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Comment by harikb | Hacker News Reader

> Patients who are not to be transported to hospitals include those whose hearts have stopped and, despite efforts at resuscitation, have no signs of breathing, movement, a pulse or blood pressure and would be declared dead at the scene.

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Wait, so normally such patients are transported? For what? Billing purposes?

Because people can be revived

Indeed. I forget the term but I've read that trauma patients hearts can stop during massive blood loss. And they are saved by another person actually pumping the trauma patients heart with the responding care givers hands.

Normally such patients aren't either. This is media sensationalism. Someone got alarmed by the wording of the reminder/clarification of the policy as-it-was. Pronounced dead at the scene and should not be transported for failure to achieve ROSC has been LA policy since the 1980s[1]. Just about everything about the memo is the same policy as before, just in less confusing wording.

[1] https://file.lacounty.gov/SDSInter/dhs/206332_Ref.No.814,Det...

A former EMT I know told me their policy was always to transport DOA patients and to tell the caller that the person died on the way to the hospital, even if they were already dead. I'm not sure if it's the same everywhere but the idea was that it's kinder to whoever found the person.

Maybe insurance covers the call then. Here if it is DOA medical insurance won't pay.

Is there any nuance to that policy? What if someone dies between the call and the ambulance arriving? What if the person making the call doesn't have the experience to know when someone is beyond saving?

On the face of it, it appears to penalise those who can't afford to get it wrong which feels morally bankrupt.

Financially rich.

Economically not rich.

Morally bankrupt.

Some of the world's most advanced western countries that profess freedom and democracy across the globe.

People's estates tend not to fight back as aggressively to spurious bills than live people...

Someone else commented this on the thread, but my understanding is that some non-zero percentage (maybe even non-trivial percentage) of people without, say, a pulse can be revived only at a hospital but not by an EMT (because of equipment or skills, I guess?). This decision forecloses that possibility completely.

I've been thru EMT training. It boils down to EMTs not having formal medical education necessary to make a call as significant as pronouncing someone deceased. It's a blanket rule, so even in extreme circumstances like if you find someone beheaded, you just log it as a severe injury and transport the body to the hospital where a doctor pronounces them dead.

That's not broadly true. Anyone has sufficient medical training to declare a beheaded person deceased.

States have more and less sane approaches to this. Obviously, many things are not as clear-cut as beheading. But there are states that allow EMTs to make a field declaration, depending on specific guidelines, and possibly with the requirement of contacting a doctor to describe the situation and get their permission to terminate resuscitation efforts.

“Injuries clearly incompatible with life”.

While an EMS may not be able to sign the death certificate, they are quite able to say in cases of major trauma or obvious rigor that the patient is exceedingly dead.

Way outside my expertise, but you still need to remove the corpse, and the ambulance is already there.

Plus, it is not really a good look for paramedics to be leaving a dead person.

EMTs are specifically supposed to not move bodies unless there is an urgent reason to do so, but leave them on the scene for coroner etc to handle.

So, leave the body by the curb?

I would assume a coroner or funeral home would handle the body.

According to some EMT on reddit, in LA County they sometimes are but in most of California they aren't. This document is really just bringing LA County in line with the rest of the state and codifying the common practices/exceptions.

Who else does it include? This statement sounds like weasel words to calm people down about what is plainly an unacceptable situation.

That's all it includes. For your convenience here is a direct link to the agency memo, from the linked article.

http://file.lacounty.gov/SDSInter/dhs/1100458_Directive_6rev...

As for "unacceptable situation", here's a bit more color from actual local EMS: https://old.reddit.com/r/LosAngeles/comments/kqlgqz/ambulanc...

> As a former paramedic now assigned to media relations, the first thing I taught my kids about the news? Never react to the headline. While COVID-19 has shaped many pre-hospital care policies, protocols and procedures across California (and beyond) over the past year - including in Los Angeles County, rest assured that the concept of "No ROSC = No Transport" is not in any way new to our region, or most others.

> Brian Humphrey Firefighter/Specialist Public Service Officer Los Angeles Fire Department

(Above reference would be a separate comment, but this lovely thread sent serial downvoters to my history and I am timed out!)

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