Social Media Commenters Don't Get It. Again.

I came across this article on one of my social media feeds: Link. In short, a FDNY ALS crew found a guy with a history of the bad variety of ALS who was in cardiac arrest. The guy's wife said the patient had a DNR, but she couldn't find it. So the FDNY guys pronounced the patient. Then filled out a patient care report describing heroic efforts to resuscitate the patient, even though said heroic efforts didn't happen. An acting district attorney is charging them with felonies.

The comments on the EMS social feed totally and completely miss the point.  For example...

"Should have just called command and let the Dr tell what to do"

"No paper...tough shit, we are starting [resuscitation]"

"Policy is in place for a reason..."

"...Medical control is there for a reason"

"Much debate over nothing. No gray area exists, no confusion should occur whatsoever. No paperwork, you work the patient..."

Wow. I shouldn't get so fired up about strangers' comments in social media. That is especially true when I am missing big parts of the story - down time, call progression, cardiac rhythm, etc. But I do habitually get all fired up, so here we go. I have four main points.

1. If your protocols demand actual DNR paperwork to be placed in your hand, your protocols are unreasonable, irresponsible, and stupid. Stupid protocols should be ignored (or at least worked around). A wise man once told me: Do what you would be proud to defend. This guy from the article had end-stage ALS and his wife stated he had DNR paperwork somewhere. Pronounce that patient! Termination of efforts and a field pronouncement makes sense based on this patient's history and clinical situation. I would be proud to defend a field pronouncement in this case. The medical principle of informed patient autonomy is not ended by the patient's inability to stash paperwork where we can find it under stress. 

1a. Oh, and I don't need a physician or supervisor to tell me the right thing to do - I am a professional paramedic.

2. Documenting care in a patient care report that didn't occur is where these medics went wrong. This is especially true when making up an entire friggin' course of patient care! It makes me question the culture and leadership of FDNY's EMS Division that the medics felt the need to invent an entire friggin' course of patient care in order to be able to do the right thing. (And four years in prison completely seems like overkill.)

3. Staten Island's newspaper is weird. I'd be bent if they published my address. How does that contribute to the story? Do other newspapers do this?
4. Who knows what actually happened in this case? It is rare for a reporter (in any media) to accurately describe a situation. Every newsworthy story I have been involved in has been at least partially misreported. I wouldn't be surprised if this article is filled with misinformation. So the above points assume that the article is accurate.

What do you think? If you can explain why the actual physical paperwork needs to be placed in your hand, please do so. Nobody has ever explained why requiring the paper to hit your hand is a sensible precondition for termination of care. I am quite serious that I don't understand it. But, judging by the comments, there are many EMS providers who think that the opposite is reasonable and necessary. Please explain it to me so we can have a conversation.