# I can't beleive this happened.....



## MikeRi24 (Jan 26, 2008)

I'm currently in a paid EMT-B training program, and I did a ride along today with an EMT-B and a Paramedic. although I have virtually no experience, my jaw was on the floor after I watched this unfold.

we get dispatched to a "elderly male with chest pains and shortness of breath." we get on scene, and the guy is in a chair, slumped over, unresponsive, and not looking so good. we hook him up to the monitor, and its clearly obvious thats we now have a full cardiac arrest on our hands. We shock him and start CPR, and in the middle of all this, we gather enough information for figure out that we are to take him to the local Veterans Affairs Hospital. Just so happens that the VA is LITERALLY less than 2 minutes away. we decide to "load and go." EMT-B drves, medic is in the back doing chest compressions and shocked him a second time, and i'm bagging. we get to the VA and as we are unloading, a nurse walks outside and demands to know whats going on. we give her the long and short of it, and she is like "well why didn't you call ahead? we had no idea you were brining this here, we heard the sirens from inside" so we explain to her that we were literally around the corner, and were doing what we needed to do to bring this guy back, sow e kinda didnt have time to call, and if we did by the time we got through and explained the situation, we would have been there anyway. Oh, and mind you we are now standing outside the ER doors, because this nurse won't let us in. 

So they finally let us in, and we get the guy on a bed, and we are STILL doing chest compressions and bagging. WE are working the guy in the ER by ourselves before the nurse comes back and tries to get information on him, and says they cant look at him until they know his info. the nurse tells us that they will take over and we are relieved. 

well, we basically watched the guy die, because the nurse made us stop resuscitating the guy, and no doctor or even another nurse came to look at the guy. the nurse then starts *****ing US out because she said we didnt start a line on him and didnt call ahead so they couldnt prepare. there was no one else in the ER, and we never saw anyone except for this nurse in the whole ED. so basically this guy died because they were lazy....


ok im done /rant


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## JPINFV (Jan 26, 2008)

and this is why there should be prehospital termination of resuscitation. Why transport when any medic worth their pay could have worked the patient on scene with 2 other providers doing compressions and ventilation?


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## MikeRi24 (Jan 26, 2008)

JPINFV said:


> and this is why there should be prehospital termination of resuscitation. Why transport when any medic worth their pay could have worked the patient on scene with 2 other providers doing compressions and ventilation?



we were, and dont get me wrong, we would have worked the patient more on scene, but since we were SOOOO close to the ED, we decided we might as well transport and get them somewhere thats better equipped then we were.


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## triemal04 (Jan 26, 2008)

Wow.  You're right.  I can't believe that either.  Why would you decide to transport someone to the ER instead of working the code on scene?  I don't give a rat's a$$ how close the ER is, the care given will be the same.  (sometimes may even be better in the field)  Add in that good, sustained compressions make a huge difference in patient outcome, and it's rather difficult to perform them satisfactorily while loading someone and then while in transport, and I have to ask...why?

Sorry.  I know this wasn't your call and you aren't in a position to make those type of decisions, so nothing personall.  But, at least take something away from this, even if it is an understanding of what should NOT be done.

1.  2 minutes of CPR BEFORE defibrillation, unless it's a witnessed arrest.
2.  ACLS is ACLS, in or out of a hospital.  Unless you're a BLS (or piss poor service) then the hospital isn't "better equipped" for the intial stages of a code.
3.  Good CPR is extremely important, especially in the initial 8-15 minutes of a code.
4.  Not notifiying the hospital...when coming in with a code...that's just plain stupid.  And lazy.  And stupid.  Tends to annoy the people in the ER.

Live and learn.


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## Ridryder911 (Jan 26, 2008)

Sorry, but I have read this story before in another EMS forum a while back, unless it is an ironic re-current identical situation. 

Personally, I can't believe that an EMT misspelled believe twice..... 

Also, V.A. are a government private hospital and do NOT have to allow just anyone to be entered. They ARE exempt from EMTALA, COBRA, etc... 
If you are with a Paramedic unit, why did they not pursue the medical care they were supposed to. 

