Guest guest Posted September 16, 2006 Report Share Posted September 16, 2006 Let's say that you're transporting a patient with a valid out of hospital DNR to the hospital and that you are half way there, on the highway, when the patient dies. What do you do? Stop, call for a JP, and wait for the JP to arrive? Continue transport to the hospital? Turn around, take the patient back where you got him, and call for the JP there? Call the treating physician and ask him to pronounce? Has anyone addressed this situation by protocol? And if so, will you share? I will appreciate any help. We need to develop a protocol for these situations, and I have never thought about this before. Any ideas will be appreciated. Gene Gandy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2006 Report Share Posted September 16, 2006 We have encountered a situation where the hospital refused to allow us to bring the patient in. They said call the JP. The JP got bent out of shape and a big kerfuffle ensued. So that's not an option for us. Gene > > Gene, > > Our practice is to notify the receiving hospital as quick as possible that > we are coming and we don't expect the patient to survive the transport (if we > don't). Then if the patient expires, we merely complete the transport and > leave the patient (former patient??!?? Our practice is to notify the receiving > hospital as quick as p > > Dudley > > PS: I need to see if this is addressed in our protocol or just our practice. > > > > > Death enroute with DNR > > Let's say that you're transporting a patient with a valid out of hospital > DNR > to the hospital and that you are half way there, on the highway, when the > patient dies. What do you do? Stop, call for a JP, and wait for the JP to > arrive? Continue transport to the hospital? Turn around, take the patient > back where you got him, and call for the JP there? Call the treating > physician > and ask him to pronounce? > > Has anyone addressed this situation by protocol? And if so, will you share? > > I will appreciate any help. We need to develop a protocol for these > situations, and I have never thought about this before. Any ideas will be > appreciated. > > Gene Gandy > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2006 Report Share Posted September 16, 2006 Gene, Our practice is to notify the receiving hospital as quick as possible that we are coming and we don't expect the patient to survive the transport (if we don't). Then if the patient expires, we merely complete the transport and leave the patient (former patient??!??) in the ED and they handle the paperwork, PD notification, etc. Dudley PS: I need to see if this is addressed in our protocol or just our practice. Death enroute with DNR Let's say that you're transporting a patient with a valid out of hospital DNR to the hospital and that you are half way there, on the highway, when the patient dies. What do you do? Stop, call for a JP, and wait for the JP to arrive? Continue transport to the hospital? Turn around, take the patient back where you got him, and call for the JP there? Call the treating physician and ask him to pronounce? Has anyone addressed this situation by protocol? And if so, will you share? I will appreciate any help. We need to develop a protocol for these situations, and I have never thought about this before. Any ideas will be appreciated. Gene Gandy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2006 Report Share Posted September 16, 2006 I have had this happen, we continue to transport to the hospital we were originally heading too, call Medical Control with a full report and document " everything " , both in the ambulance and the hospital, making sure you have the DNR with you. Granted these have happened only on nursing home transfers to the hospital. Documentation consists of the usual with emphasis on: 1. Patient condition at time care was transfered to ambulance crew, including vitals and PMH as well as current event history. 2. Valid out of hospital DNR with transfer forms/paper work 3. Approximate time of death...verified by lack of pulse and respirations. We DO NOT hook up a monitor to verify! 4. Documentation of call to medical control, name of person you talked with and orders or lack of orders given. I'll look around and see if anyone has this spelled out completely in a protocol up here. Jules Death enroute with DNR Let's say that you're transporting a patient with a valid out of hospital DNR to the hospital and that you are half way there, on the highway, when the patient dies. What do you do? Stop, call for a JP, and wait for the JP to arrive? Continue transport to the hospital? Turn around, take the patient back where you got him, and call for the JP there? Call the treating physician and ask him to pronounce? Has anyone addressed this situation by protocol? And if so, will you share? I will appreciate any help. We need to develop a protocol for these situations, and I have never thought about this before. Any ideas will be appreciated. Gene Gandy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 If en route TO a hospital: Cease interventions, take