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(CBS New York)   Victim's family shocked that even though a gym is require to have defibrillator, and staff trained to use it, they don't actually have to use it   (newyork.cbslocal.com) divider line 147
    More: Stupid, Long Island, Jonathan Lippman, negligence, gyms, Appeals Court, automated external defibrillators  
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10256 clicks; posted to Main » on 09 Feb 2013 at 10:11 PM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



147 Comments   (+0 »)
   
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2013-02-09 05:06:25 PM  
If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.
 
2013-02-09 06:17:44 PM  

cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.


They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.
 
2013-02-09 07:19:29 PM  
  This is inherent risk.  If not at the gym, this would have happened at some point.  Can't hold the gym responsible for the inevitable.  Infarction builds up over decades, not over 10 minutes on a treadmill.
 
2013-02-09 08:08:23 PM  
a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?
 
2013-02-09 08:10:39 PM  
This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.
 
2013-02-09 08:18:39 PM  
I imagine if the doctor that was there doing CPR thought it was needed, he would have said to use it.
 
2013-02-09 08:28:47 PM  

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.


Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.
 
2013-02-09 09:09:04 PM  

vygramul: They treat a very small subset of shockable rhythms to begin with. Like fewer than 20% of them.


yep

fusillade762: Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Yes, you don't use an AED on someone with a pulse. The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

How a defibrillator works
 
2013-02-09 09:09:54 PM  
FTFA: A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".
 
2013-02-09 09:18:31 PM  

cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.


They can and will if they detect artifact and the software reads it as ventricular fibrillation.

rtboardreview.com

That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".


Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.
 
2013-02-09 09:19:26 PM  
cdn.videogum.com
Maybe he'd had the Kick-Ass Cajun dressing.
 
2013-02-09 09:22:30 PM  

BronyMedic: Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


I'm not questioning anything anyone did, or why. I would have no idea what to do in that situation. I just pictured the paramedics walking in with gorilla masks on and scaring the guy. I was much funnier in my head, I assure you.
 
2013-02-09 09:24:10 PM  

Ed Finnerty: I'm not questioning anything anyone did, or why. I would have no idea what to do in that situation. I just pictured the paramedics walking in with gorilla masks on and scaring the guy. I was much funnier in my head, I assure you.


NOOO! That's not what I was insinuating! I was just illustrating what is poorly worded journalism.

Besides, everyone knows we come up to the patient like this.
 
2013-02-09 09:25:11 PM  
Damn you images!

bloximages.chicago2.vip.townnews.com
 
2013-02-09 09:37:46 PM  
CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.
 
2013-02-09 09:54:11 PM  

serial_crusher: CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.


that's farked up.
 
2013-02-09 09:56:31 PM  

serial_crusher: CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.


I'm pretty sure that's not legal, or a great way to avoid lawsuits. The financhial relationship between a w/c van attendant and their charge creates a legal duty to act to provide first aid care under the state statutes that regulate them, at least in Tennessee.
 
2013-02-09 10:09:11 PM  

BronyMedic: They can and will if they detect artifact and the software reads it as ventricular fibrillation.


You need a better AED.. Ever download the data after they've been deployed? We provide a LifePak 500 for our local PD. It analyzes twice before deciding whether to deliver a shock or not. You aren't as likely to see artifact in both segments.  Movement detection is also built in, but it does need to be turned on. The Lifepak 12 does the same thing if left in auto mode, but that may have more to do with the software version.
 
2013-02-09 10:16:58 PM  

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Logic has no place when OUTRAGE is the only answer.
I was lucky that hospital employees knew I needed to be defibed 3 times when my heart actually stopped after a rattlesnake bite.
 
2013-02-09 10:17:15 PM  
Sounds like the club did the absolute best they could do under crappy circumstances.
 
2013-02-09 10:17:49 PM  
img2.timeinc.net

Zap the son-of-a-biatch again
 
2013-02-09 10:21:44 PM  

BronyMedic: cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

They can and will if they detect artifact and the software reads it as ventricular fibrillation.

[rtboardreview.com image 498x155]

That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


I'm ignorant. Will those things fire if the patient has a pulse?
 
2013-02-09 10:23:30 PM  

"...they aren't required to actually use them on a stricken patron, the state's highest court ruled Thursday."


For heaven's sake why not? As Farkers above have said, you can put the pads on a person and the defib won't shock the person unless it detects that the person needs it. And remembering my training, compression is very important, even more than breathing into the person's airway. You have to keep the blood moving and everything oxygenated or the person's brain is screwed.

The funniest part of the training is when they tell you that before pads are applied, you should quickly shave down any hairy chests and remove any body piercing on the victims including nipple piercings. Or else if a shock is applied it will just jump in between the piercings (at least that's how I remember the trainer explaining it).

 
2013-02-09 10:23:58 PM  
What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.
 
2013-02-09 10:25:15 PM  
So eventually these people came and, somebody, gave him mouth-to-mouth.

media.avclub.com
 
2013-02-09 10:26:08 PM  
As mentioned above, AED's are trendy and are not a viable substitute for good CPR, until trained medical personel arrive who can properly interpret the cardiac rhythm. Reliance on that technology is faulty at best.
/Been there, done that, dozens of times.
 
2013-02-09 10:26:18 PM  

Notabunny: I'm ignorant. Will those things fire if the patient has a pulse?


There was a chance with the old ones that it would, but after what Cretinbob said I wonder if it's just kept in the guidelines as apopcryphia. I know our SOP with the Zoll PD1700s when I was a first responder said not to attach it if they had a pulse. it also has to do with the fact that those defib/pacer patches are about 150 bucks a pop, and they'd rather you not waste them. AEDs are useless if the patient had a pulse at any rate. Modern AEDs did away with the EKG monitoring screen (you can use the pads to monitor in Lead II) years ago because people realized they were added cost with no added value.

I do know that as of December 2012, a certain large nation-wide ambulance service I work for has in their guidelines that EMTs cannot use an AED while going down the road because of the risk of a false firing event. I've been monitoring patients on a Lifepak 12 that would literally look like they were in ventricular fibrillation when you go over some roads in Memphis, and the v.fib alarm would go off.

When you're dealing with BLS providers, namely First Responders and EMTs, you also have the issue of them performing a skill they are not legally allowed to perform - namely attempting manual cardioversion.
 
2013-02-09 10:26:39 PM  
And if they had used it and the guy died anyway - which he surely would have - they'd be suing over that. Yes, it doesn't make sense to require them to have the equipment and be able to use it to save lives, but not require that they use it to save lives. That would be like requiring a public pool have a lifeguard that knows CPR, but the lifeguard can just ignore drowning people. In this case, though, it would be like requiring the lifeguard to give CPR to everyone in the pool.
 
2013-02-09 10:27:08 PM  
And just to further mention, the defib machine my job has is pretty foolproof. It verbalizes the instructions and if it detects the person does not need a shock, it will then count off for you in time so you can compress the victim's chest in rhythm, then the machine will tell you when to apply breaths and when to restart compression.
 
2013-02-09 10:29:32 PM  
FTFA:  "a trainer detected breathing and a pulse and didn't use the AED " but also " a doctor and medical student began cardio-pulmonary resuscitation."


Was the trainer wrong about the presence of respirations/pulse or was the doctor/med student wrong about the lack of respirations/pulse?  I suppose they both could have been right given a delay between when the trainer checked and when the doc checked for a pulse, but then why didn't the doc apply the AED since it was stated in the article that the AED was already by the patient's side?   Obviously at some point he was in V-fib/pulseless V-tach at some point since the medics shocked him, so it is likely that he was in a shockable rhythm initially.
 
2013-02-09 10:30:17 PM  
The court needs to carefully examine this lawsuit.  Society and good Samaritans could be ruined infinitely because of one fark up.  Because this is an extremely small minority of cases, more people could die if the risk/benefit gets skewed by knee-jerk media outrage.
 
2013-02-09 10:32:32 PM  
what i couldn't figure out about the article is that it said a TRAINER found a pulse and breathing, but a doctor and medical student did CPR??  personally if you have an unresponsive casualty, hook the damn defib up!  We also have the life pac, and find it pretty infallible.    The paramedics shocked him when they arrived, so there had to be some kind of rhythym when they arrived.  I have had several people confuse agonal resps with "breathing", and be hesitant to start CPR...

i see a few people in this thread who could benefit from a basic first aid course... defib's do NOT start the heart, unless we are talking hospital care settings, and that is usually in conjunction with cardiac meds if i am not mistaken.  (way above my pay grade).  Portable defibrillators like the PAP ones just detect a rhythym that it can disrupt, and hopefully the heart will establish a new, normalized rhythym on it's own...
 
