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Old 04-03-2020, 04:00 PM
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New York paramedics and EMTs told to leave people to die in place.


My son is an EMT and told me this a few days ago. He told me he didn't know if he could follow this order if faced with it. Most of his fellow EMTs would have a very hard time following this edict. My question-- are there going to be Bring Out Your Dead wheelbarrows?

I am really frightened.
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Old 04-03-2020, 04:06 PM
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My question-- are there going to be Bring Out Your Dead wheelbarrows?
No, they'll be golf carts.
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Old 04-03-2020, 04:14 PM
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My son is an EMT and told me this a few days ago. He told me he didn't know if he could follow this order if faced with it. Most of his fellow EMTs would have a very hard time following this edict. My question-- are there going to be Bring Out Your Dead wheelbarrows?

I am really frightened.
Iím not quite sure what this means. In my neck of the woods the EMTs donít transport dead people. Either the ME does it if there is a follow up or they are released to the family to make arrangements with a funeral home.
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Old 04-03-2020, 04:24 PM
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Iím not quite sure what this means. In my neck of the woods the EMTs donít transport dead people. Either the ME does it if there is a follow up or they are released to the family to make arrangements with a funeral home.
EMTs don't transfer dead people but they do work on cardiac arrest victims and others who need CPR. They are being told if CPR doesn't 'R' then they are not to bring them to the hospital. Which, as my son pointed out, will be his out as EMTs are not allowed to pronounce anyone dead unless "absolute conditions contradictory to life" (or some other wording that I'm not sure of since I'm not the EMT) which means things like not having a head.

This means that if somebody is in cardiac arrest and the EMT cannot revive them, they are to leave that person dead at the scene.
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Old 04-03-2020, 04:28 PM
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https://www.nbcnewyork.com/news/coro...vival/2356265/
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Old 04-03-2020, 04:31 PM
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If the person is obviously dead, why should the EMTs be delivering more coal to Newcastle?
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Old 04-03-2020, 04:40 PM
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If the person is obviously dead, why should the EMTs be delivering more coal to Newcastle?
These people are not dead dead. They are in cardiac arrest and can be revived. Sometimes the EMTs can do it and sometimes they are revived in the ER. But that takes a whole lot of personnel and equipment. I do not know the percentages of those who enter the ER in arrest who live but some do live.
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Old 04-03-2020, 04:43 PM
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EMTs don't transfer dead people but they do work on cardiac arrest victims and others who need CPR. They are being told if CPR doesn't 'R' then they are not to bring them to the hospital. Which, as my son pointed out, will be his out as EMTs are not allowed to pronounce anyone dead unless "absolute conditions contradictory to life" (or some other wording that I'm not sure of since I'm not the EMT) which means things like not having a head.

This means that if somebody is in cardiac arrest and the EMT cannot revive them, they are to leave that person dead at the scene.
I assume that is different from location to location. Back when I used to watch Nightwatch, Nightwatch Nation and now on Live Rescue (all similar to Live PD except they follow EMTs and FDs), if someone was, for all intents and purposes, dead, they'd call a doctor who would ask a few basic questions and pronounce them over the phone.
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Old 04-03-2020, 04:48 PM
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I assume that is different from location to location. Back when I used to watch Nightwatch, Nightwatch Nation and now on Live Rescue (all similar to Live PD except they follow EMTs and FDs), if someone was, for all intents and purposes, dead, they'd call a doctor who would ask a few basic questions and pronounce them over the phone.
In this scenario docs still have to pronounce. The new rules say leave un-resuscitated victims in place. There is no 'call the doctor', they don't have time for phone calls.
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Old 04-03-2020, 04:52 PM
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Hospitals are running out of ordinary and improvised beds, and in New York are hiring refrigerated trucks to store bodies. Even if an ambulance brought a critical care patient in there aren’t resources to support or treat them. Bringing patients into the hospital who are going to die anyway without the necessary care is just compounding the problem.

This is going to be “the new normal” for the next several weeks, maybe a couple of months. I won’t say “get used to it” because it is horrifying, but you’re going to see more of it, and not just in NYC, Los Angeles, and Chicago. In fact, regional medical systems in rural areas are even less equipped to deal with this than major urban hospitals.

