DNAR and Ethics in Emergency Rescue
By Faisal Javed MirRespected Subscribers and Readers,
The goals of resuscitation are to preserve life, restore health, relieve suffering, limit disability, and respect the individual’s decisions, rights and privacy. In our today’s post we will talk about the early decisions made by the individual (if known to us at time of help needed), ethical and social rights and whenever his/her privacy matters with life saving services/skills needed to be administered to him/her.
Decisions about cardiopulmonary resuscitation (CPR)
efforts are often made in seconds by rescuers who may now know
the victim of cardiac arrest or whether an advance directive
exists or not. As a result, administration of CPR may be contrary
to the individual’s desires or best interests. The below will
help all, healthcare professionals and layman rescuers, to
understand the requirements and ethics of administering
resuscitation and basic life supporting skills in any
life-threatening situation.
Ethical Principles:
Rescuers should consider ethical, legal, and cultural factors when caring for those in need of CPR. Although rescuers must play a role in resuscitation decision making, they should be guided by science, the individual patient or surrogate preferences, local policy, and legal requirements.
Principle of Respect for Autonomy:
The principle of respect for autonomy is an important social value in medical ethics and law. The principle is based on society’s respect for competent individual’s ability to make decisions about his or her own healthcare. Adults are presumed to have decision-making capability unless they are incapacitated or declared incompetent by a court of law. Truly informed decisions require a strong healthcare provider-patient relationship/communication and a 3-step process:
1:- the patient receives and understands accurate information about his or her conditions, prognosis, the nature of any proposes interventions, alternatives, and risks and benefits;
2:- the patient is asked to paraphrase the information to give the provider the opportunity to assess his or her understanding to correct any misimpressions; and
3:- the patient deliberates and chooses among alternatives and justifies his or her decision.
WHEN the individual’s preferences are unknown or uncertain, emergency conditions should be treated until further information is available.
Do Not Attempt Resuscitation (DNAR):
A Do Not Attempt Resuscitation (DNAR) Order is a legitimate document in which one expressed his/her desire to not attempt any resuscitation effort or clearly state to “Allow Natural Death” without any resuscitation attempts. A DNAR should explicitly describe the resuscitation interventions to be performed in the event of a life-threatening emergency. In most cases, a DNAR order is preceded by a documented discussion with the patient, family, or surrogate decision maker addressing the patient’s wishes about resuscitation interventions. In addition, some jurisdictions may require confirmation by a witness or a second treating physician.
Withholding and Withdrawing CPR Related to Out-of Hospital Cardiac Arrest (OHCA):
We, the First Aid, CPR and AED trainers teach our students (as per the guidelines states) to immediately begin CPR without seeking consent, because any delay in care dramatically decreases the chances of survival. While the general rule is to provide emergency treatment to a victim of cardiac arrest, there are a few exceptions where withholding CPR might be appropriate, as follows:
1:- Situations where attempts to perform CPR whould place the rescuer at risk of serious injury or mortal peril;
2:- Obvious clinical signs of irreversible death; &
3:- A valid, signed, and dated advance directive indicating that resuscitation is not desired, or a valid, signed, and dated DNAR order.
To Your Health & Safety,
Faisal Javed Mir & First Aid to Save a Life Pakistan
You might also like:
World Day of Remembrance for Road Traffic Victims
By Faisal Javed MirRespected Readers,
Road traffic crashes (commonly RTA – road traffic accidents) kill nearly 1.3 million people every year and injure or disable as many as 50 million more. They are the leading cause of death among young people aged 15–29 years.
In October 2005, the United Nations General Assembly adopted a resolution which calls for governments to mark the third Sunday in November each year as “World Day of Remembrance for Road Traffic Victims”. The day was created as a means to give recognition to victims of road traffic crashes and the plight of their relatives who must cope with the emotional and practical consequences of these tragic events.
First Aid to Save a Life Pakistan encourages our young generation and respected parents to support safe driving behavior and through education and training before any young child get access to any type of motor like bike or car. They should also adopt correct behavior to ensure occupants (passenger, children and/or infants) safety and must have proper restraints for them too.
