# Stairs + Cardiac Arrest



## cointosser13 (Oct 18, 2013)

It seems like every time the EMS have a call for a cardiac arrest, it's a patient who's 300 pounds and is on the second floor. Having to carry all your equipment to the second floor just makes the call that much more "fun". Anyway, I've been thinking about how EMS crews could use the stairs as something of use when we have a cardiac arrest patient. So my thinking has been some what of a crazy idea... but I really want everybody's opinion. Not sure if it's realistic. I'm only a EMT-B. Maybe somebody has already thought of this. I don't know. Here's my idea:

Most stairs go up at about a 33 degree incline. That being said, if we do have a patient on the second floor, after doing CPR and artificial ventilations, we have to carry him down the stairs. Instead of carry the patient feet first, shouldn't we carry the patient head first? If the patient is angled down, isn't some of the blood going to be carried to the head, where the blood is especially needed? The brain needs oxygen or it becomes more damaged, right? It's like a kid hanging on a bar, and his head starts to become more red because some of the blood is being brought to his head. I know our goal as ems providers is to put the patient in the ambulance as fast as we can, but sometimes carrying a 300 pound patient down the stairs can take a while. While we're "struggling" to bring the patient down the stairs, wouldn't some of the blood go to the patient's brain? Of course we would have to have somebody still artificially ventilate the patient because that's the only way the patient would oxygen. The oxygenated blood would travel to his brain. The thing that I don't know, does the 33 degree decline not even help, does it matter?


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## Tigger (Oct 18, 2013)

Here's an easier solution...don't carry patients undergoing CPR down the stairs. We know that CPR when moving in an ambulance isn't effective, why so we insist on doing it while walking too?

I'm am not suggesting every arrest worked on scene without ROSC should be called as there are outliers. However by and large as a whole EMS continues to transport far too many arrests than we should.


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## Mariemt (Oct 18, 2013)

We have paramedics on call that will go to the scene on cardiac arrest.  However when we do have to transport during a code by some chance, we are lucky enough to have an auto pulse which will continue all compressions for us as we move the patient as they are on the Zoll and the mega mover


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## Medic Tim (Oct 18, 2013)

Tigger said:


> Here's an easier solution...don't carry patients undergoing CPR down the stairs. We know that CPR when moving in an ambulance isn't effective, why so we insist on doing it while walking too?
> 
> I'm am not suggesting every arrest worked on scene without ROSC should be called as there are outliers. However by and large as a whole EMS continues to transport far too many arrests than we should.



This^^^


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## FiremanMike (Oct 18, 2013)

Autopulse + megamover = problem solved.


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## NomadicMedic (Oct 18, 2013)

FiremanMike said:


> Autopulse + megamover = problem solved.



 Or, work them where they are until ROSC. Then move them. If no ROSC, it's the funeral homes problem


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## medicdan (Oct 18, 2013)

cointosser13 said:


> It seems like every time the EMS have a call for a cardiac arrest, it's a patient who's 300 pounds and is on the second floor. Having to carry all your equipment to the second floor just makes the call that much more "fun". Anyway, I've been thinking about how EMS crews could use the stairs as something of use when we have a cardiac arrest patient. So my thinking has been some what of a crazy idea... but I really want everybody's opinion. Not sure if it's realistic. I'm only a EMT-B. Maybe somebody has already thought of this. I don't know. Here's my idea:
> 
> Most stairs go up at about a 33 degree incline. That being said, if we do have a patient on the second floor, after doing CPR and artificial ventilations, we have to carry him down the stairs. Instead of carry the patient feet first, shouldn't we carry the patient head first? If the patient is angled down, isn't some of the blood going to be carried to the head, where the blood is especially needed? The brain needs oxygen or it becomes more damaged, right? It's like a kid hanging on a bar, and his head starts to become more red because some of the blood is being brought to his head. I know our goal as ems providers is to put the patient in the ambulance as fast as we can, but sometimes carrying a 300 pound patient down the stairs can take a while. While we're "struggling" to bring the patient down the stairs, wouldn't some of the blood go to the patient's brain? Of course we would have to have somebody still artificially ventilate the patient because that's the only way the patient would oxygen. The oxygenated blood would travel to his brain. The thing that I don't know, does the 33 degree decline not even help, does it matter?



If you're interested in more information about why we are advocating staying in place, do a search for some articles on CCR, Cardiocerebral resuscitation. The systems doing it are staying in place for at least 8-10 minutes with constant CPR, an OPA, NRB, and in some cases, an IO with epinephrine at regular intervals.


