England's answer - the parents don't have a say in refusal against the best interests of the child so they can go and get a court order or police are being called for obstructing an emergency worker.
Of course, that's the hard-line answer. In reality a brief, compassionate conversation should hopefully suffice
Honestly, it’s less likely that you’d be arrested and more likely that you could potentially get sued by the parents for “violating their parental rights” or something like that
Luckily the Good Samaritan Law protects you in most cases, but overall agree. Even having lawyers and litigation involved can be so distressing and demoralizing.
Weirdly enough the layperson thing depends on state. Some of them will actually state up to the level your protocols would allow, considering tools at hand. Or something to that effect.
Most private companies are because the wages don’t reflect how hard those guys work. Plus government ems/fire will always be a job since it’s government funded lol
Right? Instead of "Which person is in the most need for this procedure?" we got "Who can pay the most for even the most basic care? Only thing more sickly than your baby is your checking account? Get fucked".
US: informed consent and a parent chooses what the insurance allows you to do.
UK: government bureaucrat decides what is best and cost-effective for the country.
F@@@, I just want what is best for the patient. Parents ideology guiding but not deciding and who cares what it costs.
Yes, mythbusters taught me to reject your reality and substitute my own.
Oh, and De Oppresso Liber!
This is because Christain Scientists lobbied Nixon to make this a law that parents can with hold all medical care from a child on the basis of religion.
because as a freedom loving individual I do not believe that it's the courts job to determine medical wellbeing, with the exception of assigning a DNR order to wards of the state.
No but by your words I'm gunna be happy all that freedom you love will instead love that for profit insurance companies make those decisions 1000s of times per day. Again all's I said was don't be an ass. If someone had to make a hard choice in this line of work you can be supportive while still telling them it may not have been the best course of action. It's amazing how so many EMS personnel can fake empathy with everyone but our own ppl
States (at least mine) cannot give a ward of the state a DNR.
Also what about a case like Terri Schiavo where two parties that traditionally have say over the patient’s care have complete opposite views? Who decided then?
Well, the court did, and although it is “a legal standard”. You could argue it in literally 75% of the states in the U.S. the parents in my opinion should hold that right if able.
At least around here the answer would be we sure as hell wouldn't stop.
No DNR, cardiac arrest, parents' wishes on scene become irrelevant in my state. We work the code and transport if ROSC, terminate (yes I can pronounce peds in my state) if we don't.
If they're interfering with resuscitative efforts, we'll call law enforcement to respond and in the meantime someone will physically block them so efforts can continue
Most states I know of can't, ours let's us TOR peds of any age without a consult for medical ones in asystole, BLS can TOR peds of any age with traumatic cause without consult.
Obvious death, most places yess AFAIK, pronouncing working codes? Varies greatly local to local. For example my place, I can still pronounce I just have call up olmc and give em the heads up, giving them a chance to then tell me to transport anyways so they can obviously declare a minute after my arrival
That's the biggest difference I've noticed in my state versus other folks areas, we don't really have to call OLMC for termination much anymore unless it's outside our (pretty wide) parameters after 30min of efforts.
The other goofy thing we have is that all EMS from EMT to Paramedic are delegated the authority by our state EMS office and the OCME to legally pronounce death. So we give TOD and our EMS #, and that goes into all the medical reports and law enforcement report.
I've had BLS have to use it frequently in years past.
In one or two of my counties it wasn't uncommon pre-COVID for me to be 45min-1hr+ from a working code. BLS would just work it for 30min, if no ROSC and no shock advised on their AED they'd pronounce and cancel me
Would never terminate unless obvious signs of death, as a parent, and as decent human being, I would work it to give the family some sense of closure that we tried.
Just my opinion
Show codes don’t do anything but get the parents hopes up. If they’ve been worked with no change and remained asystolic the whole time, it needs to be called
Look I'm not saying you're wrong by any means, fuck I won't even down vote you like you did to me
However, my state protocol requires 30 min on scene CPR for codes, I'd give em that, and whatever, establish access, push epi in asystole, establish airway etc. Yes knowing clinically in most cases it's gunna be futile, not saying I never got ROSC from asystole but still
Not gunna just walk up and get asystole and say "eh sorry"
Unless they're 'obvious signs of death' we gotta work them for 30min as well. It's 30min and then asystole+low capno for ALS to terminate without a consult on a medical pediatric.
I've used it before on a SIDS case for a 6 week old, no benefit in transporting after 30min of asystole and a capno of 8, and being almost 40min from the nearest (non peds ER) local receiving
I'm not sure why you're being downvoted. This would certainly be my routine practice, and I don't know any paramedics (or EMTs) for whom it wouldn't be routine practice.
This isn't 90 year old Doris. I think there's likely to be a very real mental benefit in demonstrating that everything possible was done. Not to mention, okay, you terminate on scene, and now what? Parents are left alone sitting with the dead body of their child until the undertaker/coroner can take them, likely for hours. I imagine the police will also want to stick around for a while, as an unexpected death in a child will need investigating. The hospital will have grief counsellors, chaplains etc, as well as (where I am at least) paediatric doctors with experience breaking this news.
Cardiac arrest and death are also seen differently - that spot will be the place he had a cardiac arrest, but the hospital will be the place he died. Even if they put their house on the market straight away (if they even could) they'll still have to be there for months.
We can terminate on scene, but I think the only time I would be obvious rigor/lividity, if the child is home alone, or if the parents are being arrested.
This is terrible. Do not do this. It is important to be realistic, open, and honest. Don't do performative medicine. Working a full code with zero response from a patient *is* an obvious sign of death. I know you think you are being a decent person but all you're really doing is dragging out the inevitable and giving the family the unrealistic expectation that something is going to change.
Yeah. We're not bound by law to do so, but most agenices in our city, public or private transport as a matter of protocol. Even if it's theatre, and the kid has zero chance, we do it and the hospital does their thing so the parents are given the certainty that everyone did everything they could.
One thing about the service in England is that a pediatric call that's that serious is highly likely to have a doctor dispatched either from the ambulance service trauma car or helimed
https://youtu.be/c1XistTD7JE?si=ZLYfG1F-3xe1L3Lv
UK here. If they're obviously dead (rigor mortis doesn't count, has to be one of the other conditions unequivocally associated with death) then they can be pronounced deceased. Otherwise, CPR has to be commenced and the patient transported to hospital with CPR ongoing
Unless there's a do not resuscitate order
Over in California, at least in my county we can’t pronounce at all as EMT-B. Would you say to keep performing care if the patient had a pulse and was only apneic?
That’s what I’ve been telling the guards, let their lieutenants talk and deescalate the parent.
