List Archives

Sat Jan 13 11:08:50 GMT 2007

In Victoria, Australia, as a paramedic I am governed by a set of Clinical 
Practice Guidelines.
One of those CPGs relates to circumstances where resuscitation efforts may 
be withheld.

One of those circumstances is "an adult patient (18 yrs or older) whose 
initial cardiac rhythm is asystole (over a minimum 30 sec period), provided 
the time interval between the onset of cardiac arrest, i.e. collapse, and 
arrival of the crew at the patient has exceeded 10 minutes, and there are no 
compelling reasons to continue, such as suspected hypothermia, suspected 
drug overdose,  a child (<18 yrs of age) or family/bystander requests 
continued efforts."

These CPGs are determined by a Medical Standards Committee and CPG advisory 
committee with medical, paramedical and other specialist representatives, 
and represents accepted evidenced based practice. They are reviewed twice 
yearly.

It may be worth looking at these CPG's as evidence of reasonable practice 
that could be expected by other paramedics in the given situation.

I admit that as a paramedic, given the situation and timeframe as described 
by John, I would have done the same and not attempted resuscitation. I think 
there is such a thing as a fate worse than death - PVS.

Regards
Jenny Moncur
IC Paramedic
Oz

----- Original Message ----- 
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Saturday, January 13, 2007 3:45 AM
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

List Archives

For your convenience, find the Trauma List Archive Below

death after traumatic asphyxia