I assume most of us have already heard the news story over the weekend of the 87-year old woman who collapsed at an "independent living facility" and the 911 dispatcher pleaded with the nurse (LVN? RN?) to do CPR but per company policy, she refused. A DNR was not the issue. Just a no-CPR, let EMS respond to any medical situations policy.

From a common sense perspective, it sounds outrageous. But I didn't really want to scream and shout about that aspect of the story, otherwise I would've posted this in the Campfire.

I was wondering if there are other situations out there where a no CPR policy like this exists? My mom is getting up in years and eventually may end up in a situation like this. I just wanted to find out about other situations like this.

Apparently, the residents at this facility are all told of this policy up front when they sign up. But what about guests? Are there other places we go where we definitely will NOT be getting CPR or maybe even basic first aid per company policy? I'd just like be aware of this in places I or my mom frequent.

Tough situation. My 92 year old MIL is in an independent living facility, and she has a DNR already. I can also understand the policy too -with nearby FD / EMTs to assist and assess I would prefer their response to my 87 year old mother. CPR on the aged can be wicked brutal. Not how I want to go, frankly. Tough call Arney. My perspective on life saving measures changed once I passed 50 and watched parents and friend age and die in different circumstances. I saw my dad die in assisted living, and I'm watching my wife go very slowly of brain cancer. So I can envision this policy, but can't tell you if its the right one. Possibly start with a deep breath, and the old adage, judge not lest ye be judged.

I'm not necessarily saying it is a bad policy. But I'm saying that we should be aware if such a policy exists because it runs counter to what a normal person would expect. I'm still middle aged and still have (knock on wood) many, many years ahead of me, but heaven forbid, if I went into cardiac arrest visiting someone at such a facility and was falsely comforted thinking that there are nurses around, that would be a bad situation because of some blanket policy. At least at McDonald's, I have a chance that a concientious employee or employees will do CPR and hook me up to an AED in case EMS is delayed.

Death is a part of everyone's life but we in the US are terrible about talking about it. Technology and science has gotten way ahead of our ability to deal with death. DNR's, assisted suicide, palliative care, etc. are all important subjets to talk about, but these topics too often get turned into political hand grenades to score election points, unfortunately, and no one really takes the time to actually listen to other viewpoints.

And the consequences of doing CPR on a frail, osteoperotic 87-year old woman is certainly something I sympathize with, DNR or no DNR. But this policy, apparently would also apply to me or my very healthy 67-year mother, too, even if we happened to be visiting and something happened. Just saying we should know when such policies are in place.

I'm sorry to hear about your wife, Lono. That's a tough thing to have to go through.

The thing is that you need a policy on this kind of stuff.

Logically, it makes sense for an assisted living facility not to provide medical care to its residents as they are not licensed to do so.

As I understand it, they will pickup your drugs at the drug store for you but they are not allowed to take them out of the bottle for you as that would be considered dispensing.

It is one thing to have a clear policy of "We are not a hospital or emergency room and are not required to provide any emergency medical care." so that people don't have false expectations. However, this company's policy, or its interpetation, has gone to the extreem.

In an excerpt from the 911 tape, the desperate dispatcher pleads with the nurse to hand the phone to a passerby. The nurse flaty refuses. To the OP's point, one must wonder that if a good samaritan tried to help, would the nurse have interpeted the policy to mean she must prevent him from doing so?

Would a security guard at a shopping mall with a similar policy, for instance, hinder a passerby who tried to help?

Keep in mind that an independent living facility provides zero medical care as its services- most often it offers a living space for a monthly rent, until you move and/or die. Folks I am familiar with in that situation pray to someday *die* there rather than face the relative unknown of assisted living or a nursing facility, where you can receive CPR, if you want it.

The most typical FD response at my MIL's place is a lift after a fall, happens almost daily. The facility is among the most humane places for the elderly I am familiar with, but no way are they going to assess and lift a person on their premises. I don't mean to load the discussion with the L word, but there are plenty of residents and families of residents who are too quick to hold any facility liable for a bad assessment of their parent, or for pain and suffering afterwards. Risk managers will tell you that there are words for facilities that go beyond policy for their residents, and those are 'out of business.' I suspect the same level of care calculus extends to life saving measures, but I have no specific experience with that.

Is this perhaps a liability issue? If the nurse had performed CPR or enlisted a third party to perform CPR, would a liability issue arise?