2013-02-09 10:35:00 PM  

skinink: "...they aren't required to actually use them on a stricken patron, the state's highest court ruled Thursday."
For heaven's sake why not? As Farkers above have said, you can put the pads on a person and the defib won't shock the person unless it detects that the person needs it. And remembering my training, compression is very important, even more than breathing into the person's airway. You have to keep the blood moving and everything oxygenated or the person's brain is screwed.

The funniest part of the training is when they tell you that before pads are applied, you should quickly shave down any hairy chests and remove any body piercing on the victims including nipple piercings. Or else if a shock is applied it will just jump in between the piercings (at least that's how I remember the trainer explaining it).



Compression just buys time till defibrillation or until the underlying cause can be corrected by keeping the coronary tissue and, to a lesser extent, the brain and end organs perfused. Unless you get a shockable rhythm where the heart can be bullied into a reorganized electromechanical activity, or unless you treat the reason their ticker won't tock, compressions will not bring someone back. The only exception to this is in neonates and children, where they have a primarily respiratory cause for their arrests. (The reason why hands-only CPR is not taught for children)

They have no legal duty to act is the reason the court found their findings, more than likely, since they are not licensed/certified healthcare providers, and they were acting in the capacity of good samaritans, not as rescuers. While it's ethically questionable, legally it's perfectly gold for them to do what they did.

Even Healthcare Providers only have an ethical duty to act when off duty and not on the clock. Alabama was the only state I knew with a law mandating that people who are licensed and/or certified in that state stop to render aid in an emergency, and they struck it off the books three years ago because it was unenforcible.

As far as the shaving thing now, the AHA recommends you keep two pairs of defib patches in each AED. They dont even recommend it anymore, because you have to interrupt CPR to do so. You just jerk the first pair of patches off to rip the hair off their chest, and try to either reattach them, or apply a new set.

Britney Spear's Speculum: The court needs to carefully examine this lawsuit.  Society and good Samaritans could be ruined infinitely because of one fark up.  Because this is an extremely small minority of cases, more people could die if the risk/benefit gets skewed by knee-jerk media outrage.


HAH. People need to check and see if their State's Good Samaritan protections cover them if they have any kind of healthcare training or licensure/certification. Tennessee pretty much gave the middle finger to anyone who did a few years ago when they removed the good samaritan protections for people who had a license or certification - like EMTs and RNs - and held you accountable to act as if you were on the clock.
 
2013-02-09 10:38:56 PM  

BronyMedic: It will not do anything.


But, but, but, DO SOMETHING! Save Grandpa!
 
2013-02-09 10:39:00 PM  

vygramul: cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.

They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.


the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.
 
2013-02-09 10:41:53 PM  
How Dead Dave got his name: Years ago this supervisor at NJ Bell (Dave) treated everybody like shiat. One day Dave had a heart attack in his office right in front of a field tech. The tech said "oh well" and just left. A secretary found Dave near dead not long afterward and called an ambulance.

When Dead Dave came back to work he tried to get the tech fired. But there was nothing in the union handbook or the employee manual stating you had to call an ambulance or notify someone in such an emergency so the guy kept his job. And from that day on a certain dooshbag was forever known as Dead Dave.
 
2013-02-09 10:43:29 PM  

Ed Finnerty: FTFA: A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".


Relevant:

www.wearysloth.com

Want to see something really scary?
 
2013-02-09 10:43:46 PM  

UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!


QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.


This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.
 
2013-02-09 10:44:50 PM  

BronyMedic: HAH. People need to check and see if their State's Good Samaritan protections cover them if they have any kind of healthcare training or licensure/certification. Tennessee pretty much gave the middle finger to anyone who did a few years ago when they removed the good samaritan protections for people who had a license or certification - like EMTs and RNs - and held you accountable to act as if you were on the clock.


THIS.  There should be a federal standard for Good Samaritan laws if you ask me.  People going into cardiac arrest and the method for which you provide help to them isn't an issue that should be left up to states.
 
2013-02-09 10:45:10 PM  

BronyMedic: QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!


Oh boy, Grandpa's having a PUPPY? Mom! MOM!
 
2013-02-09 10:46:05 PM  

ltdanman44: vygramul: cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.

They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.

the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.


If it is so damned automated then why didnt it hook itself up to the dead dude?
 
2013-02-09 10:47:11 PM  
92 percent of people that  go into cardiac arrest die.
 
2013-02-09 10:47:16 PM  
Maybe at that gym, full attempt to save your live in the case of an emergency is only for the platinum members.  Good thing he didn't have a basic membership, they would have just asked him to leave for blocking equipment.  For an extra $5 per month, in the state of emergency a hot trainer of your choice will freshen their breath before performing mouth to mouth and will continue until you ask them to stop.
 
2013-02-09 10:50:41 PM  

BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


Unless you are using another article, by my count you have a trainer at the club who detected a pulse/respirations and therefore no need for the AED.  Then you had the doctor (article doesn't specify which kind of doctor and who knows, it could be a podiatrist) and med student not detect a pulse since they initiated CPR but they also did not apply the AED. Finally you have the medics who used their own monitor and shocked the pt, although it isn't known if that was done right away or after meds were given.  The only layperson was the trainer, unless I missed something.
 
2013-02-09 10:51:04 PM  
bmr68: 100 percent of people that  go into cardiac arrest die.

FTFY.
 
2013-02-09 10:51:11 PM  
BronyMedic:

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.


What if it's designed to shock VT and is counting on the responder to make sure it's pulseless?
 
2013-02-09 10:51:53 PM  

BronyMedic: This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


And that's why the court should throw this case out.  It will do more harm than good if they rule that the club was negligible.
 
2013-02-09 10:55:14 PM  
Risk getting sued for injuries? No thanks.
 
2013-02-09 10:56:32 PM  

dark brew: BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.

Unless you are using another article, by my count you have a trainer at the club who detected a pulse/respirations and therefore no need for the AED.  Then you had the doctor (article doesn't specify which kind of doctor and who knows, it could be a podiatrist) and med student not detect a pulse since they initiated CPR but they also did not apply the AED. Finally you have the medics who used their own monitor and shocked the pt, although it isn't known if that was done right away or after meds were given.  The only layperson was the trainer, unless I missed something.


WHAT IF?!!??

If the patient had a run of VTac... The trainer felt the pulse and was right to not start CPR... But then the doc felt for a pulse and it was so rapid he didn't feel one, or only caught it occasionally, or recognized the inadequate perfusion... so started CPR.... then the Medics shocked it when they got there.

OR

The patient didn't have a pulse, but the trainer wasn't sure whether he felt one or not, and just figured he did, or confused his own muscle tremors from his excitement as a pulse and therefore mistakenly didn't start... and then the doctor of some variety was correct in assessing the lack of pulse, but then was too ignorant to think about a defib, etc... and screwed up in this regard and then the medics got on scene and saved the day.

OR

We have no idea what happened because bystanders have no clue about what's going other than some doc started UPS on the guy.
 
2013-02-09 10:57:32 PM  
OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?
 
2013-02-09 10:57:32 PM  

Britney Spear's Speculum: And that's why the court should throw this case out.  It will do more harm than good if they rule that the club was negligible.


What a negligible club might look like:

img22.imageshack.us

/it's negligent
 
2013-02-09 10:57:51 PM  
This is a shocking lawsuit
 
2013-02-09 10:58:00 PM  

Smgth: What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.


Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.
 
2013-02-09 11:00:13 PM  
"Victim" *picture of Dr. Evil doing air quotes*
 
2013-02-09 11:00:25 PM  

BronyMedic: Notabunny: I'm ignorant. Will those things fire if the patient has a pulse?

There was a chance with the old ones that it would, but after what Cretinbob said I wonder if it's just kept in the guidelines as apopcryphia. I know our SOP with the Zoll PD1700s when I was a first responder said not to attach it if they had a pulse. it also has to do with the fact that those defib/pacer patches are about 150 bucks a pop, and they'd rather you not waste them. AEDs are useless if the patient had a pulse at any rate. Modern AEDs did away with the EKG monitoring screen (you can use the pads to monitor in Lead II) years ago because people realized they were added cost with no added value.

I do know that as of December 2012, a certain large nation-wide ambulance service I work for has in their guidelines that EMTs cannot use an AED while going down the road because of the risk of a false firing event. I've been monitoring patients on a Lifepak 12 that would literally look like they were in ventricular fibrillation when you go over some roads in Memphis, and the v.fib alarm would go off.