Why do you say they are "more prepared and better equipped"? Does your EMS unit NOT have ALS equipment or Paramedic not able to provide ALS? Sorry, a code is a code. Remember, I am responsible that they did NOT have an advanced care. (negligent). Sorry, that was piss poor treatment and care, of not even attempting an airway, IV/I/O medication. Your Paramedic can be reviewed for negligent care, since they did not perform according to standards. Don't blame the ER, almost anyone with EMS experience will tell you VA hospitals rarely are prepared for true emergencies or will accept most codes. As well, you contradicted yourself, you described that there were only the nurse, then stated " they will take over and we are relieved". So she relieved you and left her by herself? 


R/r 911


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## Emt /b/ (Jan 27, 2008)

Ridryder911 said:


> Personally, I can't believe that an EMT misspelled believe twice.....



Ha. Do you not realize that most of your posts are riddled with grammatical and spelling errors?


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## Meursault (Jan 27, 2008)

As far as the original story, he could just have cross-posted it.
VA hospital + no notification? I can most definitely believe that they were unhappy and unprepared. I doubt it was laziness on their part.

Ooh, and somebody's challenging Rid. The fireworks should be most interesting. If you're lucky, VentMedic and Flight-LP will show up too, giving you the full forum teaching experience.
/me grabs aluminized suit and runs for cover.


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## milhouse (Jan 27, 2008)

let the beatings begin....... lol this is gonna be interesting


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## Ridryder911 (Jan 27, 2008)

Emt /b/ said:


> Ha. Do you not realize that most of your posts are riddled with grammatical and spelling errors?



Oh, I am sure of the grammatical errors (most on purpose). As we have numerously discussed upon this forum. I and many others utilize the common usage of grammar and style for posting on forums. If you would like, I could utilize the APA, MLA, formats and styles, etc. On the point of spelling, doubt it would be numerous, one of my few talents. I also do perform spell check twice before posting as a courtesy for those that care to be able to interpret postings. 

I just thought it was ironic to post and criticize others on how poorly educated and stupid they were, when your title was misspelled and rarely capitalized the beginning of a sentence. Also, I have read a very similar to near exact same post on another EMS forum a few months ago. So I still ask did your crew leave the patient with the one nurse or did others assume care? 

I also ask what is this "special equipment" that ED's have that EMS units do not have to work upon cardiac arrests? 

Oh, by the way it is respiratory or cardiac arrest  in lieu of the common slang .."full arrest".. which most never heard of a half-arrest.. 

Have fun continuing learning....

R/r 911


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## RichmondMedik (Jan 27, 2008)

Damn !!!

I miss reading your replies Rid !!!!  

All is well here after a few harrowing months of self doubt. 

New job and back in school for more edumacation(spelled wrong on purpose)

stay safe 

Paul


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## MikeRi24 (Jan 27, 2008)

when we got there, city fire had been there for a good 5 minutes (we had a REALLY long response time because we were dispatched from the other end of the city...not sure why) and doing CPR. they continued CPR until the point where we shocked, then our guys took over to try and get the FD out of the way (the room we were working in was maybe 4x6 if that (it was like a walk in closet that this guy had made into a very small sitting room for whatever reason) and the rest of the house was really really cluttered with stuff. so we didnt really NOT do CPR first, as the fire dpt had been doing that for about 5 minutes prior to our arrival. 

like i said, you maybe would have needed to see the house we had to work in and what the conditions were an every other variable involved, but I was just doing what the medic told me. to be honest, there were a few things the medic did that kind of made me raise an eyebrow, and I think the EMT-B we were with (who happens to be a friend of mine...never met the medic before) agreed with me on most of them, but didnt say anything. By no means am I in any position to take charge over anything, so I just did what they told me and tried to take in as much as possible.

FIY, I dont think anyone realizes how close we actually were, so the blue dot is where the ED is, and the gray one is where the scene was.