A nursing home is licensed to provide medical care. An assisted living facility is not. It is that simple.

I don't know why the "nurse" on the phone refused to give the phone to a bystander. We are kind of assuming it was a real nurse, but for all we know it might well have been the receptionist or the bus driver that called. Why would an assisted living place have a nurse anyway? Most that I am aware of don't.

naval officers have a responsibility under both law and naval regulations to take care of those they are in charge of. An assisted living facility is generally banned from providing any medical care to its residents.

Update: She was the "resident services director"

All kinds of businesses and facilities have AEDs and even a team of employees designated to provide first aid and none of them are "licensed to provide medical care".

It appears like a peculiar policy when viewed from a distance without knowing the specifics.

Businesses are often required by OSHA to have first aid trained employees available.

Apparently the nurse was following the policy of the I-L facility which employed her. While I don't much like the policy of that facility, she did what some people find themselves having to do. I worked at a hospital in Texas which did not allow Respiratory Therapists (of which I'm one) to intubate patients during resuscitation. Only Physicians could do that. An R.T. who worked there till just before I got there intubated a patient after waiting what seemed to him to be an excessive time for a Physician to respond. He was fired that day. I'm pretty sure this policy was due to Liability issues, so I'll say no more.

Relevant passage:



http://www.google.com/hostednews/ap/arti...331bef3b47ab87f

It seems unlikely that a dispatcher has any legal authority to accept whatever liability there might be. Still referring to the caller as a "nurse".

I don't know the law, but maybe the dispatcher doesn't need any authority. Perhaps the rule is that once the 911 call has been placed, 911 is liable for any instruction or action performed as a consequence. But then again, I'm no lawyer, and I'm just guessing.

So, I assume that no one has heard of any other situations with a similar policy that we need to be aware of? Maybe it's just limited to facilities that cater to the very old and infirm?

I mean, anyone heard of a gym with a no CPR policy? Or perhaps a swimming pool with a lifeguard who is not allowed to do CPR but has to call EMS instead? How about a private school? Are there privately employed elementary school teachers who are prohibited from performing CPR on students?

Sorry, I know I may be sounding almost flippant with my examples, but in all seriousness, I'm curious if there are other situations like this to be aware of.

I am not an attorney and I don't play one on the Internet. Nothing I write is ever legal advice.

My understanding is that in most, if not all, US States, medical professionals have a duty to provide care if they witness someone in life-threatening medical distress. If it was in fact a nurse and the nurse didn't provide CPR when it was called for, the nurse could easily lose his or her license.

In many US States there is a Good Samaritan Law that immunizes you against liability if you act within the scope of your training to help someone who might otherwise die. If you're certified for CPR or following the 911 dispatcher's directions, you cannot be held liable for performing CPR in those states.

I would never knowingly step foot in a facility that had a "no CPR" policy.

They can have whatever policies they like,you can choose to use their business or not.

Thats my take.

Ive worked in hospitals that do not,will not or cannot treat a patient across the street from the Hosp.,they have to be brought in by either EMS or somebody,but they cannot go outside the facility property to render care by the staff on duty.Never seen a policy in a Hosp in this state to the contrary,but there may be exceptions,ie,disaster and emergency triage situations where that policy might change,I dont know about that or exactly what the policy in that situation is.

Are you required to provide free tax services,or meat cutting for those 'in need' because you work in a field?

Big difference between assisted living and a Nursing home.

Are you suggesting that you would charge someone a fee before doing CPR?

An excellent example of 'learned corporate morality helplessness'

I failed my Corporate Health and Safety Policy, which consisted on how to sit in a chair and the learned helplessness when arriving and leaving the corporate building/facility or otherwise known as 'how to aid the criminal perpetrator, so as to become a mugging/assault victim'

Must of been 'London' way of thinking!

I don't think "learned helplessness" applies here. This seems more an example of willful refusal to help.

Up until recently I was a First Responder at the facility where I work. Four months ago they not only cancelled the on-site First Responder program but actually changed company policy to FORBID one employee from helping another injured employee. We can't even go get someone else a bandaid. Management decided that the local EMS response time has averaged about 5 minutes, so that's plenty of time for them to show up and take care of any problem. If one employee were to help another then the company was afraid they (the company) could somehow get in trouble.


-Blast

IM suggesting that if professional services come free,why does that not apply to all workers across the board,oh wait,not only does it not,nobody is suggesting it should.

