Code calls, load & go or wait for ALS?

[shrewcraft]

As an EMT on a code call I prescribe to the "TEN MINUTE" rule. If your ALS can make it to you within 10 minutes or less stay on scene. My feeling is that when packaging ,moving the PT to the rig, doing CPR in the back of a moving rig, all contributes to less than optimal CPR. Wait on scene, give quality CPR (compressions compressions, ventilation and difibrillation if called for). With ALS coming to the Pt they have a better chance for survival. Am I right/wrong? 10 minutes to long? Need some input ..........Thanks

 

[Shishkabob]

Stay the whole time. Call it in the field. Don't risk your life, other responder's lives, and the lives of the public moving a dead body.


Unless, of course your agency is using outdated protocols and doesn't let you call it in the field after having done EVERY SINGLE THING the hospital will do.

 

[Epi-do]

If you have an AED and are doing good CPR, stay until ALS gets to you, or you get ROSC. Anymore, most ALS can call a code once certain parameters are met. There's no reason to risk the living for transporting a corpse.

 

[shrewcraft]

On a BLS level we do not pronounce in the field only ALS does. Sometimes ALS is "pending" which can mean that it will be more than 10 minutes before they might arrive on scene so we have to eventually package and get going to the ER...............thanks for your reply

 

[Aidey]

Let them pend. Even if it is 20 minutes, stay on scene and work the code. ALS interventions have minimal positive affect anyway.

 

[EpiEMS]

Work it on scene -- no reason to transport unless you're getting ROSC, no? ALS doesn't really make a positive impact on survival to discharge, which is really much more important than any other metric I can think of.

 

[Shishkabob]

ALS doesn't really make a positive impact on survival to discharge

Correction: MOST ALS.


Unless your EMTs can do therapeutic hypothermia?

 

[EpiEMS]

Correction: MOST ALS.


Unless your EMTs can do therapeutic hypothermia?

That's true. My B, as they say. To be fair, my system's medics don't do that either. Haven't seen a system's protocols that allow for it. Any areas that do?

 

[Shishkabob]

Haven't seen a system's protocols that allow for it. Any areas that do?

My current agency. My last agency. Nearly every surrounding agency.



It's a Texas thing. We let our EMS do what's right instead of asking nurses or politicians for permission.

 

[Epi-do]

That's true. My B, as they say. To be fair, my system's medics don't do that either. Haven't seen a system's protocols that allow for it. Any areas that do?

We do therapeutic hypothermia. Been doing it for a few years now.

 

[Aidey]

Don't forget that therapeutic hypothermia in the field requires that the hospital(s) are doing it too. If the hospitals haven't implemented it there isn't much EMS can do.

 

[EpiEMS]

My current agency. My last agency. Nearly every surrounding agency.

It's a Texas thing. We let our EMS do what's right instead of asking nurses or politicians for permission.

I wish we did that up here!

Hospitals don't seem to do it up here, hence, I suppose, why it hasn't been implemented.

 

[Wheel]

We just started right after I started my job. Most of the hospitals are continuing the hypothermia, but a few aren't, which is frustrating.

 

[fast65]

My current agency. My last agency. Nearly every surrounding agency.



It's a Texas thing. We let our EMS do what's right instead of asking nurses or politicians for permission.

We're also doing therapeutic hypothermia, although, it seems it's somewhat inconsistent as to whether or not the hospital continues it once we get there...

 

[leoemt]

As an EMT on a code call I prescribe to the "TEN MINUTE" rule. If your ALS can make it to you within 10 minutes or less stay on scene. My feeling is that when packaging ,moving the PT to the rig, doing CPR in the back of a moving rig, all contributes to less than optimal CPR. Wait on scene, give quality CPR (compressions compressions, ventilation and difibrillation if called for). With ALS coming to the Pt they have a better chance for survival. Am I right/wrong? 10 minutes to long? Need some input ..........Thanks

I don't buy into the whole "no CPR in a moving vehicle" Crap. There have been tons of saves with CPR done in a moving vehicle in our area. I wouldn't say it is common or the best thing to do for every patient.

My opinion is you need to weigh the situation. Why is the patient in cardiac arrest? How close are you to an appropriate facility that can treat the patient? How likely is survival?

Stay and play is definately appropriate for most cases of CPR but ultimately it needs to be based on patient condition.

 

[Aidey]

I don't buy into the whole "no CPR in a moving vehicle" Crap. There have been tons of saves with CPR done in a moving vehicle in our area. I wouldn't say it is common or the best thing to do for every patient.

My opinion is you need to weigh the situation. Why is the patient in cardiac arrest? How close are you to an appropriate facility that can treat the patient? How likely is survival?

Stay and play is definately appropriate for most cases of CPR but ultimately it needs to be based on patient condition.

So you're just going to ignore all the studies that have been done because you think the plural of antidote is data? Whether you like it or not CPR is significantly less effective in a moving ambulance. Both rate and depth suffer to the point that studies show an effectiveness in the teens or lower.

Also, please define "tons".

 

[Smash]

Tons? I've been in the game 15 years, working in reasonably progressive and optimised systems and I can recall maybe a dozen saves in that time, so I would be interested to know what constitutes 'tons'
The patient condition is dead. Driving somewhere isn't likely to change that.

 

[Thricenotrice]

So you're just going to ignore all the studies that have been done because you think the plural of antidote is data? Whether you like it or not CPR is significantly less effective in a moving ambulance. Both rate and depth suffer to the point that studies show an effectiveness in the teens or lower.

Also, please define "tons".

I'm not disputing the data, evidence, or consensus, but I will say that if I'm doing compressions in a rig, they are the same compressions as on the floor of the house. I believe it depends on the driver.... As long as they're driving how code three should be done (not erratically) effective CPR is absolutely possible and probable.

Again, just my own experiences.

 

[Aidey]

Just because you think it is effective doesn't mean it is effective. Look at studies done on how everyone all the way up to Anesthesiologists will over bag pts. We're really bad at judging how well we are performing some things.

 

[Brandon O]

Correction: MOST ALS.


Unless your EMTs can do therapeutic hypothermia?

Well, sorta. No real evidence yet that starting this in the field helps on an individual basis -- but on a system basis, it does help encourage area hospitals to institute hypothermia protocols. (Especially if you start threatening not to bring them post-arrest patients if they don't...)