Cardiac Arrest and Code 3 transport
- Thread starter oremtprn
- Start date
Ridryder911
EMS Guru
- 5,923
- 40
- 48
I believe there are some, but many have went instead of transporting with L/S to performing resuscitation for 20 minutes and then ceasing all efforts if in aystole. (Field termination). This appears to be more the trend.
I believe there is a fine line (legally) if the patient does go into an arrest then of one was an arrest prior to arrival. Although, my personal views is not to run in with L/S it could be misinterpreted per family, and others if not handled properly. I use it discreetly, and potential risks.
If I obtain or come upon findings, I will pm them to you
R/r 911
I believe there is a fine line (legally) if the patient does go into an arrest then of one was an arrest prior to arrival. Although, my personal views is not to run in with L/S it could be misinterpreted per family, and others if not handled properly. I use it discreetly, and potential risks.
If I obtain or come upon findings, I will pm them to you
R/r 911
medic001918
Forum Crew Member
- 60
- 0
- 0
Like Rid mentioned, the trend is going to field termination (some services require medical control authorization, others do not). At the services I work for, we don't need to call unless there are special circumstances. When it comes to transporting, it's situational. If they're still in arrest, I generally won't use lights and sirens. If I get something back (which is rare), I'll pick up the transport a little. The scene dictates to some extent how we leave as well. Some scenes just aren't safe and it's a good idea to get out. It's all situational and comes down to judgement.
Shane
NREMT-P
Shane
NREMT-P
KEVD18
Forum Deputy Chief
- 2,165
- 10
- 0
maybe its just me, but i just cant fathom sitting at a traffic light changing the channel on the radio while my partner is in the back working a code. seems a bit ridiculous.
the field termination angle, however, i agree with completely. 3 rounds of drugs, some cpr and electricity if necessary with no effect, done deal.
the field termination angle, however, i agree with completely. 3 rounds of drugs, some cpr and electricity if necessary with no effect, done deal.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
About as ridiculous as transporting a "dead body" with L/S, when one really thinks of it.
KEVD18
Forum Deputy Chief
- 2,165
- 10
- 0
disagree. a cardiac arrest is a medical EMERGENCY that, while unlikely in some or even the majority of cases, we can fix. or maybe keep viable until we get them to a H where a doc can FIX them. and you want to delay that by not running hot. strong work rid, strong work.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
I am sorry you are so misinformed. Actually pre-hospital cardiac arrest have a higher percentage of survivability's than in hospital "Dr. can fix them". In fact, by a large percentage, which is not a good deal since we have less than 6% chance, just think what your percentage is in a hospital? Yes, it is VERY scary!
Please, inform me the difference between hospital resuscitation and pre-hospital and how a physician makes a difference in a cardiac arrest? In fact, if you will review studies, most Paramedics work and perform measures more aggressive and longer than most Physicians. Again, we all take ACLS for a reason... the difference is most Paramedics remember it!
I will not await for an answer, because I already know it. Remember, I work both areas and I can assure you the worst person to work a code is a Cardiologist.
Running "hot" and saving a whopping 2- 3 minutes, in a cardiac arrest is NEVER going to save anyone... period. This is why, codes are being ceased in the field more and more per ACLS crews.... it is futile after the initial treatment, transporting them to a hospital has never proven to increase saves and to be effective.
R/r 911
Last edited by a moderator:
Agree with Rid.
Plus,
When you are running "hot", besides all of the traffic safety issues, you are more likely to make mistakes when your adrenaline is flowing and you are caught up more in the lights and sirens moment than focused on patient care.
If you are holding on for balance, you are not adequately working or assessing the patient. In the case of a cardiac arrest, you will decrease the patient's chances if you cannot provide adequate resuscitation efforts prehospital.
Providing a good report and assessment may mean the difference and not the 2 minutes you saved in traffic.
If my partner is driving lights and sirens, he/she may not have enough confidence in my abilities in the back. If you are telling the person driving to run L/S, you may be doubting your abilities also. If one is well educated and trained, one should not doubt their abilities.
Ex. A trained neonatal transport team consisting of a nurse, RT, EMT-P or B, may have a 2 hour ride with a sick neonate because the weather is too bad to fly. There must be no doubt in the abilities of any team member by another or oneself in order for the transport to be a success. Also, these teams will rarely use L/S. Moment to moment assessment is too critical and medical error is not acceptable.
If you arrive in the ER like the devil is chasing you, the staff will think "amateurs". At least those of us who have read the statistics will think that. Out of polite professional respect, we may never vocalize that to you. A team entering with a confident quick stride and a good report will really impress with professionalism. Also, nothing like realizing your IV and/or ETT are "missing" when the dust settles.