And if Im out and I see a circumstance,in MY 'professional' judgment I WILL make an instant determination if I think CPR is warranted or not,Im NOT a slave to the state.

Now where do I sign up for free taxi service....oh yeah,only medical persons need apply? Its not my job to FORCE me into providing service,is it yours?

Has zero to do with compassion,I have plenty as do most health care providers,I dont buy I HAVE to do it,why not you????

I dont think most 87 year olds do too well with CPR either.IMO there IS a time to die,as well as be born,maybe we should let God decide at a certain point.

Too much fear of death,get over it,it comes to us all,seems to me she was being taken out peacefully and as God intended after a long lived life,there is a time NOT to interfere too.

Or we can crush her ribs,maybe revive her with brain damage and a punctured lung or 2 and a month or 2 on a ventilator to rot away with multi system failures and a lingering painful exit,that happens too.A LOT of times end of life is often ugly and painful.

We should all go out as peacefully and easily as she did.

Five minutes without CPR can easily be the difference between life and death. Ditto for the Heimlich maneuver and other types of aid for choking victims. This policy is not one that I would be willing to obey if someone's life was at stake. I'd also wonder if it would end up being the difference causing me to die if I needed CPR or aid for choking.

Yeah, I tried to explain how 4 minutes without air can leave a person a vegetable, but they didn't care. As far as I'm concerned, if I find someone needing help I'll probably give them help.
-Blast

We're not talking about some young stud in a gym - we're talking an 87 y/o who is infirm enough to require assisted living.


I vaguely recall lifeguards having been fired in the past for rescues not permitted by employer policy. I'll have to do some web searches to find those.

PS. Here's one


Unfortunately case law often limits who may claim the Good Samaritan shield. There was an uproar in California a few years back when the courts excluded medical professionals from the shield. I would not be shocked if assisted living facilities were excluded in some states, even if they were required by law to provide no medical services. Or worse, might be excluded in the future even if it hasn't happened yet.

Don't assume the policy was made by someone with good knowledge of the law. A company executive may will have read newspaper articles of crazy-quilt case law rulings on the Good Samaritan shield and thrown up their hands at the mess, and decided "no" was the only safe course.

The home needs a new policy but the legislature may also need to act to remove ambiguities from statute or especially case law.

Ive only done the Heimlich one time and it works like a charm,but get this,it was on a Shih Tzu (no political comments please on if Shih Tzus worth saving,LOL!)

Anyhow,dogs airway totally occluded (Tried finger sweep,mouth tiny and too far in,couldnt see anything,he is passing out) and he was going out FAST. I put my fists clamped under his belly and forcefully jerked up,pulling him off floor.About the 5th time that meat plug popped out at at a remarkably fast speed.

Amazing! That is one awesome rescue technique!

Mrs was astounded I did that,I was astounded that training made a cross reference and I acted fast without really conscious thought of species effectiveness transfer (maybe I read about it somewhere?),just the pathways in brain connected and the action happened.

Lot to be said for training and RE-training.

People shouldn't be required to help. But that said, this appears to be some kind of
blanket decisions to not allow help, which would be an example of corporate
selfishness of the worst kind.

"At Merrill Gardens, which operates 24 independent, assisted and memory-care facilities in Washington, all the workers — even the dining-room staff — are required to get CPR training, said Wendy Gardner, vice president of quality services for the company, which operates 56 communities in nine states."

"While each state’s nursing board has its own standards of practice, McFeely said he believed such a refusal to act could put the nurse’s license in jeopardy."

http://seattletimes.com/html/localnews/2020485613_cprrulesxml.html

So many 'sources' quoting pure smack (McFeely) in my opinion,like that McFeely,sounds like pure nonsense to me promoting his facility on the back of a womens death.

Ive never seen anywhere here that a Calif nurse is required by LAW under our licensing to do CPR when not acting in a professional manner and on the clock to provide said care as legally required for the entity they are working in,a LICENSED MEDICAL facility/entity which assisted living is not,per regulations.

If the nurse was paid by assisted living to provide MEDICAL care,which I doubt is legal under terms of that facilities license,Ive never heard about it.Seems to me that Nurse would be facing all kinds of liabilities a lay person wouldnt be under the Good Samaritan law.

Again,comparing apples to oranges,2 different facilities entirely,assisted living and a nursing home.

Show me anywhere in the Calif Nursing Board regs that a RN MUST provide CPR outside company policy or in any sort of setting not licensed to provide medical care.Or that failure to do so is a licensure revokable offense,in VIOLATION of employer policy no less!

