# CPR and Moving Patients



## Asmo (Aug 30, 2007)

Sorry for the rookie question.. How long can you stop CPR for moving a PT? I know that while moving a PT that requires CPR, you alternate stops with your partner to continue CPR off and on until the PT is loaded. Just wondering how long you can stop CPR for a moving PT.

Any help would be wonderful, thank you.:unsure:


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## PArescueEMT (Aug 30, 2007)

not really a stupid question imho... if you have enough people on scene, once the patient is on the bed, someone can ride the stretcher and you would have <1min anoxic time after CPR is started to transport started. Most agencies do a multiple unit response for a code so that you can have the manpower to run it.


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## Asmo (Aug 30, 2007)

So basically you have <1 min to stop CPR, load the patient, and continue CPR? Sorry, just started my EMT-B course and the question is asking me to "Recall your CPR Class" and my CPR instructor said nothing about stopping CPR to move a patient.


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## PArescueEMT (Aug 30, 2007)

it's not you have less than one minute, it's you can minimize it to less than one minute... all you need to do is call for the appropriate manpower


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## Asmo (Aug 30, 2007)

Ok I get it now.

I greatly appreciate your help.
Thank you.


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## PArescueEMT (Aug 30, 2007)

your first code will not go as smooth as you would like, but you will get the hang of it as you progress.


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## Markhk (Aug 30, 2007)

What is your agency's policy on doing CPR while the cot is in motion? (I.e. ambulance bay to the ER). 

I have seen three variants:
1) Have someone light actually get into the cot, straddle the patient, and do CPR. Many agencies frown on this for safety reasons. 

2) Lower the cot to the lowest position and do CPR from the side. 

3) Have someone step, with both feet onto the bottom frame at the cot's side, so they can do CPR, while the cot gets pushed by two other people.


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## ffemt8978 (Aug 30, 2007)

PArescueEMT said:


> your first code will not go as smooth as you would like, but you will get the hang of it as you progress.



Now that's an understatement  .  

All codes seem to have some fustercluck factor involved, but as you gain experience, you do start to get the hang of them.


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## MedikErik (Aug 30, 2007)

I know this isn't "regulation", but if you're short staffed and the second due unit is a while off and you need to do a 2 person move (god-forbid), each of you take one side of the stretcher and move it that way, while one of you does one-hand compressions and the other does one handed bagging while keeping the other hand to move the stretcher. Not ideal, but we had an arrest outdoor in absolute pouring rain in the middle of the road, so we were trying to get into the ambulance and out of the road as quickly as possible.


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## KEVD18 (Aug 31, 2007)

i think that the real spirit of this question may have been more towards the cardiac arrest in a situation where a stair chair or long board would be needed. if that the case, here is my input:

THEY'RE SCREWED. if your in arrest and i have to carry you down the stairs to get out of the house, you pissed someone up there off. so before loading you on the chair, we'll get thing going. iv, ett, monitor(listed in no particular order) and if appropriate, we'll start giving drugs. you'll get two, maybe three rounds before we move. then its onto the prefered extrication device for the unresponsive pt. now if you have several flights of stairs with landings in between, by all means we'll stop and do some stuff at the landings but if its a straight shot or otherwise prohibits stopping, your not getting compressed ventliated or medicated from the top to the bottom. depending on the stairs, how well they know you at mcdonalds and at what point in my shift it is(i do get tired and move slower as the day goes on) this might take a few minutes.


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## Tincanfireman (Aug 31, 2007)

KEVD18 said:


> THEY'RE SCREWED.


 
Yeah, that pretty much sums it up from my perspective, too...


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## Ridryder911 (Aug 31, 2007)

Tincanfireman said:


> Yeah, that pretty much sums it up from my perspective, too...


... my basic opinion is that there more than screwed, their dead. Sorry, with only about < 10% + outcomes, very few if any ever survive and less than that are functional. 

Technically, you are only supposed to stop CPR for <10 seconds... okay, do not be surprised CPR stopped for undetermined amount of time. This is one of the few areas, that is definitely different from the clinical aspect and text book interpertation. 

R/r 911


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## Grady_emt (Sep 1, 2007)

You are over 18, you started in Asystole, stayed there after two rounds and a tube, congrats, you are now a candidate to futher the education of medical students, ill let the M.E. handle moving you when he gets to it.


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## sdadam (Sep 1, 2007)

Rid got it, per AHA CPR should only be stopped for 5 to 10 seconds. If this is a test question that's most likely the answer they are looking for. 

either that or that you should "minimize hands off time" depends what the options on the test are.


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## MedikErik (Sep 1, 2007)

If i had it my way, anyone in excess of 500 pounds overweight who's more than 1 flight of stairs up is considered to have an injury incompatible with life. Don't think the AHA would go for that, though...