When you're dealing with BLS providers, namely First Responders and EMTs, you also have the issue of them performing a skill they are not legally allowed to perform - namely attempting manual cardioversion.


Something about that brings Orville Redenbacher to mind, but not in a happy way.
 
2013-02-09 11:00:46 PM  
Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.
 
2013-02-09 11:01:04 PM  
If your only tool is a hammer...
 
2013-02-09 11:01:08 PM  

ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?


Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.
 
2013-02-09 11:01:32 PM  

cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.


Done in one. You can stick the pads on somebody, but the AED won't even let you shock if it's not appropriate.
 
2013-02-09 11:03:44 PM  

3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.


[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"
 
2013-02-09 11:06:28 PM  

HMS_Blinkin: cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.

Done in one. You can stick the pads on somebody, but the AED won't even let you shock if it's not appropriate.


Not really done in one since if he was in a shockable rhythm it very well have made a difference in the patient's outcome.  The lawsuit was correctly decided, however, since the trainer thought that the patient had a pulse and was breathing.
 
2013-02-09 11:10:46 PM  

felching pen: Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.


That's a little bit of a slippery slope there. The idea of the mandate is to have the equipment available to use appropriately by people trained to use it. The problem with creating a legal duty to respond in a case which would have otherwise been covered by the Good Samaritan statue is that you remove any protection people have for acting in good faith to aid another person, and open them up to medical malpractice and damage litigation. That is a POWERFUL motivator for people to not do anything but call 911.
 
2013-02-09 11:12:04 PM  

UsikFark: ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.


Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.
 
2013-02-09 11:12:59 PM  

ZackDanger: UsikFark: ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.

Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.


Maybe, just maybe, the reverse vampires actually set this up to murder him!
 
2013-02-09 11:14:28 PM  

ltdanman44: vygramul: cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.

They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.

the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.


No one said otherwise.
 
2013-02-09 11:14:52 PM  

BronyMedic: cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

They can and will if they detect artifact and the software reads it as ventricular fibrillation.

[rtboardreview.com image 498x155]

That run of artifact there et al.....


Nice.
 
2013-02-09 11:16:28 PM  

BronyMedic: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.

Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.


And there it is, BronyMedic pretending to be an educator, when he's really just a pompous ass.  Yet again.  You'd think Bronny would eventually mature and grow out of it, and, yet,  after all this time, he continues to not do so.

Hint: Arrogant and condescending is a bad combination.  Maybe you could, you know, contribute and teach, instead of being your usual self. Oh wait, that's not in your union contract, is it.

/with all DUE respect.  (as in, none).
 
2013-02-09 11:17:54 PM  

BronyMedic: ZackDanger: UsikFark: ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.

Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.

Maybe, just maybe, the reverse vampires actually set this up to murder him!


Maybe there was this guy in the midwest who invented a car that runs on water... and then the government decided to silence him... and they framed the trainer for the murder. But he was going to talk... so the government had to kill that random guy in the gym, so the trainer would mistakenly not do CPR (the government implanted into the gym guy, unbeknownst to him, during his sleep, a device in his blood stream to mimic a pulse), and then the trainer would be found negligent and sent to jail, and then when he was in jail his cell mate, tripping on government supplied acid, would murder the trainer, and then that other jail guy would fry in the electric chair.

All wrapped up nicely.
 
2013-02-09 11:21:18 PM  

djh0101010: BronyMedic: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.

Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.

And there it is, BronyMedic pretending to be an educator, when he's really just a pompous ass.  Yet again.  You'd think Bronny would eventually mature and grow out of it, and, yet,  after all this time, he continues to not do so.

Hint: Arrogant and condescending is a bad combination.  Maybe you could, you know, contribute and teach, instead of being your usual self. Oh wait, that's not in your union contract, is it.

/with all DUE respect.  (as in, none).


Wait... What?

What did you read? Because BronyMedic is right... there is no legal duty to act for non-proffessional responders.
 
2013-02-09 11:22:11 PM  
djh0101010:And there it is, BronyMedic pretending to be an educator, when he's really just a pompous ass.  Yet again.  You'd think Bronny would eventually mature and grow out of it, and, yet,  after all this time, he continues to not do so.

Hint: Arrogant and condescending is a bad combination.  Maybe you could, you know, contribute and teach, instead of being your usual self. Oh wait, that's not in your union contract, is it.

/with all DUE respect.  (as in, none).


Oh good, I was hoping the guy who was impersonating an EMT to troll would show up to cause his standard stupidity.

Actually, I'm an American Heart BLS-Healthcare Provider and an AAP Pediatric Education for Prehospital Provider Instructor. Nothing I've said has been arrogant or condescending in this thread. And I'm not even a member of a union, I work for a 403 Not for Profit Childrens Hospital.

What are you again, by the way? You never really answered which state the NREMT "licensed" you in?
 
2013-02-09 11:22:41 PM  

UsikFark: 3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.

[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"


That ruling does not mean what you guys apparently think it means.
 
2013-02-09 11:23:55 PM  

BronyMedic: cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

They can and will if they detect artifact and the software reads it as ventricular fibrillation.



That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


Oh boy a ricky rescue who tries to look smart every time something EMS related pops up. Prime example of why a little knowledge can be a bad thing.
 
2013-02-09 11:24:14 PM  

ZackDanger: Wait... What?

What did you read? Because BronyMedic is right... there is no legal duty to act for non-proffessional responders.


Just ignore him. He's a person who claims to have been an "EMT-Basic" who shows up to troll threads I post in. He's been doing it ever since I made an off color joke a few months ago and that apparantly rustled his jimmies. This is pretty par for the course for him.
 
2013-02-09 11:24:59 PM  
I'm Red Cross CPR trained.  I've attended several CPR classes for certification.

My takeaway is this:  I really shouldn't try.  I'll call 911, and let the pros handle it.
 
2013-02-09 11:25:02 PM  

JonPace: Oh boy a ricky rescue who tries to look smart every time something EMS related pops up. Prime example of why a little knowledge can be a bad thing.


Please point out what I've said that is wrong, or contrary to the AHA's 2010 guidelines for emergency cardiac care?
 
2013-02-09 11:25:38 PM  

djh0101010: BronyMedic: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.

Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.

And there it is, BronyMedic pretending to be an educator, when he's really just a pompous ass.  Yet again.  You'd think Bronny would eventually mature and grow out of it, and, yet,  after all this time, he continues to not do so.

Hint: Arrogant and condescending is a bad combination.  Maybe you could, you know, contribute and teach, instead of being your usual self. Oh wait, that's not in your union contract, is it.

/with all DUE respect.  (as in, none).


I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.
 
2013-02-09 11:31:18 PM  

davidphogan: I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.


I'm really honored about that then. I didn't even know why they made you do that until I asked a Zoll Rep a few months back when eh was doing our initial training on the new ProPaqs we went to. We weren't taught the "why" we do a lot of things in school as EMT-Basics, just the how and when.

As far as djh0101010 goes, he's gone on several bizarre diatribes in which he uses improper and blatently wrong terminiology, incorrect assumptions that only someone who has never been in the EMS profession could make (like NREMT Licensure), and has constantly claimed to be better at, well - everything, since he's been a volunteer "EMT" for 10 years. I called him out as a fake in a thread a few weeks ago, and he abandoned ship.
 
2013-02-09 11:32:27 PM  
BronyMedic
If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.


OTOH, if they did CPR...I remember being told during some quickie first-aid course not to do CPR if someone is just unconscious, but still breathing normally.
So given that they thought CPR was necessary, shouldn't they also have tried the AED?
 
2013-02-09 11:33:38 PM  
davidphogan:
I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.

As a point of clarification from something posted earlier in the thread, I also want to point out that an AED can shock a person who is conscious, not in VFIB, and not even moving. AEDs are designed to shock a variety of rhythms, one of which can support life in some cases and thus it is not benign to put an AED on a person who is awake.

I've even heard of EMTs proactively placing electrode pads on someone who is awake and experiencing Chest Pain "just in case." Not only is this directly in contradiction to manufacturer's guidelines, it is very dangerous and potentially deadly.

Only ever place an AED on a person with "no signs of circulation."

blogs.laweekly.com
 
2013-02-09 11:35:00 PM  

CruiserTwelve: UsikFark: 3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.

[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"

That ruling does not mean what you guys apparently think it means.


I'm pretty sure it means that the police are not obligated to protect you, and have quite a bit of discretion in that regard,and have it legally.

What do you think it means?
 
2013-02-09 11:36:25 PM  

ZackDanger: UsikFark: ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.

Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.


I am the Milkman. My milk is delicious.
 
2013-02-09 11:36:35 PM  
79 posts and nobody has blamed this on OBAMACARE?!?!

