Cardiac Arrest Question?

[ThatGirlLex4]

Say you have a patient you are transporting from dialysis to their residence and they go into cardiac arrest during transport. You're 9 min from the ER and your partner initiates CPR in the back. What do you do as the driver?

Live in NYC btw

 

[Flying]

Stop the ambulance and ask dispatch for a paramedic intercept.
Start quality CPR/resuscitation: continuous compressions and immediate AED use.

 

[Jim37F]

Pretty much what Flying said, pull over somewhere safe, radio for ALS, join your partner in the back and either take over compressions or take over/set up BVM, remember to swap positions every few cycles until the cavalry arrives....where you'll likely continue the same until either ROSC is achieved and then transport to the nearest open appropriate facility, or until it's called.

 

[CALEMT]

where you'll likely continue the same until either ROSC is achieved and then transport to the nearest open appropriate facility, or until it's called.

This, very rarely do providers do CPR in the back of an ambulance (while in transit). Most likely ALS will work the full arrest until one of two things happens. 1, you get ROSC. Or 2, you pronounce on scene.

So pretty much what Flying and Jim said. Call ALS, pull over and start pumping chest or drop a OPA and bag em.

 

[ThatGirlLex4]

Thanks guys . I'm new to the field (currently working in transport, not 911) and this happened to me a month on the job, my partner two weeks on the job. I told dispatch and ended up going right to the ER without stopping, thinking I shouldn't delay txp. Hospital ER staff continued CPR once we arrived. None of the nurses said anything to me nor did my supervisors or the dispatcher, but a coworker told me that I should have stopped, while others told me I shouldn't have. I wanted to be sure so that when it happens again, I'm doing the right thing.

I tried looking up the protocol but it was unclear, it only said that transport shouldn't be delayed, so I figured I would ask here. I'm definitely glad I asked, since there was no one to ask that day, unfortunately. Not even the dispatcher mentioned ALS, maybe since I work for a private company, the situation doesn't come up often enough for people to be familiar with it? I don't know.. but thank you for the info. I really appreciate it.

 

[Flying]

Thanks for asking in the first place.

Note that we haven't given you much reason to believe what we say over your co-workers. Have your co-workers given any logic or justification that supports the transport/no-transport decision?

 

[ThatGirlLex4]

Thanks for asking in the first place.

Note that we haven't given you much reason to believe what we say over your co-workers. Have your co-workers given any logic or justification that supports the transport/no-transport decision?

They only said that since I was already driving, that stopping the vehicle would have delayed transport to the hospital. That if they went into arrest before leaving dialysis, I would do CPR and call for ALS, but since I was already in the drivers seat and the vehicle moving, stopping would have contradicted the "load and go" mentality. I do realize though that two people giving cpr is obviously more effective than one person doing it. I tried looking up the protocol myself but it doesn't really say anything other than not to delay txp and then it just goes into how to do effective CPR.

 

[teedubbyaw]

Was your partner a medic?

 

[ThatGirlLex4]

Was your partner a medic?

No I was on a BLS ambulance, my partner 2 weeks on the job and me a month. There was no one senior to talk to but the dispatcher who seemed to agree with going to the ER. But, again I work for a private company in Transport and not 911, so I'm sure this is a situation that does not come up very often. My first instinct was to get to the ER as soon as possible. My partner used the AED and it allowed shock only once and then it told him to continue compressions. By this time, we had already been at the ER and they continued CPR upon arrival.

Just for reference, pt was 75 with ESRD and had a poor cardiac history, was in the ER two weeks before this incident happened. Hospital staff said a massive MI is probably what caused it.

I'm not entirely sure what I'm looking for here. I'm honestly not even sure if I want to know if I should have done something differently, I never thought it would happen so early on the job for me and with someone newer than I was, it was all really really terrifying. All that stuck out to me in my mind was the very top of the BLS NYC Protocol for cardiac arrest "Do not delay transport to the hospital".

I guess I'm just sort of a mixed bag of emotions right now.. feeling sad, guilty, angry, but also feeling like, at the time, I tried my best to do what I thought was best for the patient.

 

[BOS 101]

No I was on a BLS ambulance, my partner 2 weeks on the job and me a month. There was no one senior to talk to but the dispatcher who seemed to agree with going to the ER. But, again I work for a private company in Transport and not 911, so I'm sure this is a situation that does not come up very often. My first instinct was to get to the ER as soon as possible. My partner used the AED and it allowed shock only once and then it told him to continue compressions. By this time, we had already been at the ER and they continued CPR upon arrival.

