Posted on 08/02/2006 10:57:07 PM PDT by FairOpinion
BOSTON (Reuters) - About two-thirds of cardiac arrest patients taken to hospitals by emergency medical technicians die anyway, and probably most could be declared dead at the scene, according to research published on Wednesday.
The report in the New England Journal of Medicine suggests that certain emergency medical services -- not those staffed by paramedics -- could ease the distress of loved ones and dramatically reduce the number of hopeless but expensive hospital trips.
The assessment of 1,240 cardiac arrest rescue runs over two years in Ontario, Canada, found that only 1 in 500 people survived to be discharged from the hospital if EMTs could not restart the circulation, automatic defibrillators did not shock the heart, and rescue workers were not present when the heart stopped beating effectively.
The University of Toronto team led by Laurie Morrison said new guidelines letting EMTs know when to give up "would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent," a reduction she characterized as "pretty phenomenal."
"These findings suggest that it is possible to identify a subgroup of patients ... in whom resuscitative efforts can be discontinued and the patient pronounced dead in the field," Gordon Ewy of the University of Arizona Health Sciences Center added in an editorial.
But even if the new results are widely adopted, Ewy cautioned, "medical judgment will still be required to determine when enough is enough."
Requiring medical personnel to keep treating cardiac arrest patients in futile situations "limits the availability of EMS personnel to care for other patients, increases patients' waiting times in emergency departments, decreases the available beds and equipment in emergency departments and hospitals, and diverts care from patients who are potentially more likely to survive," the researchers wrote.
In addition, Morrison told Reuters, new guidelines across North America would likely make it easier for loved ones to cope. Having a sudden death pronounced at the scene seems to be more therapeutic than having it done at a hospital.
"When family members observe a resuscitation (attempt that is unsuccessful), they come away with the feeling that everything was done," she said.
"But when you go to an emergency department, the family is put into a room where you don't hear or see anything for 20 or 30 minutes. That horrible 30 minutes is pretty tough on families," Morrison added.
The findings do not apply to victims of cardiac arrest treated by EMTs who are trained in advanced life support techniques, the researchers said.
Nor do they apply to paramedics, who can use various medicines and intubation to try to restart the heart and keep patients alive. Paramedics already have similar standards.
"dramatically reduce the number of hopeless but expensive hospital trips"
"would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent,
==
Instead of advocating BETTER medical care, better trained EMTs, they are avocating less. And they have the gall to say that this is to be considerate for the families: "the family is put into a room where you don't hear or see anything for 20 or 30 minutes. That horrible 30 minutes is pretty tough on families,"" -- much better to let the loved ones die and tell that to the families. (/sarcasm)
It's hard to believe!
PING
Probably when other organs are still good enough to transplant.
Wow, I sure wouldn't want to be the first EMT sued for following new guidelines like this...
"Let the sick die, look how much money we save and how merciful it is for the loved ones" -- latest medical philosophy of the death culture.
Given the current state of Canadian health care, the survival rate would be nearly the same if NONE were transported to the hospital.
It reminds me of something some people I knew told me about medical care in Romania, when it was a communist country.
When they called an ambulance, the first question was how old was the person, and they wouldn't even come out for people over 60 or 65. The communists have no use for old people, they were not producing and all they had to do is pay them a pension.
Sounds like we are headed in the same direction.
Canadia can't afford healthcare of all their citizens, so this is one way of cutting costs. Fine socialist "healthcare for everyone" - that Hillary and John Kerry is promoting for us here.
It's all well and good to be for a culture of life, but the unanswered question in all these situations is who's going to pay for it? I've never gotten a good answer. Not everybody has great insurance, and not every family has the financial resources to pay for it out of their own pocket. So who picks up the tab for this Culture of Life you talk about? The taxpayer? And isn't that socialism?
I'm not trying to get in a big fight over this, just pointing out that at the end of the day, like it or not, it DOES come down to economics. I'd love to be able to give everybody as much care as they could possibly want and then some, but there simply are not enough resources to do that, and it's going to get rationed somehow, whether by the insurance companies, the government, or families who finally decide that they simply can't afford to shell out fifty thousand bucks to keep their hopelessly ill loved one alive for six more months. Call that a culture of Death if you like, but unle
There's a real dichotomy about health care on FR: On threads like this one you'll see people decrying what they see as a Culture of Death in the allocation of medical care. At the very same time you'll see other threads decrying the never ending expansion of entitlements like Medicare. Two sides of the same coin.
It's all well and good to come down on the side of Life, but again I ask, who pays, and who decides who pays? putting forth solutions like Tort Reform won't cut it. That may stand on its own merits, but it would only be a drop in the bucket.
Thanks for the link to the abstract in the NEJM
In a capitalist society, people have insurance and either they or the insurance pays for it. THAT is the purpose of insurance.
In a socialist society or a country like Canada, where medicine is socialistic, the problem is precisely what you point out -- they ration medical care to save cost.