Goddamn - you guys are getting sloppy.
 
2013-02-09 11:39:07 PM  

The Voice of Doom: BronyMedic
If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

OTOH, if they did CPR...I remember being told during some quickie first-aid course not to do CPR if someone is just unconscious, but still breathing normally.
So given that they thought CPR was necessary, shouldn't they also have tried the AED?


It wouldn't be unreasonable to do CPR on someone who has a very slow pulse rate... If zero beats a minute is worthy of CPR.... what about 2 or 5?

There is also something called "agonal" respirations... which are the basically the last dying gasps of a person... an experienced healthcare provider would recognize this and understand these types of respirations as basically not counting as real ones.
 
2013-02-09 11:39:50 PM  

The Voice of Doom: OTOH, if they did CPR...I remember being told during some quickie first-aid course not to do CPR if someone is just unconscious, but still breathing normally.
So given that they thought CPR was necessary, shouldn't they also have tried the AED?


That's what's not adding up here.

You have two people who would, at the very least, be considered professional rescuers who have ascertained the person had no pulse, and required CPR. At that instant, yes you would. It's the exact situation the AED was designed for.

On the other hand, you have two laypeople, who are NOT trained to check for a pulse, who claim the guy had a pulse and that's why they didn't apply the AED. However, since they did NOT have a duty to act, they're still covered under the good samaritan act for not attaching it. If they had actually said they still attached it and thought that, IANAL but it would seem like their protection under the act would then go out the window, as they willingly commited a negligent act.
 
2013-02-09 11:40:13 PM  

CruiserTwelve: UsikFark: 3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.

[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"

That ruling does not mean what you guys apparently think it means.


Please, by all means, explain to us, with a full dose of overcomplicated hyperbabble, exactly what it means.
 
2013-02-09 11:42:12 PM  
ZackDanger: OR
 
The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

That was my first thought.
 
2013-02-09 11:43:39 PM  

ZackDanger: As a point of clarification from something posted earlier in the thread, I also want to point out that an AED can shock a person who is conscious, not in VFIB, and not even moving. AEDs are designed to shock a variety of rhythms, one of which can support life in some cases and thus it is not benign to put an AED on a person who is awake.

I've even heard of EMTs proactively placing electrode pads on someone who is awake and experiencing Chest Pain "just in case." Not only is this directly in contradiction to manufacturer's guidelines, it is very dangerous and potentially deadly.


THIS.

Not only that, if someone reports an EMT for doing that, they can lose their license for practicing outside of their scope of practice, and open themselves up to a lawsuit.

All the AED sees is this: Ventricular Tachycardia.

media.tumblr.com

The AED cannot determine if it has a pulse or not with it. It is quite possible to be in V.Tach and have a perfusing blood pressure at the same time (I had a patient the other day who was refractory to adenosine, amioderone and synchronized cardioversion, and lidocaine was contraindicated), and you WILL kill them by delivering an unsynchronized shock.

This is why EMT-Basics are taught NOT to apply an AED to a patient with a pulse and a rapid heart rate.
 
2013-02-09 11:45:13 PM  

Winston Smith '84: 79 posts and nobody has blamed this on OBAMACARE?!?!

Goddamn - you guys are getting sloppy.


heh, I was actually thinking that was a good sign.  Whatever.
 
2013-02-09 11:45:29 PM  

BronyMedic: The Voice of Doom: OTOH, if they did CPR...I remember being told during some quickie first-aid course not to do CPR if someone is just unconscious, but still breathing normally.
So given that they thought CPR was necessary, shouldn't they also have tried the AED?

That's what's not adding up here.

You have two people who would, at the very least, be considered professional rescuers who have ascertained the person had no pulse, and required CPR. At that instant, yes you would. It's the exact situation the AED was designed for.

On the other hand, you have two laypeople, who are NOT trained to check for a pulse, who claim the guy had a pulse and that's why they didn't apply the AED. However, since they did NOT have a duty to act, they're still covered under the good samaritan act for not attaching it. If they had actually said they still attached it and thought that, IANAL but it would seem like their protection under the act would then go out the window, as they willingly commited a negligent act.


VTac with a Pulse (and unresponsive) and profound bradycardia (and unresponsive) are two situations where an experienced medical provider may decide, in the field, to initiate CPR... or at least chest compressions... but *not* apply an AED.

That said, I still have no idea if this is what happened in this situation.
 
2013-02-09 11:55:10 PM  

3StratMan: CruiserTwelve: UsikFark: 3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.

[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"

That ruling does not mean what you guys apparently think it means.

Please, by all means, explain to us, with a full dose of overcomplicated hyperbabble, exactly what it means.


It means get a weapon and learn how to safely and properly defend yourself.
 
2013-02-10 12:01:18 AM  
If I ever find someone who is down without a pulse (check the neck), I'm doing CPR until someone with better training tells me to stop, or I stop due to exhaustion, or someone else tags in to help.

If someone wants to use an AED I'll give them a chance, and then when nothing happens, will continue CPR.

/pretty much just CPR for a stopped heart
 
2013-02-10 12:06:11 AM  

Kraftwerk Orange: I'm Red Cross CPR trained.  I've attended several CPR classes for certification.

My takeaway is this:  I really shouldn't try.  I'll call 911, and let the pros handle it.


Please, please don't do this.

I'm begging you not to be the person who calls 911, and doesn't act when you have the training to do so. If that person needs CPR, and you just call 911 and don't do anything else, you're signing their death warrant. Even in cities with rapid EMS response, like Seattle or Wake County, NC (Two of the areas that are considered the gold standard in ECC in the United States), by the time EMS gets there they won't be viable. AHA studies have shown that less than 4% of out of hospital arrests will have a return of circulation, and less than one percent will leave the hosptial neurologically intact.

We're getting better with things like the Dr. ICE/Therapeutic Hypothermia protocols, better CPR training and real-time feedback, and mechanical CPR aids like the Lucas and Autopulse, but all that means nothing if you can't get someone to intervene in the meantime.

zoll.com

If one link is broken, the other links won't pull.
 
2013-02-10 12:10:19 AM  

studebaker hoch: If I ever find someone who is down without a pulse (check the neck), I'm doing CPR until someone with better training tells me to stop, or I stop due to exhaustion, or someone else tags in to help.

If someone wants to use an AED I'll give them a chance, and then when nothing happens, will continue CPR.

/pretty much just CPR for a stopped heart


The purpose of CPR is to keep heart tissue alive and maintain a rhythm long enough for an AED to arrive and make the difference.

For cardiac arrest, CPR will not solve the problem alone. The AED is essential. You shouldn't just be "giving [the aed] a chance"... you should be demanding someone brings you one.
 
2013-02-10 12:10:47 AM  

studebaker hoch: If I ever find someone who is down without a pulse (check the neck), I'm doing CPR until someone with better training tells me to stop, or I stop due to exhaustion, or someone else tags in to help.

If someone wants to use an AED I'll give them a chance, and then when nothing happens, will continue CPR.

/pretty much just CPR for a stopped heart


This is my understanding. 1 person should always do CPR, period. If two people are capable of assistance, one person should do CPR while the other gets the AED ready and verifies that it's the correct time to use. But CPR is first and foremost.

I review a lot of safety plans for construction work and I really think modern AEDs are quite good and relatively cheap, so every job site should consider having them available, but there's just no replacement for having two CPR basics trained people on every job.
 
2013-02-10 12:11:12 AM  

3StratMan: Please, by all means, explain to us, with a full dose of overcomplicated hyperbabble, exactly what it means.


It means the police do not have a legal obligation to protect individual people. Example: Let's say the cops are legally required to protect each individual person. You get robbed and murdered. Your family could sue the police for failing to protect you. Every crime victim would have a case against the government for failing to protect them from the criminal.

Note that I said a "legal" obligation. The police still have a moral and ethical obligation to uphold the law, and they still have a legal obligation to enforce the law within the confines of the constitution.

You can also sue the police for failing to act. This occurs when the police know there is a violation and fail to take action when they have the immediate ability to do so. Let's say the cops see you getting your ass kicked by another person and they stand there and watch without taking action. You have a case against them.

If you read the case that brought about this ruling, you can see why the ruling was made as it was. Had the court ruled that the police were at fault for not enforcing a restraining order when they did not have the immediate ability to act, it would have meant anytime a person violated a restraining order the police would be liable. That's an impossible responsibility.
 
2013-02-10 12:14:47 AM  
AEDs at gyms give people a false sense of security, he said, because nowhere in the U.S. are they mandated to use them.

