# 11 back from flat line....



## akflightmedic (Mar 27, 2019)

Poorly written article or exceptionally lucky patients under this skilled clinician?

"Austin Pugh, a six-year firefighter and paramedic, has brought 11 people back from a flat line, an “incredible” record, according to his peers..."









						Colo. paramedic known for bringing people 'back from the dead'
					

Austin Pugh, a six-year firefighter and paramedic, has brought 11 people back from a flat line, an “incredible” record, according to his peers




					www.ems1.com


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## Gurby (Mar 27, 2019)

All respect to Austin, I'm sure he's a great medic.  It's too bad EMS1 didn't hire him to proof-read this article...



> has brought 11 people back from a flat line



😭



> Nationally, the likelihood of surviving a heart attack with little to no neurological damage is 12 percent



😭



> For comparison, the department treated 134 cardiac arrests in the last five months of 2018, of which 9 patients were successfully resuscitated.
> 
> ...
> 
> In Colorado Springs, the success rate is about 20 percent, Mark Warth, the fire department’s medical program coordinator, said.



9/134 = 6.7% 🤔


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## Peak (Mar 28, 2019)

I just can't follow the article. He got ROSC 11 times in 6 years? Or good neuro outcomes? Or was it in the last five months? ROSC 11 times in 6 years, I don't mean to be a jerk but I don't find that to actually be impressive.


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## Tigger (Mar 29, 2019)

Supposedly he got ROSC on 11 patients in six months, or at least that's what was said at the award presentation as I vomited in my mouth.


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## DrParasite (Mar 29, 2019)

Tigger said:


> Supposedly he got ROSC on 11 patients in six months, or at least that's what was said at the award presentation as I vomited in my mouth.


What's with the hate?  11 ROSC in 6 months is a good thing, I know medics that haven't had 1 rosc in over 6 months.  Even the article says as a department, they got ROSC 9 times out of 134 over a 5 month span.  He wasn't boasting about it, it seemed to be something his department was making a bigger deal out of.

You might not want any recognition for doing your job, but good PR is good PR.  maybe he just got lucky, maybe his patient's weren't old with several co-morbilities, or maybe he really is a supermedic who knew what needed to be done at just the right time, and was able to do it.  I honestly don't know, and I'm pretty sure if those 11 people were able to walk out of the hospital they don't care.

Many people say EMS doesn't get the recognition for what it does, nor does it get the funding, at least not compared to the other big 2 in public safety.  and EMS is often treated as the lowest level in heathcare... maybe if we actually promote ourselves when good things happen that can change?


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## Tigger (Mar 29, 2019)

DrParasite said:


> What's with the hate?  11 ROSC in 6 months is a good thing, I know medics that haven't had 1 rosc in over 6 months.  Even the article says as a department, they got ROSC 9 times out of 134 over a 5 month span.  He wasn't boasting about it, it seemed to be something his department was making a bigger deal out of.
> 
> You might not want any recognition for doing your job, but good PR is good PR.  maybe he just got lucky, maybe his patient's weren't old with several co-morbilities, or maybe he really is a supermedic who knew what needed to be done at just the right time, and was able to do it.  I honestly don't know, and I'm pretty sure if those 11 people were able to walk out of the hospital they don't care.
> 
> Many people say EMS doesn't get the recognition for what it does, nor does it get the funding, at least not compared to the other big 2 in public safety.  and EMS is often treated as the lowest level in heathcare... maybe if we actually promote ourselves when good things happen that can change?


I've actually worked as a PIO for several years, I understand and produce similar content. EMS has an image problem and one of my personal goals is to overcome that.

What sucks is being at a mandatory system paramedic training and watching numerous fire department paramedics get recognition for their work while every AMR paramedic was left to sit there. It's a team thing. Every single one of those ROSC patients was transported by ambulance yet the FD treats us like their slaves. They refuse to recognize our contribution to the system (you know, because on average they arrive 200 seconds before us), and come out and publicly state that since they are FD members that they are worth 80k a year while "private ambulance paramedics are worth the market rate." So yes, I sat there in the conference room, pissed as I watched them do their awards ceremony while we sat there. Forgive me.


