# AED use in a moving ambulance



## BrushBunny91 (Nov 4, 2011)

Brady emergency care 12th edition states
*An AED cannot analyze a rhythm accurately in a moving vehicle. You must completely stop the vehicle in order to analyze the rhythm if more shocks are ordered.*
Our instructor eventually threw a question relating to this because he thought that you should never stop a ambulance with a cardiac arrest patient in this situation.
I wish to know what does the emtlife community think about the passage.


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## DV_EMT (Nov 4, 2011)

Somehow, I think that it may be reffering to electrode interference with movement. This is commonly seen when I monitor telemetry at the hospital when patients move around and their leads get jiggled. That being said, I think perhaps that movement of the ambulance could cause a slight interference if a patient is in an Idioventricular rhythm, Asystole, or other non rapid rhythms.

Anyone else?


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## JPINFV (Nov 4, 2011)

I don't think that cardiac arrests should ever find themselves in an ambulance to begin with. CPR and defibrillation works. Unlike wine, cardiac arrests don't get better with age.


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## BrushBunny91 (Nov 4, 2011)

The point made just before the one in my last post says *if you have delivered three shocks (a rare occurrence) and you have no ALS backup, prepare the patient for transpor. You may deliver additional shocks at the scene or en route if local medical direction approves.*


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## Chief Complaint (Nov 4, 2011)

If all that you have is an AED at your disposal, then yes, unfortunately pulling over is the only way for it to recognize the rythm.

Its sounds stupid, and it is, but an AED cant function under the same sort of jarring movement that a Lifepak can.  We get salty about too much artifact in our strip, the AED just doesnt analyze if there is enough artifact.

Your locol protocols will provide the ultimate answer, but most of the ones ive seen call for the truck to pull over.


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## Tigger (Nov 4, 2011)

BrushBunny91 said:


> The point made just before the one in my last post says *if you have delivered three shocks (a rare occurrence) and you have no ALS backup, prepare the patient for transpor. You may deliver additional shocks at the scene or en route if local medical direction approves.*



I should hope local medical direction approves. CPR quality in a moving ambulance (especially a quickly moving one) is going to be very poor at best, ditto for the BVM, since one provider is going to have to both. It's a crappy situation that I hope to never end up in. If it does happen, and the arrest occurs on scene, I think we are staying until ALS comes, even if they are going to be a bit. Realistically, where I am even if every ALS unit in the city is tied up, a truck will free up for a page of CPR in progress pretty quick. If it doesn't I trust my company enough to swallow its pride and get another companies ALS truck to me, please.


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## Handsome Robb (Nov 4, 2011)

If defibrillation is indicated, it should be delivered. Doesn't matter how many defibs have administered prior to it.

They want you to stop due to the artifact possibly caused by bumps while moving. Theoretically the AED might see vfib when it is only artifact. I don't have any experience with moving ambulances and AEDs, we only use manual mode on the monitor.


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## BrushBunny91 (Nov 4, 2011)

All 5 of my skills instructors also agreed that they would never pullover and continue transport.


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## Handsome Robb (Nov 4, 2011)

BrushBunny91 said:


> All 5 of my skills instructors also agreed that they would never pullover and continue transport.



For testing purposes you should stop. 

In the field its going to be dependent on the agency's protocols.


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## Aprz (Nov 4, 2011)