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## DesertMedic66 (Oct 18, 2013)

DEmedic said:


> Or, work them where they are until ROSC. Then move them. If no ROSC, it's the funeral homes problem



What if you are unable to get ROSC but they are still in a shockable rhythm? My last full arrest stayed V-Fib despite meds and shocks.


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## Anjel (Oct 18, 2013)

DesertEMT66 said:


> What if you are unable to get ROSC but they are still in a shockable rhythm? My last full arrest stayed V-Fib despite meds and shocks.



My thoughts as well. We can only terminate efforts in asystole.


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## DesertMedic66 (Oct 18, 2013)

Anjel said:


> My thoughts as well. We can only terminate efforts in asystole.



That's always one of my questions when I hear "we either call them on scene or transport if we get ROSC". I don't know of very many services that allow calling a patient who is in V-fib/V-Tach.


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## chaz90 (Oct 18, 2013)

DesertEMT66 said:


> That's always one of my questions when I hear "we either call them on scene or transport if we get ROSC". I don't know of very many services that allow calling a patient who is in V-fib/V-Tach.



With a medical control consult, I could absolutely see situations in which it would be appropriate to pronounce a patient in refractory V-Fib. No response to many shocks, Epi, amiodarone, and CPR for a prolonged period of time with a long transport ahead? Again, situation dependent, but there is a place for it. I can't see pronouncing a patient in V Tach, but they don't stay in that for long. V Fib eventually deteriorates to asystole anyway. I know there are a few exceptions in the literature with crazy prolonged V Fib, but most codes worked on scene for ~20-30 minutes aren't going to stay in it.


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## billydunwood (Oct 18, 2013)

DesertEMT66 said:


> What if you are unable to get ROSC but they are still in a shockable rhythm? My last full arrest stayed V-Fib despite meds and shocks.


double sequential defibrillation for VFiB. If you can't get ROSC on scene, what can the ER do that paramedics can't?


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## DesertMedic66 (Oct 18, 2013)

billydunwood said:


> double sequential defibrillation for VFiB. If you can't get ROSC on scene, what can the ER do that paramedics can't?



Depends on your area and scope. Paramedics in my area are very limited


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## billydunwood (Oct 18, 2013)

DesertEMT66 said:


> Depends on your area and scope. Paramedics in my area are very limited



Well, a paramedic would probably have to get permission from Medical Control to do a double defribillation anyways. But in my opinion(and seems like many here) is that you shouldn't transport dead bodies and if there is no ROSC on scene in a reasonable amount of time, you cease activities.


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## DesertMedic66 (Oct 18, 2013)

Redacted.


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## epipusher (Oct 18, 2013)

Well said


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## unleashedfury (Oct 19, 2013)

DEmedic said:


> Or, work them where they are until ROSC. Then move them. If no ROSC, it's the funeral homes problem




This..

I am a huge advocate of field pronouncing patients.

the prognosis for Asystole is poor, and the chance of ROSC after 8 to 10 minutes is possible but the patient returning to normal life is slim to none. 

My chief insists we transport all cardiac arrests cause he insists that its all a "fudged effort" to allow hospitals to reduce the deaths in their facility. You can show him every case study that proves how ineffective CPR in a moving ambulance is, the chance of survival of prehospital arrest is poor. So why are we doing this?? Cause in his eyes its still 1990.


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## FiremanMike (Oct 19, 2013)

DEmedic said:


> Or, work them where they are until ROSC. Then move them. If no ROSC, it's the funeral homes problem



I guess I should have mentioned I don't generally lay hands on someone until I decide it seems like there's a shot, and I'm also ok with not transporting any calling a code 1.


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## chaz90 (Oct 19, 2013)

FiremanMike said:


> I guess I should have mentioned I don't generally lay hands on someone until I decide it seems like there's a shot, and I'm also ok with not transporting any calling a code 1.



How about the fact that those potentially viable cardiac arrests are the ones that deserve to be worked appropriately on scene? It drives me nuts when people tell me they agree with me that arrests should be worked on scene and not transported unless with ROSC, and with their next breath say "but I'm OK with scooping and running with a young witnessed arrest in a shockable rhythm who had immediate CPR." There's a fundamental misunderstanding here! We don't transport arrests for two reasons. 

