CPR for older people?

[TheAvatar]

I was taught in classes (just Rescue and prerequisite) to give CPR no matter if I am going to break a persons ribs. I guess this question is mostly about rescuing older diver's. I'm not sure where anyone draws the line as "older" but I figured that if anybody was out diving they probably would want CPR. What do you think? Is there an age or appearance of the person where you would not perform CPR because you think you would do more harm if they were brought back? Seems like a HARD, ethical question to answer and think about but, god forbid, I am in this situation I wanted to know what other people thought. What do you think? Would CPR do more harm because it would inevitably damage their organs? I don't want to leave somebody sit there and give no help. It would kill me inside to do that.

What medical providers do (or do not do) for persons without a DNR and with an expected poor outcome is a frequent debate in medical ethics (fun classes, take one).

TheAvatar RN EMT (CPR instructor too)

 

[The_Aviator_1]

In the event you had an elderly person in a nursing home with a dnr it is absolutely acceptable to withhold CPR and advanced life support. Most patients with dnr's suffer from chronic medical problems and have had several conversations with their medical provider regarding their end of life wishes. When in doubt push hard and fast until EMS arrives, you'll never be faulted for that!

 

[DaleC]

I work in a Complex Care Facility (the next progression in care from assisted living) and all of our residents have some form of "DNR" paperwork (we don't call it that); it's part of the admission process. This used to be called DOI (degree of intervention) but now is called MOST (medical orders for scope of treatment) but it's all the same idea. This is a legal document signed by either the resident, POA, next of kin and a physician. It outlines very specifically the level of intervention care staff will provide. What care staff will do in such a facility, when such paperwork is in place, is not up for discretionary judgement. There is no debate. That takes place before the paperwork is signed.

If you did purposefully vary from the prescribed standing orders your facility could/would face a law suit and you would almost certainly be dismissed with cause.

Considering that most residents in such facilities are in their 80's to 90's and suffer some form of advanced dis-ease such as Alzheimer's, Dementia, Congestive Heart Failure, Parkinson's, etc... it is fairly easy to see that they are not in the same category as an older, but active scuba diver.

 

[lowviz]

Luckily, I'm neither a first responder nor a care provider and don't have to fear the same level of legal crap.

I'm Wilderness and Remote FA, CPR, AED certed till 2014 when I re-up. Carry my vomit barrier in my car. I'll ask if you want assistance, if yes, you get my best. If no, I'll wait patiently until you pass out. Then you WILL get my best under "implied consent". Good luck with the ribs, I follow only what I'm taught, no more, no less.

 

[The_Aviator_1]

TheAvatar our names are so close at first glance from my IPhone I thought my name was next to your paragraph and was thinking "I didn't write this!" Haha

 

[Nwcid]

A working EMT in the USA has rules he has to follow about when he can with hold CPR and they are quiet specific. If I break the rules of DNR or any version of "advanced directives" then myself and my company can be held liable. If you do not understand what these are you can look them up. Basically they are LEGAL rules of what you can and can not do to a patient based on that patient's wishes. If there wishes are to pass peacefully with no CPR and they have the proper legal paperwork in order who am I to say otherwise?

 

[Seefourdc]

What medical providers do (or do not do) for persons without a DNR and with an expected poor outcome is a frequent debate in medical ethics (fun classes, take one).

TheAvatar RN EMT (CPR instructor too)

I just had to respond to this. This is definitely a country by country basis, but in the USA there is no debate about how you handle a non-DNR situation as a medical provider. You provide the maximum care until it becomes clear that the patient is not going to be resuscitated with everything available and then you call it. Anything less is medical negligence. Only the family has the right to decide to cease care before every option has been attempted to treat the patient. This is entirely directed to emergency situations of course. A doctor doesn't have to take a elective procedure on a high risk patient. A EMT, Paramedic, ED MD, etc. really doesn't have the right to make that decision in the USA from a legal perspective.

This isn't directed at TheAvatar but the general atmosphere of some things that got discussed in the thread: From someone who gets to see outcomes on these situations from time to time both in providing CPR and continuum of care I don't really understand how anyone thinks they can make a judgement call on who will and won't survive or what quality of life they may achieve. Outside of extreme cases I've seen some pretty unbelievable recoveries. After watching a > 90 yr. old man survive being crushed by a tractor with significant lung and ortho injuries who was given CPR before being stabilized walk out of the hospital I'm pretty sure "knowing" who won't benefit from CPR is above most of our spiritual pay grades. You really do not know what a persons outcome will be at all and trying to assume is not really effective. The real question I think that has to be asked is are you willing to attempt to resuscitate someone or are you willing to stand by and watch them die. The only time an outcome is assured is when no bystander is willing to attempt to resuscitate someone or the patient is DNR and the family/his/her wishes are respected (Which also does not always happen).

 

[TSandM]

I believe we are neither legally nor ethically obligated to perform futile actions. For example, if you have a septic patient already on max life support in the ICU who codes, you are not under an obligation to do CPR on that patient. Similarly with terminal cancer patients.

Of course, this has nothing to do with any discussion of appropriate resuscitation for divers, since I would imagine there would be very few of them with DNRs or terminal conditions.

 

[DaleC]

And to further round out the discussion:
Just because you get "DNR" tattoo'd on your chest doesn't mean people won't do CPR. You could have been really drunk and visited a dyslexic ink artist for your "Guns and Roses" tribute.

 

[NSMEDIC]

Didn't read all of the posts but as a Paramedic for 13 years you do not withhold CPR unless they have written legal documentation that has to be shown to you signed by a doctor and the person in question. if it doens't exist on paper it doesn't exist. Also here in Canada we now teach that layperson's do not have to mouth to mouth as they have enough oxygen in their body to perfuse their organs, until medical pro's arrive on scene.