# The definition of "Field Save."



## chico.medic (Mar 9, 2007)

So my intern and I got into a lengthy discussion on what actually qualifies as a field save.  I tend to believe that any pt. in cardiopulmonary arrest that regains a pulse and lives to be discharged from the hospital with little, or no neuro deficits qualifies as a "field save."  

My intern seems to think that the pt who regained a pulse in the field, and lived long enough for the hospital to bill out for an ICU bed, then later die, never having regained consciousness or coming off of the vent was indeed a field save.

I just wanted to see what other people thought "qualifies."


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## firecoins (Mar 9, 2007)

The latter would be an improvement in my results.  If I do that I must be doing something right.  Obviously I want the previous to be the save though.


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## Epi-do (Mar 9, 2007)

I agree with you on this one.  A save is someone who regains pulses and is eventually discharged from the hospital with minimal deficits.  I don't consider being a vegetable in a bed at an ECF as any sort of positive quality of life, therefore it isn't a save in my book.


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## Chimpie (Mar 9, 2007)

Epi-do said:


> I agree with you on this one. A save is someone who regains pulses and is eventually discharged from the hospital with minimal deficits. I don't consider being a vegetable in a bed at an ECF as any sort of positive quality of life, therefore it isn't a save in my book.


Yep, what he said.


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## Ridryder911 (Mar 9, 2007)

One that is a discharged that is able to maintain a functioning life style without complications. 

The other is just responded to resuscitation efforts. ....

R/r 911


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## Airwaygoddess (Mar 9, 2007)

Yep! what Chimpie agreeded with and I say dittio!


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## chico.medic (Mar 10, 2007)

Thank you all, looks like I win, but I'm interested to hearing arguments for the other side, flawed as they may be.


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## Ridryder911 (Mar 10, 2007)

The other side .. statistical numbers on having a percentage of alive versus those that died.... Definition is narrow when documenting those that are alive and those that are dead. Quantity versus qualitative is not mentioned in M & M studies, as well for billing purposes for revenue.  

Clincal defintions are more narrow than emperic feelings most people have. 

R/r 911


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## Nycxice13 (Mar 10, 2007)

The save I had was an 80 year old woman, who fell out of her bed during the course of the night, regained a pulse after 3 minutes of CPR, lived for 2 days in the hospital and died.

I don't care what you say, that is a save.


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## Ridryder911 (Mar 10, 2007)

She alive.. no ? Then it is not a save. Getting a pulse back is only part of it.. that is a successful resuscitation, not a save. There is a difference. I have thousands of sucessful resuscitations, but very few saves. 

R/r 911


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## Nycxice13 (Mar 10, 2007)

Ridryder911 said:


> She alive.. no ? Then it is not a save. Getting a pulse back is only part of it.. that is a successful resuscitation, not a save. There is a difference. I have thousands of sucessful resuscitations, but very few saves.
> 
> R/r 911



Without a pulse is anyone alive? The point is, by resuscitating that woman, I gave her a chance to live on, a chance she otherwise would not have had. Granted, she died two days later.


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## MMiz (Mar 10, 2007)

Ridryder911 said:


> One that is a discharged that is able to maintain a functioning life style without complications.
> 
> The other is just responded to resuscitation efforts. ....
> 
> R/r 911


This seems to be the consensus around here.


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## Tincanfireman (Mar 10, 2007)

I'm with the consensus; if she was a livin', laughin', talkin' person, capable of independent movement and cognizant thought before she arrested, then what you did was little more than extend a doomed life by 48 hours. *BUT*, you had no way of knowing the outcome when you resusitated her, and to that goal I congratulate you. To do less would be on the borderline of trying to play God, and I believe that's outside my scope of practice in this state . Seriously, you did what you could and I believe trying to categorize it between "save" and "non-save" would be splitting hairs. You gave her family a chance to say goodbye to her, and that's probably more important than anything else.


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## Nycxice13 (Mar 11, 2007)

Tincanfireman said:


> I believe trying to categorize it between "save" and "non-save" would be splitting hairs..



Perfect answer.
Not everything is black and white!


