# What do you typically do in a Transport EMT job?



## Lannel (Mar 11, 2015)

hi there, my questions is in the title. What does a transport job typically entail? It's not 9-11, so what can I expect to experience during this job?


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## COmedic17 (Mar 11, 2015)

Transport. 



For an EMT- either sit in the back with pshyc pts, take vitals in the back during BLS calls and drive during ALS calls.


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## RefriedEMT (Mar 11, 2015)

Even if you get a job at a private 911 company id say 25% if not 1/3 of your calls will be inter-facility, at least that was the rate for my 911 spot in Olympia.


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## Angel (Mar 11, 2015)

Literally you will just be taking vitals and chatting with the patient if they can


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## COmedic17 (Mar 11, 2015)

RefriedEMT said:


> Even if you get a job at a private 911 company id say 25% if not 1/3 of your calls will be inter-facility, at least that was the rate for my 911 spot in Olympia.


That depends where your at. 
Almost all 911 EMS here is private and there's private companies here that only do IFT. So if you work for a 911 Private ems, you run very few if any IFT.


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## jlw (Mar 11, 2015)

You get the big D's. Dialysis and Discharges.


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## NomadicMedic (Mar 11, 2015)

And the ever popular GGH. Granny's going home.


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## Jn1232th (Mar 11, 2015)

Vitals and chatting. I work at a transport company in Orange county. First emt job so I don't mind it much. I leaned about new disease/procedure every day but does get kinda...boring. if I'm lucky though I get the cct's for the day and those are always fun


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## Jim37F (Mar 12, 2015)

Taking vitals in the back of a moving bouncing ambulance (taking blood pressures on your young and healthy classmates is fine and dandy, but wait till your on the highway and trying to take granny's not so clear as a drum BP....) But yes, lots of discharges off the floor to SNFs and Convalescent's and to home, and "abnormal labs" runs where you pick up from the SNF and drop off at the ER, Hospital to hospital transfers for insurance reasons....

How to read a medical chart to get a detailed physical, HPI, recent vitals trends (If granny's BP has been 80/40 all week long at the hospital it's probably normal for her, if it's been 120/80 but is now all of a sudden 80/40 then you might want to make sure she gets attention from a doctor or at least a paramedic in the meantime...) get a report from a nurse, how to give a handoff report to the nurse (oftentimes by including the stuff you wish your pickup reports included but never do...)

How to properly and safely operate a gurney and driving in non stressful non emergent situations (that way when you do eventually get that emergent call properly loading/unloading your gurney from the rig is second nature and you're not flustering yourself by messing around with it)

How to talk on the radio to dispatch, how to fill out PCR's using your local areas preferred method (ex. SOAP vs. chronological, single paragraph and check boxes for everything else vs. 5 paragraph novel that includes every possible detail of the call, etc..)

How to properly wear your uniform and show up to work on time....(PLEASE, please don't be that EMT who shows up to the hospital and walks inside with your wrinkled-never-seen-an-iron shirt untucked and boots unzipped and scuffed up like you just came from a week long USAR exercise (they certainly don't have to be spit shined but at least clean and serviceable) after showing up 20 min late to your shift and taking an hour to check out and go in service)

Speaking of which...how to properly check out your truck at the start of shift...If you're in the back, make sure you have your minimum required supplies (if no checklist provided by your employer, there's probably a State and/or LEMSA regulation stating what you should have at a minimum) where everything is, that nothing's expired and works properly and is clean...don't be afraid to use up cavicide spray/wipes on the gurney/bench/shelves/floor/walls/etc; If you're the driver, make sure the rig is fully operational, check all your fluids (oil, transmission, brake, coolant, power steering, DEF if you get lucky and have a fancy new rig lol), headlights, horn, windshield wipers (I personally HATE windshield wipers that do nothing more than streak so much they make visibility worse), heater, AC, radios, all your lights (code 3 lights, flood lights, 4 way hazards and turn signals (I check both because I've literally had it where the bulb is burnt out for one but not the other) headlights, high beams, etc) Clean up the trash and used gloves that inevitable always seem to squirreled away in the front cab crevices..with a little practice it shouldn't take longer that 20 min to do all this once you get it into a routine.

Oh and being able to tell your supervisor that the truck is unserviceable and you can't take it out on the road because it's unsafe for X reason (assuming there's a legit unsafe reason).


As someone above said, even on 911 there's a lot of similarities. Especially since maybe half our calls (give or take up to 10%-I'm being generous and only going off anecdote so  ) end up as BLS level transports and when a sizable chunk are out of a SNF anyway...well functionally there's not a whole heck of a lot different than a routine BLS IFT transport out of that SNF to the local hospital (except I'm more likely to be holding the wall in the ER than you are taking them straight to a room on the floor)


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## DrParasite (Mar 12, 2015)

Lannel said:


> hi there, my questions is in the title. What does a transport job typically entail? It's not 9-11, so what can I expect to experience during this job?


You know, my first thought was you will learn nothing and be bored to tears.  But that's not entirely true, especially as a new provider.

things a newbie will learn on a transport unit
1) how to read a transfer sheet, and how to write a run sheet
2) how to perform vitals, in a moving vehicle
3) how to perform a patient assessment
4) how to interact with other healthcare providers
5) how to navigate a large coverage area (geography/map study), especially one you have never been to before.
6) how to perform a through a complete  truck check, and how to do it consistently on every shift.
7) and the most important: how to actually TALK TO PATIENTS.  You would be surprised how many new EMTs & Paramedics are uncomfortable talking to patients.

The reality is, the vast majority of your patients are super stable, and an untrained monkey can do your job, at least when I worked IFTs almost 13 years ago.  When I did them, for the SNF calls anyway, if the patient was unstable, they called 911, if they were stable, or just needed a ride to the hospital, they called a transport unit.  The majority of EMTs doing transport are just biding their time until they get a 911 job, a fire or police job, complete school, are doing it on the side while they run their own business, as additional income to get while you are off from your full time job.  There is minimal loyalty to the company, and management will see you as replaceable, assuming you fill out the paperwork enough to get billing processed.

I also met some great friends, and good people, who I enjoyed socializing with outside of work.  Great people to hang out with, but to work alongside..... well, lets just say they were better friends than coworkers.

You can do very little while working a transport unit, or do a decent job.  many people will do the bare minimum (and sometime below that).  In the end, only you can decide what type of employee you will be, and how much you will get out of it.


