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Fri Jan 12 16:45:37 GMT 2007

I disagree, although I'm wrong a lot.  

Literature being equivocal-to-dismal regarding the odds of
resuscitation, I'm betting you can get any number of expert witnesses to
volunteer in the defense of the prehospital personnel.  Contemporary
practice -- globally -- was fairly demonstrated in their approach.
Knowing his passions and principles, I bet you could talk Dr. Mattox
into speaking for the defense.  It'll be the shortest and most decisive
civil case in EMS history.

Of course this may be answered more quickly another way: what do the
local protocols have to say on the subject?  Many systems have
carefully-constructed decision trees for declaration of death in the
field.  If they exist in this case, they probably represent the
proximate standard of care.  And if they were followed, then the medics
have transferred any responsibility to the system -- which is as it
should be.

I think we'll all be very grateful for news when this sorts itself out.

Best of Luck.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Thomas Anthony
Horan
Sent: Friday, January 12, 2007 9:39 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: death after traumatic asphyxia

dear John,
The reason why your side will loose is the uncertainty of when the
patient became asystolic. The time factor could not have been acurately
measured from last words to extrication. even the number you have given
us  has an error of 25% built in to it. you will get bogged down in
estimates of how long apnea and asystole lasted.  The lawyer will not
have to be smart to fry the medic for not trying. They will argue
succesfully that potential errors in measurement of and  uncertainty in
timing of events demanded an attempt.
Tom

> ----------
> From:
trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on
behalf of John Holmes[SMTP:docjohnholmes at hotmail.com]
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	sexta-feira, 12 de janeiro de 2007 06:05
> To: 	trauma-list at trauma.org
> Subject: 	death after traumatic asphyxia
> 
> I've been asked to give a medicolegal opinion to the coroner in a case
where 
> a driver was not given attempts at resuscitation by paramedics when
found to 
> be in asystolic cardiac arrest.  He was tighly trapped behind the
dashboard 
> and was initially talking, but it is likely that cardiac arrest
followed 
> traumatic asphyxia.  Downtime to extrication was around 12-15 minutes.
Post 
> mortem showed no signifciant injuries other than two small splenic 
> lacerations.
> 
> I've been looking for good references to support the paramedics'
decision 
> (which I agree with) not to intubate nor commence CPR or ACLS.   Can
anyone 
> help with some good references which directly address this scenario?
> 
> Thanks,
> 
> John
> 
> Dr John L Holmes
> Director Emergency Medicine
> Mater Adult Hospital
> Brisbane, Australia
> 
> 
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