Most of the edicts coming down from some local and state governments that can be seen as overreactions to the coronavirus pandemic have been just annoying, ranging from prohibitions against buying seeds and gardening tools in Michigan to filling a skate park in California with sand to keep it from being used. Then there was the do not resuscitate order handed down in New York. The New York Post explains.
“While paramedics were previously told to spend up to 20 minutes trying to revive people found in cardiac arrest, the change is necessary during the COVID-19 response to protect the health and safety of EMS providers by limiting their exposure, conserve resources, and ensure optimal use of equipment to save the greatest number of lives,’ according to a state Health Department memo issued last week.”
In ordinary practice, if an EMT finds you in cardiac arrest, he or she will perform heroic efforts to bring you back from the brink of death using a variety of tools. Indeed, savings lives is the very heart of the ethos of an EMT.
Naturally, first responders in New York were outraged at the guidelines. They felt that the edict took away the option of trying to save lives from them. The state of New York issued the edict to replace a previous one that prohibited taking a patient to the hospital if resuscitation could not be performed on the scene.
The coronavirus is the reason for the new edict. Hot Air expresses some understanding of the reason for its issuance –
“There’s a part of me that almost understands a move like this, at least in theory. On the one hand, the first responders are already overwhelmed. And as tough as their jobs already are, now they have to worry if the guy collapsed on the street is contagious with the virus. A desire by the state to keep them safe is at least laudable in that regard. Also, while New York was never as fully overwhelmed as some originally feared, the number of ICU beds available at some of the hospitals is still down near zero on some days, primarily because of COVID-19 patients.”
Even so, it’s not a good look to instruct EMTs to allow people to die when they might be saved, coronavirus, or no. People have often been brought back from the very gates of death by the skill and technology wielded by first responders. Even when the attempt to bring a victim back to life3 fails, the loved ones he or she leaves behind at least have to comfort of knowing that everything possible was done.
It looks like the state of New York agreed with the above sentiment, as reported in a later story by the New York Post. The New York Health Department explained the reasoning behind the original order.
“This guidance, proposed by physician leaders of the EMS Regional Medical Control Systems and the State Advisory Council — in accordance with American Heart Association guidance and based on standards recommended by the American College of Emergency Physicians and adopted in multiple other states — was issued April 17, 2020, at the recommendation of the Bureau of Emergency Medical Services, and reflected nationally recognized minimum standards.”
On the other hand, the statement went on to say, “However, they don’t reflect New York’s standards and for that reason DOH Commissioner Dr. Howard Zucker has ordered them to be rescinded.”
It should be noted that New York City’s Fire Department and other first responders did not adopt the new edict but would still attempt to revive patients on the scene for 20 minutes before giving up. After 20 minutes of no heartbeat, most people are considered to have suffered irreversible brain damage, making their revival more problematic.
More than one observer of healthcare policy has noted that the New York State do not resuscitate edict could be seen as a foretaste of what Medicare for All would look like. To be sure, the order was issued to protect EMTs from being infected with the coronavirus and not to save money. However, the poor person whose heart gives out at home or in the middle of the street would have been just as dead regardless of the rationale. Emergency healthcare is oriented toward saving lives, not letting people die, as it should be.