Just for reference, pt was 75 with ESRD and had a poor cardiac history, was in the ER two weeks before this incident happened. Hospital staff said a massive MI is probably what caused it.

I'm not entirely sure what I'm looking for here. I'm honestly not even sure if I want to know if I should have done something differently, I never thought it would happen so early on the job for me and with someone newer than I was, it was all really really terrifying. All that stuck out to me in my mind was the very top of the BLS NYC Protocol for cardiac arrest "Do not delay transport to the hospital".

I guess I'm just sort of a mixed bag of emotions right now.. feeling sad, guilty, angry, but also feeling like, at the time, I tried my best to do what I thought was best for the patient.

Hey there are always going to be times that you aren't sure what to do or haven't been prepared for a certain situation, and all you can do is put up your best effort, ask for help and think critically. See if you were 3 min away from the er probably even 5, I would say run for it. Any more though, and its better to just provide good BLS CPR because that's whats best for most codes, just good bls cpr. But hey, you made a call in the moment with some thought behind it and didn't freeze up and delay, that's good for a month in EMT in it of itself. You don't have to worry or stress, just learn from it, maybe do some practice scenarios and raise questions to be better prepared for next time, even aged and wise medics\doctors get tripped up every once in a while. Your new, just take it easy, and learn from it.

 

[teedubbyaw]

Should have stopped then. 1 bls providing care for 9 minutes in a moving vehicle is far from beneficial to the pt.

 

[ThatGirlLex4]

Hey there are always going to be times that you aren't sure what to do or haven't been prepared for a certain situation, and all you can do is put up your best effort, ask for help and think critically. See if you were 3 min away from the er probably even 5, I would say run for it. Any more though, and its better to just provide good BLS CPR because that's whats best for most codes, just good bls cpr. But hey, you made a call in the moment with some thought behind it and didn't freeze up and delay, that's good for a month in EMT in it of itself. You don't have to worry or stress, just learn from it, maybe do some practice scenarios and raise questions to be better prepared for next time, even aged and wise medics\doctors get tripped up every once in a while. Your new, just take it easy, and learn from it.

Thanks. Thank you for supporting my reasoning behind my decision and telling me what I should do for next time. It's tough being new on any job, but being a new EMT is a whole new level. I don't want to beat myself up about it, I've never even seen CPR done on a real patient, it was just all really overwhelming.

 

[ThatGirlLex4]

Should have stopped then. 1 bls providing care for 9 minutes in a moving vehicle is far from beneficial to the pt.

Well.. it's not NOT beneficial, just not as beneficial as it should have been. I see you're a paramedic and probably have been in EMS for a long time, but I've been in transport for a month. 3 weeks before this happened, I was nervous turning on the AED to make sure it worked. I made what I thought was a good decision at the time and was doing my best to follow the protocols I learned in school, which is the only thing I had to go on, especially when the dispatcher ok'ed going to the ER and with no one senior to go to for help.

I'm sure you remember when you first lost a patient, the only thing worse than that loss is having someone tell you that you did nothing to benefit the patient. Pt went into arrest, my partner started CPR and I transported as soon as possible. Maybe it wasn't what a seasoned EMS person would have done, but I know that at the time with nothing to go on, I put everything I had into what I thought was the right thing. That's all I can do when no one, including the ER staff, told me I should have done something else. The next time it happens, I will put everything I have into doing the MORE right thing...

 

[teedubbyaw]

No ones saying you did anything wrong. You asked for opinions and you're getting them. It's also on your partner moreso than you for making the decision to keep driving. He/she was responsible for pt care.

 

[ThatGirlLex4]

No ones saying you did anything wrong. You asked for opinions and you're getting them. It's also on your partner moreso than you for making the decision to keep driving. He/she was responsible for pt care.

I know I am coming off defensive, but I feel really uneasy about the whole thing. I was driving and made the decision to rush to the ER, which the dispatcher ok'ed. If I had known it would have been more beneficial to the pt to stop, I, of course, would have. I am in this field to help patients in the best way I know how, but I can't do what I don't know. Now, I do know... so it's something, I guess. I guess I can find some peace of mind in the fact that the ER told me there was nothing that could be done, but I have knot in the pit of my stomach about it.

 

[Jim37F]

Once again I'll echo the best course would've been stopping and calling for an intercept and working the patient there in the back....HOWEVER..being that inexperienced and having dispatch say "Yes, go directly to the ER" I would be hard pressed to say you did wrong. Yes compressions in the back of a moving ambulance are only slightly more effective than no compressions at all...also remember that if this patient suffered their cardiac arrest at home, they could easily have received zero compressions at all until the first responding 911 unit arrived, 6-8 minutes after the call (which could have been made however long after the arrest actually happened). Working 911, that's how virtually all my cardiac arrest calls have been done (only one or two had effective bystander CPR prior to our arrival) and none have been a private IFT ambulance calling.