I can fully understand why a company would not want to expose themselves to liability providing medical care under their auspices they arent licensed to provide when EMS exists to legally provide such care.

Thats my OPINION only as a LICENSED RN Im not a lawyer and as all facts arent in but the hysteria.

I can understand why a facility that is specifically prohibited by law from providing medical care would decide to obey the law.

Yeah, I can see how California's exemption of medical professionals from the "Good Samaritan" laws may have had an influence in this case. If a nurse acts at all she is acting as a professional and not as a "Good Samaritan". I wonder how the assistance of a third-party at the request of the nurse would be considered by a court? Probably as an agent of the medical professional an so the medical professional is still on the hook.

I'd look to Sacramento and the CA courts if I was looking to assign blame in this case. They painted the staff into a corner where the only acceptable response is to do nothing.

It will be interesting to see how this all shakes out. What is needed is more facts, including the official "policy," if it actually exists. We are all reacting to the nurses perception of that policy, after all.

It is worth bearing in mind that had CPR been administered, the chances are that the lady would have expired, anyway. Under ideal circumstances, the recovery rate is around 30% or thereabouts. Usually the time lapse before initiation of CPR is quite critical. As long as the responder adheres to their training protocols, it is hard to see where negligence could be invoked.

Not too long ago, I worked in the local County Assessor's Office and volunteered to respond to any medical emergencies that occurred in our office, which included a large number of citizens seeking information concerning the assessments of their property. I trained on company time for CPR. It is a much better policy to keep taxpayers alive. After all, dead bodies in the hallways constitute a tripping hazard....

I thought we had since learned the caller was not a "nurse"?

It really does not make much difference. CPR only rarely does any good. If they wanted to do any good they should buy an AED.

Ultimately, the woman involved in this main stream media story could have performed CPR on the elderly resident against her employers policy. After showing some display of humanity, she could then have discussed her employment contract with the corporate human resources manager, even if it was for her own future and current mental health state to protect herself against the effects of her employers corporate morality learned helplessness.

She was not employed as a nurse at the facility, but the caller identifies herself on the 911 call as a nurse. When asked, no confirmation from the company spokesman about her licensure type or status, if that makes any difference.

Ultimately all of us need a job unless we are independently wealthy. Someone who clearly understood their employer's requirements did as she agreed to do when she was hired. The time to object to the employer's rules was long before this incident. It is OK to not like the rules you are employed under, but you do not get to break them w/o consequence once you accept employment. If one does not like the rules one is employed under, it is NOT acceptable IMO to decide that when the time comes one will do as one pleases. If you don't like the rules, don't accept the man's money.

No good deed goes unpunished.BTDT,never again.When youve stuck your neck out as per the law,only to have your head chopped off,I understand fully this situation.

Doesnt matter how right you are in the eyes of the Law,can you afford to defend yourself and at what cost? Loss of income,job,career or families security? May not be right,and it isnt,but its reality.

I found out,learned a lesson.Do not involve myself in legal medical matters at all,thats just how the World operates.

Very appropriate topic,survival is certainly an issue here.Yours and your families.

the lady who died was 87 years old.
that's pretty good, isn't it?
I'd certainly be very happy if I made it to 87 and had pretty good health over most of that lifespan.

point being ... when it's your time - it's your time.

Pete2

To the best of my recollection, a quote from one of my Advances Cardiac Life Support (ACLS) Classes.

“Sometimes the last beat of the heart, should be the last beat of the heart.”

Pete

No doubt the "stupid corporate policy" was in response to some "stupid state law". I kid you not. This was obviously a bad and inhumane policy, but it probably didn't come out of nowhere with no reason.

In the assisted care facility where my aunt-in-law lived until recently, they were required by law to "not restrain residents in any way". This included not giving them a pillow to hold on to and play with while sitting in their wheelchairs (Alzheimers facility). A pillow in the lap was considered "restraint" per state law. My aunt was unable to get around without a wheelchair, but due to Alzheimers, didn't realize it. One day when she attempted to stand up due to not being restrained, she fell and broke her hip. Thank God to the politicians for making sure she wasn't restrained even with a standard wheelchair seatbelt. After surgery, rehab and all that, once she was back at the facility - it was back to the no restraint thing, even with a recently repaired broken hip. She of course tried to get up again and again, and fell again and again, and was shipped off to the ER again and again - but at least she wasn't restrained! Finally, it got to be too much for her and she died. At least she wasn't restrained! Thank goodness for stupid politicians and the stupid laws they make, which translate into stupid corporate policies. I can understand why a corporation would make stupid policies - they don't want to have their license to operate yanked for violating some idiot politicians rule.