Skill instructors aren't always the most wisest and honest either. I helped at a local EMT program, and some of the skill instructors are Paramedics who have never worked in an ambulance before, forgot how to interpret 12-leads, etc. One of them who can't interpret 12-leads says it's a complete waste and Paramedics shouldn't even bother with it/they should take it off all the rigs - he's a fire/medic and one of the lead instructor of the program. Another Paramedic measured the NPA way off... not even close. I am very lenient with measuring the NPA, I really don't care if it's the jaw line, tragus of the ear, earlobe, guestimate it using their height, I can even see the deprecated pinky technique which I'd tell a student is deprecated, but this Paramedic straight up had students measure it from the earlobe, hold it vertical to the patient face, and I literally mean vertical like a 90 degree angle so it's not touching the patient's face, lower your whole body to the level of the NPA, and make it so when you are looking at the top, the top is touching the nose (not physically), kind of like the thumb trick for when there is a hazmat situation and y'know you're not far enough if you can't cover it with your thumb... you get an absurdly smaller NPA size... that was a Paramedic - I'm not saying from earlobe to the tip against the face, but it's away from the face in a very funky style if I described it well enough... almost like the aiming thing for a gun if you y'know what I mean. They'll make up calls they've been on; war stories. I've witnessed them spewing crap that isn't true either because they truly believe it's true, they don't know it, but want to fill in the gap anyhow to make it appear they are all knowing, and/or appear all knowing even if it means sticking with the wrong answer. They tell people a bunch of opinions all the times, not facts, but act like it is a fact. I attended two EMT programs at the same time, one as an actual student, and one I just attended with permission, and both programs claimed to be the best in the area, haha! Makes me realy wonder if they are the best in the area.  I hear EMT students and EMTs who talk about medics and say "he's one hellav of a medic" when the medic knows jack, but the EMT doesn't know better so they just keep telling everyone "So and so is one hellav a medic; he really knows his :censored::censored::censored::censored:". Thinking about all of this makes me sick... it's really sad. I've attempted my best to influence the programs just a little, and help EMT students, but it's hard to be convincing when you say absurd things like the bell on the stethoscope isn't for pediatric patients, but rather it's for low pitch sounds, and it's what the AHA recommends for taking a BP, or when you tell students about how oxygen isn't as benign as we are told, and when you don't know the answer, you tell them "I don't know", they'd rather go to the guy who claims to know the answer to everything, and say the things that everyone else parrots, "people say I'm a pretty good medic", "I do a pretty thorough assessment". Needless to say, I hardly waste my time helping there anymore.

Follow your agency's guidelines and protocols. Some protocols have a thing at the beginning saying to use sound judgement. The two things that work for cardiac arrest are CPR and defibrillation. ALS and getting them to the hospital hasn't shown to improve the outcome. Why hinder the two things that WORK for two things that DON'T WORK?


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## Handsome Robb (Nov 4, 2011)

Quick point Aprz - the bell is for low frequency/pitch sounds  

Also there was a study of diaphragm vs. bell for ascultating BP. Either side works just as well.

http://www.ncbi.nlm.nih.gov/pubmed/15716689

Back to regularly scheduled programming.


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## BrushBunny91 (Nov 4, 2011)

Hopefully you'll be a medic one day so you can set em straight


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## mycrofft (Nov 4, 2011)

*Go to the protocols first. Then think.*

"Think" as in "What variables are present the protocol writers could not anticipate?". Such as:
1. Distance/time to definitive care  plus since dispatch (yes, I know, hospitals don't cure heart attack victims, yada yada).
2. How rough IS the road?
3. Can you pull over, call for a rendezvous (more ALS, or at least a driver), get your driver in back with you and really do some CPR/BVM/AED action.


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## Nervegas (Nov 4, 2011)

I guess we are spoiled out in my neck of the woods since almost 100% of the transporting 911 here is fire based staffed with 2 paramedics. Medstar, Us, AMR and TLC are the only non-firebased 911 agencies and all of them are staffed with at least one medic. I can't think of any BLS 911 units that transport, except maybe AMR in collin county a few years back, but I believe that went to Medic/EMT. Anytime an AED is in play, it is either bystander or an Engine company that is using it on scene. 

IMO: Its better to just stop, let the AED do its thing, do good basic skills (CPR/BVM/ABC's) and get an ALS intercept, the only two justifiable reasons for transporting a code via BLS transport is A) you are literally right down the street from definitive care or B) You are in the middle of BFE and don't have the ability to get a timely ALS intercept or flight crew.