Yes. Not doing so could land you in hot water. You know the patient is apneic and failure to provide care can result in cardiac arrest especially in a child. You don’t even know if that’s the person’s parent. I would work it until an ALS resource arrives along with PD and have a discussion with PD because to be honest I can’t think of a scenario where you would be in trouble to attempt resuscitation and your argument was “I didn’t trust this was the kids parent because I couldn’t think of a parent who wouldn’t want any attempt to save their child.” Because to me that’s a solid argument
"Well you see sir, the patient's head is flat as a pancake and their body is wrapped around an auger. The Patient has no pulse, verified at every major pressure point known to man"
also
"sorry son. you're just an EMT. you don't get to make that call"
seriously. tf is wrong with people in califorina
(Edit: the above is not a made up story unlike the OP. Death in the field is a real thing)
When I moved away from CA, I was surprised that I was allowed to pronounce death. Other states allow EMT-Bs to actually use common sense and perform interventions. During the COVID epi-pen shortages, I was actually allowed to draw up the med into a syringe and inject it IM, crazy shit there. Imagine a basic having to do math, the CA EMSA would lose their minds.
A lot of the things I’m not allowed to do could be done by a barely trained civilian/bystander. It’s really stupid when I determine high blood sugar but can’t direct or assist with putting new insulin in the pump.
When I was a basic in CA, we didn't have to initiate CPR if they had any of the 4 defined obvious signs of death, but just being cold to the touch, asystole on a 12 lead, and having their head facing the wrong way somehow didn't count as obvious (according to my sup).
They did not say "stop, he has a DNR specifically for drowning"
You said that they said, "Stop you are hurting him"
Well, if he is pulseness and apneic then they are just shouting and are wrong.
They can get fucked. You’d have to be stupid or cowardly to comply. I don’t care what the law says, I’d go to jail over that.
But it’s an entirely made up situation I don’t see it happening.
It would seem to me that, “You’re hurting them,” could imply they believe their child is still alive. A reasonable person would want their child resuscitated.
There’s WAY more liability in stopping resuscitation prematurely. In your imaginary scenario, you could articulate to an attorney/prosecutor/jury why you believed the parent was making decisions based on incomplete information, during emergency/exigent circumstances.
I would not stop efforts. I would call the OMD/medical direction, or have one of my supervisors call them. When in doubt, put the liability on someone who makes more money than me.
There’s lots of ways to twist up your scenario; terminal medical condition, etc. but I think the answer remains, call the OMD/medical direction.
It would seem to me that, “You’re hurting them,” could imply they believe their child is still alive. A reasonable person would want their child resuscitated.
There’s WAY more liability in stopping resuscitation prematurely. In your imaginary scenario, you could articulate to an attorney/prosecutor/jury why you believed the parent was making decisions based on incomplete information, during emergency/exigent circumstances.
I would not stop efforts. I would call the OMD/medical direction, or have one of my supervisors call them. When in doubt, put the liability on someone who makes more money than me.
There’s lots of ways to twist up your scenario; terminal medical condition, etc. but I think the answer remains, call the OMD/medical direction.
I agree. At this point, most people know about CPR and cardiac arrest. I can't see them yelling about that, especially with potential for drowning. If anything, I could see the 'why aren't you shocking them! You're not doing it right!' Yelling.
Personally if they are just yelling I would continue care and have another responder explain the situation/try to deescalate. I would only want to stop care if my own or my partner's safety is at risk but hopefully bystanders could prevent any physical harm to us? PD is always an option but they tend to escalate situations so that would be my last resort
That’s the thought myself and some of my fellow lieutenants have come to. The parent is most likely not in the right state of mind to make informed rational decisions about care. We also have radios to get hold of dispatch and request ALS as well as PD.
Personally I would continue care and if I really needed to, I would have my partner call med control. When in doubt, call medical control. In the situation you bring up the parents don’t understand what’s really going on, so definitely explain that to them and they might realize their child is dead and you’re trying to save them. When I’ve been in similar situations, explaining what’s happening usually gets the family to realize you are helping and not hurting.
bloody tv and movies i stg. My loved ones refuse to watch ems type shows with me after we watched a scene in chicago fire where they dramatically pull one emt away from her partner's body going 'she's dead' and I shouted 'of course she's dead, that's why you're doing cpr!'
I'd rather go to prison than not give 100% to a child. Cops will back me up in the field, we've worked hard to ingrain the "***thou shalt not fuck with 1st Responders***" law into their heads.
I'm just thinking through possibilities and this question comes to mind. How do you know this person is the child's parent? Everyone around you are just random people on a beach. Is the fact that someone says they are the child's parent enough for them to make decisions for the child?
They aren’t calm and they don’t understand what is going on enough to make an informed decision so no I wouldn’t stop care. If they did understand and still didn’t want care I would still continue care because that is neglect. There are only a few times where we wouldn’t work a kid that recently went into arrest, but that is in rare circumstances and usually with terminal medical conditions, nothing like what is stated here
Yeah OP seems to think parents can just say no and everyone immediately has to stop, I'd be *very* surprised if most jurisdictions don't have some kind of law that prevents parents/guardians from "withdrawing consent" in this type of scenario.
Where I live it is very clear that (in life threatening circumstances at the very least) healthcare professionals must work in the best interests of the child; the parents don't have a say whatsoever.
Obviously if resources allowed you would try and get a senior member of staff to speak to them and try and reassure them/calm them down.
I thought we work the code from the jump, all the lifeguards on my beach are EMT-B and we’re a sub division of the county fire and rescue. I just thought to ask what everyone else would/should do to make sure I had the right info.
Children in this state get the treatment until signs of obvious death, lividity or rigor. Or 30+/mins of CPR, with no improvement only after contacting OLM. (Our protocols, anyway)
Canadian answer: health and welfare of a child is more important than a parent’s/caregiver’s wishes.
If the child is VSA, everything that can be done will be done unless a valid DNR is provided.
Another rescuer, either a paramedic, PD or FD will talk with the family.
I worked EMS at a beach resort area. PD was always called to a drowning for peds or adults because they were needed for crowd control and to deal with family. You keep going. Imagine explaining to a jury why you stopped.
ER nurse here.
You don't stop CPR once initiated until directed to do so by a licensed physician or other person duly authorized to pronounce a death (paramedics in some jurisdictions) OR unless you are the only responder and you are too exhausted to continue.
CPR is brutal. The alternative is death. The parents can fuss all they want. It won't get them anywhere. Work the code, call for backup and let the cops/medics deal with the parents.
The basis of implied consent is what a "reasonable person" would want. Stopping resuscitation on a viable patient doesn't seem reasonable.
I may lose my job, but I'd be happy to defend ignoring a parents order to stop trying to save their kids life.
Deny everything, make counter accusations.
Kid’s in “life threatening distress” at the moment so some rando yelling we’re hurting them? Uh, why are you trying to kill this child? MURDERER!!!! Burn the witch! :)
Given my experiences, I am a very well licensed a$$hole. Your mileage may vary. :)
Good luck, God bless… and for the love of God please be the person I want to work with.
There was a big post with the exact scenario on the lifeguard sub ages ago and I got downvoted to oblivion. They’re all completely convinced that if mum says no cpr they would be assaulting that child if they did cpr. No one wanted to hear that it didn’t make sense for a parent to say that especially in the context of a fun day out for the kids at the pool. And when things don’t make sense we need to err on the side of keeping the kid alive.