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## E tank (Mar 29, 2019)

Tigger said:


> I've actually worked as a PIO for several years, I understand and produce similar content. EMS has an image problem and one of my personal goals is to overcome that.
> 
> What sucks is being at a mandatory system paramedic training and watching numerous fire department paramedics get recognition for their work while every AMR paramedic was left to sit there. It's a team thing. Every single one of those ROSC patients was transported by ambulance yet the FD treats us like their slaves. They refuse to recognize our contribution to the system (you know, because on average they arrive 200 seconds before us), and come out and publicly state that since they are FD members that they are worth 80k a year while "private ambulance paramedics are worth the market rate." So yes, I sat there in the conference room, pissed as I watched them do their awards ceremony while we sat there. Forgive me.



At the higher echelons of medical care there are no award ceremonies. You can walk on water for 20 years and the first and maybe only time you stumble and fall, the yappy junk yard dogs will never let you forget it. Be content with anonymity as the glory hounds get their few minutes of fame. The fall can be brutal.


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## Peak (Mar 29, 2019)

DrParasite said:


> What's with the hate?  11 ROSC in 6 months is a good thing, I know medics that haven't had 1 rosc in over 6 months.  Even the article says as a department, they got ROSC 9 times out of 134 over a 5 month span.  He wasn't boasting about it, it seemed to be something his department was making a bigger deal out of.
> 
> You might not want any recognition for doing your job, but good PR is good PR.  maybe he just got lucky, maybe his patient's weren't old with several co-morbilities, or maybe he really is a supermedic who knew what needed to be done at just the right time, and was able to do it.  I honestly don't know, and I'm pretty sure if those 11 people were able to walk out of the hospital they don't care.



Meh, I've had 4 codes in the past month and they all have had good outcomes so far. I've also had codes that were run picture perfect but the patient had a poor outcome, that doesn't mean that EMS or hospital staff did a poor job nor does having ROSC several times make you a 'life-saver' or 'the best paramedic...'. In fact I can think of many fire medics in that department who are far better in their practice. I've also gone many months without any codes or when they all had poor outcomes, the timing is largely anecdotal.

I left the area long ago, but even back then their was talk about merging the medical direction and protocols for AMR and city fire. My observations are completely as an outsider as I never worked for either group, but it seemed that all that happened is that AMR's protocols got shrunk down and moved closer to fire's which were far less progressive. They also started pushing their pit crew thing, which has many great qualities to it, but also just kind of turns codes into cook book medicine.



DrParasite said:


> Many people say EMS doesn't get the recognition for what it does, nor does it get the funding, at least not compared to the other big 2 in public safety.  and EMS is often treated as the lowest level in heathcare... maybe if we actually promote ourselves when good things happen that can change?



That is exactly what this is though. The fire medic got the glory, AMR didn't even get a mention. Not to mention the engine officer who managed the scene, the other firefighters who did CPR or started IVs, or the procedures/management done by the AMR medics and EMTs. It doesn't even promote how pit crew or whatever helped them, it is literally one guy on a pedestal.


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## CCCSD (Mar 29, 2019)

Well...he DID thank all the Little People...


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## DragonClaw (Mar 31, 2019)

Maybe I'm going to catch flack from this, and I can have a hard time explaining my process or thoughts, I'm still new to this,  and I have a habit  tangenting,  but here I go. 

If you save even one person,  I think that makes it worth it.  Giving someone extra time is something you can't put a value on. Not sure how long all the patients lived after, but even a small amount of time is no small feat. 

