>Hoary chestnut I know, but what is the point of trailing an asystolic 88
>year old with Ca in?
None. Infact it is putting the prehospital crew (and other roads users) at
increased risk for no reason.
>Should we not be upfront about this?
>How about 77 and over; DNR.
>Asystole at presentation and witnessed collapse - DNR.
I really don't like protocols for pre-hospital DNR. I mean, you need to
start resuscitation until at least you can decide it fits the protocol!
> Cat catches mouse. Cat plays with mouse for a while until bored. Mouse
>left to die.Cardiac arrest team come to A&E. Cardiac arrest team...
Been there...done it...bought the T-shirt.
2 possible solutions:
(1) PROVIDE ON SCENE MEDICAL CONTROL by sending a prehospital doctor to the
scene.
I do this when requested. It is less traumatic psychologically for the crew
and relatives and provides the best level of decision making on scene, but
it has several problems.
a. The dangers of emergency response to the scene is only slightly less
than emergency transfer to the hospital.
b. The response time for 2nd line response means resus is ongoing until you
arrive.
c. The call out rate if you joint-respond to all collapses may be
unacceptably high outside of remote areas.
(2) PROVIDE REMOTE MEDICAL CONTROL BY RADIO
Now that ambulance crews are using digital radios with personal repeaters
and we have increased senior doctor presence 24hrs in A+E, why de we not
have more remote medical control?
The crew could start CPR and apply the AED and then call the A+E dept radio
for instructions to terminate or continue.
The only problems with this approach is that doctors may not be happy to
suspend resus in patients they cannot actually see, and the depersonalised
radio conversation may upset bystanders.
We really need to tackle this issue. Every time I hear the term "Dead on
arrival" I shudder.
Robbie Coull
BASICS Doctor
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|