It may sound bad for a facility to allow an 87 to die needlessly (we'll assume that was the case - don't really know if she was viable in the first place). But what if they had provided CPR, only to have the state yank their license to operate for violating some law regarding medical care, and then putting dozens or hundreds of other residents of the facility out on the street due to the closure? It's bad all the way around. But I'll be willing to bet the idiotic corporate policy was in response to some idiotic state law.

Well I hope the company gets taken to court so there is a legal precedent set for
it and other facilities.

You guys have helped me on the option of getting long-term care insurance. I'm now DUBIOUS. Does anybody think this is possibly going to get better ... as a wave of Baby Boomers heads for these establishments over the next two decades???

I'm thinking the North American Indians got it about right.
When it's time to go ... walk off into the snow.

Pete2

my dad was in a nursing home. they are not allowed to restrain either.

the response was to lower the beds and put mattresses on either side of the beds so when the patients fell out they they didn't really fall because they were already on the floor.

just about every resident had the string to an alert device clipped to their clothing that would buzz if they moved out of their chair or bed. not technically a restraint I guess.

Up till now, the company has been defending the caller for following company policy. But I just read a new statement by the company saying that "This incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents."

I mention this new statement because I suppose it's reassuring if it means that this surprising situation is not solely a reflection of an overly extreme company policy. (Of course, corporate could also be throwing the caller under the bus by re-interpreting their policy after the fact, but it's hard to tell without more info.)

And the woman's family has said they knew the policy and have accepted what happened and not seeking any civil or criminal legal action. Of course, the attention this sad event has gotten can't be easy on them.

Should a first responder be making decisions like this on the scene of an emergency situation? -" How old are you? 87! That great. You've probably lived long enough...sorry, no CPR today!"

Where do you start drawing the line in an emergency situation? What about a 76 year old in "pretty good health"? or a 65 year old? What about a 45 year old in poor health? et cetera.....

Buzz? Buzz?! You call that a "buzz"???!!! More like a 140dB siren. Deafening. It would startle all the others, who would then try to get up out of their own wheelchairs to escape, setting off their individual sirens too. Pure hell, I tell you!

I stopped on page 1, and haven't seen updates, but here's my take.

I worked as an EMT in CA for 7 years. 3 of those were with a company that did mainly transfers between hospitals, nursing facilities and associated health care places (PT, dialysis, etc).

First, if this lady was a nurse, in any capacity, then she's probably going to lose her license. She does have a legal duty to act, which means perform CPR, unless the patient had a DNR. Which in CA is very specific - a living will doesn't hold weight. There is a state-approved form that needs to be signed.

Second, I wonder if she'll be liable for a civil suit by the family, if she did have a duty to act.

Third, EMS "authority" varies by jurisdiction. Some places allow 911 to talk people through procedures, but this opens them to liability. So it's possible that the dispatcher was correct when they said that this lady wouldn't be liable.

And in CA, assisted living facilities typically are glorified apartments. You get help with cooking, sometimes medications (ie, dispensing), help arranging appointments and to/from doctor visits and what not. There's no actual CARE given regarding medical stuff. Skilled nursing facilities are the "nursing home" that most people visualize ... which in some parts of CA, is not much.

I completely agree, you provide the help you can in an emergency situation and then let the medical professionals make the big decisions.

One thing I find missing from this discussion is the differentiation between first aid and medial care. Simpy put, first aid is something that can be provided by anyone as a stop-gap measure in emergency situations. This situation clearly falls into the realm of first aid; the nurse on the phone wasn't being asked to do anything more than the average Joe on the street would be asked. She wasn't being asked to provide medical care.

A policy against providing medical care makes sense, banning first aid does not.

What if the woman slipped, resulting in a severe cut rather than having a heart attack? Had the caller stood there and allowed her to bleed out would those defending her view this any differently?

You make an excellent point. Paradoxically, this victim would have been better off out on the street than in her facility - Not that everyone passing by would been willing or able to render first aid, but usually some one steps up.

That's a good point, Denis, but legally or in terms of the wording of the actual company policy, I don't know if there is a clear distinction between the two.