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## piranah (Jan 27, 2008)

Iagree...you should have worked that code especially with a medic on board...and not calling ahead...one of the bigges thingsthey teach you in Basic school is ALWAYS call medical control and tell them (age,sex,vitals, ETA, any interventions, current condition,also any special indications,) thats just baseline knowlege. just arriving at the hospital is like catching them with their pants down. thats why so many hospitals don't care for EMS is because people dont do their jobs correctly.


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## Jolt (Jan 27, 2008)

MikeRi24 said:
			
		

> we get on scene, and the guy is in a chair, slumped over, unresponsive, and not looking so good.





			
				MikeRi24 said:
			
		

> when we got there, city fire had been there for a good 5 minutes (we had a REALLY long response time because we were dispatched from the other end of the city...not sure why) and doing CPR.



Wow... you're a really bad liar.


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## milhouse (Jan 27, 2008)

makes you wonder what really happened now!?!?!?!?!!


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## JPINFV (Jan 27, 2008)

piranah said:


> one of the bigges thingsthey teach you in Basic school is ALWAYS call medical control



Of course you can tell people that all the time, but not everyplace had online medical control at the EMT-B level (hospital notifications were done through dispatch and as age, sex, CC, and ETA plus anything else the crew wanted to throw in).


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## JPINFV (Jan 27, 2008)

MikeRi24 said:


> FIY, I dont think anyone realizes how close we actually were, so the blue dot is where the ED is, and the gray one is where the scene was.



It's immaterial actually. CPR is never of decent quality while moving and there is no significant differences between prehospital arrest treatment and ER arrest treatment. 

That said, I don't think anyone's blaming you, it is the medic's patient.


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## MikeRi24 (Jan 27, 2008)

Jolt said:


> Wow... you're a really bad liar.



ok excuse me, thats how the FD found him, he was still in the same "area" as when they found him. u get the idea though....

I have to schedule my next ride along on Monday, I am definitely going to do it with another medic..like i said i didn't really 100% agree with some of the things that were going on, but oh well I can only learn from the better ones i guess.


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## Jolt (Jan 27, 2008)

MikeRi24 said:


> ok excuse me, thats how the FD found him, he was still in the same "area" as when they found him. u get the idea though....



Sorry, I still don't believe you for two reasons.  (1) You would have said it that way if that's what you meant, and (2) Rid already said that he saw the same post on another site.


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## Ridryder911 (Jan 27, 2008)

Mike, since you are a student, what I would had liked to seen presented is maybe what you would had done? We realize, that you were not in charged, but learn off the call.. good or bad. 

Maybe the scene or situation did make the Paramedic want to just transport with just doing the essentials. I don't know, I was not there. Again, what we do has to be justified. Performing the entirety of the code just outside the driveway or the opposite of transporting. Again, attempt to justify their action(s) or disagree with what occurred. 

I do *NOT* want my students to be mindless sheep and be followers. What might be right one time, may not be the next. This is why medicine is gray, not black & white, as well we are trying to install critical thinking skills. To judge each situation separately, independently based upon its merit. Is there general guidelines, you bet.. but, how you apply and adapt to them is what counts. 

This is what clinicals are for. To expose you to the real working environment after you have learned the basics of patient care. Take those skills that you have mastered and now apply them into a clinical setting. 

I wish you luck!

R/r 911


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## KEVD18 (Jan 27, 2008)

im throwing the bs flag:






story just doesnt add up.


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## MikeRi24 (Jan 27, 2008)

im dead serrious this really happened...i have not known of it posted somewhere else.


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## Flight-LP (Jan 27, 2008)

MikeRi24 said:


> well, we basically watched the guy die, because the nurse made us stop resuscitating the guy, and no doctor or even another nurse came to look at the guy. the nurse then starts *****ing US out because she said we didnt start a line on him and didnt call ahead so they couldnt prepare. there was no one else in the ER, and we never saw anyone except for this nurse in the whole ED. so basically this guy died because they were lazy....
> 
> 
> ok im done /rant



No, he died because your Paramedic was lazy and failed to provide any level of care. Unless I have a veteran patient that demands transport to the VA, then it does not exist as an option for any patient requiring transport to an ER. I am so sorry that your educational experience had to be ruined my an incompetent moron. Hopefully your next shift will be more fulfilling. But at least now you know what not to do...............