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## Lannel (Mar 12, 2015)

This has been A LOT of help. Thank you to everyone who took the time to comment and give me some insight into what I can expect! I definitely think this is a good starting point for me to ease myself into the field. I'm both excited and nervous! Honestly, my biggest worry is navigating around and driving the ambulance!


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## CALEMT (Mar 12, 2015)

Lannel said:


> my biggest worry is navigating around and driving the ambulance!



Do you live in the area that you work in? If no then I would recommend driving around your service area and knowing the streets and cross streets that the hospitals are on. Also the SNF's (Skilled Nursing Facility) streets and cross streets. A GPS always helps, but their not all that reliable (saw on the news that a GPS lead a bus driver 800 miles off course) as a back up a Thomas Brothers is the best. As far as driving goes, drive the speed limit, no texting and driving. For the most part its common sense, accelerate smoothly, and break smoothly/ early. Depending on the ambulance the weight can be in excess of 12,000 pounds so breaking and acceleration is going to be vastly different form you own POV.


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## Jim37F (Mar 12, 2015)

Lannel said:


> my biggest worry is navigating around and driving the ambulance!


Practice makes perfect! Listen to the radio and map yourself to other units calls. If nothing else learn your major arteries (for my city 911 job thats the major north-south, east-west streets; for my previous county wide transport job that was learning where all the freeways were in relation to each other) and how to use that network to get to your hospitals


CALEMT said:


> As far as driving goes, drive the speed limit, no texting and driving. For the most part its common sense, accelerate smoothly, and break smoothly/ early. Depending on the ambulance the weight can be in excess of 12,000 pounds so breaking and acceleration is going to be vastly different form you own POV.


This. Just remember as a driver your seatbelted up front facing forward (plus since you're the one at the controls you know when the acceleration/braking is coming) whereas in the back your partner and patient are kind of just back there more or less at your mercy. Be kind on them.


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## OnceAnEMT (Mar 13, 2015)

Jim37F said:


> Just remember as a driver your seatbelted up front facing forward (plus since you're the one at the controls you know when the acceleration/braking is coming) whereas in the back your partner and patient are kind of just back there more or less at your mercy. Be kind on them.



At that, 10x the mercy you THINK they are at. Pad your corners - in the box and while driving.


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## Jim37F (Mar 13, 2015)

During my third rider training I was actually advised that anything more than 10mph while cornering is too fast....therefore for the OP, don't drive so fast you have to slam on the brakes to take your corners slower than 10mph....IMO sudden stops and accelerations were every bit as bad as hard cornering....err on the side of driving a little slower and you'll be fine until you're more comfortable behind the wheel


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## Brandon O (Mar 13, 2015)

If you're not taking bumps and corners hilariously, comically slow, it's too fast.


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## CALEMT (Mar 13, 2015)

Brandon O said:


> If you're not taking bumps and corners hilariously, comically slow, it's too fast.



This, nothing sucks more than getting thrown around in the back.


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## NomadicMedic (Mar 13, 2015)

Thom D1ck recommends all new EMTs be given a ride in the back, on the stretcher, so they can experience it. Both at speed and when driven with caution.


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## ZombieEMT (Mar 14, 2015)

The same thing you do in a 911 job, transport... In all honesty, that's the purpose of both, right?


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## medicaltransient (Mar 14, 2015)

After a few years, you sit there and hate your life.


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## medicaltransient (Mar 17, 2015)

Don't stay too long, you need continue to apply for 911 and er tech jobs as soon as you are hired. If you get stuck there you will be on the 911 no hire black list and you will loose your skills. If you get fired from there or a 911 job you should just quit EMS.


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## medicaltransient (Mar 17, 2015)

ZombieEMT said:


> The same thing you do in a 911 job, transport... In all honesty, that's the purpose of both, right?


If that's what you think the purpose of EMS is you are very mistaken and obviously have never made a life saving intervention.


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## Jim37F (Mar 17, 2015)

medicaltransient said:


> If you get stuck there you will be on the 911 no hire black list


Must be an area specific thing....here considering there's literally somewhere in the neighborhood of 80-100 ambulance companies and only 6 or so do 911 response in LA/OC being "stuck" at a transport only company is pretty much a given. Particularly since here the transport only companies tend to pay a little better than the companies that also do 911..


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## medicaltransient (Mar 17, 2015)

Jim37F said:


> Must be an area specific thing....here considering there's literally somewhere in the neighborhood of 80-100 ambulance companies and only 6 or so do 911 response in LA/OC being "stuck" at a transport only company is pretty much a given. Particularly since here the transport only companies tend to pay a little better than the companies that also do 911..


That sucks man, good luck out there in LA/OC.


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## Jim37F (Mar 17, 2015)

medicaltransient said:


> If that's what you think the purpose of EMS is you are very mistaken and obviously have never made a life saving intervention.



I've been an EMT for 2 1/2 years now...6 months BLS IFTs, then 3 months on a CCT IFT unit, then switched companies to where I did BLS IFT and 911 response for about 6 months, and now for the last year or so have been working on the ambulance for a local FD doing ONLY 911 response.....Easily half of all my 911 responses/transports resulted in us doing the exact same thing as the inter facility transports.....code 2 BLS to the requested facility with nothing more intensive than checking vitals...Of the rest where we transported ALS, only a small fraction actually required immediate interventions to prevent loss of life, limb, or eyesight.

So IME yes, every once in a while we do get to play hero and save a life, but those are a very distinct minority for the majority of 911 calls, which in reality, don't really need much more than transport.


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## medicaltransient (Mar 17, 2015)

Jim37F said:


> I've been an EMT for 2 1/2 years now...6 months BLS IFTs, then 3 months on a CCT IFT unit, then switched companies to where I did BLS IFT and 911 response for about 6 months, and now for the last year or so have been working on the ambulance for a local FD doing ONLY 911 response.....Easily half of all my 911 responses/transports resulted in us doing the exact same thing as the inter facility transports.....code 2 BLS to the requested facility with nothing more intensive than checking vitals...Of the rest where we transported ALS, only a small fraction actually required immediate interventions to prevent loss of life, limb, or eyesight.
> 
> So IME yes, every once in a while we do get to play hero and save a life, but those are a very distinct minority for the majority of 911 calls, which in reality, don't really need much more than transport.


All those basic calls are important, thats where you form good habits that you will need for the more emergent ones. Some of those basic calls with basic assessment illicit a lot of responsibility.


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## Lannel (Mar 17, 2015)

I'm understanding alot of what I'm learning in class, but one thing I don't understand is... say you're transporting and your patient codes. How do you decide where to take them/if you should pull over and wait for ALS to arrive for backup?


