Nobody dies in an ambulance?

[Tfumes]

I work as an EMT-B w/IV cert in an ED, and part time as a body remover for a funeral home. Last week, a pt was being transferred from my ED to another facility. Pt was elderly, DNR status and very close to death. not agonal yet but toeing the line. I asked the trasporting Medic "whats protocol if they kick during transport?" rescind DNR? return to origin facility? or deliver a dead pt to receiving facility?. Medic ripped my head off, saying its a stupid question and nobody dies in a bus. Still wondering the answer...Thanks

 

[Aidey]

True story. No one dies in an ambulance. They had a pulse until the second you walked through the door of the building.

Otherwise the ambulance has to park and stay out of service until the medical examiner, coroner or mortuary can get around to taking care of the body. It isn't a pretty situation.

 

[shfd739]

For us in that situation with a valid DNR they are delivered to their destination and placed into bed. Nursing home, hospital etc can take it from there.

 

[epipusher]

I would probably not leave them dead in a bus, that makes for bad PR.As for the ambulance, if the pt is a DNR we would stop efforts and continue on to the hospital.

 

[DrParasite]

True story. No one dies in an ambulance. They had a pulse until the second you walked through the door of the building.

Otherwise the ambulance has to park and stay out of service until the medical examiner, coroner or mortuary can get around to taking care of the body. It isn't a pretty situation.

exactly. no one dies in the ambulance, they either get worked as cardiac arrest to the ER or they get worked on scene. they don't necessarily have a pulse, but they are not to be declared/pronounced dead in the back of the truck

Only time I have had someone die in my ambulance was on a head on collision (3 trauma patients and one walking wounded), we took the first person out and put her in our truck, with the paramedics attempting to intubate her. our medical director jumped the call (as did the #2 and #3 guy in the agency, as well as the shift supervisor), poked his head in the truck, say "umm those are brains, she's an obvious DOA." we had to wait over an hour for the ME to arrive.

 

[Outbac1]

We don't work people with DNRs in the truck. We call our dispatch and they tell us whether to continue to the destination or return to the sending facility. Usually we return to the sending facility. The pt is always the responsibility of the sending Dr. until care is handed over to the recieving facility.

 

[medicdan]

Interesting... I've had a DNR patient go into arrest in my truck before. We had been worried about this contingency, and consulted with medical control and spoken with family before the ride, and agreed on the circumstances. When it occurred, I simply called the doc back, and he told us to "turn off the lights, turn on the air conditioning". Because the death was under the supervision of a physician and in a medical setting, the police had no interest or need for involvement. When we got to the Ed, the doc did a quick exam, and we actually wheeled directly to the morgue.

 

[medic417]

People die in the ambulance. Only idiots claim otherwise. That t-shirt no one dies in the ambulance along with the emts save paramedics t -shirt need to all be piled up together and burned and never mentioned or seen again.

If you are doing CPR they are dead. If you are doing CPR while ambulance is rolling you are doing crappy CPR and your system is archaic for allowing it.

 

[Aidey]

Fine. No one is declared dead in the ambulance.

This discussion isn't about the sentiment behind a catchy t-shirt saying. It is about the fact that it is a logistical nightmare in most systems if someone is declared deceased in the ambulance.

 

[medic417]

Fine. No one is declared dead in the ambulance.

This discussion isn't about the sentiment behind a catchy t-shirt saying. It is about the fact that it is a logistical nightmare in most systems if someone is declared deceased in the ambulance.

They are declared frequently on board ambulances. No issues. Wheel the corpse out and into the hospital or the morgue or move onto funeral homes cot, etc and go back into service just like any other call.

 

[Aidey]

Maybe in your area, which you have made a habit of pointing out is unique. In other areas it may mean a body sitting in the ambulance for 6-8hrs or even longer.

 

[CANDawg]

Is there a reason this is in the "Suggestions, Feedback & Forum Questions" forum? :blink:

 

[JPINFV]

I think the problem is that most system policies (at least that I've seen), don't directly cover death in transit. The only one I've seen is Massachusetts' state wide protocol which says the following.

If during transport, EMTs cease resuscitation of a patient in accordance with the requirements above, they shall continue to the closest appropriate hospital for pronouncement of death. This is always a special circumstance that is in the interest of public health and safety, and thus meets the requirements of 105 CMR 170.365.

http://www.mass.gov/eohhs/docs/dph/emergency-services/treatment-protocols-1001.pdf

PDF page 155

 

[JPINFV]

I would probably not leave them dead in a bus, that makes for bad PR.As for the ambulance, if the pt is a DNR we would stop efforts and continue on to the hospital.

Well, of course. If they're dead in a bus you're screwing up the entire bus route and inconveniencing hundreds of people.

...now what about dead in an ambulance?

 

[DesertMedic66]

Had this happen to one of our units. Patient was a DNR. Patient coded in route from his home. Hospital will not accept dead patients who they can not work.

Body was left on the gurney in the back of the ambulance and covered with a sheet. A/C was turned on high and crew sat in the hospital for 2+ hours waiting for the corner to arrive.

The patient is ours until we give a hand off to the nurse at the hospital. If the patient codes as we are walking into the hospital then he/she stays on the gurney until the corner arrives. The hospital will not accept.

 

[ffemt8978]

Moved to appropriate forum.

 

[med51fl]

Fine. No one is declared dead in the ambulance.

I have to agree with medic417 that that is not true. People die and are declared dead in the back of our rigs. We simply call the ED, get the doc to approve the death declaration, and continue transport routine to the ED to turn the body over for death procedures. That is all. No working a futile code, no waiting for the coroner, and no transporting to the ME for sure.

 

[CritterNurse]

I once had a patient ask me if anyone had ever died in this ambulance. I told him quite honestly "Not during my watch" since I've never had a human patient die in front of me. I have no idea if anyone had died in that ambulance when I wasn't there, but at least the patient looked reassured for the rest of the trip.

 

[Tfumes]

I appreciate the input. Working in-hospital as an EMT I havnt been able to see the rules & regs of outdoor medicine. Thanks again

 

[MediMike]

I'm with Medic417/51 here. We can declare no problem. I don't think the ability to do so is as unique as some here think. Unless we're all in the same region.