A. Transporting dead bodies is an unnecessary risk and waste of resources.

B. When a patient is viable, their best chances for survival lie with quality care on scene of the arrest. 


When I respond to a cardiac arrest, one of my thoughts is hoping I get there before the BLS ambulance can load the patient and drive to intercept me rather than meet me on scene. That's the only problem I see with CPR assist devices right now. I love the LUCAS 2 my service uses, but some seem to see it as a free license to transport arrests now that we can do CPR during transport.


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## FiremanMike (Oct 19, 2013)

chaz90 said:


> How about the fact that those potentially viable cardiac arrests are the ones that deserve to be worked appropriately on scene? It drives me nuts when people tell me they agree with me that arrests should be worked on scene and not transported unless with ROSC, and with their next breath say "but I'm OK with scooping and running with a young witnessed arrest in a shockable rhythm who had immediate CPR." There's a fundamental misunderstanding here! We don't transport arrests for two reasons.
> 
> A. Transporting dead bodies is an unnecessary risk and waste of resources.
> 
> ...



I personally don't find that there can be universal answers to this particular question.  Each arrest is different and each has their own set of mitigating factors that will drive the decision making process as to whether transport will happen or not.  I will say (for those who have not experienced the joy of the autopulse) that compressions are productive and viable whether you're sitting in their bedroom, carrying them down stairs, rolling down the street, or heck, probably even upside down.


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## medicdan (Oct 19, 2013)

FiremanMike said:


> I personally don't find that there can be universal answers to this particular question.  Each arrest is different and each has their own set of mitigating factors that will drive the decision making process as to whether transport will happen or not.  I will say (for those who have not experienced the joy of the autopulse) that compressions are productive and viable whether you're sitting in their bedroom, carrying them down stairs, rolling down the street, or heck, probably even upside down.



The measure of the viability of an arrest is ETCO2 in the presence of good compressions. That is our universal answer, or universal measure of chance of ROSC, especially when you're 30 minutes into ACLS.


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## EMT B (Oct 19, 2013)

DesertEMT66 said:


> What if you are unable to get ROSC but they are still in a shockable rhythm? My last full arrest stayed V-Fib despite meds and shocks.



Every unstable rhythm will eventually deteriorate into asystole


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## mycrofft (Oct 19, 2013)

See posts recently about Trendelenberg.

Besides that, think physics. Lying flat, circulation is basically gravity-neutral. Tilt anything up or down, and the blood is harder to get into or out of that sector. 
Try lying with your head over the edge of the bed for long. Now think that the pump sending blood down into your head is working at 30% (or less) capacity. Blood needs to circulate, not just "go" someplace. 
And of course (go back to first sentence) and all physiologic effects side,  _*mechanically *_Trendelenberg and effective CPR are ineffective together, unless you have an effective automatic thumper which will wowk traveling down a staircase at 30 deg. inclunation.


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## Akulahawk (Oct 19, 2013)

mycrofft said:


> See posts recently about Trendelenberg.
> 
> Besides that, think physics. Lying flat, circulation is basically gravity-neutral. Tilt anything up or down, and the blood is harder to get into or out of that sector.
> Try lying with your head over the edge of the bed for long. Now think that the pump sending blood down into your head is working at 30% (or less) capacity. Blood needs to circulate, not just "go" someplace.
> And of course (go back to first sentence) and all physiologic effects side,  _*mechanically *_Trendelenberg and effective CPR are ineffective together, unless you have an effective automatic thumper which will wowk traveling down a staircase at 30 deg. inclunation.


If Trendelenburg positions were all that effective, wouldn't we then be rocking our patients thirty degrees head up and head down instead of doing CPR?? Hmmm, my patient is in full arrest... I wonder which playground has a teeter-totter...:wacko:


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## chaz90 (Oct 19, 2013)

EMT B said:


> Every rhythm will eventually deteriorate into asystole



Fixed it for you


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## phideux (Oct 19, 2013)

FiremanMike said:


> I personally don't find that there can be universal answers to this particular question.  Each arrest is different and each has their own set of mitigating factors that will drive the decision making process as to whether transport will happen or not.  I will say (for those who have not experienced the joy of the autopulse) that compressions are productive and viable whether you're sitting in their bedroom, carrying them down stairs, rolling down the street, or heck, probably even upside down.



I worked for a little over a year on an ambulance with an Autopulse, never got a chance to use it, all our arrests that whole time were too big for it.


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## Mariemt (Oct 19, 2013)

phideux said:


> I worked for a little over a year on an ambulance with an Autopulse, never got a chance to use it, all our arrests that whole time were too big for it.