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## Tigger (Mar 17, 2015)

Unless you can see the hospital, you are better off pulling over and working the arrest with your partner and concentrating on great compressions and immediate AED use. 

CPR in the back of a moving ambulance is bad.


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## MonkeyArrow (Mar 17, 2015)

This is an area of disagreement that I have between other members of this forum. Especially if you are already en route, upgrade to lights and sirens and get to the closest hospital.


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## NomadicMedic (Mar 17, 2015)

Tigger said:


> Unless you can see the hospital, you are better off pulling over and working the arrest with your partner and concentrating on great compressions and immediate AED use.
> 
> CPR in the back of a moving ambulance is bad.



^^^ This!


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## PotatoMedic (Mar 17, 2015)

MonkeyArrow said:


> This is an area of disagreement that I have between other members of this forum. Especially if you are already en route, upgrade to lights and sirens and get to the closest hospital.


So what intervention(s) is the hospital going to do, that you can't do, that is going to save this persons life?


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## Tigger (Mar 17, 2015)

FireWA1 said:


> So what intervention(s) is the hospital going to do, that you can't do, that is going to save this persons life?


If you are BLS and a crew of two and can see the hospital, it's probably worth just getting there so you can have more hands. Other than that, nothing.


MonkeyArrow said:


> This is an area of disagreement that I have between other members of this forum. Especially if you are already en route, upgrade to lights and sirens and get to the closest hospital.


So single rescue CPR in a moving ambulance is what's going to help this patient. Umm no.


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## PotatoMedic (Mar 17, 2015)

If you can see the hospital fine, but if your any distance out no.  There is no set of interventions aside from CPR and defibulation that will truly make an impact on a patients survivability.  Epi yes improves ROSC rate but does not increase survivability.  My guess is the ALPS study is going to show nothing really works and airway can be managed by a opa/NPA or superglotic.  

You could make an argument for medics/ hospitals being able to help manage the He's and T's but still the data says early CPR and early defibrillaton is what increases cardiac arrest survival.


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## Brandon O (Mar 17, 2015)

Park, call for ALS, work it. Resist the urge to do "The BLS Punt" -- flooring it for the hospital.

Edit: however, if this sort of thing happens to you a lot, you're either way out in the sticks or you're making some bad triage decisions...


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## MonkeyArrow (Mar 17, 2015)

Ugh. Really don't want to get into it again. But ok, here we go. First of all, everything assumes short, urban transport times. Waiting for an ambulance to arrive at the side of the road to help you takes what, 7-10 minutes. Driving to the hospital takes what, 7-15 minutes. Waiting for that extra set of hands, you have two providers trying to do CPR and manage the airway, while also working the defibrillator. It takes two people to get a good seal on the BVM, plus you need one to do compressions. Yes, CPR does suffer in a moving ambulance but eventually, doing CPR with 1-2 people waiting for that second ambulance will tire you out too, also regarding the quality of compressions administered.

Instead of waiting and watching compression efficacy decrease, drive to the hospital and watch compression efficacy decrease. That way, you have more hands to help, with a marginally longer time vs that of the second ambo arriving. In the hospital, you have many more hands to help, and is generally a better place to facilitate resuscitation. No one here should be arguing that an ED offers less than the back of your ambulance.

In my ED, we do cath lab with CPR in progress, ECMO, etc. Yes, not every ED has these things. However, you would be hard pressed to find a department with the aforementioned assumptions not to have an ultrasound unit (PE) and thrombolytics to lyse the patient, access to multi-disciplinary specialities who can correct reversible causes of death, the ability to start drips and push medications and perform maneuvers that you simply cannot do in the field (who paces over VFib in the field).


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## triemal04 (Mar 17, 2015)

I hope you realize that you are contradicting yourself.  A lot.

You think it takes 2 people to get an effective seal on a BVM...so you'll just haul butt to the hospital with *one* person doing compressions* and* ventilations...hmmm.

You say (correctly) that CPR will tire out 1-2 people...so you'll just haul butt to the hospital with *one* person doing compressions* and* ventilations...hmmm.

You imply that having 2 people try to provide ventilations, compressions and defibrillation is a bad thing...so you'll just haul butt to the hospital with *one* person doing compressions* and* ventilations...hmmm.

You say (correctly again) that the quality of CPR suffers in a moving vehicle...but you still want to move and negate the effectiveness of one of two interventions that we *know* works...hmmm.

Do you think that having 7-10 minutes of innefective compressions will be negated by possibly effective compressions when you reach the hospital?

I'd seriously suggest you stop and think this one through.


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## MonkeyArrow (Mar 17, 2015)

triemal04 said:


> I hope you realize that you are contradicting yourself.  A lot.
> 
> You think it takes 2 people to get an effective seal on a BVM...so you'll just haul butt to the hospital with *one* person doing compressions* and* ventilations...hmmm.
> 
> ...


No. What I am saying is that by staying on scene with 2 people or leaving with 1, the quality of resuscitation suffers nevertheless. Therefore, if the quality of resuscitation will suffer anyways, I will opt to get the patient to a higher level of care.


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## Brandon O (Mar 17, 2015)

At least do a few rounds while you're in the best possible time to get ROSC. All you need to do is push and zap and rotate if need be. Hell, you can get the police to come help if you want.


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## Chewy20 (Mar 17, 2015)

MonkeyArrow said:


> No. What I am saying is that by staying on scene with 2 people or leaving with 1, the quality of resuscitation suffers nevertheless. Therefore, if the quality of resuscitation will suffer anyways, I will opt to get the patient to a higher level of care.


 
It's actually pretty simple, person has a much better chance if you pull over and immediately shock if applicable and start quality chest compressions. That is the most important thing in an arrest. 1 or 2 people can handle CPR for 10-15 mins until (we all have done it is school) another unit to get there.

If nothing else think of this, an IFT unit encounters a code en route (BLS or ALS rig) it is more than likely their first time seeing an arrest, and this being after not using their skills what so ever since they finished school. I do not want that person up front driving with all the "excitement" in their head. Could get everyone in the box killed. Nor would I want my family member receiving subpar performance and missing treatments because the medic in the back is freaking out on a code by himself being tossed around at the same time. No bueno, if you have the pt in mind, you pull over. My opinion but it seems pretty common sense. UNLESS you are a BLS unit and can throw a rock at the ED then sure go for it.