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## Gbro (Sep 2, 2007)

I would like to comment on;


> THEY'RE SCREWED. if your in arrest and i have to carry you down the stairs to get out of the house



I went through a stage where i thought i could determine if the Pt. had a chance or not, and its a trap you don't want to fall into. After being lacsadasy on one code, pt. was revived at the hospital. 
8 miles to scene + 2-4 min to get wheels moving, 21 miles to hospital.
No intercept in those days.
I give them all 150% if not more. 
The longest breaks i have ever seen in CPR is on the intercept. Intubating.
I like to update the intercept unit prior to intercept on the need for an ET tube, as we use combi tubes and sometimes they are great and other times they are very hard to manage.
I had an ER Doc that didn't know what a PTL(Pharyngeo-tracheal Lumen) was and tugged it out and through it over his shoulder saying it obvious that thing is no good. That pt. went to ICU but never made it home. 
I do prefer Combo's to Patel's.

Give it your best, treat every Pt. like they are your family. You WILL sleep better.



> Sorry, with only about < 10% + outcomes, very few if any ever survive and less than that are functional.


You are right, only we work in that <10% survival rate area for the most part in the rural arena.


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## KEVD18 (Sep 2, 2007)

yes i approach every call witht he intent to save the pt, but it doesnt always happen. injuries inconsistent with life, comorbidities etc. one of the things generally inconsistent with life is a cardiac arrest involving a heavy pt and stairs. maybe you might win that one, but then again santa might bring you that wii this year. that doesnt mean im not going to work it but it does mean they're not going to get excellent care. its not physically possible. you can do compressions on a pt in a stair chair going down stairs. so you will have excessive hands off time. excessive hands off time has been proven to have a negative outcome.


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## Airwaygoddess (Sep 2, 2007)

I agree with Gbro, one must do their job with the and treat that patient as we ourselves or our loved ones would want to be treated.  I do not believe in "beating a dead horse" as far as Code Blues go.  If we are there to do the job do it for all it is worth.  My point here is that we have MANY young and new EMT's that need to guided and taught not to get tunnel vision and become jaded even before they get their first job.  It is the tunnel vision that causes important things to be missed.....-_-


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## SC Bird (Sep 2, 2007)

I asked one of my instructors about this exact situation, and this was his view on it.

There are multiple problems with moving a patient and still providing CPR.  
Problem #1: Compressions given from the side of the stretcher while the provider is walking alongside are rarely "good compressions".

Problem #2: The center of gravity of the stretcher can be compromised by a decent sized provider who is stradling the patient giving compressions while being transported into the ER, out of the house, etc.


I share the same P.O.V. as Rid....unfortunately, there chances are greatly decreased.

-Matt


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## MedikErik (Sep 2, 2007)

They may not be effective compressions, but it beats no compressions at all. *shrug*.


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## Emtgirl21 (Sep 2, 2007)

one word here boys and girls "autopulse"  God bless then man that invented that thing...i could give him hugs and kisses.


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## SC Bird (Sep 3, 2007)

Is that the "geezer squeezer" I've heard so much about??

-Matt


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## Ridryder911 (Sep 3, 2007)

Let's get real... Someone HAS to make the determination if their going to get a chance or not. If they are in aystole (reason to do CPR) I give two rounds of med.'s with GOOD CPR for about 10 minutes... then that's it. This is a national recognized standard of care for progressive EMS and Emergency Department procedures. Aystole patients have poor to dismal outcomes (if you consider living on a vent .. living) 

It is NOT just in the rural area codes have a < 10% chance; rather that is a National Average... scary part, hospital codes has a lower percentage. 
Codes are futile, and as medicine finally progresses and realize that it is such, we will see more and more field termination.

R/r 911


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## MedikErik (Sep 3, 2007)

I beg to differ, kind sir. I've seen people who were prime candidates to be brought back die, and those who were down for a while and "beyond hope" brought back. Only "The Man Upstairs" can determine who lives and dies, not us. Until someone who outranks me orders me to, I'm giving 110%.


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## BossyCow (Sep 4, 2007)

MedikErik said:


> If i had it my way, anyone in excess of 500 pounds overweight who's more than 1 flight of stairs up is considered to have an injury incompatible with life. Don't think the AHA would go for that, though...



We are covered on that one by the "our safety first" rule.  We are never, ever to jeopardize our own safety to administer care to a pt.  Jumping on a moving stretcher to give chest compressions is in my humble opinion, jeopardizing my personal safety.  Trying to wedge myself through a doorway while giving probably ineffective chest compressions, is equally inappropriate. 

I will do CPR as well as I can, as effectively as I can as long as to do so doesn't compromise my safety or the safety of those around me.  Gotta remember, who's emergency is it?  

I don't believe Rid is minimizing the responsiblity to do all we can to help our pts.  I think its more of an evaluation of risk vs. gain.


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## Ridryder911 (Sep 4, 2007)

I am basing my outlook on current standards as stated by the Emergency Cardiac Care, and the American Heart Association for Advanced Cardiac Life Support. Physicians and research has demonstrated, cardiac arrests (especially those in aystole) are usually futile. 

