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.
Apparently it is in writing and official
https://nypost.com/2020/04/02/coronavirus-nyc-emts-stop-taking-cardiac-arrest-patients-to-hospitals/
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. I’d say about 30% of cardiopulmonary arrests get ROSC and bystander CPR helps. In-hospital CPR also does not always work. But I’ve seen thousands of heart attacks and many hundreds of (at least short term) success stories.
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.
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 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
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.
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.
Stranger
If you can’t get the heart back after fifteen minutes of CPR, you should be calling the code. It’s not coming back. I’ve called codes after seeing no electrical activity on ultrasound, after giving other treatments.
If hospitals are ridiculously overstretched then it doesn’t seem like an unreasonable order. But presumably the paramedics are able to intubate, bag, give CPR, start a line, start oxygen, give up to three doses epinephrine and check vitals and for a shockable rhythm. That’s much of what you’d do in hospital anyway. Not all paramedics can do all these things everywhere. But given big city traffic, even with sirens, they’d better be able to do it in NYC.
People make a big deal about broken ribs in CPR but it really doesn’t happen very often and usually is not a big problem if it does, compared to what else is going on. Three layers of muscle hold the ribs in place and further damaging the lung is a small risk compared to not doing CPR at all.
Of course you want to use resources wisely. I suspect Canadian doctors and paramedics have experience here since our resources are more limited to begin with, legal liability is less and doctors don’t generally run codes they think are futile for very long.