Good luck to you!

Yo Mr. Conspiracy, see I can be sincere and nice at the same time!!!!!


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## VentMedic (Jan 27, 2008)

MikeRi24 said:


> im dead serrious this really happened...i have not known of it posted somewhere else.



I'll give you the benefit of the doubt although my first thoughts were that this thread was intended to bash the VA and/or their nurses.


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## TheDoll (Jan 27, 2008)

Ridryder911 said:


> On the point of spelling, doubt it would be numerous, one of my few talents. I also do perform spell check twice before posting as a courtesy for those that care to be able to interpret postings.


  
now, now, c'mon!


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## MikeRi24 (Jan 27, 2008)

VentMedic said:


> I'll give you the benefit of the doubt although my first thoughts were that this thread was intended to bash the VA and/or their nurses.




the guys neighbors or whoever they were DID demand he to go to the VA cuz i guess thats where he goes for medical stuff....there are much better EDs to go to for cardiacs in our area that are within a few minutes though. 

now that I think about it, something else that the medic told me at one point kind of strikes me as odd: "some paramedics will get a line and push drugs just because they can, I dont usually unless I feel that its necessary to..." I wanted to be like "no, you push drugs because the patient NEEDS it, just just because you can, or not because you don't feel like it!" but i just kept my mouth shut on that one because it's not my place to say stuff like that to a medic.


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## Emt /b/ (Jan 27, 2008)

If it wasn't a VA hospital I wouldn't really disagree with the medic's decision. Yeah, the pt goes there for all his medical stuff, but that doesn't mean anything when he is in cardiac arrest. I don't think my primary care physician would be too excited if my family made the EMTs drop me off at his office. 

If you were that close to a regular hospital, I wouldn't necessarily see the problem. If the time it takes to start ALS interventions is more than the transport time, I don't think there is any reason not to scoop and screw. I was actually at an arrest a few weeks ago, and we were literally less than 30 seconds away from the nearest ED, yet the medics started all their interventions. By the time they punched the bag and started the line, the patient could have already been in a bed. And although hospital entry notes are (at least around here) simply a courtesy, one really should be given.


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## Ridryder911 (Jan 27, 2008)

Emt /b/ said:


> If you were that close to a regular hospital, I wouldn't necessarily see the problem. If the time it takes to start ALS interventions is more than the transport time, I don't think there is any reason not to scoop and screw. I was actually at an arrest a few weeks ago, and we were literally less than 30 seconds away from the nearest ED, yet the medics started all their interventions. By the time they punched the bag and started the line, the patient could have already been in a bed. .



Nothing personal, but this in general.....

Thus the problem. EMT's attempting to second guess or presume they know what is better. This is the problem with EMS and its multiple levels. A person  basically takes a first aid course, and then assumes and attempts to critique medical care. This would be similar for me attempting to scrutinize a neurosurgeon. Are you aware a patient has a better chance of survival in the prehospital setting than in the ED or hospital setting? This is not just saying but documented scientific proof...

Second, does a dead body really need a bed? For what reason? Consider this, the patient has a lower percentage of more advanced care (physicians usually terminate codes faster than Paramedics), and there is *NO* difference or treatment! As well, now with all that wisdom you provided the patients family will now receive an additional bill for transport, ED visit and calling a code .. usually about $2000-$5,000 for an ER visit to pronounce a body. Nice going folks! ...

This is why more and more emphasis of field termination is being pushed... there is no reason to transport a code without return of spontaneous circulation (ROSC). 

R/r 911


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## Emt /b/ (Jan 28, 2008)

Ridryder911 said:


> Nothing personal, but this in general.....
> 
> Thus the problem. EMT's attempting to second guess or presume they know what is better. This is the problem with EMS and its multiple levels. A person  basically takes a first aid course, and then assumes and attempts to critique medical care. This would be similar for me attempting to scrutinize a neurosurgeon. Are you aware a patient has a better chance of survival in the prehospital setting than in the ED or hospital setting? This is not just saying but documented scientific proof...
> 
> ...