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## Aprz (Nov 4, 2011)

NVRob said:


> Quick point Aprz - the bell is for low frequency/pitch sounds





> but it's hard to be convincing when you say absurd things like the bell on the stethoscope isn't for pediatric patients, but rather it's for low pitch sounds, and it's what the AHA recommends for taking a BP


I am aware of that. ^^ I was saying (sarcastically when I say "absurd") that since everyone else uses the diaphgram and says the bell is for pediatric patients that people think I'm absurd/wrong when I say it's for low pitch sounds and not for pediatric patients. I also get odd looks from everyone when I use the bell for blood pressure.

My point with this was that you should take what your skill instructors say with a grain of salt. They might be filling in the gap, honestly believe what they are saying even if it's wrong, or straight up lie to you to appear all knowing. The lead instructor of our First Responder class (equivalent to NREMT EMR level) refused to give people a point when she marked everyone wrong who labeled the ulna as ulna and radius. She clearly got it mixed up and told everyone the radius was the ulna, and the ulna was the radius, and her excuse was that the one in the drawing was bigger and the bigger bone is always the radius regardless of where it is at. I've been around this program for about a year and a half.

Like I said, defibrillation and CPR have shown to work. ALS and getting them to the hospital hasn't. You should stay on scene, or if it happens on the ambulance, stop the ambulance, and do CPR and defibrillate. The hospital is gonna do the same thing as you, CPR and defibrillation, they'll be able to go through the ACLS algorithm, which would be pushing drugs, and those drugs haven't been shown to be effective for the end goal/result.


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## the_negro_puppy (Nov 4, 2011)

JPINFV said:


> I don't think that cardiac arrests should ever find themselves in an ambulance to begin with. CPR and defibrillation works. Unlike wine, cardiac arrests don't get better with age.



Some patients arrest en-route to hospital though?


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## WuLabsWuTecH (Nov 10, 2011)

When we're talking about an AED, is a Lifepack in "Advisory" mode the same thing as an AED?

We (EMT-B's) Are allowed to use lifepack's in Advisory mode and as such don't carry bystander style AEDs.  I've used a Lifepack in a moving vehicle in advisory mode before going down a pretty rough road and it still picked up the PEA/IVR fine.  (We had a medic with us so she confirmed my interpretation since I'm technically not allowed to interpret on the rigs).  But the lead coming from the patches was much clearer than the 12 leads we have going down the road.

Thoughts?


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## Sasha (Nov 10, 2011)

Wait I didn't think you were supposed to transport codes! D:


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## medicnick83 (Nov 17, 2011)

I wouldn't use a AED in a moving ambulance.


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## Handsome Robb (Nov 17, 2011)

medicnick83 said:


> I wouldn't use a AED in a moving ambulance.



Why? Not picking a fight just wondering your reasoning. On a bumpy road no way but like someone said on a smooth road does it really make a difference?


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## Aprz (Nov 17, 2011)

Gotta do CPR in between shocking. Would you be doing CPR in the ambulance too?


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## Handsome Robb (Nov 18, 2011)

Aprz said:


> Gotta do CPR in between shocking. Would you be doing CPR in the ambulance too?



If they went pulseless during transport, absolutely. If they are a traumatic arrest with penetrating trauma and we are within 10 mins of the TC they are getting packaged and transported unless they have injuries incompatible with life, per protocol. I can be seated and belted and do quality CPR in our units, only bummer is you aren't forward or rearward facing. We use the Philips qCPR puck on any patient who receives compressions so we know we are getting adequate depth, recoil and rate and if you aren't the monitor will yell and scream at you telling you what your doing wrong haha.


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## Tigger (Nov 18, 2011)

NVRob said:


> Why? Not picking a fight just wondering your reasoning. On a bumpy road no way but like someone said on a smooth road does it really make a difference?



The puck is one of the most disparaged but useful devices in an arrest, given how important compressions are. It's a shame they aren't on more/any AEDs as well.