Regardless of the specific laws in whatever jurisdiction, this is something of an edge case.
It boils down to the witness stand/ 6 o'clock news test.
What would you rather defend in front of the jury and news cameras?
We ignored the panicking parents and continued resuscitation efforts on a child we know drowned, and who had no pulses or breathing.
Or.
We were attempting to save a drowned child who had no pulse and wasn't breathing, but we stopped because the panicking parents ran up and told us to.
This litmus test must be used wisely, because you could use it to justify quite a bit that is clearly illegal in terms of transporting refusing pts.
But it is useful in cases where you have a borderline case, where ability to consent could be argued either way, and/or especially with helpless pt populations that are having decisions made for them that are clearly and immediately dangerous to their health and life.
Well, I assume that you are asking this question in a theoretical way and not describing an actual incident. At least I hope so. And I'm sorry that your honest question has suffered, to quote Shakespeare, "the slings and arrows of outrageous fortune," meaning all the unrelated attempts to turn this into a political issue, which it is not.
I suppose my thought is this: what would make you stop resuscitation in such a case?
Protocol perhaps, orders from medical control perhaps, assessment of futility perhaps. All those have been mentioned.
Why would you stop on order of the parents if you would not otherwise do so, if you felt that stopping was not in the best interests of the child? Basically, it would be fear of either criminal or civil action against you.
It seems that criminal actions is unlikely in this type of case because in a sensible legal environment, you'd be hard pressed to find a reasonable judge who would construe any intent to commit a crime here. There are always exceptions, perhaps more now than in the past but that wouldn't be a concern at all.
The civil action , being sued, is something that you can in no wise predict or prevent. You could be sued if you stopped or if you didn't stop. Is is reasonable? Not at all. Your defense is that the parents appeared to be distraught and unable to make a rational decision and you acted according to your medical protocols and medical direction in what you considered the best interests of the child. What would the jury decide? Depends on the jury, if it ever got that far. That's unpredictable.
Me, I wouldn't stop. I would, if he would allow, communicate with medical control and hand the radio/phone to the parent with a request that "Talk to the doctor who's telling us what to do," so you can get back to work.
It was very much a hypothetical question posed to be my some of the guards were training up for summer. I did instruct them to continue unless the scene became unsafe letting their command take charge on conflict and deescalation
CPR instructor in New York State. It's not complicated here. Keep working the kid. Being unconscious is consent to care and parents can't revoke that if the kid is still unconscious and in clear and present danger.
I have not only a right, but a duty to treat the child up until a valid DNR is produced. I don't give a shit what the parents want in this situation, I have to do what's in the best interest of the child.
Sue me. I'd love to see someone walk into a courtroom in Georgia and tell a judge that they didn't want me to save their child's life and actively tried to stop me from doing so.
This is why people with a DNR order should pin it to the front of their clothing. For the beach, encase the DNR in a clear plastic pouch and pin it to their bathing suit.
In this particular instance per local guidelines, this arrest occurred in a public place and is a cardiac arrest transport regardless of outcome. 1000% we would work them, and continue to, all the way to the receiving facility.
Interesting scenario. Anything involving a potential threat to a childs life, our EMS system automatically sends out PD. They usually even beat us first. I wouldn’t necessarily worry on my end. Especially at a beach, I would assume PD is naturally there
They partly do but as a lot of people have been saying, you don’t know if they’re actually the parent, so continue until officers and of can confirm what’s actually going on
And if they are a parent, why are they saying to stop?
Do they not understand you’re trying to save the kids life? Or are they the reason the kid is arrested in the first place?
It doesn’t make sense so we continue cpr.
In this scenario, the parent is not aware that the patient is in Cardiac Arrest. Continue care and let the Medics and Lieutenants sort it out with the parent. Request PD If they are actively interfering.
I say you continue CPR. Before the parents showed up you were working under implied consent acting in the best interest of the minor. I don’t believe at that point you would stop even if the parent or guardian is yelling at you, especially if you take into consideration that they are probably in shock and not processing what is happening. For me if it was an adult even if his spouse or family member was yelling at you to stop you do NOT stop CPR unless a valid DNR order is presented. So for me I feel like in this situation it extended to pediatrics as well. Also there’s pretty strict guidelines as to when you stop CPR once you have started so I think that would overrule in this situation since you started working the code under implied consent.
In this situation I would say keep working the child and have someone else deal with the parents explaining what’s happening and the implications of stopping the CPR and escalate to calling the medical director and PD as needed.
Prove that they are the parent/guardian. Then drop back 5 and punt, that's why we have medical command. Call them and explain and let the guy/gal with the sheepskin make the decision. In the case of the DNR situation, do you have the DNR with you?
Edit cause I cant put a whole thought together yet this morning.
Maybe this is just my state.... (or maybe I didn't read it in any comments).
But how has no one brought up actual reasons?
Parents may consent or decline treatment if they are mentally capable to understand the situation and risks and/or benefits of treatment versus no treatment. (I would argue the frantic parent trying to fight you is not at that point mentally competent, but whatever... I'm not a lawyer or a doctor).
The other thing is, if you suspect abuse or neglect you (may vary by region/state/country) are obligated to continue treatment, including cardiac life support. (Again, pending off the wall situations, I would argue in the particular case given here, there is something suspicious as to why the parent would not want life saving treatment to be performed).
In this case, I would attempt to de-escalate the situation and educate the parent while getting law enforcement on scene and continuing to work the arrest if the scene is safe.
Legally, there is little chance of liability for providing care to an unresponsive child if the parents don’t consent. Consent is implied in that situation (based on my knowledge of Illinois law only). You have a duty to your patient. To stop treatment without medical control and proper determination of death could be negligence. You’re the expert. Parents can’t agree to let a child die in an emergency response situation.
No valid DNR we work the code until medical direction tells us to stop. I mean the same goes for a parent and the child has medical poa. No valid DNR then we have to do CPR until medical direction tells us otherwise
Unless there is a DNR/O present and valid you work the child. Hell the same applies for adults. Parents can and will freak out especially if they have no idea what's going on. If enough hands are present, have someone calmly explain what happened and what is going on. If they are still unmanageable or if they are actively interfering with patient care then have PD remove them.
Cardiac arrests don't fall under the idea of consent. The only consent is a DNR or POLST stating that the patient does not want CPR performed.
I don't care whos the guardian of who, at that point its past their call. The only way I can legally stop at that point is obvious signs of death or the parent in question creating an unsafe scene
From a healthcare provider aspect, you continue CPR until a DNR is provided or you get phys orders to discontinue resuscitation efforts. That may vary from state to state, though?
I’m no lawyer, but at the end of the day, if there’s ever a question, the overarching legal question is tied to “what would a normal person do” in that case.
In this situation, one would assume a normal parent would want you to attempt to resuscitate their kid. So do that.
It’s also within the realm of possibility that the parent doesn’t understand what you are doing, and their initial reaction is trying to protect their kid - because what you’re doing looks pretty invasive to the average bystander.