Defibrillators do not give me a false sense of security. There is nothing about a publicly available defibrillator that says "it's ok if I have a heart attack here." The only place I feel safe having a heart attack is in a bed in a hospital room with a cardiologist and surgeon in the room.
 
2013-02-10 12:17:08 AM  
Just to clarify one data point for folks.  Defibrillators do not 'jumpstart' a heart.  They erase all electrical activity in the heart in the slight hope that when the heart re-polarizes on it's own afterwards that it will have a normal or better rhythm again.  In fact if one is asystolic and arythmic, defibrillators don't do much.  It's all drugs and CPR in that situation.
 
2013-02-10 12:28:13 AM  

BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


Oo! I know the answer to this one: The laypersons were using their thumbs to check for the pulse. Betcha dollars to donuts. Alternatively, the "healthcare providers" were LVNs or RNs and not emergency room personnel and were used to checking wrists, but not carotids--and it was the LAYPERSONS who were finding a pulse (in the neck) where the "healthcare providers" were not.

CSS--we had an incident when I still worked for The Mouse, a friend of mine was "just a security guard" but a paramedic in real life. Disney had just gotten AEDs but only the nurses were allowed to use them. DL nurses are mostly RNs and LVNs and not ER nurses. So a train engineer drops from a heart attack one night, the other engineers start CPR, the fire dept. is called but are 10 minutes out. Our useless nurse shows up with her AED...but won't use it because although she knows how, she isn't "signed off" on the damn thing and is afraid to use it because liability.

My friend rolls up and sees the ambulance crew standing there, the nurse standing there, security standing there, all watching the engineers doing CPR on their buddy who is probably dead by now, and the AED dangling from the nurse's hand. HE, certainly, isn't supposed to use the AED, being just a security guard; but he's also a medic (and an asshole) and says to the nurse, "give me the damn defibrillator", tells the EMTs to get him an airway started, takes over the scene, and gets a rhythm shocked into the engineer before the medics get there. Guy walks out of the hospital 72 hours later.

My friend gets a 10-day suspension and a permanent disciplinary letter put into his personnel file which is only removed after Michael Eisner writes him a personal letter and orders that the disciplinary letter be torn out. And THAT is why nobody is ever going to help you out in the gym locker room, even if they've all been trained and have the equipment handy.
 
2013-02-10 12:34:04 AM  

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.
 
2013-02-10 12:37:25 AM  

Aigoo: Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.


It's nothing a few hundred thousand volts won't fix, Aigoo. To be honest, the human body's one big potato clock.

images2.wikia.nocookie.net
 
2013-02-10 12:50:51 AM  

BronyMedic: felching pen: Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

That's a little bit of a slippery slope there. The idea of the mandate is to have the equipment available to use appropriately by people trained to use it. The problem with creating a legal duty to respond in a case which would have otherwise been covered by the Good Samaritan statue is that you remove any protection people have for acting in good faith to aid another person, and open them up to medical malpractice and damage litigation. That is a POWERFUL motivator for people to not do anything but call 911.


This.

I'm trained and certified in advanced first aid and lifesaving... in a combat environment or MASH setting. Could I adequately determine whether or not I should use the AED? Yes. If a doctor (of any sort--they all went to medical school) and a med student are on scene, then guess what? They take charge. Period, end of story. Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.

Now, if I think the doc is being a farktard, I'll take the chance of using the AED. Sorry about the expense, but I don't place dollar signs on someone's life (massive potato clocks that we are...you owe me a keyboard, Brony!). But the fact that we live in a world where you can sue me for saving your life (I've seen cases where people have sued for getting broken ribs during CPR... sweetie, if your ribs aren't broke from CPR, something is very, very wrong) makes me sympathize with anyone whose gut instinct is to pick up the phone, call 911, and wait for a professional.
 
2013-02-10 12:53:05 AM  

Aigoo: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.


Actually, you take a pair of shears, cut the ribs up each side, take out that section of the sternum, cut through the bag-thing that holds all the organs, and  grip the heart in your hand and start squeezing it like a stress ball.
 
2013-02-10 12:54:46 AM  

CruiserTwelve: 3StratMan: Please, by all means, explain to us, with a full dose of overcomplicated hyperbabble, exactly what it means.

It means the police do not have a legal obligation to protect individual people. Example: Let's say the cops are legally required to protect each individual person. You get robbed and murdered. Your family could sue the police for failing to protect you. Every crime victim would have a case against the government for failing to protect them from the criminal.

Note that I said a "legal" obligation. The police still have a moral and ethical obligation to uphold the law, and they still have a legal obligation to enforce the law within the confines of the constitution.

You can also sue the police for failing to act. This occurs when the police know there is a violation and fail to take action when they have the immediate ability to do so. Let's say the cops see you getting your ass kicked by another person and they stand there and watch without taking action. You have a case against them.

If you read the case that brought about this ruling, you can see why the ruling was made as it was. Had the court ruled that the police were at fault for not enforcing a restraining order when they did not have the immediate ability to act, it would have meant anytime a person violated a restraining order the police would be liable. That's an impossible responsibility.


Yeah Warren v DC kinda threw that one out of the window too.
 
2013-02-10 12:55:07 AM  

ZackDanger: Wait... What?

What did you read? Because BronyMedic is right... there is no legal duty to act for non-proffessional responders.


Slight nitpick, in VA at least, as of ~2006 when I was a Red Cross CPR for the Professional Rescuer Instructor, you only have a duty to respond if you are IDENTIFIABLE as a medical professional/first responder.  If you're a nurse wearing a track suit around a bunch of strangers, you don't have a duty.  If you are a nurse wearing your hospital garb who stopped at the Kroger to buy some bread on the way home, you do.

/YMMV, especially state-to-state.
//As of 2006, according to the Red Cross, no one holding a current Red Cross certification who followed procedure has ever been successfully sued for intervening medically in an emergency.  Good Samaritan laws are usually pretty good in every, or almost every state.
 
2013-02-10 12:57:10 AM  

Aigoo: Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.


I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.
 
2013-02-10 01:00:47 AM  

BronyMedic: davidphogan: I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.

I'm really honored about that then. I didn't even know why they made you do that until I asked a Zoll Rep a few months back when eh was doing our initial training on the new ProPaqs we went to. We weren't taught the "why" we do a lot of things in school as EMT-Basics, just the how and when.

As far as djh0101010 goes, he's gone on several bizarre diatribes in which he uses improper and blatently wrong terminiology, incorrect assumptions that only someone who has never been in the EMS profession could make (like NREMT Licensure), and has constantly claimed to be better at, well - everything, since he's been a volunteer "EMT" for 10 years. I called him out as a fake in a thread a few weeks ago, and he abandoned ship.


I saw the link you posted. I can't imagine why someone would pretend to be an EMT to troll Fark, but there it is.
 
2013-02-10 01:06:53 AM  

vygramul: I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.


It's not that they're useless - they're Doctors after all - it's that their not in their environment in a prehosptial setting. Many of the things a doctor would do in a hospital for a patient in an emergency situation are impractical or impossible to perform in the field. A surgeon is not going to open someone up for abdominal trauma in the field, or crack a chest to check for a pericardial tamponade. The interventions and maneuvers a Paramedic or EMT performs are geared around doing as much as possible to stabilize while minimizing on scene time and optimizing rapid transport to a definitive care facility in a critical patient.

If a physician doesn't specialize or work in the Emergency Field, they may actually perform an incorrect or inappropriate intervention and cause harm. Most doctors do not deal with spinal immobilization, for example, outside of an orthopedic, neuro, or ER setting. I've seen nurses placing pillows and towels under the head of an ejection patient before without even considering immobilization of the neck.

On our end, the problem with having someone come up and claim to be a doctor is one of verifying they actually are one. We have very, very specific guidelines (Control-F and skip to Protocol 606, at page 100) at the state level when this happens, and typically when a doctor is told about it, they step back or stop barking orders. Even if this occurs, a Paramedic is still responsible for ANYTHING that happens on scene, even if it's done by a bystander.
 
2013-02-10 01:13:45 AM  

djh0101010: crap

Just stop. Being a medic means that at minimum you've read through many thousands of pages of dry medical text, completed several hundred hours of classroom, practical clinical time, field time, and have picked up the lingo and slang from spending a lot of time around *actual* ems and medical workers. You can't fake that without a huge amount of work: It's like pretending to be ex-military or a doctor -- a real one's going to spot you instantly.

From djh0101010's bio:
Not shy about telling people when they're full of it.

Oh, the irony.

JonPace: Oh boy a ricky rescue

Nice alt.

