Hold the defibrillator

By Jomay Steen, Journal staff | Monday, December 03, 2007

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RAPID CITY — Dr. Reuben Bareis, a retired internal medicine geriatrics physician, is on a mission to educate the public about a new state law that may help people die with dignity.

At nearly 80 years old, the Rapid City man wears a bracelet that alerts emergency medical service providers, hospitals and other medical personal about his cardiopulmonary resuscitation directives and protocols.

“A friend of mine has it tattooed on her chest, ‘Do Not Resuscitate.’ They’re scared to death that they’ll be resuscitated,” Bareis said.

It’s a question about quality of life; lose it “and what do you have left?” he asked.

Last spring, the state Legislature passed a law that provides a database where people can fill out a form about their end-of-life preferences to not be resuscitated. The completed form is then sent to emergency medical service providers, hospitals and physicians. A copy is also filed at the Emergency Medical Services of the South Dakota Department of Public Safety in Pierre.

The program is Comfort One.

Modeled after a program in Montana, the legislation defines medical measures that should be withheld or withdrawn, such as chest compressions, defibrillation, advanced airway procedures, assisted breathing or administration of resuscitation medications.

Comfort measures that should be provided for the patient, according to the literature, include help in maintaining an open airway, suction, oxygen, pain medication as directed, controlled bleeding, comfort care and support to patient and family.

Deb Fischer-Clemens, a director for the Avera Center for Public Policy at Avera Health in Sioux Falls, recommends that people have a conversation with the family about end-of-life wishes and discuss who they want to make decisions for them if they are unable to speak on their own behalf.

In fact, the holidays may be a good time to establish a living will and appoint a durable power of attorney as well as discuss the options of Comfort One. She explained that a living will defines what your wishes are, while a durable power of attorney tells who will carry out these wishes.

If a family member is in palliative care, hospice care or in a situation where they’re not going to ask that extraordinary measures be taken to preserve his or her life, a Comfort One bracelet or necklace should be available. If the person cannot afford the bracelet, the state would be able to help him or her buy it. “Contact the Department of Social Services for the assistance in the purchase of the bracelet,” she said. “This is an issue for everyone.”

As part of protocol, Rapid City emergency medical technicians are trained to look for Comfort One bracelets and Medic Alert tags, an expert says.

Because these tags, bracelets and necklaces give technicians and paramedics more medical information in the treatment of the patient, it’s simply a matter of course to look for them, said Captain Mark Kirchgesler of Rapid City Fire Department Education and Information Division.

Kirchgesler has noted that automated external defibrillators are becoming more common in area businesses, city and county buildings, schools, organizations and even at airports.

“We highly recommend any business or organization that has one on site get proper training in the use of these defibrillators,” he said, which includes checking for medical tags and bracelets.

Bareis became alarmed when he realized that churches within Rapid City were buying defibrillators as a matter of routine.

He worried that the person wielding the defibrillator paddles might not check for medical tags or bracelets that inform trained personnel to withhold extraordinary medical measures.

“I’m not knocking defibrillators, but people have an image of resuscitation as portrayed over TV and everybody comes out fine,” Bareis said. “They don’t.”

After 57 years practicing medicine and resuscitating his share of critically ill patients, it may all come down to economics, as well as what is humane and ethical. He added that out-of-hospital CPR is successful less than 5 percent of the time, but occasionally it is lifesaving. The quality of life that results after being revived may not be what’s best for the patient, Bareis said.

“I don’t want my family to be saddled with the cost of taking care of me,” he said. “I don’t want personnel to be utilized needlessly to take care for me for five years and 10 years. … Believe me, people live a long time in a demented state.”

It is one thing to leap to the aid of a young father suffering a heart attack at a high-school track meet or basketball game, but would it be the same for an elderly, terminally ill great-grandfather at church? he asked.

“There’s a big push on to get more defibrillators without any thought given to the social ramifications caused by these machines,” he said.

Contact Jomay Steen at 394-8418 or jomay.steen@rapidcityjournal.com.

Comfort One bracelet

A Comfort One bracelet costs $30 and which can be used for identification in place of a Comfort One form. Complete a Comfort One application with help from your medical professional. Write a check payable to South Dakota Emergency Medical Services. Mail the completed form and check to Office of Emergency Medical Services, 118 W. Capitol, Pierre, SD 57501-2000 or go to www.state.sd.us/ dps/EMS/EMT_Information/dnr_form_request.htm.