Remember when we were being told this was all under control and go away like a miracle?

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Old 04-03-2020, 04:54 PM
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In this scenario docs still have to pronounce. The new rules say leave un-resuscitated victims in place. There is no 'call the doctor', they don't have time for phone calls.
So they're walking away from someone that's technically still alive, even if they aren't revivable? That does seem odd. What happens after that? I assume the ME has to come out and pronounce them?
Are the EMTs some how shielded from lawsuits? If I were an EMT in that situation, I'd be worried about getting sued for [something] for not continuing to work on a patient that's technically still living. Even if it was just because people saw it as a potential payday.
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Old 04-03-2020, 04:54 PM
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These people are not dead dead. They are in cardiac arrest and can be revived. Sometimes the EMTs can do it and sometimes they are revived in the ER. But that takes a whole lot of personnel and equipment. I do not know the percentages of those who enter the ER in arrest who live but some do live.
Last CPR training I had, I was told was a pretty low number-- but still high enough to be worth bringing people in.

NO ONE revives from manual CPR alone. All that's supposed to do is keep people alive until real help can take over. With actually, one exception I did read about where someone revived from the VERY FIRST push. But that person may have been in fibrillation, not actual arrest. Or maybe had JUST gone into arrest, but missed less than two beats, or something. I don't know. It was a very rare thing-- enough to merit a national news story.

I'm guessing someone did some math, and calculated that the odds of bringing in someone Covid+ in cardiac arrest, who will not be revivable due to damage from the disease, will infect and subsequently cause the death of n patients, and n+1 outnumbers the people who survive cardiac arrest after manual CPR, and are brought into the ER. That number just needs to be (n+1)-x where x>1.
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Old 04-03-2020, 05:02 PM
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That makes perfect sense Rivkah and I knew there were calculations done to come to this conclusion but it runs counter to everything all the paramedics and EMTs believe in. They are there to save people, not leave them for dead. It also leaves them to make decisions they have been told they are expressly forbidden to make because they don't have the knowledge.

This is all kinds of fucked up.
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Old 04-03-2020, 05:12 PM
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Ambulances often bring seemingly dead patients into emergency rooms. Declaring someone dead is a lot more subtle than one might think, and sometimes patients can be revived. Paramedics and doctors sometimes can revive people with a shot of glucose or naltrexone, time and warm blankets or a well placed electric shock to the heart. In cases where it is obvious, they discuss it with a supervisor or doctor. Not every dead patient should come to an emergency room.

Ecuador is having some problems as you describe. I can’t speak for New York but my sympathies to your son. “Medical triage” is a fact of life in Canada and if the doctors think there is no real hope than treatments are sometimes curtailed after “heroic” attempts. Families are encouraged to be realistic about situations and DNR orders.
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Old 04-03-2020, 05:14 PM
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I assume that is different from location to location. Back when I used to watch Nightwatch, Nightwatch Nation and now on Live Rescue (all similar to Live PD except they follow EMTs and FDs), if someone was, for all intents and purposes, dead, they'd call a doctor who would ask a few basic questions and pronounce them over the phone.
Our paramedics do that not EMTs.
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Old 04-03-2020, 05:16 PM
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That makes perfect sense Rivkah and I knew there were calculations done to come to this conclusion but it runs counter to everything all the paramedics and EMTs believe in. They are there to save people, not leave them for dead. It also leaves them to make decisions they have been told they are expressly forbidden to make because they don't have the knowledge.