Maybe his track record isn't as impressive as yours or even to everyone else's for his job,  or he didn't thank enough people.  But I agree,  many EMS are treated like less than important.  Any good PR for one of us is good for all of us (as previously mentioned).  Same goes for bad.  I'm sure we've all seen _that _video from last week or so. 

Yes,  I'm only a student and "I've been doing X longer than you've been alive" is something I've heard because of my age, but we can become dulled or calloused to things we've heard,  done,  or said many times and I think it's good to step back and remember why we're here. (I'm not saying all experienced EMTs are senile pine cones)

The outside world will never understand what all it takes to save a life.  So why expect them to? 

I had an interview as a falconer,  and they refused to let me even see the article until it was printed, and even with my careful selection of words,  they still misquoted me,  put incorrect information,  even got my bird's name wrong as well as the species. We've got no idea what was actually said versus what the story ran. 

Growing up,  I never saw some sports player as very cool,  I never thought being famous was worth it, I didn't think being a radio singer (the kind everyone knows) was what made you awesome.   Someone makes clothes and a single item costs hundreds because of the letters on the side.  Okay,  sure, you're skilled like that.  But,  not really a priority to me.

I read history books and the news  about soldiers in battle who risked everything to defend their lands or fellow solders, many of them dying for it.

Police officers going out every day, knowing they're likely to encounter someone who will try to kill them (eventually). But they put that vest on and saddle up anyway. 

Firefighters who rush into burning houses because someone got stuck inside,  the ones that go out to fight the big wildfires, even though it can be extremely dangerous or unpredictable. 

EMTs/Paramedics that spend countless hours leaning valuable and underrated skills,  to work long shifts so when a voice calls out,  you answer. 

Lay people who see a disaster,  an emergency,  and respond,  instead of taking videos and yelling "Someone should help them". That angers me.  I feel like yelling back "You!". 

Doctors, nurses and other medical staff,  many go to school for years so they can be pointed at,  that they don't want to cure people because they'd lose money.  But they help anyway. 

Those and many more people I can't count. Search and rescue and all of that.

I was to young to remember the 9/11,  but I still get angry and upset,  all of the chaos,  the tragedy,  the sorrow and pain.  Entire fire companies gone, those who rushed in after the first tower feel,  only for the second one to.  A terrible day. 

Seeing people's last words, their last moments, or hearing the audio... that's something else. Pictures of people jumping from a burning building,  the shock when they learned it  was not a small plane,  that moment when America stood still for a time. 

Yet with all of that,  people saw and they came. Many of them did not return. They had wives and husband,  brothers and sisters,  mothers and fathers,  boyfriends and girlfriend,  best friends, every reason to say "I can't do that,  that's too dangerous and I could die" but they didn't. 

But those were my heroes. Some guy can run across a field really fast,  and the crowd goes wild.  You answer a call to a 3 car MVC at 3 AM and people forget you exist. Someone makes a video about "Cash me outside" or whatever,  and they're rich, have a show.  You show up _when called _and people are angry at you.  Politicians life,  crowds cheer.  People will be angry at what you did, even if they did nothing, or only made things worse. 

People can be quick to forget what's really important.  

No, I'm not saying nobody is ever grateful or happy for what you've done, the time and money you've spent to master your skills and equipment, that you're pariahs or "lepers". Because the public general has a good impression of first responders. 

Those people are my heroes.  Volunteer or career.  You don the uniform and go out to help those who need it. Maybe of them,  unsung heroes.  It just feels more like a Batman treatment than Spider-Man.  

Fire departments make more for doing similar care for patients, so it's even more important to show value in what we do.  From what I understand,  there's a shortage of medical staff,  including EMTs/medics. Hopefully that's properly recognised and pay and other things are taken more seriously. 

 I don't think it's bad they're paid a decent wage,  I'm happy they don't have to continually fight for that. But , I get what you're saying, that we shouldn't have to either.  But I think that gives us another leg to stand on.  

Even though they didn't give a detailed list of the whole process and every person involved, we know there's more to it than that.  

