We were at the ER doing paperwork as one of our other units was dispatched for a female in labor. Seemed to be the same old call, probably just started having contractions and probably 10 minutes apart. We listen to the radio traffic and never hear them call for another unit, so it is no big deal. Then we hear them clear the scene responding to the hospital "priority 1" (emergency). So I inform the ER to get ready because either they have delivered or they have a serious complication going on. The unit calls in on the radio and informs the ER they have an "APPROXIMATELY" 19wk pregnant female who delivered 1 female. Pt has a visible heartbeat (approximately 50bpm) and is taking agonal resp. Chest compressions and ventilations are being done. Pt is fully developed in appearance and is about 10" long. I hear this and inform the secretary to call L&D and have an incubator and staff meet them on the ER ramp. The L&D said there was nothing they could do because the fetus wasn't viable. Remember she does have a heartbeat and some respirations, as weak as they may be, they are still present. I met the unit on the ramp and the mother was taken inside, while we waited on the L&D staff. As we wait I myself witness the heartbeat and respirations. I have to go inside and have the ER call to see where the staff is at and I am told they are on the way. Still waiting we decide to screw it, we wrap the fetus up as to avoid as much of the 15 degree temp as we can and go inside. As we are walking to our room the L&D nurse reiterates there is nothing to save, that she doesn't, theoretically, have a chance at surviving. ***littlle reminder*** the pt still has a heartbeat. There was no discussion about atleast performing basic manuevers until the inevitable happens. I being as disgusted and appalled as I was left the room. I heard she was pronounced soon after.

Now I do understand that her chances are next to none and that treating her would be very difficult at 10oz, but for christ's sakes give her a chance.

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Comment by Dolph Holmes on February 20, 2009 at 10:10pm
My mother-in-law was a premie over 80 years ago...(if that same attitude prevailed then I would
never have met my wife). She was a twin and her twin did not survive. She was taken home
because the hospital did not have incubators and kept near a stove for weeks. Sometimes
family has to advocate for patients!
Comment by Ross on February 20, 2009 at 9:29pm
A sad, difficult case for you. I sadly experienced a similar case- mom delivered an approx 19 week fetus in the shower. I took one look at the fetus after talking to mom, and pulled a towel over the fetus. There was some movement, could have been a heartbeat. But there just wasn't a viable pt at that time. I still remember the scene, but I have no regrets about my actions. It seemed more unfair to give the mother, the other crewmembers, false hope. And expose the ED/L&D staff to the needless trauma of seeing this pt. All in all, it's a bad scene.
Comment by Jasen Adam on January 30, 2009 at 1:31pm
James I have a read your post with a sympathetic tone and appreciate your insight. I do understand that the fetus didn't really stand a chance, but I guess what bothered me was the complete lack of effort before even seeing the pt. I looked at it through another scenario. Let's say we come up on a 1 pt ejection, severe head and abd trauma. Pt is breathing 4 times a minute and unresponsive. The statistcal rules say this guy is going to be dead in no time, but we still do something for him. It just sits wierd with me to know that a pt with a pulse is just left to die because no one knows how to prevent it.
Comment by Brian Wiegand on January 30, 2009 at 11:08am
Sorry to hear this one Jasen. I feel for you and the crew on the run. Knowing some of those involved it's hard for me to comment. I do believe you are correct. Science isn't the whole answer here. How many protocol changes have we been through together? The new one stating we were lucky not to have killed the patient doing it the old way? The patient should have been given the benifit of the doubt. Outcome probably would have been the same but............. Kind of like saying, "well he lived a good life, it's just his time"...........You should probably shoot Chance Gearheart a email and run it by him. He has much more experience with this than you or I.
Comment by James Bartus Jr. on January 30, 2009 at 12:51am
Minimal viability is 24 weeks. I repeat minimal. This fetus was as you said approximately 19 weeks, even if they were off by their estimate even by one week that was a month too early. The infant/fetus' lungs were not developed enough to function on any kind of level agonal resps, manual ventilation or not. Yes, it may have had a heart beat (as you stated twice), but so does the unformed embryo at 7 weeks, that does not even resemble a human being, and clearly is not viable. The heart rate inutero should be 120-200 beats and as you stated was only around 50. I took this sign as evidence of futility not viability as you did. I'm not trying to harp on you, please read this with a sympathetic tone. I sense hostility or frustration in your posts "science has shown, blah, blah". We practice evidence based medicine and our technology to preserve life at even the most advanced hospitals cannot revive a 19 week old premature infant. I worked for a time as an RRT at the oldest and largest hospital in New England (you can look up which it is). Even there with ECMO and HFOV (extracorporeal membrane oxygenation & High Frequency Oscillatory Ventilation) a team waiting at the ER door could not save a 19 (or 20) week old. It is unfair but is simple reality.
I am sympathetic though my wife has had 5 miscarriages over the past 2 years trying to conceive and I would not wish that on anyone.
Comment by Annette Smith on January 29, 2009 at 10:46pm
I've got to agree with you. Man, how awful. I responded to a "female down" call as a volunteer a few years ago. She was very young, a few years older than my daughter but in the same school system (small community, I "knew" her) Full arrest, g..o..n..e, her mother standing beside the bed holding this girl's infant daughter just screaming for me to help her....I started CPR.....the Town Marshall (paid fire, EMT, full time) just stood there looking at me like I was an idiot. She had ingested a 100mg MS patch about 3 hours prior it turns out....but I wasn't about to let her go without putting up one hell of a fight, for her mom's sake if nothing else. I think its our duty to "act"....and let God sort it out.
Comment by Jasen Adam on January 29, 2009 at 8:14pm
One of the guys at work said science has shown blah, blah , blah. I explained how science is ever changing. Heck look at the life expectancy of a premmie 100 yrs ago. The would almost certainly say that life couldn't survive at a certain time of pregnancy, no look they deliver and care for 16 wk premature babies.
Comment by John W. Magyar on January 29, 2009 at 5:47pm
I'm with you both on this. In my many years in the field, I have witnessed quite a few miraculous pt. events. Just recently a friend of mine had been unconscious for 5 days in the hospital. He awoke one day and the Doc asked him if he knew what day it was. He said "yeah", and gave the correct date and said "its my wife's birthday".
Although some medical professionals are ready to write off a person's life based on the statistics, I still believe it is our duty to preserve the sanctity of life. Its not our job to make the decision to give up based on the stats. Miracles can happen if "people" don't get in the way. We do all we can do and the rest is up to God. I empathize with your feelings Jasen. Been there myself a few times. Kathy, hug that little miracle for me. Thank God someone didn't just decide to write her off.
Be safe out there and remember that "EMS is NOT just a business" !!! John
Comment by Jasen Adam on January 28, 2009 at 12:49am
I am glad to hear your granddaughter is doing good.
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