I was at the ED not to long ago and a private ALS transfer agency (wont say who) came screaming into the parking lot with someone who coded on the way in, my partner and others jumped in the back to help because they were both freaking out and said they have been doing one man CPR, ventilations, and looking at monitor for the past 15-20 mins, are you kidding me? All the while driving through a county with 40+ ALS units in stations. Pt did not make it. Could or could not be because of his care given to him since we know cardiac arrests are hard to get back in first place, but I can tell you the care he received certainly did not help.


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## triemal04 (Mar 18, 2015)

MonkeyArrow said:


> No. What I am saying is that by staying on scene with 2 people or leaving with 1, the quality of resuscitation suffers nevertheless. Therefore, if the quality of resuscitation will suffer anyways, I will opt to get the patient to a higher level of care.


Actually, the quality of CPR, when done by two people, should be just fine for long enough to get extra hands on scene (in the urban setting you mentioned).  If it isn't that is more of a problem with the providers than anything, and should be corrected with remedial training.  

The quality of CPR done by one person, in a moving vehicle will be next to worthless.  The only way to fix that is to stop moving and gets more hands.


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## MonkeyArrow (Mar 18, 2015)

triemal04 said:


> Actually, the quality of CPR, when done by two people, should be just fine for long enough to get extra hands on scene (in the urban setting you mentioned).  If it isn't that is more of a problem with the providers than anything, and should be corrected with remedial training.
> 
> The quality of CPR done by one person, in a moving vehicle will be next to worthless.  The only way to fix that is to stop moving and gets more hands.


Can you cite your source?


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## chaz90 (Mar 18, 2015)

MonkeyArrow said:


> Can you cite your source?


Huh? Cite his source that having two providers work a code while stationary is better than having one try to in a moving ambulance? 

One provider provides high quality continuous compressions while the second hooks up the monitor and delivers a shock. After that shock, provider 2 starts compressions while provider 1 moves up to the airway (I believe we're assuming BLS for this scenario, but correct me if I'm wrong). At this point, it's fairly easy to switch roles every shock between both providers, and some sort of help (ALS, fire, or police) should be there any second since you're in an urban setting. I'm trying to understand your thought process here, but I feel like I'm missing something.


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## Tigger (Mar 18, 2015)

MonkeyArrow said:


> Can you cite your source?


I think we should probably ask that of you. Everyone here is advocating for doing what the AHA teaches: two rescuer CPR is more effective than single rescuer. Seems fairly obvious.

If you don't believe that CPR is ineffective in a moving ambulance
http://www.ncbi.nlm.nih.gov/pubmed/23178870
http://www.ncbi.nlm.nih.gov/pubmed/10114069

Sorry your argument makes no sense and is not based on anything but your own assumptions that are just frankly out there.


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## MonkeyArrow (Mar 18, 2015)

Tigger said:


> I think we should probably ask that of you. Everyone here is advocating for doing what the AHA teaches: two rescuer CPR is more effective than single rescuer. Seems fairly obvious.
> 
> If you don't believe that CPR is ineffective in a moving ambulance
> http://www.ncbi.nlm.nih.gov/pubmed/23178870
> ...


The first study that you cited states that there is no difference in mean chest compression depth between scene, in ambulance, or emergency department, evidence against your (collective) claim that CPR in the back of the ambulance is ineffective compared to scene.

EDIT: In variability indexes, the transport figures were in the middle for both depth and rate, meaning that they were not the worst. Note, the two comparatives are on scene and in the emergency department, both of which you advocate over in ambulance.

As to the second, it is literally a two sentence abstract from 1991 that seems to have no full get that I can read.


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## Tigger (Mar 18, 2015)

http://www.ncbi.nlm.nih.gov/pubmed/23425006
http://www.ncbi.nlm.nih.gov/pubmed/10155415

The second one showing that only 45% of compressions were effective in a moving ambulance that was operated in a non-emergent manner.

Meanwhile, we will await research showing that hauling *** to the hospital while doing single rescuer CPR is a good idea.


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## MonkeyArrow (Mar 18, 2015)

I give you:
http://www.ncbi.nlm.nih.gov/pubmed/17276575
95% efficiency compared to CPR performed on scene. 

Funny, why would you even include the first if it is not germane to the discussion (or to your point, at least)? It has no control group (scene compression). Actually, while the technically calculated rate of correct compressions is at 67%, the compression rate is on par with guidelines and the mean compression depth is .3 mm shy of the recommended rate. I'll take that. The second link was published in 1995. That's 20 years ago. I surely hope that our measuring metrics for CPR efficacy have improved since then.

Honestly, quickly leafing through PubMed myself, I see no conclusive studies. The second link that you cited showed decreased efficacy (albeit, study done in 1995), whereas the link I cited showed 5% decrease in quality in ambulance (performed in 2005, published 2007). Therefore, I think that a new, mega RCT or at least a meta-anaylsis of all the studies needs to be done to reach a conclusive decision. However, I do still believe that I am at least justified in holding the opinion that I have.


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## chaz90 (Mar 18, 2015)

@MonkeyArrow. Have you ever performed compressions in a moving ambulance? I understand that your facility does a number of interventions that may or may not prove to be effective in cardiac arrest patients, but what are the first things they do for a cardiac arrest with a shockable rhythm? I'm going to go out on a limb here and guess they perform CPR at 30:2 or continuous with two rescuers as compressors rotate out, defibrillate shockable rhythms, and administer whatever medications the ED MD running the call decides (epinephrine, amiodarone, atropine, lidocaine, mag...). 

All the other fancy stuff comes later or not at all. If we (BLS or ALS) witness a VF/VT arrest secondary to a medical cause in the field, we stand a very fair chance of treating the patient and achieving sustained ROSC with a darn good chance at a decent neurological outcome. I simply can't figure out why you would advocate any EMS unit upgrading to an emergent response with a witnessed arrest as the attending provider stands up and attempts to do horribly ineffective (secondary to experience and the majority of admittedly small scale studies available) manual compressions for 5 minutes without any attempt at electrical therapy during the time period in which the heart is most susceptible to conversion of VF back to a perfusing rhythm. 

I love to deliver live and viable patients to the ED. I recognize the ED physician's knowledge, skill set, and tools vastly surpass my own. I understand the ED and remainder of the hospital offer numerous services and interventions to help my patients that I can't, but I think part of giving these patients the best chance at survival means working them where I find them and stopping to achieve ROSC on an arrest during transport.


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## STXmedic (Mar 18, 2015)

To emphasize Chaz's point:

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


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## triemal04 (Mar 18, 2015)

MonkeyArrow said:


> Can you cite your source?


Seriously?  Do you actually understand what you're saying?

