Difficult Arrests

I've had a string of difficult cardiac arrests lately. Not difficult from a skills stand point (they all go smoothly enough) but difficult from a circumstances stand point. Last night we were dispatched to a cardiac arrest reported by PD on scene. Fire was dispatched at the same time and arrived on scene right behind us. I walked up the stairs to the 2nd story condo and found one of the local (and very well liked and respected) police officers along with a county sheriff or two.

"I just need you to do a verification for me," the local cop said. Now, I immediately slowed down at this point, going from a resuscitation mode to a confirmation mode. The local cop is one of the deputy medical examiners (DME), he would know what a dead body looks like better than most.

My partner and I entered the bathroom and found the elderly female patient lying on the floor next to the toilet. The cops, firemen, and husband all had to wait in the living room while my partner and I went about confirming the confirmation.

First thing I noticed is the cyanosis in the face and left arm (she was lying on her left side). She was pale centrally, but no dependent lividity. Her core is not quite warm, but not quite cool either. And in checking a carotid pulse, I find her to still be very warm at the neck and chest. "She's still viable," I tell my partner, "we're gonna have to work it."

We pull her to the living room and start working the arrest. Firemen start CPR, while I get to work on the airway and my partner is working on an IV. I start to ask questions and find out that PD was sent to investigation after dispatch had received some peculiar 911 calls from the husband. Due to some communication difficulties on the husband's part, the request for an ambulance never made it through dispatch.

The officers arrived and found the patient arrested in the bathroom, made the determination that it was a DBA, but called a cardiac arrest anyways. We arrive and begin working the code. The patient had been down for up to 20 minutes by the time we start CPR. The patient remains in asystole throughout the arrest, but we transport (as our protocols say we do) and call it at the hospital.

Here's where I have difficulty with this call--I don't know whether I need to be upset at the local cops or not. The communications problem that resulted in our delay aside, it seems to me that a DME should know how to check to see if the patient is still viable or not. The determination that the patient was still viable was (to me) pretty obvious and given that determination, we started working the code right away. The police are CPR trained, it's a job requirement. The DME knew enough to call this as a cardiac arrest, not a possible DBA. So I ask myself, should they have started CPR?

My supervisor had a good point about this; the cops' CPR training is primarily for themselves. They are not medical responders and can't be expected to act as such. They may not have had gloves or a pocket mask available to them for their protection. And their training is in recognizing dead versus alive, not viable versus non-viable arrest.

I'm still wrestling with this today. Do I need to, or am I expecting more than I should from the cops?

As a side note: I try to learn something from every call. From this one, I went into it with the wrong mind set. I allowed myself to slow down when the officer asked me to confirm. I know in the future to treat every cardiac arrest like a workable cardiac arrest until proven otherwise.