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Urgences-santé defends controversial directive to reduce treatment for patients who flatlined

Click to play video 'Health minister admits ‘do not resuscitate’ order given to paramedics was a difficult decision' Health minister admits ‘do not resuscitate’ order given to paramedics was a difficult decision
WATCH: Paramedics in Montreal were given 'do not resuscitate' instructions for some patients who suffered from a cardiac arrest during the first wave of the COVID-19 pandemic. The protocol meant to protect paramedics was in effect from April to late September but as Global’s Gloria Henriquez reports, some patients’ rights advocates say it is unacceptable. – Nov 24, 2020

Quebec Health Minister Christian Dubé said Tuesday that a controversial directive, affecting how paramedics treat patients in cardiac arrest, is no longer in effect.

For a period of time during the first wave of the pandemic, there was a chance that if you went into cardiac arrest and flatlined, paramedics wouldn’t perform CPR.

The directive, in effect from April until September, was a joint decision by Urgences-santé paramedics in Montreal and Laval, the Health Ministry and the Quebec college of physicians.

Essentially, the directive stipulated that resuscitation maneuvres be stopped more quickly for patients who had flatlined.

Pierre-Patrick Dupont, Urgences-santé director of care, said that under the new protocol, paramedics would evaluate the patient using a monitor. If electrical activity were detected in the heart, a defibrillator would be used to shock it in an attempt to regain a normal rhythm.

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In the case where no electrical impulses were detected, meaning the patient had flatlined, then further reanimation methods, such as CPR which includes chest compressions and mouth to mouth, would not be performed.

Click to play video 'Teaching the importance of knowing CPR' Teaching the importance of knowing CPR
Teaching the importance of knowing CPR – Oct 16, 2020

Under normal circumstances, a doctor would be called and further treatment discussed.

Dupont, however, argued that once someone has flatlined their chance of survival is very slim, regardless of the protocols.

“If you flatline, you only have a two per cent chance to survive in hospital,” he said.

As a side note, Dupont pointed to the importance of having access to automatic external defibrillators in the community saying it takes only about eight minutes for a person in cardiac arrest to flatline.

Dupont argued the protocol was necessary to protect not only paramedics but the health system as a whole, explaining that if paramedics became infected with the virus or died of the illness it would have a direct impact on patients.

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He also said that at the time, little was known about the disease and how it spread.

“Sometimes little particles were flowing in the air and we have to not start CPR compression,” he said, adding it was a difficult decision.

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The directive was applied only to adult patients.

“Not pediatric, not pregnant women only 18 years and older,” Dupont said.

Paul Brunet, a patients’ rights advocate, said this kind of directive shows how unprepared the government was to deal with the pandemic.

“For the safety of ambulance drivers I understand that such was a protocol but as I understand it is totally unacceptable that such a protocol was even thought of being written,” he said.

Dubé for his part said the controversial decision shows how dire the situation was at the time.

“When we look at it in today’s context, it’s hard to accept,” he said. “But it just goes to show how virulent the first wave was.”

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Brunet said he hopes such a protocol won’t be needed in the future.

I presume that we are now better prepared and have better knowledge of what we have to do to protect everyone,” he said.

Urgences-santé said they do have different tools and equipment in place now that allows paramedics to go back to their normal protocol of performing CPR for five minutes even if the patient has flatlined.

The province said it doesn’t yet have numbers of how many times the temporary protocol was applied.

— With files from Global’s Gloria Henriquez