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Fri Jan 12 17:04:41 GMT 2007

Pret 
No doubt that the team did its best and made a proper decision and it would certainly be nice if the coroner sees it that way. On the other hand civil litigation may function differently. The team may find itself in difficulties establishing with certainty the sequence of events. lawyers acting for a family will focus on uncertainty. If there is uncertainty about the time of death, it will act in their favor in a civil case. Can John's EMS team establish the time of death. Ultimately that may be the tiping point.
Tom

> ----------
> From: 	trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of Bjorn, Pret[SMTP:pbjorn at emh.org]
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	sexta-feira, 12 de janeiro de 2007 14:45
> To: 	Trauma &amp; Critical Care mailing list
> Subject: 	RE: death after traumatic asphyxia
> 
> 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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