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#257269 - 03/06/13 06:57 PM Re: No CPR allowed [Re: Arney]
Lono Offline
Old Hand

Registered: 10/19/06
Posts: 1013
Loc: Pacific NW, USA
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.

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#257270 - 03/06/13 07:19 PM Re: No CPR allowed [Re: MDinana]
haertig Online   content
Pooh-Bah

Registered: 03/13/05
Posts: 2269
Loc: Colorado
Originally Posted By: MDinana
Second, I wonder if she'll be liable for a civil suit by the family, if she did have a duty to act.

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".

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#257272 - 03/06/13 07:23 PM Re: No CPR allowed [Re: haertig]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2196
Loc: Beer&Cheese country
Originally Posted By: haertig
Originally Posted By: MDinana
Second, I wonder if she'll be liable for a civil suit by the family, if she did have a duty to act.

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.

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#257274 - 03/06/13 09:10 PM Re: No CPR allowed [Re: Lono]
AKSAR Offline
Veteran

Registered: 08/31/11
Posts: 1208
Loc: Alaska
Originally Posted By: Lono
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.

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.
_________________________
"Toto, I've a feeling we're not in Kansas any more."
-Dorothy, in The Wizard of Oz

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#257276 - 03/06/13 09:15 PM Re: No CPR allowed [Re: haertig]
AKSAR Offline
Veteran

Registered: 08/31/11
Posts: 1208
Loc: Alaska
Originally Posted By: haertig
Originally Posted By: MDinana
Second, I wonder if she'll be liable for a civil suit by the family, if she did have a duty to act.

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".

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.
_________________________
"Toto, I've a feeling we're not in Kansas any more."
-Dorothy, in The Wizard of Oz

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#257277 - 03/06/13 09:35 PM Re: No CPR allowed [Re: AKSAR]
AKSAR Offline
Veteran

Registered: 08/31/11
Posts: 1208
Loc: Alaska
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
patientís identity is confirmed and the patient is
determined to have a valid DNR order."


Edited by AKSAR (03/06/13 09:35 PM)
_________________________
"Toto, I've a feeling we're not in Kansas any more."
-Dorothy, in The Wizard of Oz

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#257278 - 03/06/13 10:12 PM Re: No CPR allowed [Re: AKSAR]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2196
Loc: Beer&Cheese country
Originally Posted By: AKSAR
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
patientís identity is confirmed and the patient is
determined to have a valid DNR order."

Esentially the same in CA

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#257282 - 03/07/13 06:39 AM Re: No CPR allowed [Re: Arney]
spuds Offline
Old Hand

Registered: 06/24/12
Posts: 822
Loc: SoCal Mtns
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.


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#257287 - 03/07/13 09:39 AM Re: No CPR allowed [Re: Arney]
ireckon Offline
Pooh-Bah

Registered: 04/01/10
Posts: 1629
Loc: Northern California
Follow the money. I saw at least one person allude to it. I didn't read the whole thread.
_________________________
If you're reading this, it's too late.

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#257296 - 03/07/13 05:04 PM Re: No CPR allowed [Re: Lono]
Denis Offline
Addict

Registered: 01/09/09
Posts: 631
Loc: Calgary, AB
Originally Posted By: Lono
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.

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.

Originally Posted By: Lono
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.

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.
_________________________
Victory awaits him who has everything in order ó luck, people call it. Defeat is certain for him who has neglected to take the necessary precautions in time; this is called bad luck. Roald Amundsen

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