You open by making a statement that is full of blatent contradictions, and continue to contradict yourself since it would appear that you recognize that single-person CPR doesn't work...yet you advocate it.

Now you want a study for "proof"...

How about this.  Go to google scholar.  Type in "effectiveness of CPR when moving."  And read through the numerous links that come back.  Like the ones that compare stationary vs moving CPR...compare how effective CPR is when in various positions...show how quickly people fatigue when in various positions...compare the effectiveness between standard or mechanical compressions while moving...


> However, I do still believe that I am at least justified in holding the opinion that I have.


No.  You aren't.


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## Tigger (Mar 18, 2015)

MonkeyArrow said:


> However, I do still believe that I am at least justified in holding the opinion that I have.


Are you going to support it in any way?


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## MonkeyArrow (Mar 18, 2015)

@chaz90 Yes, my facility runs through all the standard code things first. The point about not being able to shock with 1 person CPR is ludicrous. Let me refer you to the AHA 1 person CPR arrest management algorithm, since that's what everyone seems to like. The first thing that you do in a witnessed adult arrest is call 911 and go get an AED if you're all alone. You are 911, and the AED is literally a yard away from you. Take the pads, put it on the patient. Charge and deliver a shock if it is a shockable rhythm. This literally takes me all of 20 seconds to do on my LP12/15.

Also, yes, I have done CPR in a moving ambulance. I was able to do it, who knows how effectively since I or my patient wasn't hooked up to the proper scientific instruments to test its efficacy. But, I'm still alive. No one died, or got injured. As to the delivery of viable patients, I wonder how long the scene time was before transport for those patients who never achieved ROSC. If you futz around on scene for 20 minutes before transporting, chances are going to be very low. However, back to the OP's question, if the arrest happens in the back of an ambulance already en route, time to hospital will be much shorter, I'm assuming. The folded 5 or 10 minutes of shocking an arrhythmia back into perfusion doesn't magically go away just because you are in an emergency department instead of on someone's living room floor.

@triemal04 Yes. I'm fairly positive I understand what you are saying. Thanks for your concern. I typed in exactly what you told me to into the search engine which you mentioned. The studies that came up showed inconclusive results, as I noted in my previous posts as some said compression efficiency decreased while others said that it was very close to the baseline. Additionally, many studies have poor baseline performance, such as 52% on the floor, demonstrating a lack of proper training to begin with. The use of a mechanical device is not relevant here. No one is arguing that a human can outperform the LUCAS.

In fact, I do find it kind of funny that Tigger dropped the study point after I posted a study that showed the opposite results that you guys are claiming. Here is an excerpt from the same link that was in my last post, as none of you obviously cared to look at it:
*
RESULTS: *Compared to resuscitation at the scene, efficiency of chest compressions during a helicopter flight was 86% and 95% in the moving ambulance 95%. There were no differences in secondary outcomes (time without chest compression, total number of incorrect hand position relative to total compressions, and total number of incorrect pressure release relative to total compressions).

*CONCLUSIONS:*
Resuscitation during transport is feasible and relatively efficient. There is some difference between the environments, but there is no relevant difference between helicopters and ambulances regarding the effectiveness of CPR.

I'm curious, if each of you had a LUCAS, would you transport your arrests?


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## chaz90 (Mar 18, 2015)

I have a LUCAS. I continue to work my arrests on scene until termination of efforts or ROSC as the hospital offers only the same therapies I can for a patient that remains in cardiac arrest.


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## Tigger (Mar 18, 2015)

Actually I posted additional studies. 

Not to mention that "I'm still alive. No one died, or got injured." is a useless statement. One time you did something with these results. That means absolutely nothing. Especially since we know that transporting emergent significantly increases the ambulance's likelihood of being involved in an accident. And while an AMR operation in California did one tiny study showing no difference in CPR quality between seatbelted and standing providers in Type II vans, most of the time transporting a cardiac arrest involves no seatbelts for most providers. But hey, one time you did it and everything worked out, so that must always be true. 

Not to mention I still do not understand how you can advocate for single provider CPR for any significant length of time. To say that the quality of compressions will decrease at the same rate with one and two provider CPR doesn't make sense. Two providers should be able to meet compression guidelines for eight minutes or however long you think it will take for more resources to arrive.


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## Chewy20 (Mar 18, 2015)

MonkeyArrow said:


> @chaz90 Yes, my facility runs through all the standard code things first. The point about not being able to shock with 1 person CPR is ludicrous. Let me refer you to the AHA 1 person CPR arrest management algorithm, since that's what everyone seems to like. The first thing that you do in a witnessed adult arrest is call 911 and go get an AED if you're all alone. You are 911, and the AED is literally a yard away from you. Take the pads, put it on the patient. Charge and deliver a shock if it is a shockable rhythm. This literally takes me all of 20 seconds to do on my LP12/15.
> 
> Also, yes, I have done CPR in a moving ambulance. I was able to do it, who knows how effectively since I or my patient wasn't hooked up to the proper scientific instruments to test its efficacy. But, I'm still alive. No one died, or got injured. As to the delivery of viable patients, I wonder how long the scene time was before transport for those patients who never achieved ROSC. If you futz around on scene for 20 minutes before transporting, chances are going to be very low. However, back to the OP's question, if the arrest happens in the back of an ambulance already en route, time to hospital will be much shorter, I'm assuming. The folded 5 or 10 minutes of shocking an arrhythmia back into perfusion doesn't magically go away just because you are in an emergency department instead of on someone's living room floor.
> 
> ...


 
We do have a LUCAS on each arrest, and no, we don't until we have ROSC. Also we have worked someone for over an hour and got them back and they are out and about walking today. You my friend are ridiculous.


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## triemal04 (Mar 18, 2015)

MonkeyArrow said:


> @chaz90  The point about not being able to shock with 1 person CPR is ludicrous.


I hope you understand that you are continuing to contradict yourself.  Is it intentional?  Because you used the reasoning that* 2* people couldn't effectively provide compressions, ventilations, and defibrillation as a reason to not stop...and now you seem to be saying that *1* person can easily provide compressions and defibrillation.  Huh...