BronyMedic: Oh good, I was hoping the guy who was impersonating an EMT to troll

I know it gets old having to type that in every thread you post in, but thanks. His attention seeking is pretty sad: I guess some people never work past their shiatty childhood. Beyond pointing out he's a (bad) fake, I'd ignore him.
 
2013-02-10 01:21:12 AM  

UsikFark: 3StratMan: Wait till the day comes when you all realize that even though police are armed with guns for protection, and are trained to be able to protect all of you, they aren't required or morally bound to actually do it either.

[US Supreme Court] "Justices Rule Police Do Not Have a Constitutional Duty to Protect Someone"


Well, you really don't. That is a state issue. It never should have gotten to the Supreme Court.
 
2013-02-10 01:43:28 AM  

vygramul: Aigoo: Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.

I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.


As Brony said, depends on the doc. I've been on a scene where a guy damn near cut his hand off in a generator fan--both an ortho and I were on the scene, buying gas. As you say, ortho gets this "oh shiat" look on his face, I look at the dude behind the counter and start telling him what I need (and when he doesn't have 80% of it, what I'll settle for...because I just cannot sit and watch someone bleed all over the place needlessly when I'm trained and capable of doing something about it). Other times, I've seen pediatricians handle MVAs like pros until the paramedics arrived on scene. It honestly depends on the doctor, and, as Brony says, you're way better off with Emergency Medicine guys, but sometimes, you do get pleasantly surprised.
 
2013-02-10 01:44:50 AM  

UsikFark: Aigoo: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.

Actually, you take a pair of shears, cut the ribs up each side, take out that section of the sternum, cut through the bag-thing that holds all the organs, and  grip the heart in your hand and start squeezing it like a stress ball.


And now I'll brb. Need to clean the Dr. Pepper off my monitor...
 
2013-02-10 01:49:51 AM  

cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.


You're right about the rhythm,  but "false sense of security" is nonsensical.  How many gym members even notice AEDs?  If I saw one, it would remind me that I might have a heart attack, and that thought would not make me feel any more secure.  Nobody says to himself, "Hah - AED!  I can work myself as hard as I want and not worry about the heart attack!'
 
2013-02-10 02:00:37 AM  

Aigoo: UsikFark: Aigoo: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.

Actually, you take a pair of shears, cut the ribs up each side, take out that section of the sternum, cut through the bag-thing that holds all the organs, and  grip the heart in your hand and start squeezing it like a stress ball.

And now I'll brb. Need to clean the Dr. Pepper off my monitor...


Squeeze to the beat of "Papa Was A Rolling Stone," live version only. Pressing with your pinky & ring fingers on the 2, and index and middle on the 4. It's called the wakka-chikka.
 
2013-02-10 02:05:41 AM  

UsikFark: Squeeze to the beat of "Papa Was A Rolling Stone," live version only. Pressing with your pinky & ring fingers on the 2, and index and middle on the 4. It's called the wakka-chikka.


You know what's awesome? Another one bites the dust totally syncs up with the rate of CPR per minute.
 
2013-02-10 02:08:07 AM  

UsikFark: Ed Finnerty: FTFA: A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Relevant:

[www.wearysloth.com image 320x240]

Want to see something really scary?


Bender: Welcome to the future, human slave. [The man trembles and Bender laughs.] Ah, relax, chum. I'm not really a giant fly! [He takes the cape and head off.] I'm a horrible robot! [The man backs into the freezer and Bender walks towards him, turning his head and outstretching his arms.] Kill all humans!

[The old man clutches his chest.]

Terry: Dear God! He's having a heart attack!

[Bender pushes the old man into the freezer, turns the dial and freezes him.]

Bender: Ah, they'll probably find a cure for that in the future.

Terry: We have a cure for it now!

Bender: Oh, good. Then you won't mind if I use this.

25.media.tumblr.com
 
2013-02-10 02:21:03 AM  

BronyMedic: UsikFark: Squeeze to the beat of "Papa Was A Rolling Stone," live version only. Pressing with your pinky & ring fingers on the 2, and index and middle on the 4. It's called the wakka-chikka.

You know what's awesome? Another one bites the dust totally syncs up with the rate of CPR per minute.


Apparently the target is 100-120 BPM.

Don't be so quick to- walk away.
 
2013-02-10 02:23:12 AM  

ZackDanger: UsikFark: ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.

Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.


But were they Dead Milkmen?

All joking aside though, when I was trained on an AED some years ago, I was taught never to put one on someone who was breathing or had a pulse since even though it would automatically allow, and adjust for, what every arrhythmia was present if the patient had a pulse applying the AED could interfere with the body's natural responses to anomalies.  Essentially an if it ain't broke don't try to fix it.

Some very good points in here on the use of AEDs though. I'll have to see if I can get a refresher course in CPR since it is a handy skill to have just in case.
 
2013-02-10 02:27:47 AM  

JWideman: And if they had used it and the guy died anyway - which he surely would have - they'd be suing over that. Yes, it doesn't make sense to require them to have the equipment and be able to use it to save lives, but not require that they use it to save lives. That would be like requiring a public pool have a lifeguard that knows CPR, but the lifeguard can just ignore drowning people. In this case, though, it would be like requiring the lifeguard to give CPR to everyone in the pool.


My lodge is looking into getting one of those things.  Several of our lawyer members have stated that anybody trying to sue over the use of one of the things will not win.  Period.  The machines are designed to only work when they'll actually do some benefit.  The victim will die either way.  At least you used the best technology available to try to to save them.  Any asshole who sues ought to be hung and their estates stripped.  Sorry kids, your parent was an asshole.  Sucks to be you.
 
2013-02-10 02:54:53 AM  
ZackDange

You shouldn't just be "giving [the aed] a chance"... you should be demanding someone brings you one.

Agreed.  And also demanding (a good way to say that) someone to call 911 and report an unconcious person without a pulse.  And for someone to help me do CPR.

The day I find someone dead on the ground will be the day I need the help of any and all human beings within earshot.

I really hope the AED works, but my gut feeling is it won't.  Because in my experience, the more you need some electronic doodad to work, the more likely it won't.  So I'll take a time out while they do the drill, but I won't expect anything other than me just starting CPR again.
 
2013-02-10 03:14:34 AM  

felching pen: Smgth: What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.


"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)

That duty may apply to the gym.  However, the dissenting judge notes, NY has a "Good Samaritan" law that shields would-be rescuers from liability except when they are grossly negligent.  If you do what the proverbial "reasonable person" would do  under the circumstances, you can't be sued.  Your actions have to be far from reasonable to be considered grossly negligent.

The trainer found a pulse and breathing, so he decided the AED was unnecessary.  Is that far from what a reasonable person would do?  This what the case hinges upon, as far as we know.  (The plaintiffs seem to plan to contradict the trainer's testimony.)

It will also matter whether the trainer was trained in AED use or not; what a reasonable person would do depends on his training.  A trained person would know that using the AED properly could do no harm; an untrained person would not be expected to know that.  The judges said that there must be "trained staff" on the premises but not that everyone has to be trained.  In some AED laws, only one AED and one trained staffer are required; IDK about NY's law.

The majority ruled that there is no duty to rescue in the statute, as plaintiffs argued.  But plaintiffs can go back to lower court and try the common law duty described above.  They may run afoul of the Good Samaritan law.
 
2013-02-10 03:17:04 AM  

Aigoo: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.


Automatic External Defibrillators measure heart rhythm and tell the operator whether to hit the "shock" button or not.  The correct thing to do in this case was to  apply the AED's sensor to the patient and do whatever the LED screen said to do.
 
2013-02-10 03:19:29 AM  

BarkingUnicorn: felching pen: Smgth: What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)


Can they argue an ethical duty to act? IANAL so I'm curious.
 
2013-02-10 03:34:36 AM  

BronyMedic: BarkingUnicorn: felching pen: Smgth: What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)

Can they argue an ethical duty to act? IANAL so I'm curious.


Can someone be persecuted for being unethical? If so would anyone be left?

This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.
 
2013-02-10 03:36:25 AM  

BarkingUnicorn: Automatic External Defibrillators measure heart rhythm and tell the operator whether to hit the "shock" button or not. The correct thing to do in this case was to apply the AED's sensor to the patient and do whatever the LED screen said to do.


An AED only works for a few pulseless rhythms. An AED is a machine, and like all machines it can (very, very rarely) fail and cause a person harm. It's a very minor risk, but if the AED isn't going to help (and has a very slight chance of causing harm) then it's use is contraindicated. All the CPR classes/refreshers I've taken have made a point of *not* using an AED on someone with a pulse.
 
