Simon, bringing someone into the department does NOT mean continuing
with futile resuscitation efforts. Pragmatically, I will stop efforts
in the back of the ambulance, move the body to the "quiet area" which
is not near drunks ( if it is in your hospital, I suggest rethinking
the floorplan ). Certainly it ties up a doctor / nurse for a while.
Most mortuaries are going to have skeleton staff out of office hours,
and I would doubt that the viewing room and attentive staff are then on
offer for bodies brought in by ambulance. You are fortunate if that is
the case for your hospital. There is also the problem in my area that
'admitted' bodies are taken to the hospital mortuary, while those
certified outside hospital (including in the back of the ambulance )
are taken to the borough mortuary several miles away, to the
bewilderment of following relatives, to whom you then have to explain
not only the directions but also the facts of death without the comforts
of saying 'they did all that was possible ' etc.
Ideally as you say, those who are dead at home would not be brought to
hospital. However, when it does happen, I believe that my practice
makes the best of a bad job for reltively little effort on our part.
Paul Ransom
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Simon McCormick
Sent: 01 June 2004 08:29
To: [log in to unmask]
Subject: Re: deceased skills training
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.
> > >
> >
>
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