I agree with what you're saying, unfortunately that just isn't the way things go, at least not around here. 

I know they have a better chance of survival in the field, and I know there really isn't anything else an ED can do for a code. But if the transport time is that low, why not just transport them? They have to get transported anyway. I should have been more specific though, because in the call I was talking about, the BLS unit that first responded actually waited for ALS from another company to show up, while the nearest hospital was around the corner. 

Also, in this case, the patient was actually long dead. But, they're going to a hospital bed whether or not the medics start their interventions, and regardless of how dead they are (unless such things as rigor or lividity are present, which they weren't). The medics were essentially working on a patient they knew they had no chance of saving, because their protocol says to. 

I wish field termination was allowed.


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## Ridryder911 (Jan 28, 2008)

I do understand, some of the EMS I have worked at do not allow field termination for financial reasons (no transport- no billing). This is unfortunate for all, especially for the family and the EMS system. Many not care about the financial portion but an additional $5000 and a $14,000 funeral adds up quickly for most, especially if that person was the sole provider. 

R/r 911


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## Meursault (Jan 28, 2008)

KEVD18 said:


> im throwing the bs flag:
> 
> 
> 
> ...



Quick, somebody get MedicPrincess!


I don't mind the didactic styles of our more... experienced members. I lurked the Firehouse forums as a student. There, no one has any authority and it's just one continuous pissing contest. Here, we have a few people that have been right often enough that they're respected and can get away with completely owning newer members.

Back on-topic now:
Rid, where did you get the studies for better survival in the prehospital setting? And is that surviving the code or to discharge? I've always heard, and it seems intuitively correct, that out-of-hospital codes have really poor survival to discharge. Looking at PubMed, that seems about right.


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## Ridryder911 (Jan 28, 2008)

Actually, the percentages come from the ACLS text as well as many documented resources (I believe I have posted this response on here before). Many describe that the cause maybe that patient may have a predisposition of being more ill prior to arrest, or may not be found or located in a timely manner.. or the point they have to admit is that field codes are more organized and performance level is better. 

If I remember right, the percentages is based upon both discharge and morbidity rates. What would be interesting if field termination will not be included. 

Face it, codes are not successful with < 6% over-all and the best of being 10%. Until, we can develop better precursor of arrest or prevent coronary disease we are fighting an endless battle. 


R/r 911


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## enjoynz (Jan 28, 2008)

This story takes me back to the very first cardiac arrest I attended, many years ago. 
I was a volunteer for a hospital based ambulance service. 
We get a call to a Bowling Green, pt had collapse. It was 3 minutes drive from the hospital. I was on duty with a EMT-I and EMT-B and and I was a First responder.
We get there to find CPR in progress by a person on scene. I hopped out and took over the CPR in the hope that the EMT-I was getting the Defib connected. It never happened! He decided as we were so close to the hospital, that we'd continue CPR, load and go!
He didn't even bother to find out what the pt's rhythm was.
I did the compressions and he bag masked on route.
But the other thing, that cause an even longer delay, was the driver tried to leave by a different route from the park and that exit had a chain across it, so we had to back track. (More time delay)! 
The pt didn't make it, and I never got to find out what his rhythm was.
I know we don't save that many Cardiac arrests, but it would have been nice to have put in more effort at the time.
I found out later, that the pt had been a friend of the EMT-I.
So he may have panicked? I'll never know and will never forget that call!

Enjoynz


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## Jon (Feb 3, 2008)

OK... not to get too far off-topic, but how many of us can take EMERGENT patients to VA hospitals? In my part of PA, the VA is not considered a valid prehospital transport destination. 


This post just seems funny. I've seen crappy VA ED care, and I've seen a**hole charge nurses at VA ED's try to refuse to provide care to patients that deteriorated during treatment at the VA hospital... but it always gets worked out.


