I’ve been receiving some emails from readers who would like to know what happened with the 91 year old female (DNR patient) who went into PEA as she was loaded into the ambulance.
Here is the 12-lead ECG that was captured just as she went into cardiac arrest.
Here’s another that you haven’t seen.
She died. The paramedics did not interfere.
I posted the case because as long as I’ve been a paramedic, I’ve never had to deal with this situation.
It would be very difficult for me (and I suspect most paramedics) to stand by and do nothing while someone dies, even though we can rationalize that it respects the patient’s wishes.
When I discussed this case with my girlfriend (an advanced practice nurse) it became clear to me that DNRs are not always cut and dry.
We’ve all heard the saying “DNR does not mean Do Not Treat.”
But what does it mean? Exactly?
Does it mean we treat conditions that might be reversible?
What is a “heroic” measure?
I was discussing end of life wishes with my parents several years ago (a very difficult thing to do) and neither one wanted to be on life support.
But when I changed the question to something like, “What if you were only life support for a few days and then recovered?” or “What if you were on life support just long enough to see whether or not you would recover?” the response changed to “That sounds reasonable.”
DNRs, by their very nature, simplify things that are complicated.
The subject of DNRs warrants a lot more discussion than paramedic students are getting in school.
It warrants more discussion with the people who sign DNRs, too.
Before I receive any hate mail, I am not suggesting that the paramedics did anything wrong in this case, and I am not suggesting that this woman’s ribs should have been crushed.
I’m saying that the paramedic curriculum should spend more time on health care ethics.
I’m also suggesting that EMS protocols that say “DNR patients don’t go on the monitor” might be problematic because the ECG can be helpful in diagnosing a lot of reversible conditions.
There are shades of gray in the field of ethics and I’ve noticed that paramedics often demonstrate an intolerance of ambiguity.
As Einstein said, “Things should be made as simple as possible — but not simpler.”