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Every time EMS transports a patient to the hospital, there’s a risk of a crash, which is bad for the patient, the driver, other drivers, and (especially) the (generally unbelted) attendant in back.  I don’t know about you, but I’d be particularly angry if this happened while I was transporting someone who had no chance of living anyway.  (In fact, I might even be quite angry just to risk my back carrying such a person down a bunch of stairs.)

This is why it’s interesting that some medics appear to ignore protocols that allow them to terminate resuscitations in the field–according to one study, more than half of patients eligible for stoppage of efforts were ultimately transported (and all of the 131 patients died).  While there might be dozens of possible reasons for this, the authors note that “[i]n no case was a mitigating reason documented to justify transporting” any patient meeting criteria.

There might be a good reason or two to transport in some of these futile cases:  after all, you don’t really want to call the code when you’re working someone in public, do you?  But by the same token, we’re really doing a disservice to a lot of people every time we do so:  to ourselves (the risks of driving, generally in emergency mode no less), to the public (again, emergency-mode driving), to the patient (at least when they collapse at home, since most of them would rather die there), and to the patient’s family (by prolonging a hope that isn’t really founded).

The biggest disadvantage?  Paramedic training has not yet caught up with practice, and there just isn’t enough time to teach how to give bad news.  Maybe, as the training becomes longer (and becomes true education), this will sneak its way in there.

Conclusion:  Let these poor people finish dying at home, if that’s where they started.

Filed under: EMS Research