- Jurisdiction
- Pennsylvania
I am a Paramedic with over 30 years experience. I recently experienced an unusual situation for the first time.
I responded to an emergency call for a patient in their 70's who experienced sudden cardiac arrest at home. The patient was in cardiac arrest between 6 and 10 minutes until help arrived and started CPR; which means that some irreversible brain damage had started.
We provided aggressive resuscitation efforts for about 20 minutes; the same treatment that the ER would provide.
However, the patient never regained a pulse.
Our state EMS treatment protocols instruct us that, if the patient hasn't responded to treatment by this time, any further efforts are futile. The protocols discourage transporting these patients to the hospital and prefer that we end treatment in-the-field.
In order to end treatment, EMS providers must contact a Medical Command physician at the ER and obtain approval.
In addition, the patient's spouse told us that the patient "would not want all this done. and would not want to be hooked up to machines" for life support.
After discussing the patient's condition and that further efforts would be futile, I offered to transport to the ER, or, the spouse could refuse further treatment for the patient. I said that, as the spouse, they can make medical decisions since the patient was unable to do so.
The spouse repeated that the patient "would not want all this," and then said "You may stop treatment."
The problem is that the Medical Command physician, after hearing about the futility of the patient's condition, and being told that the spouse instructed us to stop resuscitation, ordered us to transport anyway. This was very unusual and the EMS providers on the scene were stunned.
We deal with people refusing medical care all the time. Medical Command does not have authority to compel a competent adult to accept treatment against their will. We maintain that the same right belongs to the spouse who is refusing care for the incapacitated patient.
Our state protocols instruct us that we must obtain medical command approval to end resuscitation efforts in the field. But, under Refusal of Care, they also say that, if the patient is incapacitated, then we "shall comply" with the decision of another competent person who we believe in good faith to has the authority to consent to, or to refuse care or refuse transport. So, we have two protocols that are in conflict with each other.
Pennsylvania Act 169 states that a spouse may act as a health care representative, by default, if there is no designated agent.
In sum, the EMS providers on this call believe that the Medical Command physician issued an inappropriate, if not an unlawful order, when he disregarded the spouse's instructions to stop treatment. Who do we listen to when the patient and family have rights, but the physician has power?
Our ambulance service is a private company and not affiliated with the hospital where the physician worked, and not a government agency
I responded to an emergency call for a patient in their 70's who experienced sudden cardiac arrest at home. The patient was in cardiac arrest between 6 and 10 minutes until help arrived and started CPR; which means that some irreversible brain damage had started.
We provided aggressive resuscitation efforts for about 20 minutes; the same treatment that the ER would provide.
However, the patient never regained a pulse.
Our state EMS treatment protocols instruct us that, if the patient hasn't responded to treatment by this time, any further efforts are futile. The protocols discourage transporting these patients to the hospital and prefer that we end treatment in-the-field.
In order to end treatment, EMS providers must contact a Medical Command physician at the ER and obtain approval.
In addition, the patient's spouse told us that the patient "would not want all this done. and would not want to be hooked up to machines" for life support.
After discussing the patient's condition and that further efforts would be futile, I offered to transport to the ER, or, the spouse could refuse further treatment for the patient. I said that, as the spouse, they can make medical decisions since the patient was unable to do so.
The spouse repeated that the patient "would not want all this," and then said "You may stop treatment."
The problem is that the Medical Command physician, after hearing about the futility of the patient's condition, and being told that the spouse instructed us to stop resuscitation, ordered us to transport anyway. This was very unusual and the EMS providers on the scene were stunned.
We deal with people refusing medical care all the time. Medical Command does not have authority to compel a competent adult to accept treatment against their will. We maintain that the same right belongs to the spouse who is refusing care for the incapacitated patient.
Our state protocols instruct us that we must obtain medical command approval to end resuscitation efforts in the field. But, under Refusal of Care, they also say that, if the patient is incapacitated, then we "shall comply" with the decision of another competent person who we believe in good faith to has the authority to consent to, or to refuse care or refuse transport. So, we have two protocols that are in conflict with each other.
Pennsylvania Act 169 states that a spouse may act as a health care representative, by default, if there is no designated agent.
In sum, the EMS providers on this call believe that the Medical Command physician issued an inappropriate, if not an unlawful order, when he disregarded the spouse's instructions to stop treatment. Who do we listen to when the patient and family have rights, but the physician has power?
Our ambulance service is a private company and not affiliated with the hospital where the physician worked, and not a government agency
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