I am not advocating heroic measures to prolong the life of someone who is 97 years old, by a few days or weeks. But would you want some random people make decisions about your life based on cost or their own likely inaccurate assumptions about you? Three is such a thing as common sense -- or should be.
I think there was an old StarTrak episode, where there was a society, where people walked into a disintegrator, when they reached age 60, regardless of their health or use to society.
Canadia can't afford healthcare of all their citizens
-------
Neither can we. Canada uses government to ration health care, we use HMO's--except for people on Medicare, and costs are out of control on that too.
Bottom line, health care DOES get rationed, it's just a matter of whether the bureaucrat making the decision works for a corporation or the government.
This stuff costs money, and I'm still waiting for the Pro Life folks to come up with a plan where everybody gets as much health care as they want without anybody having to pay for it.
For instance, take a hypothetical Terri Schiavo type person, except that this person has no private insurance, or it's long since run out. Who's supposed to pay to keep her alive? Should the family be coerced into bankrupting themselves? Should the government pay? Should churches and charities pick up the tab, and if there isn't enough charity to pick up the slack for this person and all the others like her, what then?
These are the questions that need to be asked, and I'm not seeing them asked here very often, or anywhere else for that matter.
But my point is that insurance companies also decide what they're going to pay for and how much. It's a form of rationing, just different people making the decisions. Maybe it's a more efficient way, I dunno. But you still run up against the problem of too many needs chasing too may dollars. Eventually, something has got to give.
I'd love to stick around and hash this out further, but I have an early day tomorrow.
That should be too many needs chasing to FEW dollars.
(Go Israel, Go! Slap 'Em Down Hezbullies.)
The issue is complicated. My sister is a doctor in Spain. I think she told me once that there are criteria. For instance, for a kid (who are the most likely to survive) they stopped trying resucitation after 30 mins. For an adult I think it was 15 mins. Of course that is going to leave severe brain damage.
I guess in a situation like that the family would never stop trying, but at that moment they don't realize of the consequences. I think there has to be an end.
Now, if you went for so long and finally the person survives with brain damage, then you have to take care of him/her till natural death. I read about a couple whose young son almost drawned. They tried resucitation for 30 mins. The boy survived, but became blind, deaf, lost cognitive ability and could hardly move. After a few years the parents euthanized him. (I think I read that in a FR thread).
That people have to die, is a fact hard to accept. But it has to happen. With all these medical advances, people are kept alive for longer and longer, when a natural death should have happened. I wonder what would happen 40 years from now with millions and millions of old people on respirators and too few younger people to take care for them (in financial, time and emotial terms).
Finding the balance is difficult. It also scares me to death that the decisions about my life are in the hands of undesirable people, who would let me die to have my organs or save money (even though I have insurance) when there's a chance of recovery (even if partial).
I believe what they are trying to do is change the current protocols which essentially mandate that once they start CPR they can't stop until a Dr. pronounces the victim dead.
I've used an AED about six times, had one successful save. There is only a couple minutes available for someone on scene to do anything. Too often no one in the family has a clue of what to do and they all stand around waiting for someone else to show up, wasting the minutes that matter.
A five minute response is blazingly fast, by the time 911 gets the call, the units are dispatched, and they have to drive to the scene. Unfortunately, five minutes will very likely be too late to save the patient if no one on scene starts CPR (even an untrained person doing CPR per the operators instructions is WAY better than no CPR.
If the pupils are blown, (fully dilated with no contraction at all from bright light) ER personnel are usually wasting their time, the brain is gone. The AED will look impressive and make the body jump, you may get a heartbeat back for a while, but recovery is highly unlikely.
If you haven't had First Aid and CPR training, get it now, or you'll be one of the useless family members when some one near and dear to you desperately needs help. The Red Cross will usually come to your club or workplace to train you, ask your employer or bring it up at your next club meeting. Have a plan to do something other than running in circles screaming.
And there's the rub... IF they could be saved. According to the article MOST of the patients had already expired when the ETs arrived but could not be 'pronounced' until they were at the hospital, by law.
Of course we want the best medical care for our loved ones. But I have to ask you, what did we do before ETs were a job choice? What happened is that the relatives and the medical person gathered 'round, there was a low-voiced discussion, some tears, and planning for the funeral began. Just because something is possible does not mean that it is desirable, as you know as you by the way you prefaced your opinion.
As an aside, I have read several times that half of all the money a person spends on health care in his whole life is spend in the last six months...
In the meantime, those resources are not available for other patients who are likely to survive if they receive prompt care. Of all the times I did cpr, I had one patient reach the emergency room alive, and she did not survive to be discharged from the hospital.
While we were treating those patients, we had to hope that no one else got sick or injured at the same time, becuase we were not available to treat them. It's a painful truth that there are only so many ambulances and so many hospital beds.
Also, advanced life support (paramedic) terminates cpr on verbal orders from a physician, or based on standing orders written by a physician. I can say that I'm glad I never had to decide who will get care and who will not.
The subgroup is patients with donor cards in their wallets.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.