This is all kinds of fucked up.
If they need CPR they are already dead. Only when circumstances are exactly right can that change.
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Old 04-03-2020, 05:19 PM
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"Nobody dies in the bus" is the EMT motto. They are either dead on the scene or die in the ER. EMTs have been told again and again that they are not equipped to make the judgement. It is one thing to tell the family "We've done everything we can" and a completely different thing to tell them, "Whelp, sucks to be this guy!" and leave him at the scene.
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Old 04-03-2020, 05:22 PM
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Ambulances often bring seemingly dead patients into emergency rooms. Declaring someone dead is a lot more subtle than one might think, and sometimes patients can be revived.
When I was growing up my family was obsessed with police scanners--they were left on 24/7 in my house. Many times someone who was very clearly dead (as in, massive trauma in an auto accident) would later be listed as being pronounced dead at the hospital--because a bag full of parts isn't dead until a coroner says that it is.
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Old 04-03-2020, 06:33 PM
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If the person is obviously dead, why should the EMTs be delivering more coal to Newcastle?
Because the alternative is to leave a sick mother with two children stuck in a house with the corpse of her dead husband and no way to get anyone to do anything about it because no one will come near the plague house?!?

If you are going to leave them, at least move them to the curb so that the city will be forced to act.
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Old 04-03-2020, 07:01 PM
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If they need CPR they are already dead. Only when circumstances are exactly right can that change.
If they are already dead, no amount of CPR will bring them back.
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Old 04-03-2020, 07:05 PM
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The electric shock almost never is used to start a heart that is not beating , TV and movies get that wrong. I guess it makes for a good visual. Shock is used to restore the normal rhythm of the heart. Most of the time they use drugs to try to start the heart back up.
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Old 04-03-2020, 07:26 PM
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If they are already dead, no amount of CPR will bring them back.
If you are not breathing and have no pulse you are dead. If everything lines up exactly right and the stars are aligned it may be possible to change that. That is what Iíve been taught for 30 years.
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Old 04-03-2020, 07:32 PM
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When I was growing up my family was obsessed with police scanners--they were left on 24/7 in my house. Many times someone who was very clearly dead (as in, massive trauma in an auto accident) would later be listed as being pronounced dead at the hospital--because a bag full of parts isn't dead until a coroner says that it is.
That would never happen anywhere I know. Fatal auto accidents are treated as a crime scene. If the person is dead they are pronounced at the scene and not moved until the medical examiner gets there to photograph and document the scene as well as the fatal accident team. The body and the crime scene are disturbed as little as possible. It may later be determined to be an accident with no criminal charges but no way to know that at the time.

In other circumstances I would much rather have them take the body and not leave us to baby sit. I’ve been told very clearly by the paramedics that they would get in a lot of trouble if they bring in someone obviously dead.

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Old 04-03-2020, 07:36 PM
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The electric shock almost never is used to start a heart that is not beating , TV and movies get that wrong. I guess it makes for a good visual. Shock is used to restore the normal rhythm of the heart. Most of the time they use drugs to try to start the heart back up.
The automatic defibrillators will only shock if they detect a rhythm.
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Old 04-03-2020, 07:54 PM
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If you are not breathing and have no pulse you are dead. If everything lines up exactly right and the stars are aligned it may be possible to change that. That is what Iíve been taught for 30 years.
Guess we all went to the wrong schools, and you went to the right one.
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Old 04-03-2020, 08:04 PM
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When I was growing up my family was obsessed with police scanners--they were left on 24/7 in my house. Many times someone who was very clearly dead (as in, massive trauma in an auto accident) would later be listed as being pronounced dead at the hospital--because a bag full of parts isn't dead until a coroner says that it is.
This is wrong. Coroners don't declare death; they pursue an inquiry into cause of death, and many coroners are not physicians.

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If you are not breathing and have no pulse you are dead. If everything lines up exactly right and the stars are aligned it may be possible to change that. That is what Iíve been taught for 30 years.
What you have been taught, while consistent with the medical definition of 'death', is wrong. People have been successfully resuscitated after tens of minutes of no respiratory or cardiac function (albeit typically after immersion in freezing water). However, in this particular circumstance, a general order to abandon a patient that does not respond to CPR is an essential triage measure to avoid wasting time that might save a responsive patient.