Sent from my out of area communications device.


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## DV_EMT (Nov 18, 2011)

Tigger said:


> The puck is one of the most disparaged but useful devices in an arrest, given how important compressions are. It's a shame they aren't on more/any AEDs as well.
> 
> 
> Sent from my out of area communications device.



I heard that Phillips Heartstart FRx AED is supposed to calmly tell you what your doing wrong in order to calm the responder down and have them refocus on their training... which I think is pretty useful


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## Handsome Robb (Nov 19, 2011)

It is really calm actually haha Just annoying. "Push Harder" "Push a little deeper" "Slow down" "Speed up".

Usually it gets muted and you just tell whoever is pumping on the chest to keep the peaks of the waves between the two lines on the monitor and the number above 100.


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## DV_EMT (Nov 19, 2011)

NVRob said:


> It is really calm actually haha Just annoying. "Push Harder" "Push a little deeper" "Slow down" "Speed up".
> 
> Usually it gets muted and you just tell whoever is pumping on the chest to keep the peaks of the waves between the two lines on the monitor and the number above 100.



We need an AED with a Barry White voice telling you what you need to do... that'd be epic and I'd totally buy one if it was ever made


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## nyirishemt (Dec 5, 2011)

In my opinion its way more important to get the pt into the hospital where advanced care can be given, i would never EVER pull over on a code....


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## Angel21228 (Dec 27, 2011)

As I have experienced doing CPR and AED in the back of the Ambulance.  If you pull the Ambulance over while you are enroute with a Code you are delaying the treatment the pt could be receiving at the hospital.  While enroute to the hospital, you should not pull over to Shock the pt!!!!


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## WuLabsWuTecH (Dec 27, 2011)

Angel21228 said:


> As I have experienced doing CPR and AED in the back of the Ambulance.  If you pull the Ambulance over while you are enroute with a Code you are delaying the treatment the pt could be receiving at the hospital.  While enroute to the hospital, you should not pull over to Shock the pt!!!!



I have heard this from a few different sources though...

Once again, with our lifepack 12's there is no issue, even in advisory mode, at least I don't think, but I don't know about an AED...


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## Fish (Dec 28, 2011)

An AED and manual defib from a monitor are completely different. An AED will not properly analyze the rythm if in the back of a bumpy Ambulance with 2 freaked out Basics driving as fast as they can. However, on a monitor that a Medic uses, we can see the rythm and do not depend on letting it analyze since we are analyzing it ourselves.

In a pimary CARDIAC related arrest, your AED and high quality compressions are definitive care. Yes, ALS ambulances and Hospitals have meds. But so long as the code was Cardiac in nature, the best treatment is high quality CPR and early electricity (not waiting till the ambulnace finally comes to a stop at the hospital to shock with an AED.)

So, my answer. If you have a patient who complained of left sided chest pain and then coded while enroute. You can bet your bottom dollar this was most likely cardiac, have you driver pull over while you are doing some awesome compressions the driver puts on the AED while you are still doing compressions. Let it analyze then shock if needed. Then continue to hospital, if you need to pull over to let it properly analyze again then so be it. Proper AED usage is what the patient needs.


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## Medic Tim (Dec 28, 2011)

where I work we have to do a min of 5 cycles at scene. We use the Mrx with the qcpr data. they have found that in aed more or advisory mode it cannot properly analyse or if it does it will read the artifact as vfib or vtach. It is policy for us to use the aed mode. If we think we see something on the monitor worth shocking on the road we pull over and hit the analyse. on extended transports we stop half way.