appropriate measures to " preserve patient dignity " , contact the receiving facility to advise them of the situation, and continue transport to said facility. If en route FROM a hospital: Cease interventions, take appropriate measures to " preserve patient dignity " , contact hospital of origin to advise them of the situation, and return to the said facility. We are not supposed to stop and wait on the side of the road if any patient codes in the side of the road, except to assist medic in back to change or add interventions (or pick-up extra hands), then continue on - especially if the patient is the victim of violence of other incident requiring police investigation. Good thing, too: once many years ago, we had a ATV accident victim in the back of our truck, who coded literally as the helicopter service stepped into the back of our rig. They worked the patient and called the code, leaving a now DOS in our truck, which became part of the crime/incident scene - we waited for nearly three hours, until transport to the morgue arrived. Oh, not to mention we NEVER off-load any of the above patients EXCEPT at a hospital. I think the only exception is if the patient spontaneously becomes cured and demands to leave. Barry McClung, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 These were not transfers under EMTALA. The hospital had not " accepted " the patient. However, that brings up a whole bunch of other issues, doesn't it? Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 The hospital didn't accept because the director of the ED is a !@#$%^ & * and a & *()^%$#@. Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 I worked for a transport service many moons ago. We did transfers for hospice and the VA. Did have this situation come up a couple of times. The information we were given and did was to call the JP of the county in which you are in so that pronouncement of death could be made. We also did transport via air. The situation then was to either return to the transferring facility, if it were close enough; or land as quickly as possible and call for the presiding JP. The families were also made aware of this and were either following or were with the patient enroute. Recent Activity 3 New Members 1 New Files Visit Your Group Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 Has not the recieving facillty already accepted the patient? I was unaware that a hospital could refuse to accept after accepting. I just reviewed this in the Critical Care Transport Program. I believe that certain sanctions could be given to the receiving hospital if this happens. Of course that all depends on how much you wish to stir the pot. wegandy1938@... wrote: We have encountered a situation where the hospital refused to allow us to bring the patient in. They said call the JP. The JP got bent out of shape and a big kerfuffle ensued. So that's not an option for us. Gene > > Gene, > > Our practice is to notify the receiving hospital as quick as possible that > we are coming and we don't expect the patient to survive the transport (if we > don't). Then if the patient expires, we merely complete the transport and > leave the patient (former patient??!?? Our practice is to notify the receiving > hospital as quick as p > > Dudley > > PS: I need to see if this is addressed in our protocol or just our practice. > > > > > Death enroute with DNR > > Let's say that you're transporting a patient with a valid out of hospital > DNR > to the hospital and that you are half way there, on the highway, when the > patient dies. What do you do? Stop, call for a JP, and wait for the JP to > arrive? Continue transport to the hospital? Turn around, take the patient > back where you got him, and call for the JP there? Call the treating > physician > and ask him to pronounce? > > Has anyone addressed this situation by protocol? And if so, will you share? > > I will appreciate any help. We need to develop a protocol for these > situations, and I have never thought about this before. Any ideas will be > appreciated. > > Gene Gandy > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 Ok, I have to ask. Why did the hospital not accept? If it were a 911 call then it does open another can of worms. Possibly, you didn't accept my loved one and how do you know they could not have been saved? If it were an accepting physician for a hospice I believe that it is the same in the eyes of EMTLA. Interesting subject if I do say so myself. wegandy1938@... wrote: These were not transfers under EMTALA. The hospital had not " accepted " the patient. However, that brings up a whole bunch of other issues, doesn't it? Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2006 Report Share Posted September 17, 2006 Well, I think that about says it all. wegandy1938@... wrote: The hospital didn't accept because the director of the ED is a !