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Old 04-03-2020, 08:21 PM
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When I was growing up my family was obsessed with police scanners--they were left on 24/7 in my house.
did that not create some type of sense of impending doom in your house? or maybe a distrust of the common man or something? I'd think I'd be always on edge in that environment.
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Old 04-03-2020, 08:31 PM
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This is wrong. Coroners don't declare death; they pursue an inquiry into cause of death, and many coroners are not physicians.
Maybe so, but at the very least in Upstate South Carolina in the 1980s and 1990's, the local coroner traveled to the scene of fatal accidents before the body could be moved. The police would announce that the coroner had arrived at the scene. I heard it hundreds of times over the years.
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Old 04-03-2020, 08:35 PM
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did that not create some type of sense of impending doom in your house? or maybe a distrust of the common man or something? I'd think I'd be always on edge in that environment.
No? If anything, being more aware of what was going around you was helpful. There was always a scanner running in the house from when they bought the first one around 1980 or 1981 until my grandmother's death in 2010. I didn't feel a need to keep one on myself, but there was nothing nerve-wracking about it, it was just something in the background of life that you could tune out if it didn't interest you. (The scanner picked up police, fire and rescue. Along with rescues you would hear play-by-plays of hot pursuits.)
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Old 04-03-2020, 08:40 PM
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Because the alternative is to leave a sick mother with two children stuck in a house with the corpse of her dead husband and no way to get anyone to do anything about it because no one will come near the plague house?!?

If you are going to leave them, at least move them to the curb so that the city will be forced to act.
I guess in these circumstances, the next call is to the funeral home. Who I would hope do do something about it that's better than simply leaving a dead person in place.

Still unbelievably horrible, though.
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Old 04-03-2020, 08:52 PM
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Ah, today's leading local news story was on how funeral homes are being overwhelmed.

I'm telling you, it's scary as fuck here. This guys got bodies in his chapel with his air conditioning as the only cooling.

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Old 04-03-2020, 09:20 PM
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Which, as my son pointed out, will be his out as EMTs are not allowed to pronounce anyone dead unless "absolute conditions contradictory to life" (or some other wording that I'm not sure of since I'm not the EMT) which means things like not having a head.
I'm a lapsed EMT but, from memory, those conditions were decapitation, brain separated from the skull, lividity, and obvious signs of decomposition.
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Old 04-03-2020, 09:45 PM
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One of the reasons the first heart transplant was performed in South Africa is that their laws allowed it. In most places, a person could not be declared dead until their heart stopped for a certain period, long enough to be useless for transplant. But to remove a beating heart was to risk prosecution for murder. After Barnardís success, many places lobbied for brain death to be an alternative measure so heart transplants could be attempted.

Their are several tests one does to check for brain death, but I wonít describe them here. Suffice to say, thinking you donít feel a pulse is not death. Iíve even revived people asystolic in three leads, though someone was right defibrillation is not helpful for asystole. Other methods are used for slow bradycardia.

If you continue not to breathe or have a pulse you are dead. But not in the moment, only after a certain amount of time. Physicians talk to the coroner after they think someone dead (if certain criteria mandate this) and often fill out the paperwork. In most cases the coroner waits until morning to review things.

As for training of NY paramedics, couldnít say. Itís a scary situation there. Other places will be similarly scary in 2 weeks, perhaps, and also will want respirators and medical personnel.
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Old 04-03-2020, 09:49 PM
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This is wrong. Coroners don't declare death; they pursue an inquiry into cause of death, and many coroners are not physicians.

What you have been taught, while consistent with the medical definition of 'death', is wrong. People have been successfully resuscitated after tens of minutes of no respiratory or cardiac function (albeit typically after immersion in freezing water). However, in this particular circumstance, a general order to abandon a patient that does not respond to CPR is an essential triage measure to avoid wasting time that might save a responsive patient.

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Thanks Iíve performed CPR many many times. Iím well aware of what can and does happen.
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Old 04-03-2020, 09:58 PM
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I'm a lapsed EMT but, from memory, those conditions were decapitation, brain separated from the skull, lividity, and obvious signs of decomposition.
Iím sure it depends on the location. Here an official pronouncement can only come from a doctor. It may be done over the phone and using remote telemetry but itís always a doctor on the other end.

Obvious signs of death means the EMTs donít have to try lifesaving efforts.