Anyway.  You clearly want to believe that what you are doing is appropriate despite all evidence to the contrary.  And are unwilling to consider that you might be wrong, or even look at "proof" that you in fact are.

http://informahealthcare.com/doi/abs/10.1080/10903120500373108  Stable CPR=better CPR.  Not inconclusive at all.
http://link.springer.com/article/10.1007/s00134-006-0273-8#page-1  Poor positioning=ineffective CPR.  Not inconclusive at all.
http://www.koreamed.org/SearchBasic.php?RID=0082JKSEM/2009.20.4.343&DT=1  Moving, and poor positioning=ineffective CPR.  Not inconclusive at all.
http://informahealthcare.com/doi/abs/10.3109/17482941.2012.735675  Moving CPR=ineffective CPR.  Not inconclusive.
http://ajcc.aacnjournals.org/content/17/5/417.full  Poor position=ineffective CPR.  What a shocker...
http://www.biomedcentral.com/content/pdf/1757-7241-20-39.pdf  Moving CPR=ineffective CPR.  So shocking...
http://www.sciencedirect.com/science/article/pii/S0300957207003747  Moving CPR=ineffective CPR.  I sense a trend...
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1991.tb09554.x/epdf  Single person CPR is bad.  This actually was looking at ventilations, but if you actually *read it *there is enough in there to include it here.

There's more out there, but your mind is clearly closed.  

For anyone else, some of those links will require you to actually read the study to be able to pull the pertinent info from it.


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## MonkeyArrow (Mar 18, 2015)

Glad to hear everyone is open to hearing different opinions and having an academic discussion.


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## chaz90 (Mar 18, 2015)

MonkeyArrow said:


> Glad to hear everyone is open to hearing different opinions and having an academic discussion.


That's not the impression I'm trying to make at all. I'm very open to academic discussions, but I'm honestly struggling with what your position is here. I know you advocate transport of cardiac arrests, but I'm not seeing any of the evidence that you are that suggests it's beneficial in the slightest.


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## triemal04 (Mar 18, 2015)

MonkeyArrow said:


> Glad to hear everyone is open to hearing different opinions and having an academic discussion.


An academic discussion?  That would require you to post some validation for your opinion.  Because right now that's all it is; your opinion.  You came up with one single piece of evidence, and a lot of contradictory statements.  I can look back and see several people that have posted multiple different opinions and evidence to prove you wrong.  

The ball is in your court right now.


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## Brandon O (Mar 18, 2015)

Well, people get excitable, as always. And it does sound like you're practicing in a unique environment if those intra-arrest interventions are available at your facilities. But let me make an argument that even in your case, you should at least do several minutes of CPR if a patient arrests en route.

My scenario -- let's keep this BLS as in the original example (doesn't change much if ALS IMO, but it confuses things):

1. Patient loses a pulse en route. Tech recognizes this and immediately begins compressions.

2. Driver calls for help, parks the truck somewhere safe, and comes into the patient compartment.

3. Driver finds AED, exposes patient, applies pads, runs it through the sequence until ready to analyze.

4. Tech stops compressions for the first time since pulse was lost, lifts off chest, immediately resumes compressions while AED charges (depending on device).

5. Once charged, crew coordinates defibrillation so that compressions are interrupted for less than a second while shock is applied.

6. Continue this process for at least several minutes.

In this scenario, no-flow time is almost zero, time-to-shock is as short as possible given the "surprise" circumstances, and this continues to be the pattern for the first several potential shocks. If no luck, if there's suspicion for a correctable cause, or perhaps if the first few attempts give a "no shock advised," transport could be resumed. ALS and other assistance can meet the crew at their location without difficulty and without interrupting the process.

Another scenario:

1. Patient loses pulse. Tech recognizes this and begins compressions while driver heads for hospital, bells on.

2. Tech either starts with compressions then takes a break to get the AED, or gets the AED first; either way there is no flow during the period of preparation and activation.

3. Tech must again interrupt compressions to personally apply shock. This is all while transport is ongoing, so precise back-and-forths are probably not as feasible (nor as safe), and compressions may not be as high quality.

4. Realistically, the truck will probably need to be stopped during AED analysis as well.

In this scenario, the patient probably arrives at definitive care earlier. However, the best shot for restoring a perfusing rhythm -- that is, immediately after arrest -- may be unsuccessful since it's inevitably going to be preceded and probably followed by a no-flow period. As time goes on (particularly if questionable or interrupted compressions continue), odds continue to drop, and no matter what awaits at the end of the trip it may be futile by then.

My view is that if I see a patient arrest, I have been thrown a set of delicate teacups to juggle, and I want the absolute best chance to set them back in the cupboard ASAP. That is both a logical and an evidence-based perspective. If I bobble them within those first minutes -- and running a complete code on my own in the back of an ambulance, even a BLS code, sounds like the definition of bobbling -- that may screw the pooch permanently, and it'll be my fault all the way. It's not like I can blame it on bystanders!


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## Chewy20 (Mar 18, 2015)

Academic? Didn't know I was learning anything here.


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## MonkeyArrow (Mar 18, 2015)

@Chewy20 Is your head really stuck so far up... into the clouds that you think no one has ever survived an in-hopsital cardiac arrest or a transported cardiac arrest? Your little personal anecdote does absolutely nothing to further any side of this discussion, and yet, you call me out on being academic.

@triemal04 I understand that 1 provider will not provide as effective BLS as 2 providers. However, I am also saying look at the bigger picture. There really is no study out there, that I know of, that will show difference in survival between 1 person CPR to hospital transport or 2 person CPR to ALS intercept, which is really at the heart of the question. I believe the answer is a continuum, with time to hospital, time to intercept, provider training/ how good can they do CPR, and other variables all have to be factored in to find a time when transporting will induce better outcomes than working on scene. Right now, all anyone is doing is drawing extrapolations from independent aspects of the survival cascade and attempting to apply it to the overall scene. No matter how good your CPR is, unless you defibrillate, the patient probably won't survive.

But since you would like to continue to throw studies into my face that really do not show what we need it to show, I will continue to tell you why each of these studies is not applicable. For ease of reference, I will go in order, referring to them by the number in which they appear in your post.