So while it may not necessarily have been the absolute best response...rest easy knowing you still got the patient to definitive care beyond your capability without causing further harm (which really, isn't that what we're all trying to do every call anyway?)

Now if it is (and it kind of sounds like based on what you're saying) official policy/protocol to load and go cardiac arrests, then that needs to be changed. Normally a brand new employee like yourself would be in no position to do squat to change it, however, because you actually had it happen to you, you're in a unique situation where even as a new employee you can go to your supervisor and say "Hey I was reading more about this, and I found these studies saying stay and play is better than load and go, shouldn't we start doing that instead?"

 

[ThatGirlLex4]

Once again I'll echo the best course would've been stopping and calling for an intercept and working the patient there in the back....HOWEVER..being that inexperienced and having dispatch say "Yes, go directly to the ER" I would be hard pressed to say you did wrong. Yes compressions in the back of a moving ambulance are only slightly more effective than no compressions at all...also remember that if this patient suffered their cardiac arrest at home, they could easily have received zero compressions at all until the first responding 911 unit arrived, 6-8 minutes after the call (which could have been made however long after the arrest actually happened). Working 911, that's how virtually all my cardiac arrest calls have been done (only one or two had effective bystander CPR prior to our arrival) and none have been a private IFT ambulance calling.

So while it may not necessarily have been the absolute best response...rest easy knowing you still got the patient to definitive care beyond your capability without causing further harm (which really, isn't that what we're all trying to do every call anyway?)

Now if it is (and it kind of sounds like based on what you're saying) official policy/protocol to load and go cardiac arrests, then that needs to be changed. Normally a brand new employee like yourself would be in no position to do squat to change it, however, because you actually had it happen to you, you're in a unique situation where even as a new employee you can go to your supervisor and say "Hey I was reading more about this, and I found these studies saying stay and play is better than load and go, shouldn't we start doing that instead?"

Hey Jim. I will say that if the arrest happened at their home, I definitely would have made the decision to stay and start CPR and call for ALS, the confusion came with the fact that we were already en route to the patients home when they went into sudden arrest. In my head, at the time, I thought it would be counter productive to stop the ambulance already in motion, that's when I informed dispatch and he ok'ed transport. I realize now, given everyone here is a lot more experienced than I am, that stopping would have been best response. I'm not exactly sure what the protocol is for cardiac arrests while already en route, I don't think anyone at my company does as it's probably only happened a handful of times, being a transport private ambulance.

I will ask a supervisor what the proper protocol is. We documented everything we did and no one has said anything to us, so I assume that we did the sort of right thing in our companies eyes, but I want to make sure I do right by the patient, that is all that matters to me. This is definitely a HUGE learning experience for me and I know now, thanks to all of you, what would give the patient the best chance. The people at my company have probably not seen too many arrests happen en route because a lot of what we do is routine, but this something I will carry with me throughout the rest of my career in EMS, but I'm working hard to try and change it into a positive learning experience. Right now, it's just so fresh in my mind, I feel really so uneasy.

 

[Gurby]

I just want to say major props to you, and especially your partner. As a brand new EMT who has probably never even seen a dead person in real life, your partner recognized that the patient had gone into cardiac arrest, started compressions, applied the AED and got a shock off with it... That's amazing.

Very experienced EMT's have done much worse in this situation.

 

[Probie62]

I just want to say major props to you, and especially your partner. As a brand new EMT who has probably never even seen a dead person in real life, your partner recognized that the patient had gone into cardiac arrest, started compressions, applied the AED and got a shock off with it... That's amazing.

Very experienced EMT's have done much worse in this situation.

I'm with Gurby on this one... You could have done worse. Take this experience, learn from it and allow it to make you a stronger EMT, rather than a nervous one I think you did right by your patient and will continue to do so throughout your career!

 

[ThatGirlLex4]

I just want to say major props to you, and especially your partner. As a brand new EMT who has probably never even seen a dead person in real life, your partner recognized that the patient had gone into cardiac arrest, started compressions, applied the AED and got a shock off with it... That's amazing.

Very experienced EMT's have done much worse in this situation.

That means so much to me, thanks Gurby He really did such an amazing job. This was also the first time we had even worked together and it was a real bonding experience for us too, we work together permanently now and we had to board and collar someone yesterday for the first time as well and we just work so much better as a team after that experience.