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## BossyCow (Feb 4, 2008)

We considered ourselves lucky because the VA finally, after years of whining, complaining and denying has set up a local clinic where someone can be determined to be in need of emergent care which will allow them to get treatment here instead of a 3 hour ambulance ride to the nearest VA hospital. 

I gotta call B.S on the original post as well.  Too many inconsistancies.  I think the ride-along heard a good story, believed it and passed it on as true, that is the birth of an urban legend. 

As to the comment about what killed the guy, the VA nurse, the medic or a piss poor system for managing cardiac arrest, I'm going to weigh in on Heart Disease as being what killed the guy.  Everything else is designed to offset the results of eating a high fat/sugar diet, smoking, drinking, genetics, no exercise, and a general lack of active participation in his own health.


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## MikeRi24 (Feb 4, 2008)

Jon said:


> OK... not to get too far off-topic, but how many of us can take EMERGENT patients to VA hospitals? In my part of PA, the VA is not considered a valid prehospital transport destination.
> 
> 
> This post just seems funny. I've seen crappy VA ED care, and I've seen a**hole charge nurses at VA ED's try to refuse to provide care to patients that deteriorated during treatment at the VA hospital... but it always gets worked out.



yeah we can take people there if they want to go there...we try really hard to get them to go elsewhere because you can pretty much be at any one of 5 FAR SUPERIOR hospitals within <10 min no matter where in the city you are


and if you guys want to think i am BSing, then fine but it really happened and I honestly have never seen that story posted elsewhere. This is the only EMS forum I am on, and have never even read that story before. kinda sucks I lost all creditability for myself on here from now on but oh well.


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## Doc Kafka (Feb 12, 2008)

*2 sides*



MikeRi24 said:


> I'm currently in a paid EMT-B training program, and I did a ride along today with an EMT-B and a Paramedic. although I have virtually no experience, my jaw was on the floor after I watched this unfold.
> 
> we get dispatched to a "elderly male with chest pains and shortness of breath." we get on scene, and the guy is in a chair, slumped over, unresponsive, and not looking so good. we hook him up to the monitor, and its clearly obvious thats we now have a full cardiac arrest on our hands. We shock him and start CPR, and in the middle of all this, we gather enough information for figure out that we are to take him to the local Veterans Affairs Hospital. Just so happens that the VA is LITERALLY less than 2 minutes away. we decide to "load and go." EMT-B drves, medic is in the back doing chest compressions and shocked him a second time, and i'm bagging. we get to the VA and as we are unloading, a nurse walks outside and demands to know whats going on. we give her the long and short of it, and she is like "well why didn't you call ahead? we had no idea you were brining this here, we heard the sirens from inside" so we explain to her that we were literally around the corner, and were doing what we needed to do to bring this guy back, sow e kinda didnt have time to call, and if we did by the time we got through and explained the situation, we would have been there anyway. Oh, and mind you we are now standing outside the ER doors, because this nurse won't let us in.
> 
> ...



     Yes, I will agree.....although I was not there and I do not know the specifics of the call (downtime, etc...).  ALS should always be initiated in the field.  At the very least-intubation, defib if indicated, and first-line drugs.  

I would lose my job if I walked in with a patient like that (lack of treatment).  I know nothing about the paramedic in question, but it sounds like maybe he is a bit unsure of himself.

We all know that there are certain "reversible" interventions for PEA and asystole.  Most of us have rarely seen them work.  A few are in the field (hypoglycemia, tricyclic OD, narc OD, metabolic acidosis, hypoxia, etc...), and some of them are in the hospital.  PE, MI, pericardial tamponade, etc...

I can understand the nurse's frustration with not being notified prior to arrival, which is a big no-no.  Could she have been a bit more compassionate and professional?  I think so.

Our local VA is notorious for not answering the radio.  Always have a cellphone on hand.

I can see wrongdoing on both sides here.  But you should 
ALWAYS initiate ACLS prior to transport.
You will have a miserable and short career if you don't.

Now I'm stepping down from the podium.


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