Iím not saying the OP heard wrong but if the protocols have changed in NYC it would have to be in writing and from an official source. You donít just have EMTs pronouncing death because someone told them verbally.
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Old 04-03-2020, 10:42 PM
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In the 9+ years I've spent as an EMT (I've had to retire from active duty due to a back injury that left me with arthritis in my spine and sciatic nerve damage), I've transported several dead bodies. Sometimes to the morgue, sometimes to a funeral home. I've also been able to pronounce someone dead on two different occasions.

In my area, a basic EMT can pronounce someone dead in the case of an obvious death. Decapitation, for example. Or lividity (when the body's blood pools at the lowest possible spots because the heart is no longer pumping and gravity kicks in).

As I said, I've pronounced two: one was a decapitation in a car accident (Kia t-boned by a garbage truck), and one gentleman who stuck a shotgun under his chin and pulled the trigger.

Leaving a patient to die is unconscionable to me. I can't even wrap my head around the concept.
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Old 04-03-2020, 11:29 PM
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Leaving a patient to die is unconscionable to me. I can't even wrap my head around the concept.
I worked a massive freeway pileup (80+ patients) where we had a bunch of catastrophic trauma and burns. Many of those Definitely alive, but few lived long enough to be extricated.
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Old 04-04-2020, 12:29 AM
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No? If anything, being more aware of what was going around you was helpful. There was always a scanner running in the house from when they bought the first one around 1980 or 1981 until my grandmother's death in 2010. I didn't feel a need to keep one on myself, but there was nothing nerve-wracking about it, it was just something in the background of life that you could tune out if it didn't interest you. (The scanner picked up police, fire and rescue. Along with rescues you would hear play-by-plays of hot pursuits.)
interesting. was your grandmother the one that listened to it most or something?
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Old 04-04-2020, 12:58 AM
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I worked a massive freeway pileup (80+ patients) where we had a bunch of catastrophic trauma and burns. Many of those Definitely alive, but few lived long enough to be extricated.
I understand it in the abstract. Fortunately, I was never in a situation where I had to make those snap triage decisions. All of my mass-patient runs only had, at worst, one to two serious injuries. I worked a wedding celebration balcony collapse once that had upwards of 45 patients, but even most of those were bruises and scrapes.
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Old 04-04-2020, 03:24 AM
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These people are not dead dead. They are in cardiac arrest and can be revived. Sometimes the EMTs can do it and sometimes they are revived in the ER. But that takes a whole lot of personnel and equipment. I do not know the percentages of those who enter the ER in arrest who live but some do live.
It's in the single digits.

CPR works best for young, healthy people who have suffered an arrest due to some sort of trauma. It's not very effective for the aged, or for those who have suffered an arrest due to serious illness because re-starting a heart in those cases does not solve the underlying problem that lead to the cardiac arrest in the first place.

Right now, medical care is limited. I know that's hard for a lot of Americans to wrap their heads around, but it's true. There is not enough to go around the situation is going to get worse before it gets better.

Also, if you bring someone to a hospital right now in NYC if they don't already have covid there's a significant chance they'll pick it up there.
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Old 04-04-2020, 03:31 AM
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Ah, today's leading local news story was on how funeral homes are being overwhelmed.

I'm telling you, it's scary as fuck here. This guys got bodies in his chapel with his air conditioning as the only cooling.
This is the sort of situation that results in mass graves. It would not surprise me if we see that before too long. Well, we've already seen that in Iran - apparently the trenches they've dug there for the deceased are visible from space.
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Old 04-04-2020, 10:07 AM
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Iím sure it depends on the location. Here an official pronouncement can only come from a doctor. It may be done over the phone and using remote telemetry but itís always a doctor on the other end.

Obvious signs of death means the EMTs donít have to try lifesaving efforts.

Iím not saying the OP heard wrong but if the protocols have changed in NYC it would have to be in writing and from an official source. You donít just have EMTs pronouncing death because someone told them verbally.

