AED use in a moving ambulance

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BrushBunny91

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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.
 
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?
 
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.
 
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.
 
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.
 
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.
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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.
 
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.
 
All 5 of my skills instructors also agreed that they would never pullover and continue transport.
 
BrushBunny91 said:
All 5 of my skills instructors also agreed that they would never pullover and continue transport.
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For testing purposes you should stop.

In the field its going to be dependent on the agency's protocols.
 
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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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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Hopefully you'll be a medic one day so you can set em straight ;)
 
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.
 
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.
 
NVRob said:
Quick point Aprz - the bell is for low frequency/pitch sounds ;)
Click to expand...

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
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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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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.
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Some patients arrest en-route to hospital though?
 
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?
 
Wait I didn't think you were supposed to transport codes! D:
 
medicnick83 said:
I wouldn't use a AED in a moving ambulance.
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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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