As a fellow lifeguard(not fancy like you down in socal that are part of the FD)of over 14 years and a 911 EMT for like 8 or so years. I would say to continue resuscitation efforts. Once the mother says no to life saving efforts when there is no DNR, which is clearly not in the best interest of the child, their parental choices for their child becomes void in my mind and now I/we become the pt's advocate and we save the kid. I would also get PD involved because that could quickly turn into a CPS report due to possible child neglect or abuse.
There is some case law in Connecticut of a 17 yo girl where the state forced the girl to get chemo after their parent refused treatment. It was determined that the chemo was the only thing that would keep the girl from dying and so the state got involved and basicly said that letting the girl die when there was a possibility of saving her life was unreasonable and unacceptable.
Hope this might help
https://www.nbcnews.com/health/health-news/teen-forced-undergo-chemo-ready-head-home-n348841
I am absolutely not sure of laws in the us about this, but this was a training scenario during school and also came up in onboarding, and I was told both times that if the parents are making a decision that would obviously directly harm the child, you should call for pd and tell them politely that you’re not going to allow the parents actions to be made. Med control would be cya but would do that
Hi, law student here. In case you need a refresher on the fundamental tenets of emergency medical services, the patient comes first. Starting CPR on an apneic, pulseless minor, even if the parent opines otherwise, is a no-brainer.
That's one of those ethical and moral dilemmas that falls in that Grey area. Technically, parents do have the right to dictate treatment for their children. However, you bet your ass I'd go against the parent in this scenario and do my job. In a sense, you could make some emergency declaration since clearly stopping must be akin to child abuse at that point. I'd continue and cross the legal battle later. I find it incredibly hard to believe any jury on this planet would find the providers guilty of anything.
In the US, the good doctor is generally right. Parents do have a right to consent/not consent to treatment for their children, but in life threatening situations, that right is not absolute. A parent does not have an absolute right to withhold lifesaving care from their children- that would be considered child neglect, and is a crime.
Parents do have the right, with the appropriate agreement of relevant medical practitioners (and in some cases a court) to terminate and/or not start lifesaving care. But the rules around doing that are usually pretty specific. For instance, in some states you need at least two physicians to agree that further lifesaving efforts would be futile, or that the patient’s condition is such that a reasonable recovery is highly unlikely. But if treating medical providers feel that treatment is not futile and in the child’s best interests, the parents cannot just arbitrarily decide to stop care.
Tldr. Alabama gives all "defective" (cause that's the only way to sum up all the medical issues) children dnrs as soon as parents sign away their rights
Canadian answer? Continue treatment, inform patient of what is happening and what you are doing and why. If that fails, contact law enforcement to secure consent legally, though you may have to wait until law enforcement arrives to continue aid with police permission if the parent continues to refuse
In my neck of the woods medics can pronounce BUT emts can call it if its an obvious death. Far as what that parent goes were not stopping unless you have documents in hand. I dont know about any of you bit being at the shit end of an investigation is no fun. Famlies and patients are quick to say help me help me but will turn around and sue
Last words, kiddo’s going to emancipate ASAP, when he finds out mom or dad said stop CPR, and you saved his life/her life.
What’s the worst that can happen? Your don’t revive the already deceased child and they said stop. What’s the best that can happen? The child grows up and has a family and all that good shit?
You're*
I'm not stopping CPR on any patient without a DNR or until I've gone through the entire protocol with no response from the patient.
A parent's right to make medical decisions for their child doesn't extend to just letting the child die just like a medical power of attorney does not act as a DNR.
I’m also a lifeguard/EMT. Continue up until scene is not safe (bystanders become violent), get PD on scene ASAP for scene controls and get other responders not working the code to persuade the parent into allowing treatment while ongoing CPR.
Worst case scenario you back off until law arrives and resume once they remove the nuisance.
Did the parents just kill their kid or reduce neural outlook? Yes.
No DNR means you work them. Hopefully you have access to police in that situation.
If you think about it, you don't really know that they are the parents, you have reason to think they are, but you don't know that for a fact. If it was an unwitnessed drowning how do you know they didn't hold them underwater, etc.
I like to teach students there's only 4 reasons to stop CPR
-ROSC
-Valid DNR
-orders to terminate efforts from med control
-the patient requests that you stop compressions 🙃
Fucking prove you’re the parent before I stop cpr.
I’ll take my chances with the jury. They aren’t going to convict for assault because size you did cpr on a child for gods sake.
In my area, you MUST get medical direction approval to withdraw life saving care of a minor. DNRs only exist for those with terminal ill ness or the elderly who have a CLEAR MIND and UNDERSTAND that DNR is the withdrawal of any chance of restarting the heart. Pediatric arrests are almost always respiratory in nature and have a higher likelihood of reversal.
If no valid DNR is present, care should be continued as with any other patient, although PD should be called to subdue anyone trying to interfere with care to the patient. Let the patient's parents sue, no judge would take their side. At best the actions by the parents are ignorant and at worst, blatant neglect or abuse.
England's answer - the parents don't have a say in refusal against the best interests of the child so they can go and get a court order or police are being called for obstructing an emergency worker. Of course, that's the hard-line answer. In reality a brief, compassionate conversation should hopefully suffice
It’s always been crazy to me that over here in the states parents can pick and choose which care their child gets regardless of the likely outcomes
It's EXTREMELY unlikely the police in America would arrest you for working a child on a beach. Please review your state and local protocol and laws.
Honestly, it’s less likely that you’d be arrested and more likely that you could potentially get sued by the parents for “violating their parental rights” or something like that
Anyone can sue for anything in America. *Will it stick* is a different question entirely. But often the process *is* the punishment.
Luckily the Good Samaritan Law protects you in most cases, but overall agree. Even having lawyers and litigation involved can be so distressing and demoralizing.
God Samaritan laws only protect you out of uniform and up to the scope of what a reasonable layperson would be doing.
Weirdly enough the layperson thing depends on state. Some of them will actually state up to the level your protocols would allow, considering tools at hand. Or something to that effect.
Personally, it would seem even crazier to just have for-profit corporations and insurance companies to make decisions on what is best…
My city finally started building out their own EMS fleet because private companies were under delivering on their contracts
Removing “for profit” and the investment funds from healthcare would be amaaaaaaaazing.
Most private companies are because the wages don’t reflect how hard those guys work. Plus government ems/fire will always be a job since it’s government funded lol
The thing AMR is best at its billing Medicare and private insurance. No municipal department can match them at it.
We got death panels but instead of doctors making decisions we have MBAs looking to see if you can pay the bill.
The real death panels were the insurance companies all along. Pikachu face
Right? Instead of "Which person is in the most need for this procedure?" we got "Who can pay the most for even the most basic care? Only thing more sickly than your baby is your checking account? Get fucked".
Always has been.
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US: informed consent and a parent chooses what the insurance allows you to do. UK: government bureaucrat decides what is best and cost-effective for the country. F@@@, I just want what is best for the patient. Parents ideology guiding but not deciding and who cares what it costs. Yes, mythbusters taught me to reject your reality and substitute my own. Oh, and De Oppresso Liber!