This has been known and demonstrated by research and clinical experience for years. If the patient does not respond by the second round of ACLS medications and agressive CPR, they will not. Why continue?  This will be introduced more into the new standards as they come out. 

There are several other special "situations" I do not go in heroic as well. Nursing home cardiac arrest (those that have outstanding medical history), as well as traumatic arrest are immediately called, and of those that are morbidity obesed. I do not have enough medications, as well as voltage to correct the problems. I agree, safety is included in my rational as well. 

I am not acting solo on my decision, rather this is endoresed by my Medical Director. There are several studies and papers, suggesting the same from the Emergency Medical Services Physician/Directors Asssociation, _Heart and Lung, Critical Care Quarterly_, etc. One should introduce review and possibly introduce change to current standards to their medical director for possible protocol changes.  Continuing to work predicatable cardiac arrest to the point of "no return" has possible problems, from unethical to needless costs and dangers to all. 

R/r 911


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## PArescueEMT (Sep 5, 2007)

I have to add my thoughts again... out here, we have to work EVERYTHING including obvious death (i.e. decapitation) Granted there are the calls that we know that there is no point, but you have to work them. When i go into a call, I look for the tell tale signs: Rigor, Dependant lividity, etc. 99% of the codes i have been on out here have been called pre-hospital. I can think of only one that we "saved" and he coded in the truck.

So if you know what you are looking for, that's when I say that it's okay to call it.


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## BossyCow (Sep 5, 2007)

PArescueEMT said:


> I have to add my thoughts again... out here, we have to work EVERYTHING including obvious death (i.e. decapitation) /QUOTE]
> 
> Okay, I admit I can be a bit odd at times, but my first thought here is... how do you check the airway on a decapitation?


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## Meursault (Sep 5, 2007)

That just makes it easier: no tongue to get in the way, no worries about holding c-spine... 

Even MA recognizes that working a code on anyone in multiple pieces is futile. Our standard is massive crush, decapitation, injuries like that, and, I think, a call to medical control. Medics get a bit more leeway.


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## rgnoon (Sep 5, 2007)

PArescueEMT said:


> I have to add my thoughts again... out here, we have to work EVERYTHING including obvious death (i.e. decapitation) Granted there are the calls that we know that there is no point, but you have to work them. When i go into a call, I look for the tell tale signs: Rigor, Dependant lividity, etc. 99% of the codes i have been on out here have been called pre-hospital. I can think of only one that we "saved" and he coded in the truck.
> 
> So if you know what you are looking for, that's when I say that it's okay to call it.



As per local protocols I assume?
We don't have to work a code with definitive signs of death  ;obvious mortal damage(including decapitation), dependent lividity, rigor mortis, and putrefaction. And that is per state sop.


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## PArescueEMT (Sep 5, 2007)

that would be county level B.S. but since i work on a PA card, i cheat and use PA protocol.


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## MedikErik (Sep 5, 2007)

Maryland is quite similar.

Decapitation
Pulseless, apneic pt. with an injury incompatible with life (exception made for preg. females).
Rigor Mortis.
Dependent Lividity.
Decomposition.
Full-code in a MCI.


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## Gbro (Sep 6, 2007)

Rid, said, and said, and says, and says,..........



> I am not acting solo on my decision, rather this is endoresed by my Medical Director. There are several studies and papers, suggesting the same



When i use paper to determine when to start and when to stop, in place of my "GUT"
Than its time to bail.

I see on occasion someone who is walking around, still employed that was way outside any studies. I wasn't on that call, But we had an old EMT(kind of like where i am now(just in age, mind you)).
2 new ladies, just out of EMT basic, 1st Code for both. 32 (+/-)5years as its been a long time ago,
Pt went down unwitnessed in parking lot of store he managed(stress). 20 min. out of ER and no defibs anywhere in the field then. 
CPR and when the crew left the ER pt was going up the elevator to ICU. 3-4 days in a coma, Pt. is in his >50's and still employed, doing great.

Now here is the kicker, The fossil(i can say that now) was the driver and these young ladies were using the new standard where one would pause to ventilate, He made this statement. " Those gals sure have a lot to learn about CPR"!, He was a CPR/EMT Instructor for many years prior!, But i think he thought more about what was in print, ,,,,,
my .02


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## BossyCow (Sep 6, 2007)

There will always be the guy who's number isn't up yet.  These are the exceptions.  To attempt to write protocols based on that one in a thousand, odd case is not appropriate.  I also feel to set up the expectation on every call that this call could be that one in a thousand is a path to EMS burnout.  But I tend towards a more pragmatic view.  I don't see death as an enemy to fight.  Death is the completion of a life.  None of us get out of here alive.


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## Airwaygoddess (Sep 6, 2007)

It's true what BosseyCow said, everyone will have their time and place.......


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