When my father was going down that last mile at age 86 his doctor warned me not to call 911 if Dad goes down again. The doctor told me that the paramedics would break the bones in his chest and Dad would die in pain.
Properly done CPR breaks the bones most of the time. The rib cage is there to keep things from messing with the heart, the goal of CPR is to mess with the heart. If your bones are really really healthy and pliable they might not break, they’ll still hurt like hell though.
“The doctor told me that the paramedics would break the bones in his chest and Dad would die in pain.”
That’s what I’ve read by doctors who declined to initiate a DNR. However, I wonder about how many paramedics respect a DNR during the process of life saving. Probably zero to none.
CPR is given to those who have no pulse, not breathing. If you have no pulse and not breathing then you are basically dead. Dead people basically do not feel pain.
As it turns out, in order to survive VF, VT, you need high quality CPR immediately and defibrillation very soon after. Even then chances of survival are small but still there is a chance. You have 4 minutes after arrest before permanent brain damage.
Patients that are asystole have no shockable rhythm, hence an AED will not advise a shock but to continue compressions. Where it is pointless and in my opinion abuse of a corpse is when either there are conditions inconsistent with life or if the patient has been involved in a unwitnessed arrest.
If EMS gets involved, they by protocol, have to do compressions if the family asks or if someone has already started CPR before they get on scene. In order to discontinue medics in the field need permission from the medical command doctor at a receiving hospital or if again there are conditions inconsistent with life. But in that case they still must report to medical command and depending on the situation ask the 911 dispatching authority to dispatch the coroner.
It just so happens that I responded to (an EMS Assist) as a firefighter last weekend, the family wanted us to do CPR, the patient was in rigor which is a sign inconsistent with life, so no CPR. Still, stress galore.
I have had the opportunity to perform CPR roughly a dozen times on patients that could benefit from it. (I’m a volley Firefighter/EMT). I have had patients twice return to a viable rhythm, one was a drowning the patient that lived for 2 weeks but was in a coma, the other (lightning strike) lasted 12 hours. We did compressions for about 2 hours on that one, at the scene, in the truck and in the ER. Still in both cases the family was able to say goodbye.
Having said all that it is up to the individual and/or family regarding a DNR. If I had a week to live then I don’t want to put anyone trough the stress of having to do CPR. It is, even for healthcare workers, very stressful. CPR BTW, performed on a human being is not the same as CPR on a practice dummy.
I am an EMT, not a paramedic, which is a higher certification. My best guess is that CPR does not hurt because the patient is technically dead when you do it - no heartbeat. Maybe the brain cells linger on some; supposedly hearing is the last sense to go, and I worry more about the casual conversations the patient might hear, as if he doesn’t matter, rather than any pain.
Paramedics (and EMTS, doctors, nurses) are not eager to do CPR on the old old or terminally ill. If the patient fits those categories I always ask, is there a DNR? I remember one elderly woman who had metastasized pancreatic cancer and was on hospice care but there was no DNR because the family didn’t want one. So the cop and I hauled her off the bed to the floor, bared her chest in front of her teenaged grandson, broke her ribs, brought up stomach contents, and I kept thinking, at least she’s gone already. If it was my mother, I would have held her, and told her I loved her.
So far my only CPR save, as in the patient came home from the hospital (return of pulse is common, return home much less so) was when I saved a resident of a group home from CPR. He was conscious when I got there, so I told the staff they could stop compressions...oy.