Apparently it is in writing and official

https://nypost.com/2020/04/02/corona...-to-hospitals/
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Old 04-04-2020, 02:01 PM
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Cardiac events are a terrible way thing, but not everyone of them is fatal. CPR increases the rate of return of spontaneous circulation (ROSC), and folks who survive the hospital tend to do pretty well. Iíd say about 30% of cardiopulmonary arrests get ROSC and bystander CPR helps. In-hospital CPR also does not always work. But Iíve seen thousands of heart attacks and many hundreds of (at least short term) success stories.
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Old 04-04-2020, 03:02 PM
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Quote:
Originally Posted by Loach View Post
Iím sure it depends on the location. Here an official pronouncement can only come from a doctor. It may be done over the phone and using remote telemetry but itís always a doctor on the other end.

Obvious signs of death means the EMTs donít have to try lifesaving efforts.
That's correct and something I should have addressed in my post you replied to. To 'pronounce dead' is a legally specific act which EMTs here cannot do. Instead, those obvious signs of death were when, as you said, there was no duty to treat.
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Old 04-04-2020, 03:17 PM
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Apparently it is in writing and official

https://nypost.com/2020/04/02/corona...-to-hospitals/
The way that is written in the article is not much different than business as usual, at least here. No mention of EMTs pronouncing. Paramedics are still rendering aide. Here the paramedics push the same medication and render the same aide they would get in the ER. If there is no change they call it at the scene in consultation with a doctor. They have to at least get some indication they are having an effect and be assured that effective CPR began immediately. If anything it seems they are giving the paramedics more ability to make the call.
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Old 04-04-2020, 03:35 PM
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The way that is written in the article is not much different than business as usual, at least here. No mention of EMTs pronouncing. Paramedics are still rendering aide. Here the paramedics push the same medication and render the same aide they would get in the ER. If there is no change they call it at the scene in consultation with a doctor. They have to at least get some indication they are having an effect and be assured that effective CPR began immediately. If anything it seems they are giving the paramedics more ability to make the call.
Of course I donít know the old procedures in NYC. Maybe they routinely transported even those with no chance of survival.
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Old 04-04-2020, 03:43 PM
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New York paramedics and EMTs told to leave people to die in place.


Quote:
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Of course I don’t know the old procedures in NYC. Maybe they routinely transported even those with no chance of survival.

Yes , according to the article they previously transported when they couldn’t get the heart restarted on scene. Which may not mean there’s no chance of survival, but it’s certainly very low

Last edited by doreen; 04-04-2020 at 03:45 PM.
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Old 04-04-2020, 07:22 PM
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While it's true that CPR by itself won't ever bring someone to recovery, EMTs have more options available to them than just CPR by itself, such as a defibrillator. And, heck, nowadays even minimally-trained laypeople have access to defibrillators-- They're found in nearly all public places, and they're really easy to use. So EMTs can and do sometimes "bring people back", or however you want to describe it; they're just not doing it entirely via CPR.
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Old 04-04-2020, 07:40 PM
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While it's true that CPR by itself won't ever bring someone to recovery, EMTs have more options available to them than just CPR by itself, such as a defibrillator. And, heck, nowadays even minimally-trained laypeople have access to defibrillators-- They're found in nearly all public places, and they're really easy to use. So EMTs can and do sometimes "bring people back", or however you want to describe it; they're just not doing it entirely via CPR.
That's true, but according to the TV news report, "If, after 20 minutes of CPR, the defibrillator or the heart monitor shows a "no shock indicated" or a non-shockable rhythm and there is no blood circulation, CPR is to be terminated." That wasn't the previous procedure - they used to continue CPR on the way to the hospital.
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Old 04-04-2020, 08:23 PM
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Despite what you see on the medical fun time shows, you don't alternate defibrillation with CPR. The entire point of defib is to stop a heart that has an irregular heartbeat so it can restart with a steady action. Also, when you perform CPR there is a significant chance of breaking ribs because you are forcefully pushing down on the entire chest cavity, which is something you wouldn't want to do with someone who is already in respiratory distress because it is just going to compound the problem. Long story short, if there is someone who is already presenting with severe respiratory symptoms and they go into cardiac arrest, the likelihood of pulling through is very slim, and when emergency care systems are overstressed you are essentially at a point of having to pick the fights you have a chance of winning. As Loach noted, abandoning a non-responsive patient in place is not the same as pronouncing death, but the order does seem to give EMTs and paramedics latitude to put there efforts where they can be best used.

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