2013-02-10 03:39:48 AM  
Gym staff called 911, broadcast an in-house request for anyone with medical training and brought the club's Automated External Defibrillator to Miglino's side, where a trainer detected breathing and a pulse and didn't use the AED, according to court affidavits. A doctor and medical student began cardio-pulmonary resuscitation, then paramedics arrived and shocked Miglino, but he died.

It sounds like they did basically all they could do. I don't think you're supposed to use those things if there is a pulse because shocking a 'stabilizing' heart could just throw it into defibrillation again.

Then, it depends on the patient and the type of heart attack. I worked in a hospital for years and even with all of the advanced equipment, we lost patients when heart attacks struck -- even in the ER.

Now, the AED is supposed to be idiot proof. I looked them over when they came out, having had a heart attack myself, and considered buying one. The instructions were basic and easy. The machine would fire on it's own when it detected certain indicators of a heart attack or it could be triggered by someone. It was designed even for a person having an attack to quickly apply it.

I was driving when I had my heart attack. Delivering freight. I just kept on going, figuring it was just stress pains. Later, I was diagnosed as having an attack and had a dead spot on my heart. I got lucky.

I don't think you can force laymen to operate a defibrillator, even one as simple as the AED. Imagine the whole new world of lawsuits that would open up if someone screwed up.

Besides, back then the device was expensive. No doubt it needs to be tested and calibrated now and then. Still, it's a step in the right direction for fast response for heart attack victims.

I also recall when the EEG machine that recorded the electrical activity of the heart was a huge device, with ink fed wands tracing over a roll of paper. Now, they're small, little devices about the size of a laptop.
 
2013-02-10 03:40:00 AM  

Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.


You cannot mandate someone with no formal licensure or certification, and no formal duty to render care under the tenents of a financhial or volunteer relationship do so. The laws are actually in place, and written the way they are to protect non-professional, every day people who have decided to get a CPR or First Aid Card, and don't want to worry about having the pants sued off them for doing so for the slightest thing they may have done wrong in a situation which they were never meant to encounter even with that training.

If the gym decided to employ a formal "emergency response team" of people who are CPR/AED and First Aid trained, it would be different, or if they decided to employ someone certified in Athletic Training or sports medicine, it would be different.
 
2013-02-10 03:40:49 AM  
the CORRECT way to defribrillate a person is to turn on STAYING ALIVE by the BEEGEES and shocking them at random intervals
 
2013-02-10 03:49:22 AM  

BronyMedic: Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.

You cannot mandate someone with no formal licensure or certification, and no formal duty to render care under the tenents of a financhial or volunteer relationship do so. The laws are actually in place, and written the way they are to protect non-professional, every day people who have decided to get a CPR or First Aid Card, and don't want to worry about having the pants sued off them for doing so for the slightest thing they may have done wrong in a situation which they were never meant to encounter even with that training.

If the gym decided to employ a formal "emergency response team" of people who are CPR/AED and First Aid trained, it would be different, or if they decided to employ someone certified in Athletic Training or sports medicine, it would be different.


But they're mandating someone be there who can use the machine...to what end? If you can't mandate it's use, why bother insisting it be there with someone to who knows how to use it?

I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.

/Sorry if I'm missing something here, but I just don't get it.
 
2013-02-10 04:06:53 AM  

Smgth: But they're mandating someone be there who can use the machine...to what end? If you can't mandate it's use, why bother insisting it be there with someone to who knows how to use it?


All the New York state law says, and IANAL, is that the gym has to make available the machines for use, and that they have to provide CPR and AED training to their personel there. That's different than a legal mandate for their people to provide care under their employer. Every state has provisions in place which throw out the good samaritan protections a person has if they are required as a course of their employment or volunteer position to provide any type of medical care, from first aid to open heart surgery, and require anyone acting as an emergency response team to maintain a certain level of liability insurance on that person, and require a certain level of certification beyond basic first aid.

Smgth: I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.


Because in an emergency, you're more than likely going to have SOMEONE trained in a modern society in AED/CPR, and more than likely you're going to have someone who's altruistic to step up and help. It's the same reason we have them in airports, large resteraunts, stadiums, and the like.
 
2013-02-10 04:27:58 AM  

BronyMedic: BarkingUnicorn: felching pen: Smgth: What's the point of mandating they carry the equipment and mandating they have someone to USE the equipment if you have zero intention of holding them to it's use?!!! Isn't the intention of the mandates to save lives? If you don't insist they ACTUALLY try and save lives, then you're just out to make sure gyms spend money.

Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

"Failure to stop" is not a violation of an implied duty;  laws specify when you must stop, although they can be rather vague about it (e. g., "whenever it would be unsafe to proceed").

Under common law (which plaintiffs in this case plan to rely on), there is generally no duty to rescue a person who is in peril.  A doctor walking down the street can ignore a stranger  who's having a heart attack.

There are certain relationships which give rise to a duty to rescue.  EMTs and firefighters have to do their jobs.  Parents have a duty to rescue their children (but not someone else's).  Common carriers have a duty to rescue their passengers.  And the one plaintiffs are asserting here is, a property owner has a duty to rescue invitees who fall into peril on his property. (He can let trespassers die.)

Can they argue an ethical duty to act? IANAL so I'm curious.


Sure, if they can find a court of ethics.
 
2013-02-10 04:34:15 AM  

Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.


TFA says nowhere in the U. S. are you mandated to use an AED.  So take your pick:

1. First AED  law was written poorly and everyone else just copied it.
2. Every legislature decided after careful deliberation that mandated use was a bad idea.
 
2013-02-10 04:41:25 AM  

mllawso: BarkingUnicorn: Automatic External Defibrillators measure heart rhythm and tell the operator whether to hit the "shock" button or not. The correct thing to do in this case was to apply the AED's sensor to the patient and do whatever the LED screen said to do.

An AED only works for a few pulseless rhythms. An AED is a machine, and like all machines it can (very, very rarely) fail and cause a person harm. It's a very minor risk, but if the AED isn't going to help (and has a very slight chance of causing harm) then it's use is contraindicated. All the CPR classes/refreshers I've taken have made a point of *not* using an AED on someone with a pulse.


I guess it depends on what "use" means.  Using it to measure heart rhythm or taking the next step of using it to shock.

I assume an AED would not recommend shock if it detected a pulse that a rescuer could detect.

Or maybe I'm wrong and the AED simply won't shock unless it detects one of these special arhythmias.  That relieves the operator of all decision-making responsibility.
 
2013-02-10 04:52:13 AM  

BarkingUnicorn: I assume an AED would not recommend shock if it detected a pulse that a rescuer could detect.


AEDs will not check for a pulse. They only analyze electrical activity from an anterior-posterior lead placement, and determine if the waveform of the lead matches with the software waveforms for two specific kinds of lethal arrhythmias - Ventricular Tachycardia and Ventricular Fibrillation. The reason that it's important to not put it on a patient who is spontanenously circulating (has a pulse to the HCP, or has signs of circulation and effective breathing to the layperson) is that if the patient has a perfusing pulse, but IS in ventricular tachycardia, the machine will detect this, sense it, and shock - and kill the person you're trying to help

There is also a risk, especially with the older models, that movement and muscle artifiact from the patient - for example analyzing going down the road or if the patient is having a seizure or shivvering - can cause the software to mistakenly detect ventricular fibrillation and deliver an erronious shock. EMTs have been taught for years that they have to pull over to deliver a shock with an AED on a patient because of this, and there are areas in Memphis that I can drive through with a patient on a Lifepak 12, a relatively modern monitor, with good EKG placement on a 4-lead and still trigger the Ventricular Fibrillation alarm because of the bumps.

BarkingUnicorn: Using it to measure heart rhythm or taking the next step of using it to shock.


They actually stopped making AED models, for the most part, that displayed the rhythm the A+P lead placement was showing because it was considered a legal risk for BLS personel, and it was acting as a distraction, and adding to the costs of the machines. Our ALS volunteers at the fire department I started at carried keys on their keychains that switched our PD1700s from AED into manual mode, for example, and it would convert the display from text only to one lead waveform display.

BarkingUnicorn: Or maybe I'm wrong and the AED simply won't shock unless it detects one of these special arhythmias.


An AED won't shock anything but those two rhythms. You can still be in arrest from PEA, which is where the heart is electrically organized but not muscularly beating, and you can have an SVT where the heart beats so fast that it cannot effectively pump blood or perfuse itsself. Even things like Atrial Fibrillation and flutter can cause abnormally fast rhythms. The treatment for that is usually drugs, or synchronized cardioversion where the monitor delivers a very specifically timed energy dose during the depolarization phase. This can actually induce VFib if you try to do it without synchonizing. And in Atrial rhythms greater than 24 hours, you have to worry about the risk of throwing a PE or causing a stroke from emboli formation.