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## WuLabsWuTecH (Dec 28, 2011)

Fish said:


> An AED and manual defib from a monitor are completely different. An AED will not properly analyze the rythm if in the back of a bumpy Ambulance with 2 freaked out Basics driving as fast as they can. However, on a monitor that a Medic uses, we can see the rythm and do not depend on letting it analyze since we are analyzing it ourselves.
> 
> In a pimary CARDIAC related arrest, your AED and high quality compressions are definitive care. Yes, ALS ambulances and Hospitals have meds. But so long as the code was Cardiac in nature, the best treatment is high quality CPR and early electricity (not waiting till the ambulnace finally comes to a stop at the hospital to shock with an AED.)
> 
> So, my answer. If you have a patient who complained of left sided chest pain and then coded while enroute. You can bet your bottom dollar this was most likely cardiac, have you driver pull over while you are doing some awesome compressions the driver puts on the AED while you are still doing compressions. Let it analyze then shock if needed. Then continue to hospital, if you need to pull over to let it properly analyze again then so be it. Proper AED usage is what the patient needs.



Are you considering a lifepack 12 in advisory mode as an AED or a Monitor?  Basics around here are allowed to use the LP12 in advisory mode.  The tracings we get from it are usually pretty good (I know how to interpret EKGs but I'm not technically allowed to do so in the field).  If we see a shockable rhythm, we can call medical control, fax over the ekg, and have them prescribe a "dosage" of shock.  It's simple enough, for us, turn the knob to the desired joulage, and hit the shock button.

The way were were taught in school is 3 tries with the AED (~3 cycles of cpr) and then load 'em and go.  In urban areas, we might pull over to shock up to twice more, but in a rural area, it's pointless.  If we stopped every 2 minutes, that 30 minute transport is now getting closer to an hour...


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## Fish (Dec 28, 2011)

I would say, if you can read the rythm yourself, then no need to stop. If you are dependent on an AED analyzing, well then it cannot properly do that while moving


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## WuLabsWuTecH (Dec 28, 2011)

Fish said:


> I would say, if you can read the rythm yourself, then no need to stop. If you are dependent on an AED analyzing, well then it cannot properly do that while moving


This is a grey area for me.  I can read the rhythm clear as day, but I'm not allowed to interpret.  I have no idea if the machine can interpret the rhythm I'm seeing (Yes, I have a degree in Biomedical Engineering, yes I have designed an ekg machine before, no, no computer is as good as a human reading it)


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## Fish (Dec 29, 2011)

WuLabsWuTecH said:


> This is a grey area for me.  I can read the rhythm clear as day, but I'm not allowed to interpret.  I have no idea if the machine can interpret the rhythm I'm seeing (Yes, I have a degree in Biomedical Engineering, yes I have designed an ekg machine before, no, no computer is as good as a human reading it)



I've had time to think, this questions answer is full of variables and what ifs. I would say if you have a ten minute transport, full over and shock. 30mins out? get driving! If your own a smooth road? why pull over, bumpy as crap and only 10mins out? pull over, etc etc etc


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## pertinente (Apr 26, 2012)

is it safe to use a manual aed in a moving ambulance?
i have experience in using aed in moving ambulance, the aed started "shock advised, shock advised" constantly, it was not a safe situation, then i turned off the aed for safety reasons, because one slight touch, the fall of the aed, the bump against the wall of the ambulance could trigger the shock button at anytime.

even going down the stairs with the victim is a tricky situation.

is this the right thing to do? 
should i risk all the trip hearing "shock advised"?
what is your experience?


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## RustyShackleford (Apr 26, 2012)

If you are receiving a "shock advised" prompt then you must have your pads on the patient unless you are using a funky monitor that I am unfamiliar with, if so then the patient is either in arrest or pre arrest therefore I would be hesitant to ignore a shock advised from an AED in this situation, I am unfamiliar with a machine giving a shock advised without an analysis with pads on, are you referring to a "check patient" prompt which you may receive regularly on rough roads.  I work in a more rural area so if my patient goes VSA during transport depending on the distance to the receiving facility I will pull over and run the arrest there with my EMT partners assistance and then either transport after a ROSC or a stabilization or TOR the patient if they meet the protocol either on scene or during an arrest during transport.  This will obviously vary depending on the area you work with and the road conditions, where I am the roads are atrocious and the call distances are long.


