June 18, 2018
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To die at home

When we learned of a new statewide policy allowing EMTs to leave dead people in their homes it sounded callous, like a dump-and-run scheme designed to benefit ambulance companies.

But after some research and talking to state officials, we understand it as a justifiable response to changing times and technology. But it may take some time for that understanding to spread.

Some older readers may remember when funeral directors were the ambulance drivers for many rural areas. Some funeral hearses were even built to serve double duty with interiors that could be switched out depending upon the type of run.

In urban areas, firefighters trained in first aid were responsible for moving people from an emergency or illness at home to the hospital.

The premium then was placed on packing up a sick or injured person and rushing them — with lights flashing and sirens wailing — to the closest hospital.

As a result, many of us still have the expectation that when an ambulance arrives, the first priority should be loading up and moving out as quickly as possible.

Over the decades we learned how the first 10 or 20 minutes in a medical emergency can be the most critical.

We have responded by greatly expanding the training to the EMT level and vastly increasing the technology carried by crews to quickly assess and stabilize a sick or injured person.

EMTs now spend more time in the home working to save a life rather than rushing patients away to care that might be too late in coming.

But a recent change in practice has raised some eyebrows in Maine.

In December, Maine updated its EMS Prehospital Treatment Protocols giving EMTs and paramedics the authority to stop resuscitation efforts after 20 fruitless minutes.

Before, first responders would contact a medical control, such as an ER doctor, to make that call.

When patients are treated on the scene, more of them are going to die on the scene rather than in the back of a speeding ambulance.

And that has been an adjustment for families and ambulance crews.

Now, many families will learn in their own living room that their loved one has died … and an EMT will likely tell them.

After that, the rescue crew may pack up and leave while the family waits for a funeral home vehicle to arrive. And that may create, well, an awkward moment.

Yet family members have been dying at home since the beginning of time.
When you think about it, the last wish of many older people is to die at home rather than in a hospital.

Those who have attended a family death can probably attest that it is painful and vivid, but also a loving moment when everyone realizes a circle has been closed.

The new policy may allow for more of those quiet moments.

Sun Journal, Lewiston (July 15)

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