Cardiac Arrest and Code 3 transport

[Ridryder911]

Perhaps they have some surgical issue effecting the heart which can only be fixed in the hospital, thus requiring a code 3 t/p?

One is not going to take an arrest into surgery. The only studies I have seen is arrest in the hospital setting on a trial basis of placing them on perfusion by-pass machines.

Usually, if one is too unstable to maintain life on its own, no surgeon is going to take the chance under anesthesia. Again other factors of age and isolated injuries or disease portion may change the difference.

R/r 911

 

[Gbro]

We load and intercept with ALS. They work the code and with direction from ER, will terminate when appropriate. However the pt. is going to the hospital. There is no other alternative.

off the subject, But i was turned away from the hospital with a DOA. New rules in the old building. The ME(new) left rules that "no-Body" is admitted to the morgue unless it is OK'ed (by same) EM.
There i am with Grandma in the back and coroner orders to transport to morgue early one Sunday morning.
I had to find a funeral director willing to take Grandma(visiting from out of state).
This was resolved through the proper channels that next Monday.

 

[firecoins]

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

It is possible to drive safely and drive lights and sirens. These things are not mutually exclusive. The reverse is also true. It is possible to drive unsafely and not have your lights and sirens on.

 

[emt/ff71185]

No one has touched on the BCLS level of care. In my district, ALS is not usually an option so in this case we ride code 3 because the hospital really can make a big difference over what we can do as B's. Do the medics in the room agree with this. Do the drugs help significantly or no?

 

[OreoThief]

I'm very curious as well... looking forward to some feedback from others.

 

[medic001918]

It is possible to drive safely and drive lights and sirens. These things are not mutually exclusive. The reverse is also true. It is possible to drive unsafely and not have your lights and sirens on.

Sure, it is possible to drive safely. You're assuming that I'm worried about my partner's driving. That's not the case. It's not always our driving that's the concern. It's those around us that panic when they see lights and sirens. Driving safety is a huge topic in our field. And statistically so, motor vehicle accidents are one of the greatest risks to us as a provider, and that risk increases significantly with the use of lights and sirens. Again, this doesn't have to have anything to do with your partner's driving. I'm not going to increase the risk of someone hitting us for a patient that will not benefit from it. There is little more (if anything in most cases) that gets done for cardiac arrest patients in the hospital. Routine transport is fine for me.

No one has touched on the BCLS level of care. In my district, ALS is not usually an option so in this case we ride code 3 because the hospital really can make a big difference over what we can do as B's. Do the medics in the room agree with this. Do the drugs help significantly or no?

This paints a different scenario where there could be a benefit for the patient from expedited transport. This comes in the form of pharmacological therapy and airway management. ACLS medications generally help to increase a favorable outcome, but the biggest things are quality, early CPR with defib (if indicated). Many times when pulses come back in a cardiac arrest, it can be the medications working and it may not be sustainable. ACLS medications range in function from suppressing disrhythmia, reversing acidosis and correcting blood glucose levels (if indicated).

Shane
NREMT-P

 

[BossyCow]

No one has touched on the BCLS level of care. In my district, ALS is not usually an option so in this case we ride code 3 because the hospital really can make a big difference over what we can do as B's. Do the medics in the room agree with this. Do the drugs help significantly or no?

I worked a code just yesterday. The gentleman was 6'8 and about 400lbs. Was conscious and talking to dispatch, c/o difficulty breathing, told dispatch "I'm dying" and then hung up. Hx of COPD, CHF, stent placement several years earlier and multiple MI's 8 - 10 years prior.

We were on scene in 8 minutes from being dispatched, and less than 3 from his last contact with the dispatcher. He lived in a small travel trailer, and there was no way we were gonna get him out of there while doing CPR. He was flat line, no shock advised when we arrived and stayed that way. We had ALS meet us on scene but the guy's color and O2 sat were so good that the medic did two full rounds of drugs and then called the MPD. We ended up calling it in the field and not transporting, but because of the timing, and the almost immediate Combi-tube and CPR after the event, the guy was nice and pink through the whole process. His number was just up! Now, we could have transported him and met ALS enroute, but that would have involved stopping CPR for at least 8 - 10 minutes while we hauled his bulk out of there.