Hospital trauma teams especially prefer a good report so the appropriate protocols and technology will be in place. A well organized trauma team will also have a leader who calls for a moment of calm amongst the team just before you burst in through the doors. This part few outsiders rarely get the opportunity to see but it is awe inspiring. But, it is also a safety mechanism to prevent adrenaline rushes from creating the potential for errors, needle sticks and blood splashes.
Experienced medical code teams also may have a silent moment but for questioning what else can be done if anything.
Granted there are exceptions to everything. However, if you and another crew member are in the back, the person driving should be more concerned for your safety then the possibility of saving two minutes that will rarely make a big difference in outcome especially in a cardiac arrest.
Now as far as studies, the EMS journals are full of them especially with the numerous fatal ambulance accidents.
For articles from many sources:
www.pubmed.gov
Plus,
When you are running "hot", besides all of the traffic safety issues, you are more likely to make mistakes when your adrenaline is flowing and you are caught up more in the lights and sirens moment than focused on patient care.
If you are holding on for balance, you are not adequately working or assessing the patient. In the case of a cardiac arrest, you will decrease the patient's chances if you cannot provide adequate resuscitation efforts prehospital.
Providing a good report and assessment may mean the difference and not the 2 minutes you saved in traffic.
If my partner is driving lights and sirens, he/she may not have enough confidence in my abilities in the back. If you are telling the person driving to run L/S, you may be doubting your abilities also. If one is well educated and trained, one should not doubt their abilities.
Ex. A trained neonatal transport team consisting of a nurse, RT, EMT-P or B, may have a 2 hour ride with a sick neonate because the weather is too bad to fly. There must be no doubt in the abilities of any team member by another or oneself in order for the transport to be a success. Also, these teams will rarely use L/S. Moment to moment assessment is too critical and medical error is not acceptable.
If you arrive in the ER like the devil is chasing you, the staff will think "amateurs". At least those of us who have read the statistics will think that. Out of polite professional respect, we may never vocalize that to you. A team entering with a confident quick stride and a good report will really impress with professionalism. Also, nothing like realizing your IV and/or ETT are "missing" when the dust settles.
Hospital trauma teams especially prefer a good report so the appropriate protocols and technology will be in place. A well organized trauma team will also have a leader who calls for a moment of calm amongst the team just before you burst in through the doors. This part few outsiders rarely get the opportunity to see but it is awe inspiring. But, it is also a safety mechanism to prevent adrenaline rushes from creating the potential for errors, needle sticks and blood splashes.
Experienced medical code teams also may have a silent moment but for questioning what else can be done if anything.
Granted there are exceptions to everything. However, if you and another crew member are in the back, the person driving should be more concerned for your safety then the possibility of saving two minutes that will rarely make a big difference in outcome especially in a cardiac arrest.
Now as far as studies, the EMS journals are full of them especially with the numerous fatal ambulance accidents.
For articles from many sources:
www.pubmed.gov
Not that I am a big fan of reading my protocol book word for word, but we just got the new ones last week and i figured this tidbit was relevent:
Found under 'Cardiac Arrest'
"Special Note: Unless special situations are present (e.g. hypothermia), for nontraumatic and blunt traumatic cardiac arrest, evidence confirms that ACLS care in the emergency department offers no advantage over ACLS care in the field. If ACLS care in the field cannot successfully resuscitate such victims, ED care will be likewise unsuccessful. In the field, termination of unsuccessful resuscitation should be strongly considered"
(that part really is in bold print as well)
Needless to say that (some) doc's recognize this fact as much as we do
Found under 'Cardiac Arrest'
"Special Note: Unless special situations are present (e.g. hypothermia), for nontraumatic and blunt traumatic cardiac arrest, evidence confirms that ACLS care in the emergency department offers no advantage over ACLS care in the field. If ACLS care in the field cannot successfully resuscitate such victims, ED care will be likewise unsuccessful. In the field, termination of unsuccessful resuscitation should be strongly considered"
(that part really is in bold print as well)
Needless to say that (some) doc's recognize this fact as much as we do
- 5,591
- 455
- 83
Our protocols changed so that the patient was worked for 30 minutes on scene, and then either called or transported.
The study information we were presented showed a dim picture of in-ambulance CPR. The study showed that CPR done in an ambulance while transporting incorrect and wasn't useful or helpful.
This was a change in our protocols about two year ago, and I've since left the service since then. I'm not sure if they've made changes since then.
Pre-hospital treatment for cardiac arrest or many cardiac issues is almost identical to that of in-hospital treatment. There isn't much that a hospital can do that a Paramedic in the field can't do.