Our service has one in each ambulance. I've seen it used a handful of times.
Once took a patient to am er where the doc had never seen one.  He was so impressed by the rhythm and quality of the compressions he bought one for his local ambulance team.


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## Carlos Danger (Oct 19, 2013)

billydunwood said:


> if you can't get rosc on scene, what can the er do that paramedics can't?



ecmo


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## billydunwood (Oct 19, 2013)

Halothane said:


> ecmo


True, but there has to be limited or no brain damage for it to be effective and not many hospitals/er's have that capability.


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## NomadicMedic (Oct 19, 2013)

Halothane said:


> ecmo



Ha. I needed a laugh today.


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## VFlutter (Oct 19, 2013)

billydunwood said:


> If you can't get ROSC on scene, what can the ER do that paramedics can't?



Transvenous pacing, thoracotomy / aortic cross clamp, rapid infusers with central lines, diagnostic imaging, Echo, pericardiocentesis, blood products, thrombolytics.

Not that any of those will improve surivival in most cases.


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## EMT B (Oct 19, 2013)

dont forget the good ole Intracardiac drugs!


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## billydunwood (Oct 19, 2013)

Chase said:


> Transvenous pacing, thoracotomy / aortic cross clamp, rapid infusers with central lines, diagnostic imaging, Echo, pericardiocentesis, blood products, thrombolytics.
> 
> Not that any of those will improve surivival in most cases.


Yes, that's what I meant. What can they do that will improve their survival(most cases)? Not much more.


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## Handsome Robb (Oct 20, 2013)

Halothane said:


> ecmo



Bro, paramedics could totally be trained to do cutdowns and start ecmo in the field, bro. 

:lol:


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## Carlos Danger (Oct 20, 2013)

DEmedic said:


> Ha. I needed a laugh today.



You do know that ECMO for primary cardiac arrest is being done in some centers, right?

There are only a few places right now that do emergent ECMO in the ED, but from what I understand the outcomes are excellent. I think we will see the practice spread to other tertiary hospitals before long, if the data that is being gathered continues to support the practice.


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## Carlos Danger (Oct 20, 2013)

Robb said:


> Bro, paramedics could totally be trained to do cutdowns and start ecmo in the field, bro.
> 
> :lol:



Man, don't give anyone any ideas.....


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## NomadicMedic (Oct 20, 2013)

Oh yeah, I understand it's a thing. I was more laughing at the idea of one of the hospitals HERE adding ECMO to the Charlie Foxtrot that accompanies anything other than a straightforward "ACLS style" resus. 

"Hey Bob, wanna give some vasopressin? And bicarb? Hell, howzabout some injectable kitchen sink?"

"Sure. Why not. Can't hurt, might help. And let's get that Ekk-Moe thing in here too..."

Yikes.


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## HMartinho (Oct 20, 2013)

DEmedic said:


> Or, work them where they are until ROSC. Then move them. If no ROSC, it's the funeral homes problem





chaz90 said:


> With a medical control consult, I could absolutely see situations in which it would be appropriate to pronounce a patient in refractory V-Fib. No response to many shocks, Epi, amiodarone, and CPR for a prolonged period of time with a long transport ahead? Again, situation dependent, but there is a place for it. I can't see pronouncing a patient in V Tach, but they don't stay in that for long. V Fib eventually deteriorates to asystole anyway. I know there are a few exceptions in the literature with crazy prolonged V Fib, but most codes worked on scene for ~20-30 minutes aren't going to stay in it.





unleashedfury said:


> This..
> 
> I am a huge advocate of field pronouncing patients.
> 
> ...





billydunwood said:


> double sequential defibrillation for VFiB. If you can't get ROSC on scene, what can the ER do that paramedics can't?





DEmedic said:


> Oh yeah, I understand it's a thing. I was more laughing at the idea of one of the hospitals HERE adding ECMO to the Charlie Foxtrot that accompanies anything other than a straightforward "ACLS style" resus.
> 
> "Hey Bob, wanna give some vasopressin? And bicarb? Hell, howzabout some injectable kitchen sink?"
> 
> ...



The video has 18 minutes, but it's worth it.
Everyone, especially young and healthy people, should have a chance.

http://www.youtube.com/watch?v=vDHUBu_Kl6k


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## chaz90 (Oct 20, 2013)

HMartinho said:


> The video has 18 minutes, but it's worth it.
> Everyone, especially young and healthy people, should have a chance.



