scene evidence gathering? " DUH! GG In a message dated 12/26/2003 1:36:52 PM Central Standard Time, je.hill@... writes: > > I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a > non- > issue because you really shouldn't be running an asystole strip to prove > death. Asystole is a potentially " treatable " rhythm based on the AHA > guidelines, which could be used against you in a courtroom when they ask > you, " So, Mr. , what IS the interpretation of this strip? And isn't it > > true that you have a protocol to treat asystole? So why didn't you follow > it? Why did you leave this person to die with a treatable rhythm by your > own > protocols?? " That is NOT a position I want to be in.... > > Jane Hill > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 I'm glad Jane is with me on this, because she is 100% correct. In this day of maddog lawyers and nitwits galore, I don't intend to have to explain why I didn't Code the patient whose strip showed asystole. I also don't want to be subpoened to trial in a criminal case and sit on the hard bench outside the courtroom waiting to be called till I have decubitus ulcers on my butt. For LE to call EMS to crimescenes where there are no live persons needing treatment and transport is dumb. " So, officer, you're telling this Court and jury that in order to find out that Mr. was dead, even though the top of his head was shot off, you had to call a Paramedic to let you know? And now you want this jury to believe that you're an expert in crime scene evidence gathering? " DUH! GG In a message dated 12/26/2003 1:36:52 PM Central Standard Time, je.hill@... writes: > > I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a > non- > issue because you really shouldn't be running an asystole strip to prove > death. Asystole is a potentially " treatable " rhythm based on the AHA > guidelines, which could be used against you in a courtroom when they ask > you, " So, Mr. , what IS the interpretation of this strip? And isn't it > > true that you have a protocol to treat asystole? So why didn't you follow > it? Why did you leave this person to die with a treatable rhythm by your > own > protocols?? " That is NOT a position I want to be in.... > > Jane Hill > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 In a message dated 12/26/2003 3:25:13 PM Central Standard Time, wegandy1938@... writes: > So, my question is: What on earth does LE do with this strip? Is that the > > only way they can tell the person is dead? > All they have told us in the past is they are required to attach it to their report. I have told them we do not run ekg's on obvious dos's, or those pts that we dont intend to work. Why they need it is beyond me! On one occasion they called out a neighboring ems agency to run the ekg for them--that hasnt happened recently however. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 In a message dated 12/26/2003 3:25:13 PM Central Standard Time, wegandy1938@... writes: > So, my question is: What on earth does LE do with this strip? Is that the > > only way they can tell the person is dead? > All they have told us in the past is they are required to attach it to their report. I have told them we do not run ekg's on obvious dos's, or those pts that we dont intend to work. Why they need it is beyond me! On one occasion they called out a neighboring ems agency to run the ekg for them--that hasnt happened recently however. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 In a message dated 12/26/2003 3:25:13 PM Central Standard Time, wegandy1938@... writes: > So, my question is: What on earth does LE do with this strip? Is that the > > only way they can tell the person is dead? > All they have told us in the past is they are required to attach it to their report. I have told them we do not run ekg's on obvious dos's, or those pts that we dont intend to work. Why they need it is beyond me! On one occasion they called out a neighboring ems agency to run the ekg for them--that hasnt happened recently however. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 , Not that this case was in County, but here, we are the only field providers that can effectively get a pronouncement. LE is not allowed to do it and much confusion is caused when a DRT is found by LE. The norm is for LE to request us to confirm death. This doesn't have to be a strip or anything specific, but it needs to be a paramedic with A/TCEMS who has visualized the corpse and deemed them dead and called the doc for a time. I don't agree with it, but I've been " counseled " about it. Mike Schadone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 Mike, then I am guessing that JP's aren't involved in the process at all? IMHO, this is closer to how this should be handled anyway. JP's get, what, 30-40 seconds of training in JP school on pronouncements/inquests. It always made me giggle in a special way when an admitted politician had more authority to determine deadness than anyone else with a modest idea of what they were doing. Randell Ps- Merry .well, whatever this season is to you!! RE: DOS/Assessment , Not that this case was in County, but here, we are the only field providers that can effectively get a pronouncement. LE is not allowed to do it and much confusion is caused when a DRT is found by LE. The norm is for LE to request us to confirm death. This doesn't have to be a strip or anything specific, but it needs to be a paramedic with A/TCEMS who has visualized the corpse and deemed them dead and called the doc for a time. I don't agree with it, but I've been " counseled " about it. Mike Schadone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 LE is NOT entitled to an EKG strip, I do believe. Do the HIPAA experts want to weigh in??? Mike Schadone Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 Hey, some of us need to show proficiency at SOMETHING! Mike Re: DOS/Assessment My question is why is the crew there in the first place? Were they requested to come run a strip? Our practice would be just to document what you see and clear. If they were called specifically for a strip, then the crew would be canceled, we don't go just for that! DOS/Assessment > Can some of you legal types attempt to resolve an ongoing difference in > philosophy, at least from the legal point of view. > > DOS on scene, obvious crime scene. Long down time--pt. ice cold, lividity, > cyanotic. Bloody scene. Pt. covered to neck with blanket, flowers on chest. > > Documented as such(with a little more detail). > Here's the difference in opinion---crime scene, obvious dos. EMS isnt going > to be doing anything for her. Leave pt as is, with adequate documentation due > to crime scene, or remove blankets etc to do complete assessment including > search for any obvious cause of death--ie shooting/stabbing etc. > > Thanks! > Kathi > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 Randell, Actually, even if there is a physician onscene, more times than not EMS is called out for the pronouncement. Just the way it is here, I guess. Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a non- issue because you really shouldn't be running an asystole strip to prove death. Asystole is a potentially " treatable " rhythm based on the AHA guidelines, which could be used against you in a courtroom when they ask you, " So, Mr. , what IS the interpretation of this strip? And isn't it true that you have a protocol to treat asystole? So why didn't you follow it? Why did you leave this person to die with a treatable rhythm by your own protocols?? " That is NOT a position I want to be in.... Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 please update me with this issue about not running strips on a DOS? Are we just suppose to go with the s/s of death? >From: je.hill@... >Reply-To: >To: >Subject: RE: DOS/Assessment >Date: Fri, 26 Dec 2003 19:30:26 +0000 > >I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a >non- >issue because you really shouldn't be running an asystole strip to prove >death. Asystole is a potentially " treatable " rhythm based on the AHA >guidelines, which could be used against you in a courtroom when they ask >you, " So, Mr. , what IS the interpretation of this strip? And isn't >it >true that you have a protocol to treat asystole? So why didn't you follow >it? Why did you leave this person to die with a treatable rhythm by your >own >protocols?? " That is NOT a position I want to be in.... > >Jane Hill > _________________________________________________________________ Working moms: Find helpful tips here on managing kids, home, work — and yourself. http://special.msn.com/msnbc/workingmom.armx Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 Documentation should be thorough and complete regarding things like estimated time last seen alive, rigor mortis, dependent lividity, obvious injuries incompatible with life, etc. But what does attaching an ECG to this person with these signs accomplish?? Absolutely nothing but potential liability. Attorneys have gotten quite a bit smarter in dealing with prehospital issues over the last few years. They have become very adept at reading your protocols and using them against you. I think most of us have protocols for what to do when we work " asystole " rhythms which involve things like CPR, intubation, IV, Pacing, Epinephrine, and Atropine at the least. So now you have a strip showing asystole on a dead person, but the granddaughter is suing you saying that he WASN'T dead and that you just left him there to die with a workable ECG rhythm. The point is that sometimes we do things because that's the way it has always been done. Does that make it right? Maybe not. Maybe we have been borrowing trouble in some situations such as this. It was ok to do this before EMS litigation became so popular, but handing the barking maddog attorney a tool such as this when there are better ways to document obvious death and WHY we didn't work this patient is asking for trouble. Jane Hill > please update me with this issue about not running strips on a DOS? Are we > just suppose to go with the s/s of death? > > > >From: je.hill@... > >Reply-To: > >To: > >Subject: RE: DOS/Assessment > >Date: Fri, 26 Dec 2003 19:30:26 +0000 > > > >I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a > >non- > >issue because you really shouldn't be running an asystole strip to prove > >death. Asystole is a potentially " treatable " rhythm based on the AHA > >guidelines, which could be used against you in a courtroom when they ask > >you, " So, Mr. , what IS the interpretation of this strip? And isn't > >it > >true that you have a protocol to treat asystole? So why didn't you follow > >it? Why did you leave this person to die with a treatable rhythm by your > >own > >protocols?? " That is NOT a position I want to be in.... > > > >Jane Hill > > > > _________________________________________________________________ > Working moms: Find helpful tips here on managing kids, home, work — and > yourself. http://special.msn.com/msnbc/workingmom.armx > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 26, 2003 Report Share Posted December 26, 2003 Documentation should be thorough and complete regarding things like estimated time last seen alive, rigor mortis, dependent lividity, obvious injuries incompatible with life, etc. But what does attaching an ECG to this person with these signs accomplish?? Absolutely nothing but potential liability. Attorneys have gotten quite a bit smarter in dealing with prehospital issues over the last few years. They have become very adept at reading your protocols and using them against you. I think most of us have protocols for what to do when we work " asystole " rhythms which involve things like CPR, intubation, IV, Pacing, Epinephrine, and Atropine at the least. So now you have a strip showing asystole on a dead person, but the granddaughter is suing you saying that he WASN'T dead and that you just left him there to die with a workable ECG rhythm. The point is that sometimes we do things because that's the way it has always been done. Does that make it right? Maybe not. Maybe we have been borrowing trouble in some situations such as this. It was ok to do this before EMS litigation became so popular, but handing the barking maddog attorney a tool such as this when there are better ways to document obvious death and WHY we didn't work this patient is asking for trouble. Jane Hill > please update me with this issue about not running strips on a DOS? Are we > just suppose to go with the s/s of death? > > > >From: je.hill@... > >Reply-To: > >To: > >Subject: RE: DOS/Assessment > >Date: Fri, 26 Dec 2003 19:30:26 +0000 > > > >I'm with Gene. The HIPPA issue with the ECG strip on a dead person is a > >non- > >issue because you really shouldn't be running an asystole strip to prove > >death. Asystole is a potentially " treatable " rhythm based on the AHA > >guidelines, which could be used against you in a courtroom when they ask > >you, " So, Mr. , what IS the interpretation of this strip? And isn't > >it > >true that you have a protocol to treat asystole? So why didn't you follow > >it? Why did you leave this person to die with a treatable rhythm by your > >own > >protocols?? " That is NOT a position I want to be in.... > > > >Jane Hill > > > > _________________________________________________________________ > Working moms: Find helpful tips here on managing kids, home, work — and > yourself. http://special.msn.com/msnbc/workingmom.armx > > > > > > Quote Link to comment Share on other sites More sharing options...
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