I see dead people

This post arose from a discussion I had with a colleague.  I was being singled out, and essentially berated, for terminating resuscitation efforts on an 87 year old man who died while his wife was in church.  His wife agreed, as did the physician on the phone.  I was at the hospital after obtaining the physician's order signature to terminate resuscitation. 

My colleague stated "people aren't dead until they are in a hospital, and a doctor says they are dead."

My colleague is an idiot, and thankfully, does not wear the same patch as I do, and does not serve in a primary caregiver role. 

He is of the thinking that there is "something that they can do" that we can't.  Like open cardiac massage on a 60-something year old patient?  Hardly.  This job is nothing like television makes it out to be.  (Did anyone ever get pooped on during an episode of E.R.?)

Death is the most unavoidable part of life.  From the moment we are born, or from the moment we are conceived, depending on your political leanings, we are destined to die. 

The CDC reported 2,436,652 deaths in 2008.  Only 170,314 of those were attributed to "Accidents (unintentional injuries) Intentional self-harm (suicide) and Assault (Homicide).  We are ten times more likely to die from heart disease or cancer.  Interestingly enough, Blacks have a much higher infant mortality rate, more than twice that of whites. 

EMS responds every day to people not breathing, and without a pulse.  Out-of-hospital cardiac arrest has, for lack of a better term, a terrible prognosis.  On the high end of the prognosis, 8% of patients in prehospital cardiac arrest survive to discharge, while the low end cites a percentage of 2.  The prognosis for in-hospital cardiac arrests are much higher, but still gravely low.  One could argue for the importance of early defibrillation, and the access to healthcare providers in the hospital.  (Even the janitors at my local hospital have CPR certification.)

Patients presenting in the prehospital system with either ventricular fibrillation or pulseless ventricular tachycardia have a 10-15 times greater chance of survival. 

These are statistics from one source, the CDC.  I doubt you would find a prehospital provider that would argue with these statistics, however.  Personally, in my years of experience, I have seen a total of 2 patients who presented initially in ventricular fibrillation survive to hospital discharge, 2 patients who presented in pulseless ventricular tachycardia, and 0 who presented in a pulseless electrical activity (PEA, EMD, Ventricular escape, whatever...) survive past the emergency room.  I could not tell you how many cardiac arrest calls I have run, but I would venture to say it is well over 200, which would be in line with the (admittedly doubtful) Wikipedia article.

Transporting patients without perfusing rhythms is fruitless.  It does nothing but provide false hope for family members, increase the risks of accident enroute to the hospital, and increase the opportunity for injury to a provider in the back of the ambulance. 

As mentioned by a person much smarter than I, "asystole is not a workable rhythm, it is a confirmation of death."

Granted, there are times to perform CPR and transport these patients to a hospital.  The elderly person who collapses at the Sunday buffet is a good example.  It simply wouldn't be prudent to leave a dead body covered by a sheet in front of the salad line.

There are also times in which transport is not warranted.  The person in cardiac arrest, with a patent airway and intravenous access, with no signs of life, and no response to pharmacological intervention should, with family concurrence, have efforts terminated on scene.

Medical directors who insist their medics continue to transport dead people emergency to the closest hospital do nothing to advance this field.  Medics who are not ready to challenge those medical directors are doing nothing for the field either. 

We, as a whole, should stop transporting dead people to the hospital, only for a physician to confirm what we already know.

My colleague is still an idiot.