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I wonder why they even tried CPR or a defibrillator. They spent 42 minutes rescuing someone who was underwater, and then decided to try and revive him? Maybe

I wonder why they even tried CPR or a defibrillator. They spent 42 minutes rescuing someone who was underwater, and then decided to try and revive him? Maybe there are details left out, like he was not fully submerged the entire time...

JshWright 11y ago
It's a kid... you try. Worked a 3 year old a couple weeks ago with an unknown downtime in a pool (up to 15 minutes). He was dead from the outset (initial rhythm was asystole), and he stayed dead (much warmer water in this case), but you still try... This is especially true for cold-water drownings. Downtimes even longer than 42 minutes with full recoveries are not unheard of. You're not dead until you're warm and dead.
- sukilot 11y ago
  I'd hope you'd try for an adult too. But anyway, thank you for your life-saving service.
  - JshWright 11y ago
    The window for 'trying' is longer for kids (that's based on more than just emotion though... kids are a lot more resilient).
    - jnardiello 11y ago
      Don't you have protocols for this? Is it entirely up to individual preparation for how long (and how) you 'try'?
      - JshWright 11y ago
        It's a bit of both... I have an 'obvious death' protocol that can apply if someone is, well... obviously dead. If they are not obviously dead, and do not have a DNR (or a 'MOLST' in New York) then we'll begin resuscitative efforts (using either ACLS[1] or PALS[2] guidelines, as appropriate). If the patient's heart has any sort of electrical activity going on, we'll generally spend 15-20 minutes trying to get it working properly again before calling a medical control physician to get permission to stop efforts and pronounce death. If there is no electrical activity, then we'll go through a couple 'rounds' of ACLS, and it there is no response, we'll just pronounce them. Very rarely do we transport an adult in cardiac arrest. CPR in a moving ambulance is very difficult to perform adequately, and in most cases we would just be bringing them to a facility that would be providing the same level of care that we are in the field (albeit with more hands available to help, but the tradeoff in time and poor quality CPR isn't worth it). The only exception to this are cases of traumatic arrests. If something is physically broken, no amount of CPR, drugs, or electricity are going to help, and their only hope is bright lights and cold steel (in a surgeon's hand). Needless to say, the survival rates for out of hospital traumatic arrests are _vanishingly_ small. Kids are different though... They're easier to move, and easier to do CPR on. This means in most cases a pediatric arrest is a 'scoop and run', with any interventions being performed on the way in. This is in part because the resiliency of kids means they are a _little_ more tolerant of the time, and scene's with dead kids tend to be extremely chaotic. It can be very difficult to concentrate with an (understandably) distraught parent yelling at you. [1] https://en.wikipedia.org/wiki/Advanced_cardiac_life_support https://en.wikipedia.org/wiki/Advanced_cardiac_life_support [2] https://en.wikipedia.org/wiki/Pediatric_advanced_life_support https://en.wikipedia.org/wiki/Pediatric_advanced_life_suppor...
jnardiello 11y ago
Context: I spent my civil service (+2 more years as a volunteer) serving as a paramedic for the italian national healthcare in Milan. Paramedics/EMTs can't declare anyone deceased (they are not doctors) and on ambulances there are no doctors. This means that, as paramedics are first to arrive on the scene, they HAVE to perform CPR and defibrillation over anyone until a doctor declares death (only exception is with conditions that are "incompatible to life", example: decapitation). Two more details: no doctor would declare a boy dead on the place - they would AT LEAST require the ambulance to bring the person to the closest hospital, which implies that CPR and Defibrillation is performed for several minutes anyway (usually, ~10-30mins to reach the closest hospital). Last detail, doctors are anyway required by law to ensure that at least 45 mins of CPR has been performed before being able to declare anyone formally dead. All this procedure may seem overkill but I can assure you that I personally experienced at least two cases where I thought the person didn't stand a chance but then actually fully recovered. So, the whole story makes perfectly sense :)
- JshWright 11y ago
  Perhaps things are different in Italy, but here in the US I can absolutely pronounce someone dead. 'EMT' is a lower level of training, and do require the 'injuries incompatible with life' criteria, but as a paramedic, I have far more leeway. patient has an unknown downtime, is cool centrally, has visible lividity, or early stages of rigor, then I'm just going to hook up an EKG to confirm asystole, call my dispatcher for an official timestamp, and hand the scene over to the police.
mod 11y ago
It said they took 15 days reviving him.

