CPR, Morality, Legality, Common Sense, EMS, Medical Control,

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I must have missed something over the week end.   The  tone of the posts 
regarding pre-hospital and EC care of  terminal trauma patients completely 
changed 180  degrees.      
 
Towards the end of last week, I read of some logical, practical, and just  
common sense approaches to a patient who was obviously already dead, and by 
all  data available was going to stay that way.    Field aggressive  
"resuscitations" to include CPR, intubations, and even thoracotomies have been  the 
subject of many discussions on this list server, and for persons who have  
evidence of a meaningful recovery, there is NO ONE on this list server who 
would  be more aggressive than me.     
 
HOWEVER, to extend misery, to go on an ego trip and create more pain,  
expense and mutilation of an already dead body, is just plain selfish,  
expensive, and foolish.   PERIOD.   It is also illegal,  even if done in the name of 
EMS, emergency medicine, or trauma  surgery.    If recognizing death is a 
"backwards" trait, then  count me among the shaman of the distant past and 
the barber surgeons of the  middle ages.    
 
I think I try to keep up with the literature, both social, legal, surgical, 
 EMS, emergency medicine, and critical care.  I also must have  missed the 
articles that were referred to which caused one writer to suggest  that we 
are backwards in EMS in the United States.   Within the  greater Houston area 
there is no hospital that has a greater number and  percentage of families 
that lovingly agree that their brain dead loved one can  and would want to 
be an organ and tissue donor, than our hospital.    However, to assault a 
dead body just for the hopes of scavenging the organs for  transplant, is just 
plain ghoulish and weird.  If this is where  medicine has come, then I am 
delighted that my time as part of this wonderful  caring guild is soon coming 
to an end.      
 
Quite frankly, I was offended by the tenor of the post which prompted Dr.  
Gross to react in amazement.    I would hope that for  the wonderful 
knowledgeable people on this trauma list server, that  the one comment calling us 
backward is an outlier, or was mere thrown  out there to prompt discussion on 
a slow weekend.       

Finally, EVERY EMS system has a medical director (somewhere).    Escalation 
of decisions and advice is paramount to all medical, surgical,  social, 
disaster, and social systems.    I am not sure that  escalation of advice and 
seeking of wisdom is part of  political or  economic systems.    Such advice, 
consent, and leadership is  always available to all of us in health care 
delivery.      That is what EMS medical direction is all about.   Even after 
50  years in the practice of medicine (some of it during the medical school,  
military, and residency years), I still openly and freely seek council from 
 my peers, superiors, and underlings.   I seek advice and input and  
education from all of you here on this list server.    
 
May this open professional exchange never change.
 
The Op-Ed piece I wrote for the New York Times supporting the  
professionalism and the ethos of the EMS and Trauma System in the USA will be  put on 
hold for the time being, until I re read it 10 times, and watch to see  the 
continuing reaction to all of our backwardness. 
 
In the meanwhile can someone help me to understand what I had  missed.      
 
 
Kenneth L. Mattox, MD
Houston      
 
 

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