RE: M ostly, sincerely, or permanently dead?

[Guest guest]

Gene, since I seem to have a personal relationship with that " trooper in

Abilene " - not by name but by response run-in's - send me your license plate.

Maybe he will pick on YOU next time. LOLOLOL

Jane Dinsmore

To: texasems-l

From: wegandy1938@...

Date: Tue, 4 Aug 2009 23:21:30 -0400

Subject: M ostly, sincerely, or permanently dead?

I recommend AGAINST running a strip on obviously dead (most sincerely,

SERIOUSLY and PERMANENTLY DEAD) patients.

Now, I realize this supposes that one can tell the difference between a

patient who is really dead and one who is only mostly dead. There's a big

difference. One has no pulse whatever, the other does, or at least a hint of

one. If you have a pulse or I think you might, then you get the full Real

Meal Deal, supersized, including cardiac monitor, IV, caustic drug

injections, intubation, and gallons of sweat spilled on your chest. Possibly

even

chicken soup, tambourine music, chanting, and burning guinea feathers.

From a legal point of view, if you place the monitor on the patient and it

reveals a " workable rhythm " such as asystole, or PEA, then I think you have

the duty to work it. If you don't, how do you explain not doing it?

Since the Texas Supremes have said that ACLS guidelines are per se proof of

standard of care (Bush v. Columbia Las Colinas), and the ACLS guidelines have an

algorithm for asystole, I think you're up the creek without a paddle if you

didn't go through it before finally declaring the patient truly dead. Not

that you'd lose the lawsuit. You'd probably win, but being sued can spoil a

few years of your life and cost you that vacation in St. Maartin on the

nude beach, and more.

From what we know from media reports over the last couple of years, there

are obviously those amongst us who are unable to distinguish between

seriously dead and perhaps dead with a pulse and respirations, or CTD, TTD, and

all

those things. It's arguable that one who's only TTD and who is left to die

is DWPA (dead with paramedic assistance).

It's particularly galling that in some of these reports it's the COPS of

all people who are rooting for the patient's only being mostly dead rather

than permanently and seriously dead. Though I have attempted to understand

the thinking of those who argue with somebody who says, " Hey, that patient

just moved " I completely cannot. Yep, they can move after death, and it

usually clears the room when they do, but most of the time purposeful movements

indicate a very mild death rather than a chronic death.

Even my patient who had blown his skull off got transported, since I

couldn't think of anything else to do with him. For all I knew they had a brain

at the hospital just waiting for a transplant recipient.

Sorry for the sarcasm, but folks, although sometimes the signs of death are

not as obvious as at other times, dead is dead. One oughtn't need a strip

to figure that out. And if you DO have a strip showing asystole, you are

just opening yourself up to a lawsuit if you didn't work the patient.

In Texas you have to work with lots of folks who think they know something

about medical stuff but don't. Foremost among that group are our

illustrious Justices of the Peace. Many of them have developed theories of

medical

science that can only have come from a life of tractor repair. Some of

them demand a " strip. " I knew one who would arrive on scene, pinch his nose,

and say in a voice loud enough to be heard in the next county, " Gene, is he

DAY-ED? " Another one would carefully auscultate the carotid arteries of

the patient before pronouncing death, which was always followed by a statement

such as, " This man died at 3:48 pm. " So it was, and so be it. LOL.

Just say, " Judge, trust me. This body is dead, most sincerely and

permanently dead. I don't need a strip to know that. "

My advice is to do an adequate physical exam and determine whether or not

the patient has respirations and cardiac activity. If neither or present,

then that patient is DEAD and is going to remain dead for days, maybe even

years, in permanent asystole with a GCS of 3.

[Contrary to popular belief and the literature, 3 is not the lowest score

possible. Many DPS troopers and JPs are actually a 1 or a 2.] No, no!

PLEASE don't send my license plate number to that damn trooper in Abilene

who loves to pull over EMS volunteers responding and hassle them.

Maybe we should start an archive for stupid JP and trooper statements and

actions. Anybody else have experiences to share?

GG

>

> " Medicine Man "

>

> What if you placed a Cardiac Monitor and ran a Lead II strip and it showed

> Asystole. Would you attempt recusation or not? If you said no you wouldn't

> work him based on the MOI, remember that more than likely you have a

> protocol for " Asystole " in your system. What if was PEA?

>

> Shiplet, LP, AASP

> EMS Education Coordinator

> Collin County Community College

> <><

>

> " Tomorrow's Pre-Hospital Health Care Team...Learning Together Today "

>

>