JshWright 11y ago

It's a kid... you try. Worked a 3 year old a couple weeks ago with an unknown downtime in a pool (up to 15 minutes). He was dead from the outset (initial rhythm was asystole), and he stayed dead (much warmer water in this case), but you still try... This is especially true for cold-water drownings. Downtimes even longer than 42 minutes with full recoveries are not unheard of. You're not dead until you're warm and dead.

sukilot 11y ago
I'd hope you'd try for an adult too. But anyway, thank you for your life-saving service.
- JshWright 11y ago
  The window for 'trying' is longer for kids (that's based on more than just emotion though... kids are a lot more resilient).
  - jnardiello 11y ago
    Don't you have protocols for this? Is it entirely up to individual preparation for how long (and how) you 'try'?
    - JshWright 11y ago
      It's a bit of both... I have an 'obvious death' protocol that can apply if someone is, well... obviously dead. If they are not obviously dead, and do not have a DNR (or a 'MOLST' in New York) then we'll begin resuscitative efforts (using either ACLS[1] or PALS[2] guidelines, as appropriate). If the patient's heart has any sort of electrical activity going on, we'll generally spend 15-20 minutes trying to get it working properly again before calling a medical control physician to get permission to stop efforts and pronounce death. If there is no electrical activity, then we'll go through a couple 'rounds' of ACLS, and it there is no response, we'll just pronounce them. Very rarely do we transport an adult in cardiac arrest. CPR in a moving ambulance is very difficult to perform adequately, and in most cases we would just be bringing them to a facility that would be providing the same level of care that we are in the field (albeit with more hands available to help, but the tradeoff in time and poor quality CPR isn't worth it). The only exception to this are cases of traumatic arrests. If something is physically broken, no amount of CPR, drugs, or electricity are going to help, and their only hope is bright lights and cold steel (in a surgeon's hand). Needless to say, the survival rates for out of hospital traumatic arrests are _vanishingly_ small. Kids are different though... They're easier to move, and easier to do CPR on. This means in most cases a pediatric arrest is a 'scoop and run', with any interventions being performed on the way in. This is in part because the resiliency of kids means they are a _little_ more tolerant of the time, and scene's with dead kids tend to be extremely chaotic. It can be very difficult to concentrate with an (understandably) distraught parent yelling at you. [1] https://en.wikipedia.org/wiki/Advanced_cardiac_life_support https://en.wikipedia.org/wiki/Advanced_cardiac_life_support [2] https://en.wikipedia.org/wiki/Pediatric_advanced_life_support https://en.wikipedia.org/wiki/Pediatric_advanced_life_suppor...

jnardiello 11y ago

Context: I spent my civil service (+2 more years as a volunteer) serving as a paramedic for the italian national healthcare in Milan. Paramedics/EMTs can't declare anyone deceased (they are not doctors) and on ambulances there are no doctors. This means that, as paramedics are first to arrive on the scene, they HAVE to perform CPR and defibrillation over anyone until a doctor declares death (only exception is with conditions that are "incompatible to life", example: decapitation). Two more details: no doctor would declare a boy dead on the place - they would AT LEAST require the ambulance to bring the person to the closest hospital, which implies that CPR and Defibrillation is performed for several minutes anyway (usually, ~10-30mins to reach the closest hospital). Last detail, doctors are anyway required by law to ensure that at least 45 mins of CPR has been performed before being able to declare anyone formally dead. All this procedure may seem overkill but I can assure you that I personally experienced at least two cases where I thought the person didn't stand a chance but then actually fully recovered. So, the whole story makes perfectly sense :)

JshWright 11y ago
Perhaps things are different in Italy, but here in the US I can absolutely pronounce someone dead. 'EMT' is a lower level of training, and do require the 'injuries incompatible with life' criteria, but as a paramedic, I have far more leeway. patient has an unknown downtime, is cool centrally, has visible lividity, or early stages of rigor, then I'm just going to hook up an EKG to confirm asystole, call my dispatcher for an official timestamp, and hand the scene over to the police.

mod 11y ago

It said they took 15 days reviving him.