At our regional medical advisory committee's meeting last week I listed a number of issues I wanted us to address when we reconvened in the fall, including changing our state's DNR regulations to enable paramedics to accept a family's verbal wishes not to initiate resuscitation in a patient with a terminal condition in cardiac arrest. I will be giving a presentation on the proposal in September.
This proposal is the "Compelling Reasons" protocol initiated in King Country, Washington.
I have written about this in previous entries:
DNR Study Results
Here is a direct link to the King County study:
Futile Resuscitations
Withholding Prehospital Resuscitation: A New Approach to Prehospital End of Life Decisions (Full Study Text)
Withholding Prehospital Resuscitation (Editorial)
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Today I had a ninety-seven year old man found in his bed by his daughter not breathing. She had previously seen him alive an hour before. It was hot in the room and the patient was still warm with no rigor or lividity. As I put the pads on(which showed asystole), I asked the daughter if her father had any DNR orders. She replied he did in the nursing home, but they had expired. I asked what her wishes for resuscitation were? She said his wishes were that he not be resuscitated. I had my crew start basic CPR and then I called the hospital and spoke with a doctor who gave me permission to presume the patient dead without having to initiate ACLS. The daughter was already on the phone calling her brothers and sisters to tell them their father had died.
This scene could have played out any number of ways. The family member could have said she wanted the father to be resuscitated, I could have simply chosen to work the patient on my own lacking a current DNR, intubated him, and put in an IV and done 20 minutes of ACLS before presuming him dead, or when I did call for permission to presume, the doctor could have told me to work the patient doing full ACLS and transport.
All in all I thought it worked out all right. A 97 year old dead, curled on his side in his own bed, in the house (I found out) he had lived most of his life and raised his family in.
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My preceptee was cut loose last week. We never did get a cardiac arrest. I wonder how I would have handled the call if she were still with me. Finally, getting the code, the warm body to prove her skills on.
I wrote about a similar situation last summer in Practice.