Great story, but totally different scenario than what we're talking about. It's not like any of us are saying we would have worked the hypotensive semi-responsive syncope patient on scene and not transported her. Believe me, I'm not someone whining that we can do everything the hospital can do. I'm fully aware that there are plenty of potentially life saving interventions that are outside my knowledge, skill, and scope that can be performed in a hospital. I am saying that OHCA has a different set of rules than the witnessed arrest in an ED with a surgeon and ED doc available.

We do give every single person a chance. If we have a viable patient, we'll do whatever we can to provide appropriate care that gives the patient the best chance of survival. Transporting every single cardiac arrest in the mindless hope that the hospital is going to perform a miraculously life saving thoracotomy is anathema to that goal. Again, this is why feel good anecdotes don't create policy. It's great that this patient survived what would seem to be an almost invariably fatal event, but there's a reason this kind of thing makes it on TV.


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## mycrofft (Oct 20, 2013)

Akulahawk said:


> If Trendelenburg positions were all that effective, wouldn't we then be rocking our patients thirty degrees head up and head down instead of doing CPR?? Hmmm, my patient is in full arrest... I wonder which playground has a teeter-totter...:wacko:



Used to rock them on a barrel for drowning.


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## mycrofft (Oct 20, 2013)

billydunwood said:


> double sequential defibrillation for VFiB. If you can't get ROSC on scene, what can the ER do that paramedics can't?



Shirley you jest?


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## STXmedic (Oct 20, 2013)

A study our department just released and presented at the ACEP Convention:

http://www.ncbi.nlm.nih.gov/m/pubmed/22834854/

Of patients who were transported without ROSC: 0.69% survival rate for patients not in asystole; 0% survival rate for asystolic patients.


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## Akulahawk (Oct 20, 2013)

mycrofft said:


> Used to rock them on a barrel for drowning.


Yes, I know... Made for some interesting discussion in my Lifeguard class when we went over some Lifeguarding history, and that was some 20 years ago. :blink:


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## cointosser13 (Oct 24, 2013)

mycrofft said:


> See posts recently about Trendelenberg.
> 
> Besides that, think physics. Lying flat, circulation is basically gravity-neutral. Tilt anything up or down, and the blood is harder to get into or out of that sector.
> Try lying with your head over the edge of the bed for long. Now think that the pump sending blood down into your head is working at 30% (or less) capacity. Blood needs to circulate, not just "go" someplace.
> And of course (go back to first sentence) and all physiologic effects side,  _*mechanically *_Trendelenberg and effective CPR are ineffective together, unless you have an effective automatic thumper which will wowk traveling down a staircase at 30 deg. inclunation.



Well what if you did use an automatic thumper (we call it the LUCAS at our place), while going down the stairs. With the automatic thumper, and somebody doing artificial ventilations, would that factor in a better chance of ROSC if the patient is positioned 30 or so degrees down (head first) while going down the stair. Or factors like that are too small and just don't matter? Would anything change?


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## chaz90 (Oct 24, 2013)

cointosser13 said:


> Well what if you did use an automatic thumper (we call it the LUCAS at our place), while going down the stairs. With the automatic thumper, and somebody doing artificial ventilations, would that factor in a better chance of ROSC if the patient is positioned 30 or so degrees down (head first) while going down the stair. Or factors like that are too small and just don't matter? Would anything change?



Dude, we can guess all day long, but no one has done any kind of research on if carrying a patient head up or head down with automated CPR makes any difference in cerebral perfusion. All we can provide for you on this topic is a bunch of opinions. Again, the bigger deal here is avoiding doing any kind of chest compressions (automated or otherwise) while moving the patient down stairs. Picture the scenario you're laying out here. You mentioned a 300 lb patient; coming from an upper level; being carried down stairs with a LUCAS, and someone else is supposedly trying to provide ventilations as well? This is a bad looking situation that could be very easily avoided. Don't make things harder on yourself.


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## Tigger (Oct 24, 2013)

The point of Lucas devices isn't to make it easier to transport arrests, it's to reliably ensure high quality compressions. Even with mechanical arrests we still should not make a habit of transporting arrests unless certain circumstances are met.


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## NObama (Nov 17, 2013)

lol i love how the general consensus is, "eff it, do your best to call them," which I am completely on board with, I cant wait till our system starts making an aggressive stance against transporting full arrests, but did anyone answer the guys question?


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## NomadicMedic (Nov 17, 2013)

Yes. The question was answered, (transporting a patient head first, down stairs, while working a code is a bad idea) but more importantly, the rational behind most of us electing to terminate efforts and NOT transporting arrests was explained.


