If They Don't Come Back, It's Best to Leave Them Behind

One of the hardest things we paramedics have to do is to tell a loved one when a patient doesn't make it. When I started in this business, we never had to have that talk. We transported every patient to the hospital unless they had very obvious signs of death.

Sometimes we even transported those patients just to avoid the unpleasantness.

In modern EMS, there is a push not to transport patients who die at home and can't be revived. Basically, if a patient's heart doesn't pick up where it left off we won't even put that patient in an ambulance. Instead, we make contact with an emergency physician for direction. More often than not, we are told to leave the patient at the scene and discontinue our efforts to resuscitate.

A study published in June in the journal Prehospital Emergency Care provided pretty concrete evidence that patients of cardiac arrest who don't get a pulse back with the paramedics will not survive. With those odds, it makes sense to stay out of the ER.

So, if you find yourself on the scene of a cardiac arrest patient who doesn't end up going to the hospital, please understand that the paramedic crew isn't being lazy or heartless. On the contrary, they are making a modern, evidence-based treatment decision that makes sense for the system and the patient.

• Wampler DA, et al. "Cardiac Arrest Survival Is Rare without Prehospital Return of Spontaneous Circulation." Prehosp Emerg Care. 2012 Jul 26.