1: talks about CPR on a moving stretcher, which does not provide as stable as a platform to work off since there isn't, oh, I don't know, a floor? Also, the baseline rate for correct compressions was 54% indicating a lack of provider training.
2: I don't understand how kneeling on the bed can be extrapolated to CPR in an ambulance. You have chairs and you can stand where the patent will actually be at optimal height for compressions.
3: Nothing to do with a moving ambulance. Said standing is less effective than in a supported position. Kneel on the stretcher.
4: The study is comparing a mechanical CPR device to humans, first of all. (Not that this study hasn't been addressed in a previous post) The rate of compressions was good and the depth was .3mm off of the recommended depth. If I'm less than 1/100 off of my target depth, I think I deserve a pat on the back. There is no control with the same humans doing compressions not in an ambulance. *Actually, this study supports the notion that effective CPR can be done in a moving ambulance*, if you are willing to accept compressions an average of .3 millimeters too shallow.
5: 80% of compressions by males were effective irrespective of position, compared to 40% of females. Kneeling requires more energy but is more effective. Again, training is needed to increase 40% effectiveness in all positions, because that is dismal. Kneel on the cot if you so please while doing compressions.
6: What the hell is the relevance of a study detailing mechanical devices to humans. Yes, the LUCAS is better than me. Do you want me to buy one now? None of these studies, that are reputable, have any control group with human rescuers not moving vs. moving.
7: Finally, you give me a reputable, conclusive study. It shows that hands-off time does increase with transport and average BPM falls approximately 10 compressions. However, note that the fractions of compressions on scene deemed effective would have been very low because it did not meet the 100 BPM threshold. Also, the conclusion says transport with CPR in progress is not futile, as everyone here is saying is.
8: Single person CPR is not effective n=3 in a moving ambulance, anecdotally speaking of course.
Look, I've already told you that single person CPR is not as effective as 2 person CPR, and that CPR in a moving ambulance is not as good as on the ground. However, with properly trained providers, it is not futile either. In addressing @Brandon O 's point, who I believe actually understands what I am trying to say, there are definitely trade-offs that must be made. I think that a balance must be struck between all these various factors. For example, when does 1 person CPR in a moving ambulance followed by definitive care, with higher quality CPR and access to better and more advances treatments lead to better outcomes compared with 2 person CPR and marginally better CPR with standard ACLS algorithms and nothing more?

I think the peri-shock pauses that you brought up, while valid, is starting to split hairs a bit. If we're talking about a delay of minutes vs. seconds for one vs. the other, I would understand the argument. However, I highly doubt that the extra 30 seconds it would take for a single provider to deliver a shock, and the 5-10 seconds of additional peri-shock pause will affect outcomes. All the literature that I have read states to limit total pauses to less than 20 seconds, and pre-shock pause to less than 10 as blood will still flow for a little while when you stop compressions. Getting a pre-shock pause time of 1 second, while feasible, is fairly rare and probably will not happen in the context of this resuscitation. Therefore, I think the effect of having a single provider deliver the electricity is negligible in this instance. More and more of the recent studies actually demonstrate that hands-on defibrillation/compressions, while they decrease the total interrupted compression time and decrease the coronary perfusion pressure restoration ratio, do not affect ROSC, indicating that we have probably reached a plateau at which 1 second vs 3 seconds is not clinically significant.


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## DrankTheKoolaid (Mar 18, 2015)

You get the chance to practice your history taking technique, learn home medications, non stressed physical exams, listen to a ton of lung sounds, build relationships with Ed and other medical staff at various facilities, learn the area and so much more.   Sure everyone wants a 911 job but the competition is fierce to say the least.   Make the best of whatever position you get and take away from it as much as you can


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## chaz90 (Mar 18, 2015)

MonkeyArrow said:


> I think the peri-shock pauses that you brought up, while valid, is starting to split hairs a bit. If we're talking about a delay of minutes vs. seconds for one vs. the other, I would understand the argument. However, I highly doubt that the extra 30 seconds it would take for a single provider to deliver a shock, and the 5-10 seconds of additional peri-shock pause will affect outcomes. All the literature that I have read states to limit total pauses to less than 20 seconds, and pre-shock pause to less than 10 as blood will still flow for a little while when you stop compressions.



I beg to differ. 

http://www.resuscitationjournal.com/article/S0300-9572(13)00814-9/abstract

I agree with you in that I have been unable to find any study comparing survival to discharge or ROSC rates between working on scene and intercepting ALS vs. continuing in to the hospital as a single provider. At this point though, I believe the body of evidence leads us to believe that any study attempting to compare these two populations and treatment plans would be ethically inadvisable. If the individual pieces seem to lead us to believe that one person CPR in a moving ambulance is ineffective, what review board is going to authorize a RCT in which cardiac arrest patients are stratified into a treatment category that clearly seems to be inferior in all ways? 

I'm trying to get past my inherent bias as a pre-hospital provider that I have more to offer these patients than a diesel bolus, and everything I'm finding seems to emphasize we're doing the right thing by working these patients where we find them. I truly can't see the benefit of hauling butt to the ED for five minutes as a single provider just to arrive somewhere where the same interventions are going to be utilized as in the field, with sometimes worse compression ratios and peri/post shock pauses. 

As you mention, even your medical Mecca does the same frontline treatments as everywhere else in the world. If we effectively achieve rapid ROSC pre-hospitally and then transport to your facility rather than sprinting to the ED room with compressions alone can't we give that patient more effective time under perfusion?


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## chaz90 (Mar 18, 2015)

DrankTheKoolaid said:


> You get the chance to practice your history taking technique, learn home medications, non stressed physical exams, listen to a ton of lung sounds, build relationships with Ed and other medical staff at various facilities, learn the area and so much more.   Sure everyone wants a 911 job but the competition is fierce to say the least.   Make the best of whatever position you get and take away from it as much as you can



Thanks for the return to on topic discussion. This is great advice.


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## Brandon O (Mar 18, 2015)

chaz90 said:


> I beg to differ.
> 
> http://www.resuscitationjournal.com/article/S0300-9572(13)00814-9/abstract



Admittedly some of this data is beginning to get peeled back a little. Some of the individual components of modern "high-performance resuscitation" are. Yet we can't deny that when it's done you can transform a system with awful survival into one with excellent survival. And the method to achieving that seems to be pursuing a model of resuscitation where you do early, fast, deep, nonstop compressions with early defibrillation and as little else as possible to mess with those things.

There's a parallel to be made with the package of interventions in early goal-directed therapy for sepsis. We're seeing a bunch of recent data that many of the individual pieces of that may not matter very much; yet when it was first pioneered, all we knew is that the whole package worked, and until more studies on the granular components were available, we had to run with it. Similarly, lots of weird stuff is being tried now in the cardiac arrest game, and a lot of it's probably useless, and some probably harmful. But until we can unravel it, the best we can do is "play the game" where the brass ring is perfect compressions and defibrillation, because it's very clear that when we play the game, it works.


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## DesertMedic66 (Mar 18, 2015)

If they code in my ambulance we are upgrading and getting to the hospital. Why? If I pull over, work the patient, and end up determining death my ambulance is now considered a crime scene which means I have to stay where ever I am pulled over at until the coroner arrives. It's not unheard of for them to take 4-8 hours to get there.

Also our protocols don't let us determine death on full arrests that we witness.


