Monday, July 25, 2005

Dead is Dead

Guy goes into a gun shop, buys a gun. Goes next store, buys a coffee. Gets in his car.


We get dispatched for a man unresponsive in a car, covered with blood. Priority One.

My partner and I converse as we head in that direction. The address is on a street lined with cheap hotels. Its where many marginal people rent by the week. He's going to be dead, I say. I just hope he's been in the car a long time.

Maybe they shot him and left him there, my partner says.

It sounds like that, I say. He's probably been dead awhile.

Maybe its esophageal varices, my partner says.

In that case, I realy hope he's good and dead, I say.

Esopheageal varices are nasty. Veins in the esophagus burst and people drown in their blood. Very messy.

We get an update. Slow down to a two. Its a suicide.

We hit off the lights and sirens. A simple presumption. Put the electrodes on, run off the asystole, call the time.

It takes us another six or seven minutes to get there.

There are police cars all over, yellow police tape blocks off the parking lot. A photographer is taking photos.

Something doesn't seem quite right. This is a pretty public area. How did he go so long unnoticed? Maybe the car had tinted windows? Maybe people just aren't observant?

We have to drive up on the grass to get around the police tape. I get out, and take the monitor out of the side door. I approach the car. I can see a man slumped back in the seat.

Give us a minute to finish taking pictures, an officer says, holding up his hand. I am standing back. I am hearing some conversation, scattered bits about getting the names of patrons who were witnesses.

Did this just happen? I ask.

I don't get an answer, but I get a look.

I might have to work, this guy, I say. If he's dead dead, I am not going to work him, but the state regs suggest if he's fresh, he may need to be worked.

The cop says nothing.

I am still standing back. I'm looking around at all the cops, the cameras, the people in the restaurant.

I know what the state protocols say, they say you have to work someone in arrest unless they have rigor mortis with dependent lividity, decapitation, decomposition or body transection. We all used to think there was a line in there about injury incompatible with life, but it isn't in there. The state knows there are problems with the protocol, and the state medical committee is actively rewritting it. The line incompatible with life is getting put in.

The committee wants to require medics to call medical control to presume. I have been against this because what happens when the doctor tells you to work the person who you have not been working, who no one has been working because he is dead. I have been a big advocate of letting the medic use his judgement following a reasonable protocol. Dead is dead.

They finally let me have access. The man has a gun in his curled left hand. His head is back against the headrest. His mouth is closed. There is a hole in the back of his head -- not exactly what I would call gaping. He is pulseless and apneic. He is not cold.

Look there's some brain, my partner says.

There is some, but not what you would call chunks.

I hook up the monitor and attach it. The officer is watching my eyes. I look back at him.

I think he is thinking don't you even think about working this guy.

I am thinking this strip better be flatline.

I can picture the scene, me yanking the body out of the car, all ten of the cops, going what the f... And all hell breaking loose.

It is flatline.

I run a long, long strip, then detach the monitor. I write my name down a piece of paper along with the date, time and my licence number. I give it to the investigating officer. I walk back to the truck.

A supervisor has arrived and I explain the situation. She thinks I should call medical control just to get it on record. What if he says I have to work it? I say. The guy is dead. He's not coming back. He's been dead for at least twenty minutes.

They won't make you work it, she says. You need to cover yourself.

I call, hoping I don't get a moonlighter. I explain the situation. We were slowed down, delayed access, bullet through head, brain matter, asystole.

I'm think this is going to be something now if all of a sudden I have to go back, and say sorry the doctor wants me to work him.

He grants his concurrence with my decision, but from his tone it sounds like he is thinking "Why are you even bothering me with this?"

It all leaves me slightly uneasy.


Twice before I have been slowed down to a not breathing, told it would be a presumption, only to find the patient did not quite meet the standard. They were dead -- no doubt -- dead and not coming back, but not dead enough if you follow the protocol.

Picture the scene, officers offering the family condolences, the family calling relatives to tell them that granny has passed on. And the medics come in with their monitor only, then suddenly they go throw granny on the ground and start doing CPR and yelling for their gear.

And what does the family think after they've talked to the lawyer. The police did nothing. They slowed the ambulance down. Maybe granny would have lived.

No, granny was dead.

Sometimes its a matter of interpretation.

I guess I have to fall on the side of doing the right thing for my own conscience.

Dead is Dead.


Did a couple transfers. A lady with numb hands, A refusal.