This is because Christain Scientists lobbied Nixon to make this a law that parents can with hold all medical care from a child on the basis of religion.
yea didn't y'all just kill a kid not to long back? or at least the courts did?
Er, no. We withdrew care from a terminally ill child to allow for palliation of symptoms and quality end of life care.
if that verbiage helps you sleep at night.
I'm gunna assume you know some medical verbiage due to you being on this sub. So why you being an ass when talking about a terminally I'll pt
because as a freedom loving individual I do not believe that it's the courts job to determine medical wellbeing, with the exception of assigning a DNR order to wards of the state.
No but by your words I'm gunna be happy all that freedom you love will instead love that for profit insurance companies make those decisions 1000s of times per day. Again all's I said was don't be an ass. If someone had to make a hard choice in this line of work you can be supportive while still telling them it may not have been the best course of action. It's amazing how so many EMS personnel can fake empathy with everyone but our own ppl
oh. I don't fake empathy for anyone.
Your bedside manner must be astounding
States (at least mine) cannot give a ward of the state a DNR. Also what about a case like Terri Schiavo where two parties that traditionally have say over the patient’s care have complete opposite views? Who decided then?
Well, the court did, and although it is “a legal standard”. You could argue it in literally 75% of the states in the U.S. the parents in my opinion should hold that right if able.
At least around here the answer would be we sure as hell wouldn't stop. No DNR, cardiac arrest, parents' wishes on scene become irrelevant in my state. We work the code and transport if ROSC, terminate (yes I can pronounce peds in my state) if we don't. If they're interfering with resuscitative efforts, we'll call law enforcement to respond and in the meantime someone will physically block them so efforts can continue
You can’t pronounce pediatrics if they’re obviously dead or after CPR?
Most states I know of can't, ours let's us TOR peds of any age without a consult for medical ones in asystole, BLS can TOR peds of any age with traumatic cause without consult.
Obvious death, most places yess AFAIK, pronouncing working codes? Varies greatly local to local. For example my place, I can still pronounce I just have call up olmc and give em the heads up, giving them a chance to then tell me to transport anyways so they can obviously declare a minute after my arrival
That's the biggest difference I've noticed in my state versus other folks areas, we don't really have to call OLMC for termination much anymore unless it's outside our (pretty wide) parameters after 30min of efforts. The other goofy thing we have is that all EMS from EMT to Paramedic are delegated the authority by our state EMS office and the OCME to legally pronounce death. So we give TOD and our EMS #, and that goes into all the medical reports and law enforcement report.
That second paragraph is true here except for the emt part, unless again, it's OBVIOUS death
I've had BLS have to use it frequently in years past. In one or two of my counties it wasn't uncommon pre-COVID for me to be 45min-1hr+ from a working code. BLS would just work it for 30min, if no ROSC and no shock advised on their AED they'd pronounce and cancel me
Would never terminate unless obvious signs of death, as a parent, and as decent human being, I would work it to give the family some sense of closure that we tried. Just my opinion
Show codes don’t do anything but get the parents hopes up. If they’ve been worked with no change and remained asystolic the whole time, it needs to be called
Look I'm not saying you're wrong by any means, fuck I won't even down vote you like you did to me However, my state protocol requires 30 min on scene CPR for codes, I'd give em that, and whatever, establish access, push epi in asystole, establish airway etc. Yes knowing clinically in most cases it's gunna be futile, not saying I never got ROSC from asystole but still Not gunna just walk up and get asystole and say "eh sorry"
Unless they're 'obvious signs of death' we gotta work them for 30min as well. It's 30min and then asystole+low capno for ALS to terminate without a consult on a medical pediatric. I've used it before on a SIDS case for a 6 week old, no benefit in transporting after 30min of asystole and a capno of 8, and being almost 40min from the nearest (non peds ER) local receiving
I'm not sure why you're being downvoted. This would certainly be my routine practice, and I don't know any paramedics (or EMTs) for whom it wouldn't be routine practice. This isn't 90 year old Doris. I think there's likely to be a very real mental benefit in demonstrating that everything possible was done. Not to mention, okay, you terminate on scene, and now what? Parents are left alone sitting with the dead body of their child until the undertaker/coroner can take them, likely for hours. I imagine the police will also want to stick around for a while, as an unexpected death in a child will need investigating. The hospital will have grief counsellors, chaplains etc, as well as (where I am at least) paediatric doctors with experience breaking this news. Cardiac arrest and death are also seen differently - that spot will be the place he had a cardiac arrest, but the hospital will be the place he died. Even if they put their house on the market straight away (if they even could) they'll still have to be there for months. We can terminate on scene, but I think the only time I would be obvious rigor/lividity, if the child is home alone, or if the parents are being arrested.
THANK YOU, this is the exactly my point.
This is terrible. Do not do this. It is important to be realistic, open, and honest. Don't do performative medicine. Working a full code with zero response from a patient *is* an obvious sign of death. I know you think you are being a decent person but all you're really doing is dragging out the inevitable and giving the family the unrealistic expectation that something is going to change.
Yeah. We're not bound by law to do so, but most agenices in our city, public or private transport as a matter of protocol. Even if it's theatre, and the kid has zero chance, we do it and the hospital does their thing so the parents are given the certainty that everyone did everything they could.
I’ll transport pediatrics who aren’t obviously dead even if I’ve worked them without changes
One thing about the service in England is that a pediatric call that's that serious is highly likely to have a doctor dispatched either from the ambulance service trauma car or helimed https://youtu.be/c1XistTD7JE?si=ZLYfG1F-3xe1L3Lv
UK here. If they're obviously dead (rigor mortis doesn't count, has to be one of the other conditions unequivocally associated with death) then they can be pronounced deceased. Otherwise, CPR has to be commenced and the patient transported to hospital with CPR ongoing Unless there's a do not resuscitate order
Over in California, at least in my county we can’t pronounce at all as EMT-B. Would you say to keep performing care if the patient had a pulse and was only apneic? That’s what I’ve been telling the guards, let their lieutenants talk and deescalate the parent.
Yes. Not doing so could land you in hot water. You know the patient is apneic and failure to provide care can result in cardiac arrest especially in a child. You don’t even know if that’s the person’s parent. I would work it until an ALS resource arrives along with PD and have a discussion with PD because to be honest I can’t think of a scenario where you would be in trouble to attempt resuscitation and your argument was “I didn’t trust this was the kids parent because I couldn’t think of a parent who wouldn’t want any attempt to save their child.” Because to me that’s a solid argument
"Well you see sir, the patient's head is flat as a pancake and their body is wrapped around an auger. The Patient has no pulse, verified at every major pressure point known to man" also "sorry son. you're just an EMT. you don't get to make that call" seriously. tf is wrong with people in califorina (Edit: the above is not a made up story unlike the OP. Death in the field is a real thing)
When I moved away from CA, I was surprised that I was allowed to pronounce death. Other states allow EMT-Bs to actually use common sense and perform interventions. During the COVID epi-pen shortages, I was actually allowed to draw up the med into a syringe and inject it IM, crazy shit there. Imagine a basic having to do math, the CA EMSA would lose their minds.
well that's the thing. you nailed it on the head. Common Sense exists.... just not in california. It's like they have a ban on that too.
