Lee County (FL)

[FiremanMike]

Maine gets a HUGE +10 however for insisting on NO TRANSPORTING of cardiac arrests unless you get ROSC. Kudos for this...rest of it is archaic and "mother may I", but thats ok, it gives me something to work on.

We've had 2 arrests in the last year who were in persistent v-fib and ultimately survived with a CPC of 1.

I've heard of such "no rosc, no transport" policies, and I'm ok with the theory behind it, but feel it should be amended to add persistent shockable rhythm (as ours is)

 

[GMCmedic]

We've had 2 arrests in the last year who were in persistent v-fib and ultimately survived with a CPC of 1.

I've heard of such "no rosc, no transport" policies, and I'm ok with the theory behind it, but feel it should be amended to add persistent shockable rhythm (as ours is)

Why amend it? We know CPR in a moving ambulance is inadequate, and we know patients in refractory vfib with high quality CPR are regaining ROSC ~50 minutes in with good neurological outcomes. If anything I would ad dual sequential defib. That data for termination/conversion of refractory vfib is good.

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[NomadicMedic]

I'd love to see some good studies on DSD. Admittedly, I haven't searched very deeply, but only found a porcine study that was "meh".

 

[GMCmedic]

I'd love to see some good studies on DSD. Admittedly, I haven't searched very deeply, but only found a porcine study that was "meh".

Most studies only have 7ish patients which for obvious reasons its hard to go off of. I was skeptical because the survival to discharge is dismal but the ROSC data is pretty good. Ive been told there is a study out of the NW (washington maybe) that had 11 patients and was trending towards better survival rates. I havent had an opportunity to look for it yet.



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[RocketMedic]

There's a certain power that comes from having a scope of practice that allows you to effectively manage pain and resolve serious problems. It is a significant obstacle to moving. For example, the other day, I ran a forearm fracture. In a lot of places, that's BLS, due to design or culture or paramedic laziness. I used fentanyl and ketamine to give that kid a great, pain-free ride. Most agencies would have allowed me a small dose of fentanyl and allowed me to "take the edge off", but being able to go from 10/10 to 0/10 instead of 7/10 is a powerful thing.

 

[FiremanMike]

Why amend it? We know CPR in a moving ambulance is inadequate, and we know patients in refractory vfib with high quality CPR are regaining ROSC ~50 minutes in with good neurological outcomes. If anything I would ad dual sequential defib. That data for termination/conversion of refractory vfib is good.

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My point is that one shouldn't stand for a universal "you will not transport until you get ROSC" policy when there is data to support the idea that folks in persistent shockable rhythms are viable, despite being pulseless at the time that the "go/no-go" decision is made.

 

[akflightmedic]

I understand your point...I do. Now let me flip it a different direction....purely for argument's sake.

At what point in the scene code, do we start putting everyone at risk? 20 minutes in? Ok guys we have persistent shockable rhythm...let's start packaging for movement to truck. How many minutes elapse during this time (rhetorical cause it could be 5 it could be 20). If the patient remains in shockable rhythm during packaging and moving to truck...we now have transport. Do we run Code 3 or do we go Code 1??

How many people on the streets and in the transport unit do we put at further risk for a patient who now is in "persistent shockable rhythm" for 30+ minutes or more if you count pre-911 arrival.

Now we have transport of 10, 30, 45 or more minutes and in some areas way more...but 10 should cover a city and 30 should cover most urban, semi-urban areas....now we are there and we unload the patient. More minutes ticking away...pretty damn impressive they remain in this state if still in it.

We wheel them in, hand over care and what does the ER Doc do?

What if at any point during this scene call the rhythm terminates? What then? Proceed but with less urgency? Continue to tie up a unit and support staff from another unit or apparatus? Tie up ER staff when we get there?

So many variables from the other side which seem in my opinion as of now to greatly outweigh the benefit vs risk of transporting those statistically rare persistent shockable rhythm cases.