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## triemal04 (Mar 18, 2015)

DesertEMT66 said:


> If they code in my ambulance we are upgrading and getting to the hospital. Why? If I pull over, work the patient, and end up determining death my ambulance is now considered a crime scene which means I have to stay where ever I am pulled over at until the coroner arrives. It's not unheard of for them to take 4-8 hours to get there.


Oh come on, forget the potential overtime...just think of the fun you could have with that!  

Monkeyarrow...I had a nice long reply all typed out and ready to go where I pointed out that you are continuing to contradict yourself, as well as ignoring information that doesn't jibe with what you think.  

And then I deleted it.  Because there is no point.  Believe what you want for whatever reasons you want.  It's ok.


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## DesertMedic66 (Mar 18, 2015)

triemal04 said:


> Oh come on, forget the potential overtime...just think of the fun you could have with that!
> 
> Monkeyarrow...I had a nice long reply all typed out and ready to go where I pointed out that you are continuing to contradict yourself, as well as ignoring information that doesn't jibe with what you think.
> 
> And then I deleted it.  Because there is no point.  Believe what you want for whatever reasons you want.  It's ok.


Some of the areas we go to are literally in the middle of nowhere. I don't want to be at a rest stop with a body in the back of my unit for 8 hours... I also don't want to fill out the incident report stating why I clocked out 8 hours late.


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## MonkeyArrow (Mar 18, 2015)

The thing with RCTs is they have pre-determined cut-offs to prevent unethically harmful procedures, either experimental or control in some cases, from needlessly being conducted when it is clear that superiority has been proven without needing to continue the course of the trial's enrollment, not that it is really relevant. While if you are able to achieve the same ROSC rates as the ED, then sure. But this is completely dependent on how aggressive your ED (MD) is and what they are willing to do. If they are more current and into resuscitation and critical care, and for example, use hemodynamically based dosing of pressers and utilize weight based pressor admin instead of 1 mg of epi for every adult, then the ROSC rates might be higher in the ED. Again, it comes down to is the number of people the ED additionally saves higher than the number of people who die due to inadequate compressions/ventilations/defibrillated etc. while being transported. I don't know. 

As to triemal04, touché good sir. Touche.


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## Chewy20 (Mar 18, 2015)

MonkeyArrow said:


> @Chewy20 Is your head really stuck so far up... into the clouds that you think no one has ever survived an in-hopsital cardiac arrest or a transported cardiac arrest? Your little personal anecdote does absolutely nothing to further any side of this discussion, and yet, you call me out on being academic.


 
I see what you did there, clouds, ha! Anyways, nowhere did I mention no one ever surviving a code during transport, you said you have done it, and I am sure it has been done before. The only valid excuse I have seen so far to keep on transporting is from @DesertEMT66 and that's only because that's the only one that makes any sense so far even though it wasn't a serious statement. ( I think? Maybe not)



MonkeyArrow said:


> However, with properly trained providers, it is not futile either


 
Ok, so what is your advice for the 99% of strictly IFTers who have never seen a cardiac arrest before, and who have only ever practiced with a pt on stable ground while switching off rotations? Keep on driving while the basic in the back is about to lose his mind? Or pull over and let them hopefully fall back on the only scenario they have run in class while they wait for 911? If they cant fall back on that with two minds working together long enough for back up to get there, then they should have a card in the first place. Never mind I know which one you would choose. Stopping here so the thread can get back on topic. Have a good one.


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## CALEMT (Mar 18, 2015)

DrankTheKoolaid said:


> learn home medications



This. Remember Levothyroxine.


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## Muse (Mar 18, 2015)

When I worked for a company that only did IFT we had BLS and CCT units, as BLS we mainly did dialysis, transports to and from radiation treatment, transport to doctors appointments for patients that couldn't be transported by wheelchair van, psych patient transports, and discharged patients from the hospitol. But we also did "code 2" calls where we would pick a patient up from a skilled nursing facility and take them to the ER for some reason. On code 2 calls I had patients that where septic, had chest pain, shortness of breath and didn't respond to breathing treatments, stroke patients, hypo and hyperglycemic patients, patients that had fallen (mainly out of bed at skilled nursing facilities but some times at a private residence). I also some times transported patients from an ER at one hospital to ICU at another as BLS or ER to ER and so on. On CCT we worked with a nurse and we would transport patients from one hospital to another for higher level of care some sometimes just to get the patient in a hospital closer to their home/family. Doing CCT the patients where sicker then BLS but generally these patients where transported CCT for the possible need for ALS/CCT care so the EMTs mainly just drove, moved the gurney around, moved the patient to and from the gurney, put the patient on the cardiac monitor and assisted the nurse with any other care the patient needed, but it was not unheard of working CCT to transport a patient or respond to a hospital lights and sirens and EMTs on occasion did CPR, suctioned, used the BVM and did other skills that an EMT or paramedic would do working 911.

I now work for a different company in the same area and we do IFT and 911 but the company will never dispatch a BLS unit under normal circumstances to take a patient to the ER so just know that what you many get to do and see will be based on the company you work for and county that you work in. 

**You can learn a lot working IFT if you want to learn. Working IFT you can learn what medications patients typically get prescribed and why. All you have to do is want to, when you are documenting a patients medication list you can ask the nurse and sometimes the patient why they are receiving the medication and you can google medications and medical conditions after the call. And you can see first had some of the pathophysiology of the medical conditions so that when in comes time on a "code 2" or 911 call to try and figure out what is happening to your patient you maybe able to go "I saw this before, this could be happening to cause the patients signs and symptoms" and have an idea as to appropriate treatment.


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## DesertMedic66 (Mar 18, 2015)

Chewy20 said:


> I see what you did there, clouds, ha! Anyways, nowhere did I mention no one ever surviving a code during transport, you said you have done it, and I am sure it has been done before. The only valid excuse I have seen so far to keep on transporting is from @DesertEMT66 and that's only because that's the only one that makes any sense so far even though it wasn't a serious statement. ( I think? Maybe not)
> 
> 
> 
> Ok, so what is your advice for the 99% of strictly IFTers who have never seen a cardiac arrest before, and who have only ever practiced with a pt on stable ground while switching off rotations? Keep on driving while the basic in the back is about to lose his mind? Or pull over and let them hopefully fall back on the only scenario they have run in class while they wait for 911? If they cant fall back on that with two minds working together long enough for back up to get there, then they should have a card in the first place. Never mind I know which one you would choose. Stopping here so the thread can get back on topic. Have a good one.


My statements were serious.


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