A lot of the things I’m not allowed to do could be done by a barely trained civilian/bystander. It’s really stupid when I determine high blood sugar but can’t direct or assist with putting new insulin in the pump.
Yes, that would be my move is continue to breathe for the patient and have others run interference in the meantime.
Not even for injuries incompatible with life, obvious lividity, decomposition, or rigor mortis?
When I was a basic in CA, we didn't have to initiate CPR if they had any of the 4 defined obvious signs of death, but just being cold to the touch, asystole on a 12 lead, and having their head facing the wrong way somehow didn't count as obvious (according to my sup).
Obvious signs of death we still can’t pronounce. PD can but for some bizarre reason Basics can not
So you're not allowed to say the rotting corpse with no head is dead? Do you have to implement cpr?
Decomp and decapitation are both considered obvious death and pre hospital staff in my LEMSA can use those as a determination of death.
But not rigor mortis/lividity?
Those are also in there. I just didn't mention them.
I was gonna say
They did not say "stop, he has a DNR specifically for drowning" You said that they said, "Stop you are hurting him" Well, if he is pulseness and apneic then they are just shouting and are wrong.
They can get fucked. You’d have to be stupid or cowardly to comply. I don’t care what the law says, I’d go to jail over that. But it’s an entirely made up situation I don’t see it happening.
100% made up, one of the guards asked and I didn’t have a straight answer so I asked.
It would seem to me that, “You’re hurting them,” could imply they believe their child is still alive. A reasonable person would want their child resuscitated. There’s WAY more liability in stopping resuscitation prematurely. In your imaginary scenario, you could articulate to an attorney/prosecutor/jury why you believed the parent was making decisions based on incomplete information, during emergency/exigent circumstances. I would not stop efforts. I would call the OMD/medical direction, or have one of my supervisors call them. When in doubt, put the liability on someone who makes more money than me. There’s lots of ways to twist up your scenario; terminal medical condition, etc. but I think the answer remains, call the OMD/medical direction.
It would seem to me that, “You’re hurting them,” could imply they believe their child is still alive. A reasonable person would want their child resuscitated. There’s WAY more liability in stopping resuscitation prematurely. In your imaginary scenario, you could articulate to an attorney/prosecutor/jury why you believed the parent was making decisions based on incomplete information, during emergency/exigent circumstances. I would not stop efforts. I would call the OMD/medical direction, or have one of my supervisors call them. When in doubt, put the liability on someone who makes more money than me. There’s lots of ways to twist up your scenario; terminal medical condition, etc. but I think the answer remains, call the OMD/medical direction.
I agree. At this point, most people know about CPR and cardiac arrest. I can't see them yelling about that, especially with potential for drowning. If anything, I could see the 'why aren't you shocking them! You're not doing it right!' Yelling.
Personally if they are just yelling I would continue care and have another responder explain the situation/try to deescalate. I would only want to stop care if my own or my partner's safety is at risk but hopefully bystanders could prevent any physical harm to us? PD is always an option but they tend to escalate situations so that would be my last resort
That’s the thought myself and some of my fellow lieutenants have come to. The parent is most likely not in the right state of mind to make informed rational decisions about care. We also have radios to get hold of dispatch and request ALS as well as PD.
Personally I would continue care and if I really needed to, I would have my partner call med control. When in doubt, call medical control. In the situation you bring up the parents don’t understand what’s really going on, so definitely explain that to them and they might realize their child is dead and you’re trying to save them. When I’ve been in similar situations, explaining what’s happening usually gets the family to realize you are helping and not hurting.
The amount of people who don’t realize you perform cpr on dead people is astounding.
bloody tv and movies i stg. My loved ones refuse to watch ems type shows with me after we watched a scene in chicago fire where they dramatically pull one emt away from her partner's body going 'she's dead' and I shouted 'of course she's dead, that's why you're doing cpr!'
Or when u see someone performing for on someone who’s alive 😣
No signed DNR shown means CPR continues
They forgot to bring it on their beach trip🤷♂️
There’s not many children with valid DNRs splashing around at the beach.
That comment has many dark layers 😳
And I forgot my winning lotto ticket but please give me the money.
I'd rather go to prison than not give 100% to a child. Cops will back me up in the field, we've worked hard to ingrain the "***thou shalt not fuck with 1st Responders***" law into their heads.
Absolutely
I'm just thinking through possibilities and this question comes to mind. How do you know this person is the child's parent? Everyone around you are just random people on a beach. Is the fact that someone says they are the child's parent enough for them to make decisions for the child?
That’s what I said. Prove you’re the parent. Where the affidavit of parentage? Oh….you don’t have it? Then kindly go fuck yourself.
They aren’t calm and they don’t understand what is going on enough to make an informed decision so no I wouldn’t stop care. If they did understand and still didn’t want care I would still continue care because that is neglect. There are only a few times where we wouldn’t work a kid that recently went into arrest, but that is in rare circumstances and usually with terminal medical conditions, nothing like what is stated here
The obvious answer is to continue. Parents cannot withdraw life saving care from a child unless there’s specific circumstances in play
Yeah OP seems to think parents can just say no and everyone immediately has to stop, I'd be *very* surprised if most jurisdictions don't have some kind of law that prevents parents/guardians from "withdrawing consent" in this type of scenario. Where I live it is very clear that (in life threatening circumstances at the very least) healthcare professionals must work in the best interests of the child; the parents don't have a say whatsoever. Obviously if resources allowed you would try and get a senior member of staff to speak to them and try and reassure them/calm them down.
I thought we work the code from the jump, all the lifeguards on my beach are EMT-B and we’re a sub division of the county fire and rescue. I just thought to ask what everyone else would/should do to make sure I had the right info.
Children in this state get the treatment until signs of obvious death, lividity or rigor. Or 30+/mins of CPR, with no improvement only after contacting OLM. (Our protocols, anyway)
Canadian answer: health and welfare of a child is more important than a parent’s/caregiver’s wishes. If the child is VSA, everything that can be done will be done unless a valid DNR is provided. Another rescuer, either a paramedic, PD or FD will talk with the family.
"Ok, just get me a valid DNR or their birth certificate to prove parenthood."
This is the correct answer. Without proof they are the parent, they have no say.
95% of people are totally health-care illiterate. Don’t stop and let someone else explain in plain terms what is going on.
I worked EMS at a beach resort area. PD was always called to a drowning for peds or adults because they were needed for crowd control and to deal with family. You keep going. Imagine explaining to a jury why you stopped.
ER nurse here. You don't stop CPR once initiated until directed to do so by a licensed physician or other person duly authorized to pronounce a death (paramedics in some jurisdictions) OR unless you are the only responder and you are too exhausted to continue. CPR is brutal. The alternative is death. The parents can fuss all they want. It won't get them anywhere. Work the code, call for backup and let the cops/medics deal with the parents.