The study information we were presented showed a dim picture of in-ambulance CPR. The study showed that CPR done in an ambulance while transporting incorrect and wasn't useful or helpful.
This was a change in our protocols about two year ago, and I've since left the service since then. I'm not sure if they've made changes since then.
Pre-hospital treatment for cardiac arrest or many cardiac issues is almost identical to that of in-hospital treatment. There isn't much that a hospital can do that a Paramedic in the field can't do.
Getnjgywitit
Forum Probie
- 15
- 0
- 0
This is interesting, only because I was always told that if someone is in cardiac arrest and you go Code 3, you are only stressing the patient and yourself out more causing more stress. But when I was doing my internship, each cardiac arrest was different. Some we went Code and others we didn't. If the patient was conscious we didn't, but if they were unconscious, then it was L/S the whole way. This is from my very limited experience. I don't claim to be a wonder medic, or even a great EMT. I'm new to this career and go to this message board to lean. 
h34r:
~Toodles!
h34r:~Toodles!
Grady_emt
Forum Captain
- 301
- 0
- 0
Field Termination of the Medical Cardiac Arrest:
Start in Asystole, IV, ETT, Two rounds of meds, stays in asystole
Family in agree-ance with EMS crew
Pt over 18
Field Supervision notified and/or response (great for dealing with irate families)
Med Control Orders approved
Start in Asystole, IV, ETT, Two rounds of meds, stays in asystole
Family in agree-ance with EMS crew
Pt over 18
Field Supervision notified and/or response (great for dealing with irate families)
Med Control Orders approved
medic001918
Forum Crew Member
- 60
- 0
- 0
Using lights and sirens shouldn't really cause you any additional stress as a provider, unless you have someone who doesn't know how to drive code three. If that's the case though, that's a whole other issue.
When it comes to cardiac arrest, you shouldn't have a concious patient. If they're concious, then they aren't really in arrest and lights and sirens may be warranted. Not all unconcious patients require lights and sirens as well. There are a number of causes of a patient being unresponsive, and not all warrant a priority transport.
This is from my very limited experience. I don't claim to be a wonder medic, or even a great EMT. I'm new to this career and go to this message board to lean.
~Toodles!
It sounds like you have a good outlook on your career with knowing that you have much to learn. Forums like this are a great source of valuable information. Keep up the strong work. The more you learn, the more you realize you don't know and it keeps things in perspective.
Shane
NREMT-P
Getnjgywitit
Forum Probie
- 15
- 0
- 0
Hey Shane, I think I made a simple mistake with my definitions of cardiac arrest and just an M.I. Of course they aren't going to be conscious if they are in cardiac arrest. :blush: I haven't been thinking as a medic for a few months. If you don't use it, you lose it. Just trying to get the hamster back on the wheel!
medic001918
Forum Crew Member
- 60
- 0
- 0
No problem. I just wanted to clear up any confusion. Good luck getting your hamster back running again.
Shane
NREMT-P
Shane
NREMT-P
Getnjgywitit
Forum Probie
- 15
- 0
- 0
LMAO! Pretty obvious I need it huh?:wacko:
firecoins
IFT Puppet
- 3,880
- 18
- 38
We call in the field after a length of time and several rounds of meds if the patient remains in asystole.
If we transport a code, it goes code 3. The driver doesn't need to drive like a maniac though. Family members are upset and would get more upset if you don't do what they perceive to be necessary and driving code 3 is perceived to be necessary. It is for them at least. It may do nothing for the loved one.
If we transport a code, it goes code 3. The driver doesn't need to drive like a maniac though. Family members are upset and would get more upset if you don't do what they perceive to be necessary and driving code 3 is perceived to be necessary. It is for them at least. It may do nothing for the loved one.
Getnjgywitit
Forum Probie
- 15
- 0
- 0
Our protocal was that after 3 rounds of meds and continuous cpr, if there was no rhythm change, you could call them at the scene. But I'm pretty sure we always transported code 3 if we did transport.
medic001918
Forum Crew Member
- 60
- 0
- 0
I agree with field termination of codes in the field. But I can't agree with transporting code three for the family. Take a look at ambulance crash statistics and you'll find that most crashes occur while running lights and sirens. I'm not going to risk the safety of myself and my partner to run lights and sirens for the benefit of the family. If it would have a possible impact on patient outcome, I would do it without hesitation. But that's not the case. My safety, my partner's safety and the safety of the general public comes over the perceived benefit that the family may get.
Shane
NREMT-P
bstone
Forum Deputy Chief
- 2,066
- 1
- 0
Perhaps they have some surgical issue effecting the heart which can only be fixed in the hospital, thus requiring a code 3 t/p?