Road traffic crashes are among the world’s largest public health issues:
- Traffic fatalities are the leading cause of death for people ages 15-45 worldwide, resulting in 1.3 million deaths per year.
Road traffic crashes are robbing communities and developing countries of their future – the young generation:
- Globally, more than 40% of all road traffic deaths occur among the 0 to 25 age group; &
- 85% of traffic fatalities and 96% of child traffic fatalities occur in low- or middle-income countries.
Road traffic crashes place extreme financial strain on developing economies:
- For many low- and middle-income countries, the cost of road crashes represents between 1-2% of GNP (GDP);
- In some cases exceeds the total amount they receive in international development aid; &
- Many road traffic crash victims are the primary income generators for their family. The injury or death of these victims negatively impact the standard of living for their entire family.
Road traffic crashes are predictable and can be prevented
People who survive the initial crash frequently suffer brain damage that impedes their ability to continue as an income generator for their families, and in fact may require a lifetime of personal care that can drain resources from already impoverished families. Helmet use makes a difference. Appropriate helmet use reduces the risk of fatality by an average of 42% and of severe head injury by 69%.
A recent case study of motorcycle accidents from Los Angeles and Thailand similarly found that that un-helmeted riders were two to three times as likely to be killed and three times as likely to suffer a ‘disastrous outcome’. Of survivable crashes, universal helmet use would have prevented about 80% of fatalities and brain injuries.
The goal of training programs offered by First Aid to Save a Life Pakistan is to help you gain the knowledge, skills, and confidence necessary to manage a medical emergency until more advanced help i s available.
Emergency First Aid does not require you to make complex decision or have in-depth medical knowledge. It’s easy to learn, remember, and perform.
Being volunteer is very good and our social and ethical responsibility to help victims and provide first aid (if trained to do so) but have to remain extremely careful if you are providing first aid on or near a roadway. Each year, many people are struck and killed by motor vehicles while providing assistance.
On this World Day of Remembrance for Road Traffic Victims, let us mobilize all possible contributions; knowledge and experience; to improving road safety. Let us honour those who have lost their lives on the world’s roads by acting to save the lives of others.
To Your Health & Safety,
Faisal Javed Mir
Using Social Media for SOCIAL GOOD
By Faisal Javed MirA Very Warm Welcome to Our Respected Readers,
The use of technology and social media for effective advocacy and awareness was a key topic in recent times. But in Pakistan one of our minister who may be don’t know IT Technology and How Internet Traffic Works wants some of the social media giants to be shutdown in Pakistan. I don’t know why but he has expressed his intentions publicly. On the other hand, other nations are conducting surveys to know how people use social media in emergencies.
The Social Good Summit was held in New York from Sep 19 – 22, 2011 to know the role of social media when natural threats and disasters warnings are passed out. The Social Good Summit also highlighted a range of ways in which technology is improving our ability to get messages out.
Remarkable innovations done in the recent past history has changed the face of the earth we know and know we call it global village. Here, I would also like to pay a high tribute to Mr. Steve Jobs (Died Oct 5, 2011), for his innovations in information technology those have major contributions in today’s silicon chip life.
Let me share with you some of the facts those will reveal how we use social media in emergencies.
1:- Online news is the 3rd most popular source for emergency information.
2:-18% use facebook to get information about emergencies.
3:- 24% would use social tools to tell their loved ones that they are safe.
Also, there are devices built and programmed for purpose to locate the nearest AED devices in public areas, shopping malls, sports centers etc.
All above are positive and encouraging signs for those who thinks social networking sites are of no use/benefit. In the end, I would like to include one quote of Mary Engelbreit.
“If you don’t like something change it; if you can’t change it, change they way you think about it.”
To Your Health, Safety & Prosperity,
Faisal Javed Mir
You might also like:
Clearing Myths about Dengue Part4
By Faisal Javed MirWelcome Our Respected Readers,
A lot has been said by medical experts on prevention/precautions of dengue fever: and local, provincial and national government also launched very heavy campaigns to control havoc/panic created by dengue fever. First Aid to Save a Life Pakistan would like to discuss some of the myths while discussing precautions and medications for dengue fever.