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## EMT91 (Apr 26, 2012)

We have the textbook Prehospital Care 9th Edition. According to it, you should stop the ambulance to use the AED because the movement of the ambulance might mimic V tach or V fib and thus shock when the heart is asystole or in another unshockable rhythm. I think it would depend on the timing as well, as during the circulation phase, (minute 4-10) the chances of having a shockable rhythm are rather low, from what I understand.


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## pertinente (Apr 26, 2012)

my concern is with my safety.

yes, the sticky pads are on the victim.
but the road movements influence the aed, and the "shock advise" reading cant never be real in movement,

my doubt is, 
what prevents me from the aed fall, or a road bump trigger the shock button during the shock advise alert?

i work regulary on street and i have experience that a sudden break of the ambulance can make aed fall and trigger the shock button,
a 5 minute trip to hospital, constantly breaking the ambulance to aed evaluation, can became a 30 minute trip.
all the time to move the victim in local and during transportation to hospital is enough to stop the cpr by exhaustion.

my safety isnt reason to turn off the aed in a moving ambulance?

my aed button as no protection, is wide open with a tissue/fiber protection.

a doctor has paddles that removes from lifepack only when needed and then stores again in lifepack,
the lifepack paddles doesnt go all the way atttached to the victim.

i think my doubt is stupid, but i have serious doubts in using a aed in movement, even if we can stop near the road,
imagine we are down a 5 floor building stairs moving the patient, isnt impossible the aed to fall? isnt impossible the oxygen bottle to fall? 
if the aed fall, cant it trigger the shock button, even if we are ignoring it?


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## Maine iac (Apr 26, 2012)

First thing should you be transporting a dead pt? Why not work them on scene and either call it or get ROSC and transport. But that is besides the point I suppose.

The biggest thing about an AED in a moving ambulance would be if the machine incorrectly interprets Vfib or Vtac because of the movement. But i'd argue how would it hurt the person if you shocked PEA/Asystole... they are already dead.

It has been shown that you can do compressions right through the defib without removing your hands, so I wouldn't be worried about being close to the pt.

If you are worried about the AED falling all over the place then secure it. Put it between the pt's legs, put it under the head of the cot, maybe tell the chap driving to slow down and not drive like a bat out of :censored:.

If you are worried about the O2 tank rolling down the stairs... well the pt managed to still be alive when you showed up so a few more minutes of no O2 probably won't kill him. Or.. you could get fire (or a helper) to carry it.


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## Handsome Robb (Apr 26, 2012)

Maine iac said:


> First thing should you be transporting a dead pt? Why not work them on scene and either call it or get ROSC and transport. But that is besides the point I suppose.



My guess is BLS service. Correct me if I'm wrong, we use all ALS so all codes get worked where they are and we don't transport unless it's a refractory rhythm or we get ROSC. I'm not super familiar with BLS agency protocols regarding arrests seeing as I have never worked in one. I do know that rapid transport is emphasized in pretty much all EMS even at the paramedic level in the current education system. 

My biggest worry about the AED when moving is an over-zealous provider immediately defibbing a patient as soon as they hear the AED say it without checking for a pulse first. The first thing that comes to mind is V-tach with pulses since the AED will see it as VT and can't analyze if it has pulses with it or not, that responsibility lies with the provider.


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## SoCal911 (Apr 27, 2012)

Ever grabbed AED pads, hit analyze and shook your fingers (with the pads on your finger)? Itll say shock advised... My guess is using the AED with the rig moving would have the same effect.


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## Handsome Robb (Apr 27, 2012)

SoCal911 said:


> Ever grabbed AED pads, hit analyze and shook your fingers (with the pads on your finger)? Itll say shock advised... My guess is using the AED with the rig moving would have the same effect.



Just like "white lead CPR".