@#$%^ & * and a & *()^%$#@. Gene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2006 Report Share Posted September 18, 2006 Gene, Isn't that an EMTALA violation? The patient isn't actually " dead " until a doctor or JP says he is, right? How can the hospital refuse to do a screening exam and stabilization on someone who hasn't been pronounced? Randy R. (Randy) Loflin, M.D., FACEP Associate Professor Medical Director, City of El Paso EMSS Death enroute with DNR > > Let's say that you're transporting a patient with a valid out of hospital > DNR > to the hospital and that you are half way there, on the highway, when the > patient dies. What do you do? Stop, call for a JP, and wait for the JP to > arrive? Continue transport to the hospital? Turn around, take the patient > back where you got him, and call for the JP there? Call the treating > physician > and ask him to pronounce? > > Has anyone addressed this situation by protocol? And if so, will you share? > > I will appreciate any help. We need to develop a protocol for these > situations, and I have never thought about this before. Any ideas will be > appreciated. > > Gene Gandy > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2006 Report Share Posted September 18, 2006 So, to misquote Clinton, doesn't that depend on what your definition of " is " is? In this case the patient can be very clearly clinically dead - even to the point of signs incompatible with life. But, until legally dead as declared by a physician or JP, the law considers them alive. So, here's how I'd search for case law on this... let's say that has a DNR and dies in the back of my ambulance, but I keep going to the hospital, which is 60 minutes away. lies on my stretcher for 60 minutes, turns blue-gray, and starts pooling blood. I get to the ER, and 's neighbor, who hates with a passion, is standing on the ER dock. When I open the doors, the neighbor steps in and shoots in the head, exposing brain matter (an obviously fatal wound). Can 's neighbor be arrested for murder? Did he in fact commit murder because was legally, but not clinically, alive? Or, did he tamper with a corpse? Which " death " matters? Which is legally challengeable? Another scenario - under current Texas criminal law if I shoot a pregnant woman in the head and kill her then I can be charged with her death and with the death of her fetus - two counts of felony murder. I would wonder, though, how easy it might or might not be to challenge whether or not the fetus was clinically alive at the time of the mother's murder... because fetuses die and women miscarry " all the time " , right (statistically enough to raise as a defense, I'd guess)? How do you " prove " that someone who is not very obviously dead was actually alive at the time of the perceived cause of death absent solid forensic (forensic pathology) signs? If there are answers to these questions in case law, then you could likely extrapolate whether clinical death == legal death in certain circumstances, then try to apply that precedent to EMTALA laws. Just my strange, twisted, random take on this... Mike > > Gene, > > Isn't that an EMTALA violation? The patient isn't actually " dead " until a > doctor or JP says he is, right? How can the hospital refuse to do a > screening exam and stabilization on someone who hasn't been pronounced? > > Randy > > R. (Randy) Loflin, M.D., FACEP > Associate Professor > Medical Director, City of El Paso EMSS > > > Death enroute with DNR > > > > Let's say that you're transporting a patient with a valid out of > hospital > > DNR > > to the hospital and that you are half way there, on the highway, when > the > > patient dies. What do you do? Stop, call for a JP, and wait for the JP > to > > arrive? Continue transport to the hospital? Turn around, take the > patient > > back where you got him, and call for the JP there? Call the treating > > physician > > and ask him to pronounce? > > > > Has anyone addressed this situation by protocol? And if so, will you > share? > > > > I will appreciate any help. We need to develop a protocol for these > > situations, and I have never thought about this before. Any ideas will > be > > appreciated. > > > > Gene Gandy > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2006 Report Share Posted September 18, 2006 In a message dated 9/18/06 4:41:08 P.M. Central Daylight Time, paramedicop@... writes: So, to misquote Clinton, doesn't that depend on what your definition of " is " is? Is that actually a misquote? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 18, 2006 Report Share Posted September 18, 2006 Yeah, actually what he said was... " It depends upon what the meaning of the word is means. If is means 'is, and never has been', that's one thing. If it means 'there is none', that was a completely true statement. " Either way, as politicians will often do from both sides...it merely muddied the waters a bit more..:-) See ya'll at the conference. Mike Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Re: Death enroute with DNR In a message dated 9/18/06 4:41:08 P.M. Central Daylight Time, paramedicop@ <mailto:paramedicop%40gmail.com> gmail.com writes: So, to misquote Clinton, doesn't that depend on what your definition of " is " is? Is that actually a misquote? Quote Link to comment Share on other sites More sharing options...
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