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## EpiEMS (Nov 17, 2013)

STXmedic said:


> A study our department just released and presented at the ACEP Convention:
> 
> http://www.ncbi.nlm.nih.gov/m/pubmed/22834854/
> 
> Of patients who were transported without ROSC: 0.69% survival rate for patients not in asystole; 0% survival rate for asystolic patients.



Thanks for posting this!

I wish more places would realize the futility (and added risk) of emergent transport without ROSC.


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## Tigger (Nov 17, 2013)

NObama said:


> lol i love how the general consensus is, "eff it, do your best to call them," which I am completely on board with, I cant wait till our system starts making an aggressive stance against transporting full arrests, but did anyone answer the guys question?



It's not really an "aggressive stance" to not transport every arrest when you look at the numbers that STX just posted.


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## CFal (Nov 18, 2013)

how about CPR in a moving toboggan?  our protocol is to have stops along the way to do a round of cpr and continue down


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## Tigger (Nov 18, 2013)

CFal said:


> how about CPR in a moving toboggan?  our protocol is to have stops along the way to do a round of cpr and continue down



Couldn't be all that effective I'd imagine. If I remember right you guys have ALS on the mountain, seems like it be worth working it on the hill and if you get ROSC then work on a careful transport down or possibly flying them, that's how some mountains out here operate.


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## Handsome Robb (Nov 18, 2013)

Tigger said:


> Couldn't be all that effective I'd imagine. If I remember right you guys have ALS on the mountain, seems like it be worth working it on the hill and if you get ROSC then work on a careful transport down or possibly flying them, that's how some mountains out here operate.



If it were me that's how I'd do it. Cause the helo isn't gonna take them and most of my ground counterparts, myself included, would be very opposed to transporting someone with CPR in progress from the hill considering its a curvy 45 minute ride to the closest ED.


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## Christopher (Nov 18, 2013)

NObama said:


> lol i love how the general consensus is, "eff it, do your best to call them," which I am completely on board with, I cant wait till our system starts making an aggressive stance against transporting full arrests, but did anyone answer the guys question?



You make it sound like staying on scene is somehow a flippant choice...

EMS owns out-of-hospital cardiac arrest. It is our responsibility to resuscitate patients in the field, not the hospital's. The reality of the situation is your patients arrest too far away from the ED, so we have to do it where we find them.

This is not an aggressive stance, well Ok maybe it was "aggressive" in 2005 or 2006...my EMT class in the very beginning of '07 stressed working patients where you found them.

As for answering the OP's question...when you have to start describing the logistics of moving someone anywhere during active resus the answer is obvious: don't freaking move them. _Move the resuscitation to the patient._

It is ridiculous that we even wonder about this anymore.


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## Rialaigh (Nov 18, 2013)

Christopher said:


> You make it sound like staying on scene is somehow a flippant choice...
> 
> EMS owns out-of-hospital cardiac arrest. It is our responsibility to resuscitate patients in the field, not the hospital's. The reality of the situation is your patients arrest too far away from the ED, so we have to do it where we find them.
> 
> ...



Down here just south of you we still have issues because several of the counties around here require online medical control to call a code once you have started working it. And there are several area doctors that want to pronounce everything themselves and refuse to call a code in the field regardless of transport time (once you have started working them). It's a old fashioned protocol issue down here


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## Christopher (Nov 18, 2013)

Rialaigh said:


> Down here just south of you we still have issues because several of the counties around here require online medical control to call a code once you have started working it. And there are several area doctors that want to pronounce everything themselves and refuse to call a code in the field regardless of transport time (once you have started working them). It's a old fashioned protocol issue down here



Rarely we're asked to transport by an MD unfamiliar with modern resuscitation...and we usually can help them make the right call: "Are you sure? We've worked them for 45 minutes, persistent asystole for the last 10 minutes, and EtCO2 is now sub 10 mmHg. We're not likely going to improve anything by driving 15 minutes to your facility. Is there something we're missing?"


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## Rialaigh (Nov 18, 2013)

Christopher said:


> Rarely we're asked to transport by an MD unfamiliar with modern resuscitation...and we usually can help them make the right call: "Are you sure? We've worked them for 45 minutes, persistent asystole for the last 10 minutes, and EtCO2 is now sub 10 mmHg. We're not likely going to improve anything by driving 15 minutes to your facility. Is there something we're missing?"



Woopsie post


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