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CTM VT 2K
2005-Feb-14, 10:51 AM
Monty Python meets Emergeny Medical Services

http://www.msnbc.msn.com/id/6954586/

In Virginia EMT's can only pronounce death when... there are "Obvious Signs of Mortality" or "Signs Inconsistant with Life" - e.g. the head is separated from the body, obvious putrification (the body has been there for a while and is decaying) etc.

The only time we'd leave this guy for dead would be in a Multiple Casulty Incident. In an MCI, we triage the patients and those that are not breathing / do not breathe on their own when we open their airway we leave for dead. We move on to those who are still breathing and try to save them. Those who can walk, we have walk to a holding area where we'll get to them when we can. It's not a good feeling when we have to leave someone for dead - I've done it. Eventually if enough medics arrive, we do a good check on even the black tags.

This guy was the lone patient. It shouldn't have made a difference how bad he was hurt - as long as the head was still attached to the body he should have been treated. He still might die, but in VA that determination isn't made in the field. It's made in the hospital.

How is it that it can be this bad in NC?

/rant

Swift
2005-Feb-14, 02:26 PM
I agree, this was just bad work by the EMTs. Especially arriving that quickly at the scene, they should have run the code. 99 times out of 100 (I'm making up that stat) a trauma code that bad will not make it, but you need to try.

Back when I did this in Rhode Island, we had basically the same rules as you mentioned. I had one call along those lines, where the patient had obvious signs they had been dead for a while (I'll skip details, in case anyone is sensitive). I was kind of thankful we didn't have to run that one. I feel some sympathy for the EMTs, but they did mess up.

Nicolas
2005-Feb-14, 02:45 PM
Related, local workplace first aid rules used to presribe that a person needed to be reanimated (mouth to mouth + heart massage) by other (previously assigned) personnel (until professionals arrived) as long as the head wasn't fully detached from the body and separated by more than 20 (or 30?) cm. This was done to prevent any non-professional from mistakenly leaving someone unaided and "dead".

The 30cm rule is rejected last year: the new personnel medical training (first aid training for members of the personel who volunteer to participate) prescribe that reanimation should be attempted unless the head is fully separated from the body, no distance given.

Sorry for the details, but this is how those rules prevent misidentfication of death by unprofessional people.

I don't know what the professional's list looks like, but I don't think it is a bad thing to aim it at the safe side.

Let's hope the man recovers.

jfribrg
2005-Feb-14, 07:02 PM
I had a neighbor years ago who was declared dead in his youth. I remember him as a very fit and healthy old man, but in 1909, when he was 21 years old, he was supposedly "killed" in some kind of army accident. He was taken to a morgue where many hours later the coroner discovered that he was still breathing. They took him to the hospital (back then not many seriously ill people came out alive), where he eventually made a full recovery. I was certain that he would make it to 100, but he failed quickly and died in 1988 at the age of 95. As an aside, he had a certain claim to fame. He bunked for a while with a certain junior officer. 2Lt Patton was his bunkmate's name.

kucharek
2005-Feb-14, 07:07 PM
in 1909, when he was 21 years old...
...in 1988 at the age of 95.

[-X

sts60
2005-Feb-14, 09:26 PM
Here in Maryland, the protocols allow for presumption of death in the field for:
a) Decapitation
b) Decomposition
c) Rigor mortis
d) Pulseless, apneic patient in MCI situations
e) Pulseless, apneic patient with injury not compatible with life

But they go on to say:
Do not attempt to guess future outcomes based on the appearance of the patient... Failure to act because of mistaken notions of outcome will result in a self-fulfilling prophecy.

Bingo.

It seems that there was some groupthink at work here ("Looks dead. What do you think?"). Maybe some people got lazy too (ugly injuries, dark, cold). I mean, I wasn't there... But I can't see not working the guy unless there was gray matter all over the place.

Doodler
2005-Feb-14, 09:32 PM
Do not attempt to guess future outcomes based on the appearance of the patient... Failure to act because of mistaken notions of outcome will result in a self-fulfilling prophecy.

I like the quote, its basically saying, "Cover Your Backside, try anyway".

SciFi Chick
2005-Feb-14, 10:10 PM
I can vouch for Georgia having the same rules already mentioned. I'm a little nervous now, since I live here in Virginia. I have to believe they just ignored protocols, not that the protocols don't exist.

Swift
2005-Feb-14, 11:59 PM
I can vouch for Georgia having the same rules already mentioned. I'm a little nervous now, since I live here in Virginia. I have to believe they just ignored protocols, not that the protocols don't exist.
Actually, my impression has been that Virginia generally has pretty good EMS. I remember from my EMT days that a lot of the training films I saw were made in conjunction with a Virginia fire department somewhere in the DC area.

SciFi Chick
2005-Feb-15, 12:17 AM
That's why I think it was a case of ignoring protocol. Most of our stuff is volunteer, and the volunteers are very caring as well as gung ho. Who knows? Maybe it's even been misreported, or the report maybe left out some facts?

CTM VT 2K
2005-Feb-15, 04:24 PM
I can vouch for Georgia having the same rules already mentioned. I'm a little nervous now, since I live here in Virginia. I have to believe they just ignored protocols, not that the protocols don't exist.

The article was about an accident in North Carolina. As a Virginia EMT, I can tell you that Virginia has a generally good EMS system. Standards and Protocols are established at either a Regional or State level (In fact, last time I checked, Virginia would not accept the National Registry for the B-level cert, but the VA B-level was good enough for the National Registry).

A few years ago, I was looking at taking a job in North Carolina. I looked over the NC EMS system, and thought to myself "That's a Malpractice Suit waiting to happen." It seems to have happened. As far as I understand, protocols and standards in NC are established only at the station level, and only occasionally at a regional level. Thre is no reciprocity with the National Registry system.

SciFi Chick
2005-Feb-15, 08:31 PM
I can vouch for Georgia having the same rules already mentioned. I'm a little nervous now, since I live here in Virginia. I have to believe they just ignored protocols, not that the protocols don't exist.

The article was about an accident in North Carolina. As a Virginia EMT, I can tell you that Virginia has a generally good EMS system. Standards and Protocols are established at either a Regional or State level (In fact, last time I checked, Virginia would not accept the National Registry for the B-level cert, but the VA B-level was good enough for the National Registry).

A few years ago, I was looking at taking a job in North Carolina. I looked over the NC EMS system, and thought to myself "That's a Malpractice Suit waiting to happen." It seems to have happened. As far as I understand, protocols and standards in NC are established only at the station level, and only occasionally at a regional level. Thre is no reciprocity with the National Registry system.

Well, that's what I get for not actually reading the article. :oops:

What a relief. I've been very proud of this state for their police and emergency services for some time. :D