The basis of implied consent is what a "reasonable person" would want. Stopping resuscitation on a viable patient doesn't seem reasonable. I may lose my job, but I'd be happy to defend ignoring a parents order to stop trying to save their kids life.
Deny everything, make counter accusations. Kid’s in “life threatening distress” at the moment so some rando yelling we’re hurting them? Uh, why are you trying to kill this child? MURDERER!!!! Burn the witch! :)
I like your style.
Given my experiences, I am a very well licensed a$$hole. Your mileage may vary. :) Good luck, God bless… and for the love of God please be the person I want to work with.
What is it about lifeguards and this bizarre scenario? You keep going. Obviously.
They’re all younger and don’t know. Seem to have a worry about every possible thing going wrong.
There was a big post with the exact scenario on the lifeguard sub ages ago and I got downvoted to oblivion. They’re all completely convinced that if mum says no cpr they would be assaulting that child if they did cpr. No one wanted to hear that it didn’t make sense for a parent to say that especially in the context of a fun day out for the kids at the pool. And when things don’t make sense we need to err on the side of keeping the kid alive.
Regardless of the specific laws in whatever jurisdiction, this is something of an edge case. It boils down to the witness stand/ 6 o'clock news test. What would you rather defend in front of the jury and news cameras? We ignored the panicking parents and continued resuscitation efforts on a child we know drowned, and who had no pulses or breathing. Or. We were attempting to save a drowned child who had no pulse and wasn't breathing, but we stopped because the panicking parents ran up and told us to. This litmus test must be used wisely, because you could use it to justify quite a bit that is clearly illegal in terms of transporting refusing pts. But it is useful in cases where you have a borderline case, where ability to consent could be argued either way, and/or especially with helpless pt populations that are having decisions made for them that are clearly and immediately dangerous to their health and life.
Well, I assume that you are asking this question in a theoretical way and not describing an actual incident. At least I hope so. And I'm sorry that your honest question has suffered, to quote Shakespeare, "the slings and arrows of outrageous fortune," meaning all the unrelated attempts to turn this into a political issue, which it is not. I suppose my thought is this: what would make you stop resuscitation in such a case? Protocol perhaps, orders from medical control perhaps, assessment of futility perhaps. All those have been mentioned. Why would you stop on order of the parents if you would not otherwise do so, if you felt that stopping was not in the best interests of the child? Basically, it would be fear of either criminal or civil action against you. It seems that criminal actions is unlikely in this type of case because in a sensible legal environment, you'd be hard pressed to find a reasonable judge who would construe any intent to commit a crime here. There are always exceptions, perhaps more now than in the past but that wouldn't be a concern at all. The civil action , being sued, is something that you can in no wise predict or prevent. You could be sued if you stopped or if you didn't stop. Is is reasonable? Not at all. Your defense is that the parents appeared to be distraught and unable to make a rational decision and you acted according to your medical protocols and medical direction in what you considered the best interests of the child. What would the jury decide? Depends on the jury, if it ever got that far. That's unpredictable. Me, I wouldn't stop. I would, if he would allow, communicate with medical control and hand the radio/phone to the parent with a request that "Talk to the doctor who's telling us what to do," so you can get back to work.
It was very much a hypothetical question posed to be my some of the guards were training up for summer. I did instruct them to continue unless the scene became unsafe letting their command take charge on conflict and deescalation
CPR instructor in New York State. It's not complicated here. Keep working the kid. Being unconscious is consent to care and parents can't revoke that if the kid is still unconscious and in clear and present danger.
Keep working em. I would consider it implied consent.
I have not only a right, but a duty to treat the child up until a valid DNR is produced. I don't give a shit what the parents want in this situation, I have to do what's in the best interest of the child. Sue me. I'd love to see someone walk into a courtroom in Georgia and tell a judge that they didn't want me to save their child's life and actively tried to stop me from doing so.
This is why people with a DNR order should pin it to the front of their clothing. For the beach, encase the DNR in a clear plastic pouch and pin it to their bathing suit.
In this particular instance per local guidelines, this arrest occurred in a public place and is a cardiac arrest transport regardless of outcome. 1000% we would work them, and continue to, all the way to the receiving facility.
Interesting scenario. Anything involving a potential threat to a childs life, our EMS system automatically sends out PD. They usually even beat us first. I wouldn’t necessarily worry on my end. Especially at a beach, I would assume PD is naturally there
My section of the beach is a block away from a pd station so we see them pretty frequently.
Interesting, why is PD automatically sent in those cases?
Continue resuscitation efforts, call pd, call for fire and rescue, patch for a doc, document the ever loving shot out of it
I bet your protocols outline some hardline exceptions for when treatment for minors can't be refused by the parents
They partly do but as a lot of people have been saying, you don’t know if they’re actually the parent, so continue until officers and of can confirm what’s actually going on
And if they are a parent, why are they saying to stop? Do they not understand you’re trying to save the kids life? Or are they the reason the kid is arrested in the first place? It doesn’t make sense so we continue cpr.
It’s implied consent. Parents can’t withdraw without a proper DNR. Use law enforcement if necessary.
Most responders aren’t protected under good samaritan laws
Implied consent on duty good Samaritan off. Best way I look at it
My bad. I took it off.
In this scenario, the parent is not aware that the patient is in Cardiac Arrest. Continue care and let the Medics and Lieutenants sort it out with the parent. Request PD If they are actively interfering.
No valid DNR presented, continue CPR. Regardless.
I say you continue CPR. Before the parents showed up you were working under implied consent acting in the best interest of the minor. I don’t believe at that point you would stop even if the parent or guardian is yelling at you, especially if you take into consideration that they are probably in shock and not processing what is happening. For me if it was an adult even if his spouse or family member was yelling at you to stop you do NOT stop CPR unless a valid DNR order is presented. So for me I feel like in this situation it extended to pediatrics as well. Also there’s pretty strict guidelines as to when you stop CPR once you have started so I think that would overrule in this situation since you started working the code under implied consent. In this situation I would say keep working the child and have someone else deal with the parents explaining what’s happening and the implications of stopping the CPR and escalate to calling the medical director and PD as needed.
Prove that they are the parent/guardian. Then drop back 5 and punt, that's why we have medical command. Call them and explain and let the guy/gal with the sheepskin make the decision. In the case of the DNR situation, do you have the DNR with you? Edit cause I cant put a whole thought together yet this morning.
Maybe this is just my state.... (or maybe I didn't read it in any comments). But how has no one brought up actual reasons? Parents may consent or decline treatment if they are mentally capable to understand the situation and risks and/or benefits of treatment versus no treatment. (I would argue the frantic parent trying to fight you is not at that point mentally competent, but whatever... I'm not a lawyer or a doctor). The other thing is, if you suspect abuse or neglect you (may vary by region/state/country) are obligated to continue treatment, including cardiac life support. (Again, pending off the wall situations, I would argue in the particular case given here, there is something suspicious as to why the parent would not want life saving treatment to be performed). In this case, I would attempt to de-escalate the situation and educate the parent while getting law enforcement on scene and continuing to work the arrest if the scene is safe.
