futile resuscitation attempts

[Timothy J Coats (SURG) 7728]

I think that the handling of relatives at an incident scene is a very 
real problem in the pre-hospital phase, when it is decided that 
further treatment is futile. In London it is our usual practise to 
continue a 'resuscitation attempt' and transport the patient in 
circumstances where the pre-hospital team feel that it would be 
better to handle the relatives in the more controlled situation of an 
emergency department.

BUT it is important that all those involved (pre-hospital providers and 
the receiving hospital trauma team) understand why the patient is 
being 'resuscitated' to prevent misunderstanding and anxiety (and to 
give the victim some dignity in death). This requires good 
communication and a good understanding of the pre-hospital 
situation by the hospital teams.

Tim.



> Dear Dr. Ursic
>  Caracas is a violent city, in the laters years there are around 40 to
>  50 violent deaths every week-end. We have in some hospital the
>  police, in some others the national guard and in others just the
>  security personel. Never the less with the police in, I had a couple
>  of self defence hand fights (the people is taken to jail afterwards),
>  once  I was assaulted once by hand gun and I have taken out around 5
>  drunken family members lifted up by hands out of the emergency ( in
>  most cases after they had hitted a female collegue).
> The hospitals here have guarded entrances but once the patient and
> family  is in you can spect anything to happen. In one moment you can
> be physically assaulted, so would it be improper to do a minimun of
> resucitation,  meanwhile some security comes in and, in the street
> what would you recomend if the paramedics (facing a similar situation)
> arrives before the police as is usual?. Finally. I have around 12
> years working in ER (since I was a student) and I still consider these
> "incidents", not the normal part of my dayly work, but they happends
> once in a while. Regards Manuel Sotelo M.D. PS: May be this killing
> will end with the advice of a former N.Y. city mayor that=B4s in town
> now.  ----- Original Message ----- From: cursic To:
> trauma-list@trauma.org Sent: Saturday, September 16, 2000 11:34 AM
> Subject: Re: futile resuscitation attempts
> 
> 
> Dr. Sotelo:  What you should be doing is hiring new security guards to
> keep the "mob" away from your doctors and nurses, instead of
> performing resuscitations that are not medically indicated. C. Ursic,
> M.D. Oakland
> 
> 
>   Dear Ursic
>   The "mob" can be real. I would recomend regarless the situation of
>   the patient do the procedure. Is not for the patient is for the real
>   danger of medical personel at the scene. Once inside the the ER I
>   did performed a resusitascion for a infartated patient.(one of those
>   patients that you know is dead at 20 feet) He came in dead but the
>   family wasn=B4t and there where very, I mean, very aggresive. I still
>   think no harm is done when one uses a minimun resusitation
>   maniuvers. not the complete prosedure regards Manuel Sotelo
> 



Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.