This incident took place in California and I was looking at the California "Good Samartian" law and it mentions "medical care" but not "first aid". I agree with what you're saying, but I don't know if this commonsense distinction is clearly spelled out.

The company is now saying that the caller misunderstood the company policy, but the wording of the policy is probably just as vague about any distinction between first aid and "medical care". Especially when the caller is a nurse and an employee of the victim's housing facility (although not employed as a nurse), I can see where there can be some confusion.

First responders always respond to medical emergencies - that's the point. The independent living facility apparently - despite their subsequent denials - didn't want to be put in the position of a first responder to cardiac arrest. I would be confident that the same facility would respond to a fall, or a fall resulting in a severe cut, differently than the decision to perform CPR. This woman had her heart attack in the dining area, and a similar fall resulting in pain to her hip or bleeding to her head would get approximately the same medical treatment - call 911, otherwise keep the patient immobile until arrival. Apply pressure to the cut to reduce bleeding, but otherwise do not administer first aid. You have EMTs 7 minutes away. You would be nuts to move a woman with a broken or dislocated hip, or to begin to apply dressings to a head lac, which just have to be ripped off when the EMTs arrive on scene.

It sounds very much like the woman's family was aware of her wishes to die naturally; however, a 911 operator can't assume that, or accept it from a facility director, or even from a member of family. It seems as though some who are responsible for the care of the elderly are arguing for any 911 operator to make a call about resuscitation of the elderly - again, she fell in the dining area, away from her room or apartment. What if she had a DNR, could the facility produce it in time to ward off the EMTs, or the appeals of the 911 operator for kitchen staff to begin CPR? In my MIL's facility DNRs are posted just inside the front door of their residence, shared with management, and I believe they are also proactively shared with the local FD who respond to the facility (they keep them in a binder). But they aren't shared with 911 operators obviously. I think its up to families and people themselves to sort out whether to DNR or not to DNR - a decision once made that makes the care considerations crystal clear, provided everyone nearby knows about the written DNR and can produce it quickly enough. If you find yourself living in a facility, they should be able to advise you on this too.

Before dementia really took hold, my Dad joked about having DNR tattooed across his chest so that anyone ripping open his shirt to start compressions would be faced with that, luckily for us that never came up. Dad died naturally too, and despite very labored breathing near the end, he was never intubated or had any meds to prolong his life beyond what could be expected to make him comfortable. And even that was a very hard decision that split my family in the last 24 hours of his life - whether to transport him to an ER and prolong his life (or suffering). We all respond differently to this for very natural reasons. And the more I mention this, I recognize that almost everyone has a similar story along the same lines that informs their views on dealing with death. There's probably no one response to it all.

In todays paper, an article said the family stated she was in that facility because she wanted to die with dignity, without all the "medical care".

Great. Good on them for sticking to their guns. Someday I hope to go the same way. I too have joked about the DNR tattoo on my chest. I've also told my wife to just roll me out of the car as she's driving through Yosemite, and let me just turn into bear droppings. Anything to avoid a nursing home.

Unfortunately, having "DNR" tattooed on the chest probably wouldn't be sufficient. When I did EMT training, we were taught that unless we had an actual hard copy DNR in our hands, we should always attempt to resuscitate. Even if there was a family member there telling us there was a DNR, we should still resuscitate unless they handed us a hard copy DNR. The reason is that sometimes one son or daughter thinks it's time for dad/mom to go. But another son/daughter who is not present will think otherwise. If the EMT does not attempt to resuscitate (even if told not to by a family member) and it turns out later that there is not a formal legal DNR, that EMT could be sued by another family member.

That is fine if that is their wish. However, they could have avoided a lot of controversy for a lot of people if they had also made the effort to get a formal DNR ("Do Not Resuscitate") order. In most jurisdictions, Dispatchers, EMTs and Paramedics are obligated to try to resuscitate if they don't see a formal, legal, hardcopy DNR.

The details of exactly how DNR works will depend on the State. In Alaska it is called "Comfort One" and you enrole through your physician. Here is how it works in my state:

The Alaska Comfort One Program: Information for Health Care Providers

Note that it states explicitly:

"The protocol (contained in state regulations)
requires that the physician or other health care
provider (EMT, Paramedic, etc.) immediately
proceed with patient assessment and care,
including administration of CPR, until the
patient’s identity is confirmed and the patient is
determined to have a valid DNR order."

