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Fri Jan 19 14:39:58 GMT 2007

Dear Jenny,

Thank you for pointing your prior post out to me. I stand corrected.

Now lets get back to the point, The crew worked feverishly to get him out but they did not have any access to him ie no way of telling if he had a pulse only that he did not speak for a period >12 minutes.  they had no idea how long he did not have a pulse. IE they were uncertain when his signs of life ceased. He would have been ressused where i am, because of that uncertainty. It has been suggested that he would have been brain damaged if successfuly reanimated. But we don´t know when he stopped so we can´t say that would be true. Traumatic asphyxia has a high survival rate compared to other arrests. 

There is a discrepancy between what the EMS personel would "want for themselves" and the satisfaction rates for their lives of individuals rescued but suffering  serious neurological injury. Thus we cannot base what we want to do for others based on what we think we would want done for us.

Moreover in this case there is significant variance of the given time estimates between "down time" and extrication that could call into question the decision not to ressus. Since there was no way of determining when respiration and pulse ceased there is no way to determine whether or not the 10 minute rule in Victoria was exeeded or not. Doubt exists, thus i feel the benefit of doubt  should demand an attempt at resussitation.

Yours truly

Tom Horan

> ----------
> From: 	trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of Jenny Moncur[SMTP:jmoncur at netspace.net.au]
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	quinta-feira, 18 de janeiro de 2007 18:27
> To: 	Trauma &amp; Critical Care mailing list
> Subject: 	Re: Wrongful Life vs Wrongful Death
> 
> 
> 
> Dear K and fellow travellers,
> 
> 
> .................. apart from your declarations of support what do your 
> hospital and EMS guidelines state to cover this situation?
> 
> That is afterall the request that John made in his first post.
> 
> tom horan
> 
> 
> 
> Tom,
> to answer your question , I will repost my initial reply to John.
> I think it is validation that the decision made by the paramedics is 
> consistent with the practice of other paramedics in Australia ,
> 
> "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
> 
> 
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