CPR Transfer of Care

[mikie]

I have yet to transport a cardiac arrest patient. I have a few questions:

1. When you roll the pt to the stretcher, how are compressions handled?

2. What is it like when you transfer the pt. to the hospital when you need to radio/contact the receiving facility, does it not interupt CPR/ACLS ?

3. When you get to the hospital, how do you transfer care? Do they greet you a the door?

Thanks!

 

[Jon]

Greet at the door? You've been watching too much TV. Count on doing CPR until the patient is on the resuscitation bed... and probably beyond that, depending on the size of the ED and code team. In a larger facility, there will probably be an ED tech ready to take over compressions form you... in a smaller setting, or if the ED is slammed... you might need to stay and help for a minute or two.

When you have to move the patient - onto a stretcher, backboard, etc... you would hold compressions, but only for as brief a time as possible. When you are moving the patient down stairs, keep compressions going as much as possible.

When you are transporting... depending on the staffing... someone will call the hospital... once in a while, if we are shorthanded, we will ask the communications center to call the hospital and notify them that we are bringing a cardiac/respiratory arrest in.

 

[Ridryder911]

I have yet to transport a cardiac arrest patient. I have a few questions:

1. When you roll the pt to the stretcher, how are compressions handled?

CPR is of course stopped. It is usual for a pulse check and a quick assesment and removal of leads, etc. CPR is resumed as soon as possible. Although, probably nothing close to just 10 seconds.

2. What is it like when you transfer the pt. to the hospital when you need to radio/contact the receiving facility, does it not interupt CPR/ACLS ?

I usually have a Firefighter doing CPR, or will have my EMT or Paramedic driver give a report. It should not have to be very lengthy. i.e. Enroute with a cardiac arrest, pt is intubated, ECG remains aystole, 3'rd dosage of ACLS, no changes, ETA 7 minutes. Will advise further.

3. When you get to the hospital, how do you transfer care? Do they greet you at the door?

It all depends upon the ER. How busy, staffing, etc. I have worked some where they will meet & others where they will not.

Not to be harsh, but in the real life most codes are terminated as soon as possible. If the patient did not respond to field resuscitation measure, it is very doubtful they will respond to ER's. Most physicians will either immediately terminate all measures or may give a few rounds of med.'s until history is obtained then cease efforts.

I must forewarn you it is not alike on t.v. Codes are really not that big of a deal in the hospital setting. Definitely due to crowding, low staffing, out of hospital codes are considered a pain in the arse. Again, majority die and doing the amount of paperwork is longer than the process of the code.

R/r 911

 

[mikie]

Thanks guys!

I saw once an EMT when we were rolling a pt to the ambulance (I didn't transport, was on a different truck) doing compressions with one hand as we were rolling from the house to the ambulance (about 50 meters or so), is this advisable?

 

[JPINFV]

It shouldn't matter. Unless the patient codes during transport or has other circumstances (hypothermia), then the patient shouldn't be transported until ROSC has been achieved. No ROSC, no transport, no transfer of care to the hospital. Codes, unlike fine wine, do not get better with age.

Simple fact is that one handed CPR doesn't work well. If it did, then why is so much effort get into getting people to be right over the patient and use two hands? Unfortunately, if your system either doesn't allow for field termination, or your paramedic is too scared to ask for one, then it's not like you have very much of a choice.

 

[Grady_emt]

I have yet to transport a cardiac arrest patient. I have a few questions:

1. When you roll the pt to the stretcher, how are compressions handled?

2. What is it like when you transfer the pt. to the hospital when you need to radio/contact the receiving facility, does it not interupt CPR/ACLS ?

3. When you get to the hospital, how do you transfer care? Do they greet you a the door?

Thanks!

Usually a FF will "ride" the stretcher meaning that he will stand on the bottom tray and do compressions while rolling the stretcher into the ER.

Usually on all critical calls, my partner is in the back and me as the EMT/EVO will call the er, 'intubated asystolic arrest, 2 rounds ACLS, 5 minutes out" and that really all they need to know. Even for a shooting or wreck "35-40 yom, rollover MVC, ejected with multiple extremity fractures and rigid abdomen, pulse 130, B/P 80palp, resp 6 intubating at this time, eta 5-7" and that tells them everything they need to know: the pt is low sick, and the trauma team needs to be activated.

At the ER, its an unwritten rule that the two spaces infront of the ER doors are for units bringing critical pts. Its about 200' from there to either the Trauma Bays to the righ, or CPR & Critical Care rooms to the left

 

[Grady_emt]

It shouldn't matter. Unless the patient codes during transport or has other circumstances (hypothermia), then the patient shouldn't be transported until ROSC has been achieved. No ROSC, no transport, no transfer of care to the hospital. Codes, unlike fine wine, do not get better with age.

Simple fact is that one handed CPR doesn't work well. If it did, then why is so much effort get into getting people to be right over the patient and use two hands? Unfortunately, if your system either doesn't allow for field termination, or your paramedic is too scared to ask for one, then it's not like you have very much of a choice.

Our protocol for field termination is "found in asystole, intubated, two rounds of drugs IV/IO, stays in asystole, consensus amongst Fire, EMS, PD and Pt Family if present to terminate, contact med control for termination orders."

 

[Pittsburgh Proud]

Usually a FF will "ride" the stretcher meaning that he will stand on the bottom tray and do compressions while rolling the stretcher into the ER.

Done that many of times... B)

 

[MSDeltaFlt]

Usually a FF will "ride" the stretcher meaning that he will stand on the bottom tray and do compressions while rolling the stretcher into the ER.

...depending on the size. If they're 475lbs (I have a partner who fits that description on the ground), riding the stretcher will void the warrantee.

 

[Anomalous]

... riding the stretcher will void the warrantee.

Good point. It looks good on TV though.