Is that wrong? Skewed? Biased? Maybe.  Is it bad? I don't think so.

But I guarantee you,  someone, some kid  somewhere is reading that headline or article and thinking "That guy's a real hero,  that who I want to be some day"


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## akflightmedic (Mar 31, 2019)

Emotions are great. Then there are facts. There is evidence based medicine. There are likely and unlikely outcomes.

The intent of this was to sort the objective from the subjective. Blasting the warm and fuzzies does nothing overall for what is being discussed. Thank you for sharing.


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## mgr22 (Mar 31, 2019)

DragonClaw, here are some aspects of that article I think are worth further consideration:

1. Inaccuracy -- e.g., "the likelihood of surviving a heart attack with little to no neurological damage is 12 percent." If that were the case, there'd be an awful lot of cath labs with some 'splainin' to do.

2. "Bringing people back from the dead" #1: Are we talking about survival to discharge with quality of life, or just ROSC? I'm not saying the latter has no value, but I think we have to recognize the medical, financial, and social differences in those two outcomes.

3. "Bringing people back from the dead" #2: How would you like to be known as the person who does that? I wouldn't. Imagine the expectations.

You mentioned heroes several times. Each of us gets to decide what we think is heroic. To me, heroism involves risking one's own life to save another. Most of us do that never or hardly ever in EMS. That's not a knock on what we do; it's just being realistic and honoring the truly heroic among us.


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## VentMonkey (Mar 31, 2019)

@DragonClaw also re-read @mgr22 and @akflightmedic's replies above mine. Here's some food for thought from a paramedic who indirectly got involved with EMS as a direct result of 9/11 (I initially wanted to be a firefighter)~

My daughters think what I do for a living is "cool", however, I would much rather they viewed me as a hero for acts as a selfless parent than anything regarding what it is I do for a living. The most important role my job plays in my family's life is that it helps put food on our table, and provides a better opportunity for them than this career itself.

I think that you have good intentions, but you might be setting yourself up for a quick exit out of this field should some of your view points not mature once you're an actual provider. Callousness can be a form of growth. Some form of burnout is normal and inevitable; not having any outlet/s or seeking help is not.

There's nothing wrong with being curious, open-hearted, etc. But like others have already suggested, go out and do the actual job for a while first. Ask providers that you will eventually work with questions on topics that you see on here. Some providers will be better than others at their jobs, but again, that goes for any line of work in general. It's the type of provider (i.e., worker) that _you_ want to be that makes you stand out, even if it's (admirably) for nothing more than self-gratification.

RE: the article? Meh, I didn't even bother to read it because well, quite frankly I've grown less drawn to spectacle in my career. It's made me a happier provider for it as well.

Nobody's discouraging your inquiries, but think of it this way: we could ask you tons of questions regarding falconery until we're blue in the face, but until we have the firsthand knowledge and experience to share and form our own opinions on it, what good are we really doing ourselves?

Most of the providers on this forum are also more of the exception than the rule, so keep this in mind as well.


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## DragonClaw (Mar 31, 2019)

mgr22 said:


> DragonClaw, here are some aspects of that article I think are worth further consideration:
> 
> 1. Inaccuracy -- e.g., "the likelihood of surviving a heart attack with little to no neurological damage is 12 percent." If that were the case, there'd be an awful lot of cath labs with some 'splainin' to do.
> 
> ...



Oh, I'm not against facts by any mean. I'm just taking a different look at the same article.

And yes, heroic things mean different things to different people. At the least, going out to help strangers, even with minimal danger to yourself, if still something honorable to do.

I'm not always warm and fluffy, believe me. For some reason coworkers call me heartless, or cruel. I don't really get wine, I would take a bullet for any one of them. That araside.

And yes,  just being resuscitated often times isn't enough.  Some people are concerned they'll be vegetative or otherwise permanently impaired.  So,  we follow DNC orders. 

