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Case Studies: Emergency Medical Treatment

Henry

Henry is an 80 year old resident of an aged care home. He is vision impaired and has Type 2 diabetes. He has limited mobility and requires care with some activities of daily living.

One evening he starts experiencing chest pain, and presses his call button for assistance. The personal care assistant who attends immediately calls the nurse to assess Henry. The nurse performs an assessment, and given he has no history of angina or cardiac issues calls 000, asking for an ambulance to attend the home urgently.

The ambulance arrives and paramedics examine Henry. The nurse tells them Henry does not have an Advance Care Directive, and his only relative, his son John, is away overseas. Henry’s chest pain becomes stronger and he suddenly loses consciousness and goes into full cardiac arrest.

As Henry is unconscious he cannot provide consent to treatment. He will die unless CPR is given immediately. Given the urgent need for treatment and that it is not possible to obtain consent from Henry or John (and Henry has not previously refused the treatment) it is lawful for the paramedics to commence CPR.

Henry is able to be resuscitated and is taken to the local hospital emergency department for further investigation and treatment.

Helena

Helena is a 92 year old aged care resident. She is frail but otherwise in good health.

One afternoon she suffers a suspected cerebrovascular accident (CVA) and experiences respiratory distress. Mandy, a nurse on duty at the aged care home, calls an ambulance immediately. She then looks at Helena’s medical records, which show she has an Advance Care Directive refusing a range of life-sustaining treatment, including artificial ventilation.

By the time the ambulance arrives, Helena’s breathing has deteriorated and she cannot communicate. The paramedics are considering whether intubation may be needed and whether to transfer Helena to hospital. Mandy shows them Helena’s Directive refusing life-sustaining treatment.

Relying on the Directive, the paramedics decide not to administer life-sustaining treatment but provide comfort treatment including analgesia for pain relief and benzodiazepine for relief of Helena’s distress. This course of action is lawful. Helena dies peacefully shortly after.

Page updated 28 August 2018