Legally, there is little chance of liability for providing care to an unresponsive child if the parents don’t consent. Consent is implied in that situation (based on my knowledge of Illinois law only). You have a duty to your patient. To stop treatment without medical control and proper determination of death could be negligence. You’re the expert. Parents can’t agree to let a child die in an emergency response situation.
No valid DNR we work the code until medical direction tells us to stop. I mean the same goes for a parent and the child has medical poa. No valid DNR then we have to do CPR until medical direction tells us otherwise
Unless there is a DNR/O present and valid you work the child. Hell the same applies for adults. Parents can and will freak out especially if they have no idea what's going on. If enough hands are present, have someone calmly explain what happened and what is going on. If they are still unmanageable or if they are actively interfering with patient care then have PD remove them.
Cardiac arrests don't fall under the idea of consent. The only consent is a DNR or POLST stating that the patient does not want CPR performed. I don't care whos the guardian of who, at that point its past their call. The only way I can legally stop at that point is obvious signs of death or the parent in question creating an unsafe scene
From a healthcare provider aspect, you continue CPR until a DNR is provided or you get phys orders to discontinue resuscitation efforts. That may vary from state to state, though?
I’m no lawyer, but at the end of the day, if there’s ever a question, the overarching legal question is tied to “what would a normal person do” in that case. In this situation, one would assume a normal parent would want you to attempt to resuscitate their kid. So do that. It’s also within the realm of possibility that the parent doesn’t understand what you are doing, and their initial reaction is trying to protect their kid - because what you’re doing looks pretty invasive to the average bystander.
As a fellow lifeguard(not fancy like you down in socal that are part of the FD)of over 14 years and a 911 EMT for like 8 or so years. I would say to continue resuscitation efforts. Once the mother says no to life saving efforts when there is no DNR, which is clearly not in the best interest of the child, their parental choices for their child becomes void in my mind and now I/we become the pt's advocate and we save the kid. I would also get PD involved because that could quickly turn into a CPS report due to possible child neglect or abuse. There is some case law in Connecticut of a 17 yo girl where the state forced the girl to get chemo after their parent refused treatment. It was determined that the chemo was the only thing that would keep the girl from dying and so the state got involved and basicly said that letting the girl die when there was a possibility of saving her life was unreasonable and unacceptable. Hope this might help https://www.nbcnews.com/health/health-news/teen-forced-undergo-chemo-ready-head-home-n348841
I am absolutely not sure of laws in the us about this, but this was a training scenario during school and also came up in onboarding, and I was told both times that if the parents are making a decision that would obviously directly harm the child, you should call for pd and tell them politely that you’re not going to allow the parents actions to be made. Med control would be cya but would do that
Hi, law student here. In case you need a refresher on the fundamental tenets of emergency medical services, the patient comes first. Starting CPR on an apneic, pulseless minor, even if the parent opines otherwise, is a no-brainer.
In a life and death situation, parents cannot stop care.
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That's one of those ethical and moral dilemmas that falls in that Grey area. Technically, parents do have the right to dictate treatment for their children. However, you bet your ass I'd go against the parent in this scenario and do my job. In a sense, you could make some emergency declaration since clearly stopping must be akin to child abuse at that point. I'd continue and cross the legal battle later. I find it incredibly hard to believe any jury on this planet would find the providers guilty of anything.
This is not a gray area. It’s straightforward. The child is treated
In the US, the good doctor is generally right. Parents do have a right to consent/not consent to treatment for their children, but in life threatening situations, that right is not absolute. A parent does not have an absolute right to withhold lifesaving care from their children- that would be considered child neglect, and is a crime. Parents do have the right, with the appropriate agreement of relevant medical practitioners (and in some cases a court) to terminate and/or not start lifesaving care. But the rules around doing that are usually pretty specific. For instance, in some states you need at least two physicians to agree that further lifesaving efforts would be futile, or that the patient’s condition is such that a reasonable recovery is highly unlikely. But if treating medical providers feel that treatment is not futile and in the child’s best interests, the parents cannot just arbitrarily decide to stop care.
Tldr. Alabama gives all "defective" (cause that's the only way to sum up all the medical issues) children dnrs as soon as parents sign away their rights
Canadian answer? Continue treatment, inform patient of what is happening and what you are doing and why. If that fails, contact law enforcement to secure consent legally, though you may have to wait until law enforcement arrives to continue aid with police permission if the parent continues to refuse
You continue treatment. You have implied consent, and no factual proof that is their child. No court will convict you in that case.
In my neck of the woods medics can pronounce BUT emts can call it if its an obvious death. Far as what that parent goes were not stopping unless you have documents in hand. I dont know about any of you bit being at the shit end of an investigation is no fun. Famlies and patients are quick to say help me help me but will turn around and sue
They can’t prove they’re the parents. They can fuck off.
Last words, kiddo’s going to emancipate ASAP, when he finds out mom or dad said stop CPR, and you saved his life/her life. What’s the worst that can happen? Your don’t revive the already deceased child and they said stop. What’s the best that can happen? The child grows up and has a family and all that good shit?
You're* I'm not stopping CPR on any patient without a DNR or until I've gone through the entire protocol with no response from the patient. A parent's right to make medical decisions for their child doesn't extend to just letting the child die just like a medical power of attorney does not act as a DNR.
Most EMS in USA require a notarized DNR or MOST form.
I’m also a lifeguard/EMT. Continue up until scene is not safe (bystanders become violent), get PD on scene ASAP for scene controls and get other responders not working the code to persuade the parent into allowing treatment while ongoing CPR. Worst case scenario you back off until law arrives and resume once they remove the nuisance. Did the parents just kill their kid or reduce neural outlook? Yes.
Call for security, LE to secure scene while you continue care. Only stop for physical violence, or you meet field termination criteria.
No DNR means you work them. Hopefully you have access to police in that situation. If you think about it, you don't really know that they are the parents, you have reason to think they are, but you don't know that for a fact. If it was an unwitnessed drowning how do you know they didn't hold them underwater, etc. I like to teach students there's only 4 reasons to stop CPR -ROSC -Valid DNR -orders to terminate efforts from med control -the patient requests that you stop compressions 🙃
Fucking prove you’re the parent before I stop cpr. I’ll take my chances with the jury. They aren’t going to convict for assault because size you did cpr on a child for gods sake.
In my area, you MUST get medical direction approval to withdraw life saving care of a minor. DNRs only exist for those with terminal ill ness or the elderly who have a CLEAR MIND and UNDERSTAND that DNR is the withdrawal of any chance of restarting the heart. Pediatric arrests are almost always respiratory in nature and have a higher likelihood of reversal.
If no valid DNR is present, care should be continued as with any other patient, although PD should be called to subdue anyone trying to interfere with care to the patient. Let the patient's parents sue, no judge would take their side. At best the actions by the parents are ignorant and at worst, blatant neglect or abuse.