I wish I has stats on how many people were revived vs outcome,  that would be interesting.  I've seen conflicting information on this,  so if anyone's got reputable sources,  I'd love to see.

And ventmonkey, I know this. I'm still pretty green to all of this,  and experience should sharpen the lens I look through. 

I no I'm young, that I've got all kinds of Notions that may or may not be true, or aren't to the degree that I thought. Then I'm probably some sort of meme right now. That being said, I will probably be interested in looking back on this in a few years and comparing notes.

And I definitely understand about having bills to pay, that's one reason why I'm glad that the firefighters don't have fight over that. And I'm not against getting paid, though if I could afford it, I would volunteer. But I can't.

Online, they called me the man of a thousand questions. I probably think, then overthink just about everything. I have a lot of questions, a lot of scenarios, just a lot I want to know and learn.

I know I'm barely dabbling a toe in the ocean. I apologize for sounding like I'm on a high horse, or if I know it all.

Be honest, do I sound like a nightmare EMT, or somebody who's got the markings of one? I just hope that my heart is in the right place. I can learn the rest.


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## akflightmedic (Mar 31, 2019)

Aside from some unique special situations in my past, I would never "take a bullet for a coworker"...I intend to go home every day and live out my years enjoying life and my family. If I have opportunity to recognize a harmful situation before it happens and I can safely alert my coworker, then I will do so. If I can safely extract them post incident without harming myself, I will do so...otherwise, I lost the hero mentality a very long time ago. 

Having said that, you sound intelligent, are asking the right questions and have good intentions for the profession. Pursue EMT and see what comes from it, stay here, stay in touch with us and share with the old farts and the padiwans. 

Just remember, heroes go home in a box and life savers are a candy.


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## DragonClaw (Mar 31, 2019)

I'm not saying that everyone has to even want to take a bullet for somebody, because I certainly don't want to get shot. The same way that I never want to have to shoot anybody. I'd rather the situation be able to be handled without an escalation to such violence. Then everybody can go home, and nobody in a box. I'm just saying,  I would. Or, I think I would. 

I will do so.  I just one of my biggest fears, is thinking that I know what to do, but then when it comes down to it, I don't. And that can cause somebody their life, or something to that effect. Even if I'm not in a situation to be able to fix things, I should at least be able to not make it worse. I think, starting out, I would just have to refer to and trust the experiences of those who came before me. I'll always have my own opinions, I'm very much like that, but I'd be stupid to ignore the lifetime of work that other people have put in.

I'm that kind of person who always wants to be the best, my shop teacher would tell all the other kids to strive for perfection, he would tell me, beg me to stop my project because it was already "Good Enough". 

I just didn't like seeing things with my name on them be called finished when I didn't think it was good enough. The work of your own craftsmanship should have some quality to it, you know? 

And I'm not saying that in a professional way to say that I'm better than somebody else, but especially when you deal with potential emergencies, I just think I rather be on a team where everybody's trying their best.  

When I post a question, a lot of the times I'll just honestly watch the conversation and see where that goes. My question will probably have already been answered oh, but I do like to see how you interact with one another when you've all been doing this longer than I have.


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## Peak (Mar 31, 2019)

DragonClaw said:


> Doctors, nurses and other medical staff,  many go to school for years so they can be pointed at,  that they don't want to cure people because they'd lose money.  But they help anyway.



What?



DragonClaw said:


> I was to young to remember the 9/11,  but I still get angry and upset,  all of the chaos,  the tragedy,  the sorrow and pain.  Entire fire companies gone, those who rushed in after the first tower feel,  only for the second one to.  A terrible day.



And now I feel old.



DragonClaw said:


> Fire departments make more for doing similar care for patients, so it's even more important to show value in what we do.  From what I understand,  there's a shortage of medical staff,  including EMTs/medics. Hopefully that's properly recognised and pay and other things are taken more seriously.



