I understand what you're saying Paul but are we really the best place for
someone to say goodbye to their relatives?  If you are bringing in someone
from an ambulance to continue resuscitation and they die then fair enough,
continuity of care etc deems it important that we deal with what happens.
However, if someone is dead on arrival and we are not allowed to certify in
the back of an ambulance then resus must continue into the department and
therefore into a resus bay prior to a decision being taken to stop.  This
ties up a resus space, two nurses and atleast one doctor for a period of
time.  Following this a nurse will find his/her time taken up for anything
up to an hour or more dealing with the relatives.  These relatives are
occupying our only relatives room so we cannot put anyone else in there or
we have to gently push them out (towards the mortuary anyway) to make space
for the next set of relatives.  All this for a patient who was dead on
arrival and could have gone to the mortuary where they have a fair degree of
experience dealing with death, dying and relatives.  They also don't have
the distraction of further resus cases, drunks and screaming children.  They
will end up dealing with the patient/relatives anyway so why not let them do
so from the start.  In any case, we deal with the relatives of BIDs in the
first instance but then pass them on to the mortuary where it is quiet and
they can spend as much time as they wish with their loved one.

Don't get me wrong, I sincerly believe that dealing with acutely grieving
relatives is something we should be very good at but I don't believe we are
the only people who can do so.  Declaring a patient BID is a LOT less work
for my department than a DID, allows us to concentrate more on the (slightly
more) living and lets the mortuary staff do their work.

Simon McCormick

----- Original Message -----
From: "Paul Ransom" <[log in to unmask]>
To: "Simon Mccormick" <[log in to unmask]>
Sent: Monday, May 31, 2004 7:27 PM
Subject: Re: deceased skills training


> I used to be in favour of certifying in the ambulance and then the body
> can move straight to the mortuary,  but have converted to the BAEM
> suggestion because of the relatives who follow on.  Dealing with
> grieving relatives is something we are usually pretty good at,  there is
> a room,  nurses,  telephones etc,  unlike in the mortuary.  It may be a
> little more work for us,  but you have to ask yourself where would YOU
> want to say good bye to your recently deceased relative ?
>
> Paul Ransom
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Simon McCormick
> Sent: 31 May 2004 10:02
> To: [log in to unmask]
> Subject: Re: deceased skills training
>
>
> I agree that we resuscitate in futile circumstances all to often, so how
> does this square with the BAEM view that we should not certify patients
> in the back of an ambulance.  Surely a patient is as dead in the
> ambulance as in a resus room.  Whilst you continue resus in to the
> department before you officially end it you tie up a number of staff.
> for no good reason.  It is interesting that this edict from BAEM
> appeared 18 months ago, was then hastily withdrawn and hasn't been heard
> of again.
>
> Simon McCormick
>
> ----- Original Message -----
> From: "Ray McGlone" <[log in to unmask]>
> To: "Simon Mccormick" <[log in to unmask]>
> Sent: Sunday, May 30, 2004 9:50 PM
> Subject: Re: deceased skills training
>
>
> > I agree. We need to teach staff when to stop... as well as when to
> > start resuscitation.
> >
> > Ray McGlone
> > Lancaster
> >
> > ----- Original Message -----
> > From: "Rowley Cottingham" <[log in to unmask]>
> > To: <[log in to unmask]>
> > Sent: Sunday, May 30, 2004 6:13 PM
> > Subject: Re: deceased skills training
> >
> >
> > > I would go further. I am increasingly concerned at the number of
> > > clearly
> > futile resuscitation
> > > attempts that drag on and on through cycle after cycle, often on
> children
> > or young adults because
> > > people are not brave enough to say that the person is dead. I regard
> this
> > as abuse of the newly
> > > dead, and I have intervened countless times to stop them.
> > >
> > > Rowley Cottingham.
> > >
> > > Consultant in Emergency Medicine.
> > >
> >
>