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## HorseHauler (Mar 11, 2007)

Ridryder911 said:


> She alive.. no ? Then it is not a save. Getting a pulse back is only part of it.. that is a successful resuscitation, not a save. There is a difference. I have thousands of sucessful resuscitations, but very few saves.
> 
> R/r 911



So whats the difference between this person living two days or another 2 years? You can't help that. My save is bringing a perfusing patient in the ER. From there you can't help what the nurses and doctors do.


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## Ridryder911 (Mar 11, 2007)

The difference is the patient being discharged. Just because you were able to get a pulse back is nothing. I have resucitated many patient's that regained a pulse back and later died 5 minutes after arrival to the ER... Was that a save ? No!

Again, saves according to most data are categorized either as sucessful resucitation or those are able to have ADL's without complications. Those that are able to have functioning without any major neuro complications. 


That is why it is resuscitation is still considered effective only 20% of the time in hospitals and slight more 32% out of hospitals. 

Personally, it is not hard to revive a heart, the problem is the post arrest syndrome. Lack of or poor circulation, not just coronary but cerebral as well. What good is a resuscitation if they are brain dead ? ... A piece of meat with a heart beat...That is why AHA and many EMS are suggesting field DNR and no resuscitation efforts on many criteria now. The outcomes are very poor to say the least. 

Quality of life is now being questioned, in regards to resuscitation efforts. 

R/r 911


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## Nycxice13 (Mar 11, 2007)

Seriously, as an EMT, how in the heck am I to know how long that person will live? Its a save to me, any form of reviving a patient is a save, and thats all. What happens after I get them to the hospital is between them, god and the doctors.


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## Ridryder911 (Mar 11, 2007)

You don't, that is why obtaining an accurate history of "downtime" and PMHX is becoming more and more important as more and more EMS employs either not starting resuscitation efforts or performing field termination. 

Personally, we perform two rounds of ACLS then call it. If the patient does not respond to at least two rounds of epi, atropine.. etc.. then the patient will not respond to pharmacological treatment and resuscitation efforts are futile. 

You may see more and more protocols changing as the national standard and trends are going towards this. An emphasis on an accurate history to evaluate if resuscitation should even be performed, as well checking for viability of responding to emergency resuscitation efforts. 

According to 2005 ACLS text.._"there is not documented medication, that has demonstrated and increase in survivability"... _

It is estimated only one in three thousand ever responds to resuscitation efforts and less respond effective to be able to function. 

R/r 911


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## MMiz (Mar 11, 2007)

That said, my grandfather was saved with a full recovery after having an MCI.  CPR, early defibrillator, the whole nine yards.  It's rare, but *absolutely does* happen.


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## Stevo (Mar 14, 2007)

well i think it's high time they gave ems the holy water.  the thing about some of our current polices is there's no wiggle room


for instance, don't stop cpr if started...


we've had a number of calls where family or coworkers have started cpr on a man down long enough to gain lividity


can you say patty-cake cpr ? 


and inasmuch as there are codes well worth rolling on, i gotta say that i've been part of sooo many where i know they're stone cold dead and gone , and we just deliver a nice pink oxygenated dopped up corpse...

that's at an expense too....

~S~


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## chico.medic (Mar 14, 2007)

Stevo said:


> the thing about some of our current polices is there's no wiggle room         for instance, don't stop cpr if started...
> 
> we've had a number of calls where family or coworkers have started cpr on a man down long enough to gain lividity
> 
> ~S~



Are you saying your local policies don't allow you to determine death in the field?  I don't care if family starts cpr, but if their loved one has rigors, or levidity, it's DOA.

Here's our LEMSA's policy for it:

http://www.norcalems.org/pnp-manual..._Care_Policies/301_Determination_of_Death.doc


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## Jon (Mar 15, 2007)

Nycxice13 said:


> Without a pulse is anyone alive? The point is, by resuscitating that woman, I gave her a chance to live on, a chance she otherwise would not have had. Granted, she died two days later.


I think the question is, what was her "Quality of life" in the hospital? Was she CAOx4 in ICU, and then just died from something else, or did she spend 2 days gorped out in the ICU on a vent and a feeding tube before the family could bring themselves to pull the plug?

One could be a save. The other is a "successful resusitation."

I've gotten pulses back a few times... all my pt's die well before hospital discharge, so I've not had a save yet.


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