There is very little actual shortage in the healthcare field, certainly not with EMTs. There is a fair bit of shortage in certain areas or specialities (be it rural medics, family practice, experienced nurses who don't jump ship for management or advanced practice), but not overall. 



DragonClaw said:


> But I guarantee you,  someone, some kid  somewhere is reading that headline or article and thinking "That guy's a real hero,  that who I want to be some day"



I hope not. That is all a pony show, and not really where the care actually matters. I hope that kids are inspired by the police officer who helped them find their parent when they were lost, the social worker who found a way for her to play softball when her parents couldn't afford the cost, the nurse who held their hand and calmed them down as they went to surgery, and the medic who reassured them that their life wasn't over as they were carried off the field after an injury. Those are real moments that make a huge difference. Working grandma who has end-stage gastric cancer but the family won't let her go is a waste, and getting ROSC for a short bit isn't something to celebrate. Most codes will have poor outcomes not because of how they were worked, but the massive disease process that typically causes a patient to die.



DragonClaw said:


> For some reason coworkers ... I would take a bullet for any one of them.



No, just don't. I wouldn't "take a bullet" for any of my coworkers past or present. Thats not to say that I won't do something with risk to help them out, but my life is worth more than theirs to me. 



DragonClaw said:


> I wish I has stats on how many people were revived vs outcome,  that would be interesting.  I've seen conflicting information on this,  so if anyone's got reputable sources,  I'd love to see.



This could be  a great way for you to learn how to research, but sufice to say that outcomes for the vast majority of outside of hospital cardiac arrest are very poor.


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## mgr22 (Mar 31, 2019)

DragonClaw said:


> And yes, heroic things mean different things to different people. At the least, going out to help strangers, even with minimal danger to yourself, if still something honorable to do.
> 
> I wish I has stats on how many people were revived vs outcome,  that would be interesting.  I've seen conflicting information on this,  so if anyone's got reputable sources,  I'd love to see.
> 
> ...



DragonClaw, I chopped up your post a bit to make it easier to reply:

I agree, helping others is honorable. It's also a worthy goal almost every day in EMS.

There are plenty of stats out there regarding cardiac arrest outcomes. I know that because I just Googled "cardiac arrest outcomes."

Forgive me, this is kind of off-topic, but I can't help being curious: When they called you "the man of a thousand questions," did that bother you, as a woman?

No, you don't sound like a "nightmare EMT"; just a young, impressionable, confused one. Being kind-hearted is not usually enough to sustain a lengthy career in EMS. I'm telling you that not to discourage you, but to let you know that as you "learn the rest," you may not like much about "the rest." If you can try doing EMS before committing to it, you might be better off.


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## DragonClaw (Mar 31, 2019)

mgr22 said:


> DragonClaw, I chopped up your post a bit to make it easier to reply:
> 
> I agree, helping others is honorable. It's also a worthy goal almost every day in EMS.
> 
> ...



Well, a lot of people assume I am a guy. Not in person, but online people can be very quick to assume. I don't always advertise it. And no, it didn't bother me. They weren't trying to insult me, they were just making a humorous remark that I ask a lot of questions. If things like that bothered me, I don't think I have the strength to go outside.

And Peak, I'm not ignoring you, I'm just taking a moment to think about it. Sometimes I have to just sit there and kind of absorbent material, think about what that means and what sort of of implementation or ideas that would support or contrast.

I understand there's a lot that you just can't really know, and you kind of just have to do it to decide if that's something that your attuned to, something that you can live with. I imagine some calls you take pretty hard, they'll probably stick with you forever.

As with falconry, Simply Having a heart and loving birds or something like that is not sufficient. When you go out hunting, sometimes people don't like the sounds the animals make when they're caught, or the stress that happens if you lose a bird, or something like that. It's also not for everybody.

But would you agree that without a heart for it, there's not a way to be successful? Or do you find that there are plenty of EMTs that just do the job, No Love, No hate, just a punch in and punch out kind of thing? And they do just fine?

