Extubate?

[traumasurg]

With HIPAA mind I will try to present this case as anonymous as possible.

A few weeks back I was running a call with my local fire department. We arrive and an elderly female is in cardiac arrest. To paint the picture, we are a small volunteer fire dept in a small community where everyone pretty much knows everyone. Myself *a basic* and two paramedics off our dept respond. the ambulance gets there so total 3 medics plus myself and the basic on the ambulance. I run on a bls ambulance with the same company so I know the crew. It was difficult but the patient was tubed and one round of acls took place. Called med control and got permission to terminate efforts. *unkown down time of patient*. We get ready to leave and the family wishes to sit in the room and look at the patient while the police ask questions "just protocol no signs of foul play"

One of the medics on my dept who used to be a supervisor at the ambulance company says he will not leave the tube in and let the family *which we all know* look at the patient tubed for 30 minutes. He extubates and everyone agrees. My mom *a nurse at a local hospital* says she thinks that the tube must stay in for a physician to see if it was placed properly. Just wondering what your understanding of this in your state is.
Thanks

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[docB]

We always leave the tubes in both in hospital and pre hospital where I am. I guess I don't really know the true reason but I've always assumed it was so that a misplaced tube could be found if an autopsy was done.

 

[Paseo Del Norte]

Docb, this is exactly how I have dealt with in-hospital and pre-hospital deaths. Messing with the patient after terminating a resuscitation could be a problem if other organisations become involved. I think this would be especially true in the pre-hospital environment where leaving the patient in situ after termination of resuscitation efforts is important should additional investigation be warranted at some point. Extubation following field termination could be seen as a problem.

 

[TerraMedicX]

We always leave the tubes in both in hospital and pre hospital where I am. I guess I don't really know the true reason but I've always assumed it was so that a misplaced tube could be found if an autopsy was done.

Agreed. When I was trained we were taught that EVERYTHING is left in/on the patient including IVs, EKG patches and particularly tubes! Even though the police were only asking questions routinely, it's a death outside of the care of a physician and must be investigated by the coroner's office (again, at least in Colorado). I know I would have gotten in a LOT of trouble for extubating in that situation!

Nate.

 

[jdh71]

Tubes and lines need to be left in until pronouncing physician can ask family if they want an autopsy.

 

[psychbender]

A buddy of mine used to be a medical death examiner for the ME's office back home. All tubes/lines/devices are to be left in/on for the investigation (should any occur). Tubes were particularly important, especially when it went to autopsy.

 

[Dwindlin]

Pretty much what everyone else has said is the standard for both Ohio and Indiana.

 

[traumasurg]

I figured this would be the case. My mom was rambling about improper tube placement and possible negligence and all kinds of stuff. I'm sure this is the case in Alabama as well. I'm just surprised the medic on the truck didn't say anything. I have to think she would get in some trouble should this issue come up. Thanks for the input.

 

[Altruist]

Tubes and lines need to be left in until pronouncing physician can ask family if they want an autopsy.

Where I worked, we used to remove tubes and lines if, in an uncomplicated, unsuspicious death, the body was released to a funeral home. However, that was after talking to the med control physician to call it, AND talking to the coroner about the death and the circumstances, AND making sure the PD didn't have any objections.

If there was any hint of an autopsy, we'd leave everything in place. We also transported bodies to the morgue, which is a gripe for a different day--it was unique system.

So anyway, there are nuances, but I somehow doubt anyone has been sued successfully for leaving the tube and lines in.

And while I'm sympathetic, in the case of the OP, about knowing the family and wanting to pull the tube... I also think that it would have been more prudent to leave it in. Sometimes that's enough to show the family that everything was done, and give them a head start at absorbing the finality of the situation.

On the other hand, you'd probably start getting pink froth up the tube by the end of 30 minutes, which is probably why your medic pulled it. Gruesome detail for the day.

 

[Dwindlin]

If there was any hint of an autopsy, we'd leave everything in place. We also transported bodies to the morgue, which is a gripe for a different day--it was unique system.

The system I worked for in Indiana was a private company that was contracted by the county for 911, and we used to transport DOAs/Called codes to funeral home or medical examiners office (which ever they were destined to) quite frequently.

 

[jdh71]

So anyway, there are nuances, but I somehow doubt anyone has been sued successfully for leaving the tube and lines in.

Yeah. I'm sure there are slight differences from state to state, and since I work on the other side of the hospital door, perhaps the rules are a bit different.

But it all seems kind of straight forward cover your ass, until the next of kin and/or the coroner say no autopsy, leave the stuff in, because it can only look bad if you don't.

 

[traumasurg]

Yeah. I'm sure there are slight differences from state to state, and since I work on the other side of the hospital door, perhaps the rules are a bit different.

But it all seems kind of straight forward cover your ass, until the next of kin and/or the coroner say no autopsy, leave the stuff in, because it can only look bad if you don't.

In my short time in ems, if I've learned nothing else I have learned this. This was my first thought. I knew the family and I would feel bad leaving the tube in but it's important I don't get in trouble.