This is a very interesting thread and from what I pick through you can see the perspective among a variety of medical types in the chain of survival
as we say.
First off, a little background. I have been an RN for well over 20 years. All of it has been spent in Pediatrics. Ive worked Peds ED, Peds ICU, Peds
Cardiac ICU, and the last 16 years as a Pediatric Transport Nurse Specialist which involves airborne and ground transportation of ICU level children.
I have seen countless children die and often for no good reason. But, I also see the dark side of our medical science all to often.
From the perspective of my first responder colleagues: rolling up to a scene is one fo the MOST difficult aspects of medicine. You get to start from
scratch, often assessing, extracting, stabilizing and transporting in god awful conditions. You often do not have the luxury of an ethical discussion
regarding a plan of care unless it really obvious. Children also get a visceral reaction from all of us and that is to help at all costs. An adult
face down in a lake for a hour will most likely be pronounced right there but a kid down longer will get a full on life saving attempt. IMHO children
should be given the benefit of the doubt
We are a point where medical science can revive a dead lifeless child with high reliability. Give me enough drugs, and medical equipment I can revive
anything. But at what cost?
When you are down more than say 3 minutes, brain cells start to die off. beyond 10 minutes, you will be lucky if you have brain stem function left.
Thats the hard reality and not disputable. What happens after a resuscitation after a prolonged downtime? That child more often than not ends up
getting a tracheotomy and a gastrectomy tube for feeding and is shuffled off to a skilled nursing home where they go back and forth to the hospital
with pneumonia, infections, bedsores etc. until some disease process finally kills them.
Families are not exempted from this horrible process. They come day in day out to visit and care for the patient. Families are often torn apart from
the stress and guilt that accompanies tragedy. The stress is brutal and the suicide rate among these families is much higher than average as well.
You see everything that made that child special died at the bottom of the pool, or lake, or when their head hit that pole etc. Whats left is almost an
hollow shell of that special person. Who's heart and lungs continue to function but does not do much else. There is a reason you don't see any of
those where are they now "Miracle boy pulled from cold lake stories" because there is seldom a happy ending..............
Objectively, first responders do not have enough information in 99% of the case to do anything but follow their training and fully code patients in
the field. But once in the hospital, and proper assessments are made there should be a mechanism in place to prevent futile care IMHO
2/11/18 by FredT because: (no reason given)