I've gone on a few ride-alongs, and it is a little different than what I imagined, but nothing that I couldn't expect. Like with anything that has any sort of TV show or something that's talked about, there's always quite a few misconceptions. People seem to have this idea that when we hunt with birds, it's always a falcon. Or that the bird will somehow fetch for us.

But at the same time, I knew I had been affected by things that I thought, my own ideas, things you see and shows and everything else, so I expected there to be differences. And so far, it's nothing that I don't think I can handle. It's probably more paperwork, and less lights and sirens, but I'm okay with that. One of my things come is that I am looking for some sort of purpose. I feel compelled to help people. So even if a job is work, it doesn't have to be something I hate.  You know?


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## DragonClaw (Mar 31, 2019)

On another note, I am young, so I'm not exactly the Fountain of wisdom. But, if I have failed to learn anything of value from my experiences, mistakes, or from other people than I think I failed the purpose of life. So I'll to some people it may seem that I may not be wise enough, or mature enough or something like that, know that I do take everything in and think on it.


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## CCCSD (Mar 31, 2019)

A Hero ain’t nothin but a Sandwich...


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## DragonClaw (Mar 31, 2019)

CCCSD said:


> A Hero ain’t nothin but a Sandwich...


What do you mean by that?


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## CCCSD (Mar 31, 2019)

Just what it said. In about 30 years, you’ll figure it out.


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## RocketMedic (Apr 1, 2019)

I am the King of the Impossible!


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## CCCSD (Apr 1, 2019)

I’m a Tactical Obturator...


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## wtferick (Apr 3, 2019)

All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.


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## DragonClaw (Apr 3, 2019)

wtferick said:


> All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.



So,  if you get called to grandma's house,  you'd prefer she have a DNR? (Not attacking you by any means,  collecting opinions)


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## wtferick (Apr 3, 2019)

DragonClaw said:


> So,  if you get called to grandma's house,  you'd prefer she have a DNR? (Not attacking you by any means,  collecting opinions)


Pretty much.


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## DragonClaw (Apr 3, 2019)

wtferick said:


> Pretty much.


 Did you always think that?


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## wtferick (Apr 3, 2019)

DragonClaw said:


> Did you always think that?


Of course not.


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## Tigger (Apr 3, 2019)

wtferick said:


> All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.


Maybe we just tone the salt back a little bit and remember that there are many patients that EMS can and do resuscitate and thanks to the work of the ED, ICU, and rest of the system, some of these patients do actually walk out of the hospital. I don't run my arrests with the assumption that they _all_ end up dead.


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## VentMonkey (Apr 3, 2019)

Tigger said:


> Maybe we just tone the salt back a little bit


Awww, but I don’t wanna...

All jokes aside, a number of years ago I ran an arrest with a very promising intern. It was an older gentleman who’s wife I’m convinced wasn’t completely aware of the gravity of the situation thanks in part to the FD coddling their words of “comfort” with her.

I’d asked both the FD and the patient’s wife several times about a DNR, but unfortunately his poor wife appeared so overwhelmed I don’t know that she had time to grasp the calls momentum, or the choices required to be made on her behalf at that moment. 

The call went well and the patient was bucking on the ETT by the time we offloaded with an adequate SPO2 and other signs of promising perfusion.

In the end, the family decided to discontinue efforts once more of them had gathered around his side for the vigil. 

When I later found this out, my admitted self-gratifying feelings alongside the pride I felt in my interns performance turned more melancholic.

So, it does happen- both the good and bad feels. And yes, patients of all ages can survive a cardiac arrest with a good neurological recovery. 

And I’m also going to bet most of the “salts” on this forum have brought at least 11 back from “flatline”...(inserts gag here). 

As far as their outcomes, we’ll never know most of them. Glory hounds aren’t just in the firehouses, they’re just typically more abundant there.