We have released 3 posts to clear the myths associated with dengue fever and this is our fourth post on the same subject, “Myths about Dengue!”
In our today’s post we will highlight one more myth associated with dengue and while presenting the rationale against the steps taken and advised by governmental authorities in Pakistan to control dengue are beyond our understanding.
4:- Drain the water from swimming pool and cultured water fountain then dry it and refill it 2 times a week – might be a problem for WAPDA and WASA/LSWM organizations also or might be a solution to combat dengue? Doubtful? This should be a BIG NO!
I was surprised the day I heard the news that government has issued the directive to stop service stations in Lahore from working and asked the hotels and owners of private swimming pools to drain the water and dry the pools to help them control dengue spread observed in Lahore in earlier September 2011.
To someone this may appear to be an act of bravery of CM or very calculated and proactive response to control the epidemic but there are also number of persons who think it was & still is not required and have nothing common to stop/control breeding of aedes mosquitoes. They also believe that this was a face-saving step to tell nation that they (government) do care about us and can go to every limit to save their lives.
Dengue mosquitoes don’t live near swimming pools and there is no record from any country who have asked their citizens to drain and dry their pools 2 times a week. See below notification by Govt. of Punjab in a newspaper and read clause # 5 for your information.
One thing we would like to appraise here is the promulgation of regulation to stop the infectious diseases and hope it does work well to have long-term benefits and fulfill its prime objective in near future.
Centers for Disease Control (CDC) and Prevention is the world leader (arguably) research center works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other organizations. CDC focus disease prevention and control (especially infectious diseases and foodborne pathogens and other microbial infections), environmental health, occupational safety and health, health promotion, injury prevention and education activities designed to improve the health of the people of USA and in partnership with other global research centers and organizations like WHO.
Recently CDC has released two MMWR (Morbidity and Mortality Weekly Report) Surveillance Summaries: “Surveillance for Waterborne Disease Outbreaks and Other Health Events Associated with Recreational Water—United States, 2007-2008” and “Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water—United States, 2007-2008.”
The reports cover outbreaks associated with recreational water (e.g., swimming pools) and drinking water. In 2007-2008, the most recent year for which waterborne disease outbreak data are finalized, 134 outbreaks were associated with recreational water and 36 outbreaks were associated with drinking water. Surprisingly (for us) there is no mentioning of aedes mosquitoes presence which causing nuisance or leading to outbreak or even threat to their public in recreational water (e.g., swimming pool). We don’t have any research center in Pakistan on dengue yet we know that swimming pools help them breed and should be drained! Oops I forgot to complete my words that they should be drained and dried, “2 times a week”!
To Your Health, Safety & Knowledge,
Faisal Javed Mir
Other Related Posts:
Clearing Mythos about Dengue Part3
Clearing Myths about Dengue! Part3
By Faisal Javed MirWelcome Our Respected Readers,
A lot has been said by medical experts on prevention/precautions of dengue fever: and local, provincial and national government also launched very heavy campaigns to control havoc/panic created by dengue fever. First Aid to Save a Life Pakistan would like to discuss some of the myths while discussing precautions and medications relating to dengue fever.
3:- Misguiding the nation and many less-educated people
with irresponsible media campaign – If dengue doesn’t spread by
specific breed of mosquito then what is aedes
aegypti?
I got amazed when I read news reports like this (below given) from very senior medical officials. I don’t know why this is happening but what else I know is that citizens of Pakistan are receiving double meaning statements (might be caused by poor reporting) which is not helping them understand what dengue virus is and how it spreads. Do read below news article especially 4th last line to onward.
Where most of the government officials are portraying that dengue virus spreads when aegypti mosquito from aedes genus bites an infected person and transmits the virus to others with next bite. There are also three other mosquito breeds from aedes genus those can spread this virus but never named before. Aedes Albopictus is the other breed which has been identified by World Health Organization Pakistan as a vector who spread this virus. And some of the very senior medical executives saying that there is no specific mosquito who spreads dengue virus.
I just like to mention here an old quote which is very true in case of dengue fever.
“Prevention is the best CURE.“
To Your Health & Safety,
Faisal Javed Mir
Other Related Posts:
Subscribe
