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Home > Topics > EMS Management
July 28, 2011
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EMS News in Focus
by Arthur Hsieh

Even in death, paperwork rules

By Arthur Hsieh

A Texas man was surprised in 2008 when, after reading his dying father's living will, paramedics halted treatment on the patient. He is now working with the San Antonio Fire Department to improve education and training about DNR requests.

This news story serves as a sober reminder of the legal world in which we practice.

Back in 2008, paramedics stopped resuscitation efforts on an out-of-hospital cardiac arrest after locating what appeared to be a valid "living will."

Unfortunately, the family may not have realized that the patient had expressed his views on resuscitation, and it created conflict on scene and long afterwards.

The crew was cleared on any wrongdoing, and it appears that since then several steps were taken to more formally recognize and implement a do not resuscitate order.

Like most other states, Texas does have processes in place for its EMS providers to follow in DNR situations.

Being only on the receiving end, however, puts us at a disadvantage when family and friends are not advised of the legal ramifications associated with violating what is in fact a physician's order.

It is incumbent upon the primary care providers to work closely with the patient AND the family to make sure all members are clear about what should happen when the end of life process begins.

I recently experienced the loss of a relative who was experiencing terminal cancer. A private individual, he kept the full extent of his illness private until nearly the very end.

Most of the family was oblivious to the seriousness of his condition, until "suddenly" he became very ill and was admitted to an intensive care unit. It was painful to watch family members cope with the grief, anger and fear of having to come to terms with his death during his last days.

There was debate about how aggressive his treatment should be; in the end, ongoing discussions with his primary care provider and an advanced directive were able to help the members of the family who felt conflict in "doing nothing" as he lay dying.

I know that these situations occur regularly. We manage these events carefully and professionally as EMS providers. It's important to recognize that, during these times, others on scene may not be able to fully comprehend what is happening, and part of our job is to help those folks as well.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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