Esentially the same in CA

Getting closer to the truth,now that the sensationalism has died down a bit and Facts starting to emerge.....

Read more: http://www.foxnews.com/us/2013/03/05/spo...d#ixzz2MphdS112

The family of an 87-year-old woman who died after an employee denied to give her CPR at a California independent living home says she chose to live in a facility without medical staff and wanted to pass away without life-prolonging intervention.....


The California Board of Registered Nursing is concerned that the woman who spoke to the 911 dispatcher did not even respond to requests to find someone who might want to help.

"If she's not engaged in the practice of nursing, there's no obligation (to help)," agency spokesman Russ Heimerich said.
===================================

http://www.cnn.com/2013/03/06/us/california-cpr-death/index.html

(CNN) -- No charges will be filed in the case of a California woman who died after a worker at an elderly living facility refused to give CPR when requested by a 911 operator, the Bakersfield Police Department said Wednesday.

Investigators determined no laws were broken, police said in a press release.

Follow the money. I saw at least one person allude to it. I didn't read the whole thread.

Given the available evidence, I'm unable to have your level of confidence in the staff. Also, given the staff are not medical practitioners they are not in a position to diagnose why the woman was in distress, whether it was due to natural or other causes. Heart failure isn't the only reason one could collapse & not be breathing; she could have choked on some food & collapsed and without someone noticing, for example.


No one is suggesting the staff should have done anything more than simple first aid. As far as I am concerned, CPR for an non-breathing victim is the equivalent to RED for a deadly bleed. These are emergency techniques applied by non-medical people while awaiting for medical help.

NPR published an article which may be of interest to you:

http://www.pbs.org/newshour/rundown/2013/03/when-cpr-for-the-elderly-becomes-morally-gray.html

The while article is probably worth reading for those of you who are really into the issue. But a few paragraphs caught my eye --

The person on the other end of the phone was a trained nurse, but her job in the facility was administrative, not nursing:



The coordinator is now on voluntary leave while the company figures out what to do.

As for the legal issue:



However, the article points out that the company could still be sued, even if the individual couldn't be.

Finally, the victim in question had a stroke, not a cardiac arrest. So the CPR might not have helped.

Huh? Are you implying this person still had a heartbeat? You don't do CPR on someone who has a beating heart. What caused a cardiac arrest - be that stroke, myocardial infarction, drugs, loss of blood volume, whatever - doesn't matter. You still do CPR. True, some causes of cardiac arrest are less survivable than other causes, but that doesn't mean you withhold CPR. For example, cardiac arrest due to trauma is only rarely surviveable, but first responders shouldn't be making a judgement call on that in the field.

From the NPR article: "The scene is now familiar to many: Lorraine Bayless, 87, was barely breathing at Glenwood Gardens independent living facility in Bakersfield, Calif." It looks like CPR would indeed have been inappropriate.

In any case, when you administer CPR, there are only seconds left in the fourth quarter, and you are throwing a hail Mary. Your victim is probably going to die, unless they are dead already. That has been my experience in the two real world situations where I have given CPR.

My CERT trainer, a highly experienced fire captain, said that of the 300 or so CPR situations in which he was involved, only seven were significant saves (the victim walked out of the hospital.

Speaking of which, my CERT training is that in a mass casualty situation (multiple victims), administration of CPR is not contemplated. You essentially separate the quick and the dead, treating massive bleeding and similar cases rather than devote disproportionate resources to those not breathing. It was a bit of a shock to me to confront this strategy, but it does make sense. i hope I never have to follow it.

That's a pretty good ratio. One of my instructors (former law enforcement now EMT) did CPR for ten with two saves, but that's very unusual. Another instructor (former military corpsman, former Paramedic, now law enforcement) said that he'd had one save out of over one hundred attempts.



That's part of the CERT standard nationwide. Our mission is to do the greatest good for the greatest number. The idea is that we'll save more people if we don't invest all the manpower and effort in one or two. As you said, this only applies during a mass casualty event.

Current CPR training de-emphasizes pulse checks. It can be difficult under stress to find a pulse, even when present. The current training for lay-persons is that you look for other signs of life, such as movement or breathing. If the person is not breathing, or is only gasping occaisionaly ("agonal respirations") you still start CPR. People with BLS CPR training, which a nurse would have had, still do pulse checks, but even there pulse checks are de-emphasized.

CPR only buys you (a little) time. Early use of an AED is what saves lives. Even then, as others have observed, the success rate is rather low.