Today's post is another EMS post. I recently had a call to a local nursing home for difficulty breathing. When I entered the patient's room, she was in agonal respirations, known as "guppy breathing." We began bagging her, and I then checked pulses, and found no radial pulse, and her carotid pulse was less than 40. Applying the monitor, she was in a sinus brady at 34 beats per minute, so I began pacing.
I was waiting for help in moving the patient to the stretcher because she weighed over 500 pounds. By the time help arrived, we had lost capture and she was in PEA. Because she had a valid DNRO, efforts were discontinued and she was determined to be deceased. I was later told by an EMS supervisor that since we had initiated ALS, we were bound to continue after the patient coded, and that he (the supervisor) would be referring this call to the medical director for more action. I disagreed, and sent him the following:
Section 64J-2.018 of the Florida Administrative Code (PDF alert) specifies that an emergency medical technician or paramedic shall withhold or withdraw cardiopulmonary resuscitation upon the presentation of an original or a completed DNRO. (emphasis added)
Note that the word "shall" means that a paramedic has no choice in the matter, cardiopulmonary resuscitation must not be initiated, and if it has already begun, must be withdrawn, as soon as you are presented with a valid DNRO. The supervisor is clearly wrong in this case, and I will await more word on how that goes.