In slow heart rhythms, the treatment is either removing the underlying cause, or pacing - either chemically or electrically. No AED can do this.
 
2013-02-10 04:52:53 AM  

Smgth: I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.


You want to help this dying guy, but there's no AED in the building.  That's the problem the law addresses.

Would you want somebody sending electricity through you who didn't want to do so?
 
2013-02-10 04:58:53 AM  

BronyMedic: AEDs will not check for a pulse. They only analyze electrical activity from an anterior-posterior lead placement, and determine if the waveform of the lead matches with the software waveforms for two specific kinds of lethal arrhythmias - Ventricular Tachycardia and Ventricular Fibrillation. The reason that it's important to not put it on a patient who is spontanenously circulating (has a pulse to the HCP, or has signs of circulation and effective breathing to the layperson) is that if the patient has a perfusing pulse, but IS in ventricular tachycardia, the machine will detect this, sense it, and shock - and kill the person you're trying to help


Thank you.  I thought maybe AEDs were more foolproof than that.

So, human judgment is required.  A trained AED operator would not have shocked a guy with a pulse.  A layperson could reasonably be expected not to use the AED if he felt a pulse. End of lawsuit, unless plaintiffs can prove that the trainer didn't detect a pulse.  Good ,luck with that.
 
2013-02-10 05:08:47 AM  

Smgth: This still doesn't answer my question as to why mandate having the equipment and a trained user if they're under no obligation? Sounds like laws intending to protect no one but make it look like SOMETHING is being done.


^^^^^^^

What we're seeing here is the collision of "Let's look like we're being prepared, so we can't be sued for not being prepared," with "What actually happens when something happens and you actually have to be prepared to do something."

People (and tort lawyers) will sue for any plausible reason, so either being prepared OR not being prepared is grounds for suit these days. The more technology makes it easier for less-trained personnel to perform tasks, the easier it is for lawyers to "reasonably ask" why the hotel/theme park/grocery store didn't have such simple technology available. As our resident medic has indicated, an AED is hardly "simple technology", but the average jury isn't going to realize it; they're going to wonder howcome someone died because Safeway couldn't be bothered to have one bolted to the back door so Fred could be saved at the push of a button. Cha-Ching!

Then, of course, when Safeway gets AEDs bolted to every door, and ol' Fred dies because the stockboy used that amazing push-button lifesaver and killed him--"Why weren't your people trained correctly on how to use these complex and sensitive devices?" Cha-ching!

Back in the day when only paramedics could be legally allowed to do all this fancy crap, the hotel's responsibility ended with calling 911, which is as it should be imo. They've got the skills, extra equipment, and experience to do what needs doing and to know what not to do; and unless you live anywhere but Outer Mongolia, they can get there in enough time to save poor old Fred, and if they CAN'T, he was dead anyway. I know whereof I speak, because I worked for The Mouse back when we got sued for not having paramedics actually ON DL property, and so they couldn't get to the victim in under 8 minutes. Disney paid, at great expense (passed on to the guests, might I add) to have medics stationed in the park during operating hours year-round, and it cut their response time to eight minutes. What it did not do was increase anybody's survival rate. Nor did it decrease the number of lawsuits against Disneyland.
 
2013-02-10 08:37:23 AM  

Smeggy Smurf: JWideman: And if they had used it and the guy died anyway - which he surely would have - they'd be suing over that. Yes, it doesn't make sense to require them to have the equipment and be able to use it to save lives, but not require that they use it to save lives. That would be like requiring a public pool have a lifeguard that knows CPR, but the lifeguard can just ignore drowning people. In this case, though, it would be like requiring the lifeguard to give CPR to everyone in the pool.

My lodge is looking into getting one of those things.  Several of our lawyer members have stated that anybody trying to sue over the use of one of the things will not win.  Period.  The machines are designed to only work when they'll actually do some benefit.  The victim will die either way.  At least you used the best technology available to try to to save them.  Any asshole who sues ought to be hung and their estates stripped.  Sorry kids, your parent was an asshole.  Sucks to be you.


Of course they won't win. That won't stop them from suing.
 
2013-02-10 08:48:55 AM  

BronyMedic: ZackDanger: As a point of clarification from something posted earlier in the thread, I also want to point out that an AED can shock a person who is conscious, not in VFIB, and not even moving. AEDs are designed to shock a variety of rhythms, one of which can support life in some cases and thus it is not benign to put an AED on a person who is awake.

I've even heard of EMTs proactively placing electrode pads on someone who is awake and experiencing Chest Pain "just in case." Not only is this directly in contradiction to manufacturer's guidelines, it is very dangerous and potentially deadly.

THIS.

Not only that, if someone reports an EMT for doing that, they can lose their license for practicing outside of their scope of practice, and open themselves up to a lawsuit.

All the AED sees is this: Ventricular Tachycardia.



The AED cannot determine if it has a pulse or not with it. It is quite possible to be in V.Tach and have a perfusing blood pressure at the same time (I had a patient the other day who was refractory to adenosine, amioderone and synchronized cardioversion, and lidocaine was contraindicated), and you WILL kill them by delivering an unsynchronized shock.

This is why EMT-Basics are taught NOT to apply an AED to a patient with a pulse and a rapid heart rate.


There is only about a .12 second window (or less) where you have a chance of hurting someone with an unsynchronized shock, which is the relative refractory period.

You are correct that shockable rhythms with a pulse, excluding polymorphic VT should be synchronized.
 
2013-02-10 09:26:55 AM  
This is why you don't let rookie EMTs have shock paddles, they view the world like this:
i7.photobucket.com
 
2013-02-10 09:46:50 AM  
Can I point out that personal trainers are technically healthcare providers. I know that healthcare provider means something very specific in CPR, but I'm a BLS provider personal trainer. Unfortunately, some of the healthcare staff in my BLS class seemed too stupid to tie their own shoes.

IMHO most trainers should be able to correctly identify if a client is respirating and has a pulse, and shold not apply an AED if a pulse is detected. I'm inclined to believe that either the trainer was incompetent or the sick person's condition deteriorated. Unless the gym is back tracking and making shiat up, it doesnt sound like a case of negligence. Just because the equipment is there, doesnt mean its use is always appropriate.

/also the case for a lot of gym equipment
 
2013-02-10 10:37:53 AM  

Gyrfalcon: Back in the day when only paramedics could be legally allowed to do all this fancy crap, the hotel's responsibility ended with calling 911, which is as it should be imo.


That's how it is all over the country, as TFA says.

The problem for  defendants is that we have no way of summarily dismissing a lawsuit before they have to spend a lot of money.
 
2013-02-10 10:50:26 AM  

elysive: Can I point out that personal trainers are technically healthcare providers. I know that healthcare provider means something very specific in CPR, but I'm a BLS provider personal trainer. Unfortunately, some of the healthcare staff in my BLS class seemed too stupid to tie their own shoes.

IMHO most trainers should be able to correctly identify if a client is respirating and has a pulse, and shold not apply an AED if a pulse is detected. I'm inclined to believe that either the trainer was incompetent or the sick person's condition deteriorated. Unless the gym is back tracking and making shiat up, it doesnt sound like a case of negligence. Just because the equipment is there, doesnt mean its use is always appropriate.

/also the case for a lot of gym equipment


Like the hidden cameras in the bathrooms? :-)
 
2013-02-10 11:09:49 AM  

Whole Wheat: There is only about a .12 second window (or less) where you have a chance of hurting someone with an unsynchronized shock, which is the relative refractory period.

You are correct that shockable rhythms with a pulse, excluding polymorphic VT should be synchronized.


Well, it's still preferable to synchronize cardiovert Torsades... The problem is that some monitors won't be able to depending on the morphology, and unsymchronized cardioversion is a necessary evil.
 
2013-02-10 12:16:04 PM  

MythDragon: This is why you don't let rookie EMTs have shock paddles, they view the world like this:
[i7.photobucket.com image 800x600]


I wonder if there are any good servers left.
 
2013-02-10 12:19:00 PM  

vygramul: MythDragon: This is why you don't let rookie EMTs have shock paddles, they view the world like this:
[i7.photobucket.com image 800x600]

I wonder if there are any good servers left.


Jesus, it's been
 
2013-02-10 02:01:49 PM  
Those machines are used just for abnormal heart rhythms. They do not nor are the used for restarting a heart. Why they're placed for that purpose is beyond stupid.
 
2013-02-10 06:44:21 PM  
Has to wear this so getting a kick:

http://www.youtube.com/w atch?v=SlYe1VvE_Uo
 
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