Next time you're in class and put someone on the monitor tap the end of the white lead at the same pace you would be doing CPR and watch the monitor. h34r:


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## Aprz (Apr 27, 2012)

I actually haven't heard of it before. I wanna see.


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## Simusid (Apr 27, 2012)

Let me preface this reply by saying (so as not to start an argument) I'm not saying the guidance in textbooks that you should stop a moving vehicle is wrong, or that it AEDs can't improperly interpret artifact as v-fib or that you should do anything differently than your own personal clinical judgement dictates in a given situation.

Since for once, I am qualified to render an expert opinion in this forum, I'm going to do so    The question is, is it possible to design an algorithm that can distinguish road noise from v-fib and the answer is yes.  You may think the two look the same but in fact they are very different.  When you view a signal on the monitor you are viewing it in the time domain, which is a natural view for a human.   

For analysis, it is often more interesting to view a signal in the frequency domain.... this includes some fun or scary math (depending on your point of view) called a Fourier Transform (often just FFT).   Here is an example of the frequency response of some road noise:

http://binary-services.sciencedirect.com/content/image/1-s2.0-S1361920911001313-gr1.sml
(very small pic, you'll have to ctrl-+ to enlarge it)

and here is an example spectrum of v-fib
http://europace.oxfordjournals.org/content/early/2011/04/13/europace.eur105/F1.expansion.html

Note the spectra are very different and it's certainly possible to write very smart algorithms to distinguish the two.

Flawlessly?   Nope.   Implemented in every AED?   Probably not.   Treat the patient not the monitor?   Yup!


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## preggoeggo (Apr 30, 2012)

I haven't had to AED a pt yet, but I've heard that if the AED won't find a shockable rhythm, hit the rumble strip on the side of the road...Joke? I'm not so sure :unsure:


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## airborne2chairborne (May 1, 2012)

I think the time for transport is the deciding factor, the New England Journal of Medicine did a study in 2008 on defib time vs survival rate, until you hit the 4 minute mark there's very little change in survival rate (40% at 1 and 2 minutes, 35% at 3, and 25% at 4). 

cant post links yet (guess I need 5 posts)


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## pghboy2011 (May 4, 2012)

JPINFV said:


> I don't think that cardiac arrests should ever find themselves in an ambulance to begin with. CPR and defibrillation works. Unlike wine, cardiac arrests don't get better with age.



That's almost silly, you'll need to get that patient to the hospital as soon as it's safe to move them, it's not like you just get their heart going again, and wish them the best. With that being said, once you get them going, and in the ambulance, depending on what caused it, they will likely go back into cardiac arrest.


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## Medic Tim (May 4, 2012)

pghboy2011 said:


> That's almost silly, you'll need to get that patient to the hospital as soon as it's safe to move them, it's not like you just get their heart going again, and wish them the best. With that being said, once you get them going, and in the ambulance, depending on what caused it, they will likely go back into cardiac arrest.



I am pretty sure he means only transport if ROSC is achieved. Some services still wait an additional 10 min or so.


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## pghboy2011 (May 4, 2012)

Medic Tim said:


> I am pretty sure he means only transport if ROSC is achieved. Some services still wait an additional 10 min or so.



Never and Always aren't used in the medical field for a reason....is it possible to go back into cardiac arrest from ROSC? Of course...it's less likely, but it's possible, even with the 10 minute wait.


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## Medic Tim (May 4, 2012)

pghboy2011 said:


> Never and Always aren't used in the medical field for a reason....is it possible to go back into cardiac arrest from ROSC? Of course...it's less likely, but it's possible, even with the 10 minute wait.



there are always exceptions to the rule and times where you have to work with the hand you were given. that said 

 Unless you have an autopulse or something similar you are doing no favors to your pt. The pt stands the best chance getting worked on scene where cpr can be most effective and defibrillation can be prompt. It is also much safer for the crew.


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## RustyShackleford (May 4, 2012)

I don't transport dead patients, I don't work for the funeral home.


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