Posted by: medicblog999 | November 29, 2010

Another string to the EMS Bow

We all know how EMS is changing and evolving.

Most of us get excited about the new challenges and possibilities that are opening up to Medics that have never been there before.

I have certainly seen my own role change dramatically in the 11 years I have been in EMS.

Sometimes though, we all still find ourselves in situations that we have not been in before, and sometimes, these can be challenging even to the more experienced of us.

But this isn’t a clinical post as such. Let me set the scene for you…….

Some time ago, I was working on the Rapid Response car and I was dispatched to a cardiac arrest. It wasn’t too far away, and as is usual, I requested more details over the radio prior to me arriving on scene. I was then told that the patient was a 40yr old man who had been sent home from the local hospice to die at home, and he had apparently just died.

Errr, Okay……now not being disrespectful to the dead, why was a paramedic being sent on blue lights to a patient that had died, who was expected to die?

A further update came through telling me that the patient’s wife was now saying that she didn’t think she was dead, and may still be breathing.

“Is there a DNR (do not resuscitate) order in the house?”

“That’s a negative, as far as we are aware, there is no DNR’

Great! Just Great!!

As I was pulling onto the scene, my mind was working through the various scenarios that I was about to have to deal with, but all of those various scenarios ended with me having to very quickly make a decision on whether to do something or not.

As I walked up to the front door, Judy, his wife met me. She had the wide shocked, panicking eyes that usual great me when a patient dies suddenly and without warning. Surely this time, she new that her husband was about to die?

Entering the patient’s bedroom, I could see him (Roger) lying in the bed. He looked comfortable and asleep, but he also looked dead. His skin had that usual white tinge to it, there was no obvious respiratory effort, lack of pulses and his pupils were fixed and dilated. The skin of his legs and abdomen were quickly becoming mottled and taking up the recognisable look of post mortem lividity. There was no question about whether I was going to work this or not, I had made my mind up as I walked in.

I still attached the cardiac monitor and printed of a strip showing continued systole. No CPR had been done prior to my arrival, so the whole DNR worry was now a mute point.

I couldn’t help but still wonder why 999 had been called?

I know that even when a death is expected, there is still obviously the final shock of losing the one that you love, and sometimes people still reach for the phone in a vain attempt to stop the inevitable, but this didn’t seem the case here. Judy appeared calm once I had told her that he was dead. She turned to becoming a host, offering me drinks and something to eat.

I tried to get some history regarding what had happened throughout the day and was told that the doctors in the hospital had told her that it was unlikely that he would last more than a day, and the decision had been made to bring him home to die. He had become agitated once at home, but a couple of hours before I arrived the nursing team had visited to the house and had gave him some sedation to ease his discomfort.

“I didn’t think that he was going to die so quickly……I thought I would have one last night with him”

We discussed what had happened and I tried to support her through the immediate phase of the grieving process. She apologised that she had called but then gave me the reason why I found myself in this house on this night.

“I just want to get him to the chapel of rest. I don’t want him to deteriorate in the house”

And there we have it. Judy had a fear that now that her husband had died, he was going to decompose before her eyes. She was afraid, and this was her emergency now.

Was this the best use of a trained rapid response paramedic? Some may say no, and before I got the whole story, I too thought that I shouldn’t be there.

It transpired that Judy had called the nursing team when she thought that her husband had died. The nurses had told her that they would be coming back out to see him and sort things out, but there was other patients that needed seeing first. Fair enough I guess…..This was an expected death, and is really, in no way, an emergency.

However, there is still a need to care for those left behind, and hearing Judy’s fears, I wanted to help.

I phoned the funeral directors that her and her husband had decided to use and arranged for the undertakers to come and collect him from the house. I contacted the out of hours GP service to inform them of the death, and I completed my paperwork for the recognition of life extinct.

All in all, I spent over an hour with Judy and left just as the undertakers were arriving. I made the usual cup of tea (the all conquering medication for those relatives of the recently deceased) and I had asked her neighbour to come around and sit with her until her family arrived.

