[ad_1]
For five months, some people with cardiopulmonary arrest could not be resuscitated by ambulance assistants due to a directive in Montreal and Laval to avoid overloading the intensive care units. However, the directive was maintained until 21 September, despite returning to normal in hospitals this summer.
Implemented on April 4, the ministerial directive “stop intensified maneuvers” provided in particular to no longer perform heart massage or defibrillation in people with “asystole”, ie without a detectable pulse.
“Patients with the lowest chance of survival and who require the greatest care will be ‘left behind’ to allow treatment of the greatest number of patients. In these conditions, the common good takes precedence over individual care ”, reads the ministerial protocol for Urgences-santé, approved on 24 April by the College of Doctors.
Only children, pregnant women and cases of hypothermia have escaped the application of these extreme measures, designed to protect the intensive care capacity in Montreal and Laval at the height of the pandemic.
Maintaining this directive until September caused some unrest among paramedics, ordered not to intervene with some victims. “The hardest thing was the anguish and anger of families and loved ones, especially when the person was 30 or 40,” said an ambulance technician who requested anonymity. It was only at the end of the summer, after repeated pressure from the union on Urgences-santé and the Ministry of Health, that this protocol was abandoned.
The hardest part was the anguish and anger of families and loved ones, especially when the person was 30 or 40 years old.
“In the early days of COVID-19, it was expected that our resuscitation capacity would be overwhelmed. In the presence of asystole, with some exceptions, no maneuvers were performed. We filled out the death certificate […] so as not to clog the system with patients who have little chance of survival ”, explains Réjean Leclerc, president of the Syndicat du préhospitalier (CSN), which brings together the paramedics of Urgences-santé.
The chances of resuscitation in cases of asystole, especially after 4 minutes without a pulse, are very low, the latter agrees. About 1 to 3%. “But we have to discuss it socially, we have to explain it to the population,” he believes. What had meaning in March, April, May, no longer took place in June, July, August. “
Other directives have also led to the arrest of cardiac massages and other resuscitation techniques capable of generating aerosols upon the arrival of paramedics at the emergency room, to avoid possible contamination of the premises and personnel. “Even without asystole, some patients could not get the help they normally would. As an emergency responder, it was very frustrating, ”adds another paramedic anonymously.
A hole in the data
Urgences-santé, responsible for 40% of ambulance transport in the province, says it is unable to quantify the number of patients who have not been able to receive routine care due to these protocols linked to the context of the pandemic. Telework has hindered Urgences-santé’s ability to collect accurate data since March and admits there is a “hole”.
But in 2019-2020, nearly 1% of calls to Urgences-santé were linked to cardiorespiratory arrests and 28% to respiratory or heart problems, Urgences-santé’s latest annual report reveals. And since the beginning of the pandemic, more than 18,000 emergency interventions have been carried out.
The ambulance corporation defends the merits of the protocol that remained in force until 21 September and considers the number of people affected to be very low. “Yes, defibrillation saves lives, but after 6-8 minutes, when there has been a lack of oxygen to the brain, he says, there are also risks of sequelae. It was necessary to protect intensive care and to safeguard the entire pre-hospital intervention chain. A person who is resuscitated on the street ends up in intensive care, “says Pierre-Patrick Dupont, director of care at Urgences-santé.
At the start of the pandemic, “we didn’t know much about the virus, we had little evidence,” he added. We were the epicenter of the outbreak in Canada. In Montreal, there were choices to be made […], everyone was confused by the changes. Then we readjusted ”.
Over the weeks, new procedures have made it possible to minimize the risk of aerosols during resuscitation and other treatments. Paramedics were also among the health workers most spared from the virus, as they were equipped from the beginning with 3M 6000 masks (more effective than N95), visors, waterproof gowns and double pairs. gloves.
So why did you keep the directive until the end of September? “The health network predicted a wave this summer. We wanted to avoid “back and forth” in the protocols and mix them all up, Dupont says. But now, I don’t think we’ll go back to this protocol. “Other ambulance corporations have thus suspended resuscitation of patients, according to the latter.
In the New York area, similar “no resuscitation” protocols have been adopted to relieve emergencies with a record number of patients. The use of defibrillators was forbidden when the electrocardiogram of the patients to be rescued showed a “flat” line. But in New York, the directive caused such an uproar among the public that it had to be withdrawn.
In the Newark, New Jersey area, data was collected on this type of event. It was noted that 65% of the emergency interventions carried out for cardiopulmonary arrest fell within the scope of the non-resuscitation directive. Even if only 1-3% of these patients could have survived, “ethical dilemmas arise with this way of doing things”, said Dr Terry Hoben, emergency medical services coordinator at Newark University Hospital.
Watch a video
[ad_2]
Source link