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## Peak (Apr 3, 2019)

wtferick said:


> All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.



I've had many field arrests who end up walking out of the hospital. 

In fact we very recently had a case where the patient left with no neurological deficits at all. The patient lived because when fire arrived they immediately started high quality CPR and used their AED to defibrilate him, the paramedic ambulance service intubated him and provided amazing respiratory support and transported him, the ED in less than an hour stabilized his ventilatory managment and corrected his acute electrolyte abnormality which likely precipitated the arrest before then admiting the the unit, and the ICU cooled him and recovered him. Without every peice of that puzzle the patient would likely not be alive let alone without deficits. 

I can recall many cases with similar outcomes because every part of the system worked together from precips to older adults. I've also had countless codes that either got called or the patient ended up having a subsequently poor outcome, and these are statistically in the majority but that doesn't discount those who we've saved.


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## VentMonkey (Apr 3, 2019)

Peak said:


> The patient lived because when fire arrived they immediately started high quality CPR and used their AED to defibrilate him, the paramedic ambulance service intubated him and provided amazing respiratory support and transported him, the ED in less than an hour stabilized his ventilatory managment and corrected his acute electrolyte abnormality which likely precipitated the arrest before then admiting the the unit, and the ICU cooled him and recovered him.


I don’t care how long any provider has been doing this, the calls that flow like this would make anyone of us feel good inside. 

It’s also an excellent example of the team concept. Even if most of the players never receive credit for their role, it’s a feeling that’s kept many people (including myself) around long enough to call it a career.


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## E tank (Apr 6, 2019)

Peak said:


> ...... and corrected his acute electrolyte abnormality which likely precipitated the arrest before then admiting the the unit, and the ICU cooled him and recovered him. Without every peice of that puzzle the patient would likely not be alive let alone without deficits...



So, this certainly speaks to the reality that not all arrests are the same. A vasculopath with CAD arresting either directly or indirectly 2/2 those problems is not the same guy as the one with frogged up electrolytes because of whatever reason. I'm not sure that whatever 'neuro deficits' occur, don't occur in the ICU after successful resus because of cardiac function and attendant perfusion that has progressively declined in the period after admission to the hospital.


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## StCEMT (Apr 7, 2019)

wtferick said:


> All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.


That's a pretty big generalization to make. My first solo arrest as a medic was a 91 year old male. He was awake and looking around before we had him on the stretcher since he had CPR by fire immediately. I've had other instances of people 60+ leaving the hospital with no neuro deficits. 

I admittedly am quick to pull the trigger to cease resus on unwitnessed arrests with a laundry list of issues, but just because it's someone older doesn't mean good outcomes almost never happen. Hell, my grandma is 75, still works full time, takes my sister's to school a lot, and constantly insists on making sure I'm well fed. She isn't taking tons of meds or in poor health like what we see a lot. There are still plenty of people in the 60+ category that are good people to get ROSC on, but it's the people that don't take care of themselves we see most often.


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## wtferick (Apr 8, 2019)

StCEMT said:


> That's a pretty big generalization to make. My first solo arrest as a medic was a 91 year old male. He was awake and looking around before we had him on the stretcher since he had CPR by fire immediately. I've had other instances of people 60+ leaving the hospital with no neuro deficits.
> 
> I admittedly am quick to pull the trigger to cease resus on unwitnessed arrests with a laundry list of issues, but just because it's someone older doesn't mean good outcomes almost never happen. Hell, my grandma is 75, still works full time, takes my sister's to school a lot, and constantly insists on making sure I'm well fed. She isn't taking tons of meds or in poor health like what we see a lot. There are still plenty of people in the 60+ category that are good people to get ROSC on, but it's the people that don't take care of themselves we see most often.


First Full Arrest was a 17 year old at the High School. Called at the ED. Recently had a 19 year old brought in by friends, with the patient being called at the ED as well. We all have a different point of view on this subject matter.


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