So, is this another string to the EMS Bow?….Absolutely, but it is also another example of EMS being the catch all for anything medical in the community that does not fit into a perfectly shaped box.

Whatever it is though, it is also an opportunity to make a difference to another family.

About these ads

Responses

  1. [...] This post was mentioned on Twitter by InsomniacMedic, John Broyles and Lizzie , Mark Glencorse. Mark Glencorse said: New Blog Post – “Another String to the EMS Bow” – http://bit.ly/eAv5xe [...]

  2. Good job, Mark! Over the years I’ve found education of the family of terminal patients to be one area where my local system falls down badly. I’ve seen (and experienced) very good Hospice care, where everyone knows what is happening and it all goes smoothly, but I’ve more often seen the reverse.

    The norm here seems to be sending the patient home with no DNR and no education to the family as to what to expect when their loved one dies. It’s rarely as peaceful or pretty as it appears on television. For that matter, it’s rarely as definitive. They simply don’t take one final breathe, close their eyes, and die. These poor folks often panic and dial 911, plunging us into a situation where we don’t belong.

    I’m glad it worked out OK for you and ‘Judy.’

    • There is one hidden weapon in the EMS armoury that does not beep, cardio-convert an errant heart, or chemically bring a patient back from the brink.

      It has been around for many many years, and is the staple upon which a good EMS responder acts in any given situation.

      COMPASSION. Fortunately for your patients Mark, you have that in abundance.

  3. Nice work! Is this the best use of EMS? Of course not, the best use would have been, as you mentioned it, proper patient education, support services supplied by hospice, and properly done paperwork (why is it that hospice can rarely do the paperwork that comes with their specialty?). However is it an appropriate use of EMS? Also definitely. There should never be one layer because mistakes do occur.

    Similarly, this is where community resources come into play. While I only have knowledge of the programs in passing, some areas (sometimes through the police, sometimes through the fire department, some times through hospitals) train community volunteers to respond to both console the victims and families of traumatic events (including, but not limited to death), but also to liaison between the multiple first response and support agencies.

    Finally, in terms of DNR, the problem with paper work is why I’m in favor of extremely liberal DNR policies. One of the areas I used to work in allowed immediate family members to request EMS to withhold or withdraw resuscitation. No or improperly completed DNR? Is the immediate family members easy to identify? If so and everyone agrees, sign my PCR and here’s a de facto DNR. If there’s concerns about who is the immediate family or disagreement between them, start resuscitation and contact medical control.

    Trauma Intervention Program: http://www.tiporangecounty.org/index2.htm
    Orange County LEMSA DNR policy: http://ochealthinfo.com/docs/medical/ems/P&P/330.51.pdf

  4. Good on you, mate. I can think of a dozen people just off the top of my head that I know would have hauled the poor sod to the floor and flogged him for all they were worth. Common sense isn’t.

  5. I often feel that we misrepresent the term “patient care” when it comes to meds, immobilization, and other interventions we perform. In reality, those are “patient treatments” and have very little to do with actual “patient care”.

    That above, in my opinion, is true “patient care”… and my idea of EMS 2.0.

    Thanks for sharing.

  6. You done well! Often we overlook the other family members present and they often need ems support of a different kind than the patient, but need it just as badly. Thanks for being there and once again being an example of the kind of Paramedic I hope I can be.

  7. Patinet care in my view would exceed the tragedy of one partner predeceasing the other.

    Let me illustrate. One Sunday morning my crewmate and I attended a call about 0200 hrs. The couple had been married for over 60 years, and this lovely lady was now a widow. Her late husband was clearly DOA on our arrival, showing exactly the same clinical signs of Mark’s patient.

    What do I do? Her husband is removed to a ‘final care unit’ whilst I fretted about his wife. Conclusion; If I can’t get a reletive or neighbour out, I’ll take her home myself.

    Compassion!

  8. Wish I were in your neighborhood when I get sick or injured; you are compassionate and caring and that’s what our world needs most.

  9. [...] Glencorse showed us something we should already be doing even though we don’t receive training or recognition for it. That is a great example of what [...]


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

Follow

Get every new post delivered to your Inbox.

%d bloggers like this: