Definition of Save a Life

[catskills]

When do you recognize an EMT-B for saving a life?

Does it have to be cardiac arrest to be credited for saving a life?

What about a call where Pt unresponsive with pulse, not breathing and use of BVM, OPA, NPA is what kept the Pt alive for over 15 minutes until medic arrived and was able to successfully intubate Pt after a number of tries. Other factors, Pt had a lot of fluid in lungs which made it extremely difficult to bag Pt. Pt had to be suctioned often while bagging Pt. It was a good call. Everyone worked well together and the Pt lived.

Personally I think this was a difficult call and yes had the EMT-Bs not been there the Pt would have gone into cardiac arrest. This is what EMTs do. On the other hand if this was considered a save, I would like to recognize the EMTs for saving a life.

What do you think? When does your agency recognize a life saving event?

 

[VentMedic]

Saving a life to where the patient walks out of the hospital without assistance or prolonging the pronouncement of death?

Nobody questions the possibilities of early CPR to improve chances but in reality, without advanced care of ALS and a hospital ED, the patient's chances of a successful recovery without major deficits dwindles from very slim to nil.

A successful save is one that the patient can move his/her own hand to shake yours or at least acknowledge your presence and show they are grateful to be alive regardless of whatever disabilities or deficits they may have.

Just getting a patient to the ED with a heart beat that lasts for one hour is not a save although the one hour time period is often used by some agencies.

 

[EMSLaw]

Vent is right. In terms of when you are credited with a "save" - that varies by agency. For mine, the patient has to survive 24 hours past arrival at the ED.

But personally, I would say that you haven't saved someone's life unless they walk out of the hospital with their faculties at least mostly in tact. If your patient makes it to the ED, and has a spontaneous heartbeat, but no brain function, that's more a tragedy than a "save".

 

[CAOX3]

We recognise a "save" as neurologicaly intact at time of discharge.

I have participated in ALS and BLS saves.

 

[DV_EMT]

I agree... if a little old lady falls down some stairs... and isn't stable when you get there... and is D/C'ed from the hospital to go back home... thats a save in my book.

 

[VentMedic]

I have participated in ALS and BLS saves.

By BLS save, do you mean a foreign body object removal by Heimlich or one that required no advanced airway or no medications and no time in the hospital?

 

[CAOX3]

By BLS save, do you mean a foreign body object removal by Heimlich or one that required no advanced airway or no medications and no time in the hospital?

I was speaking in terms of cardiac arrest. By BLS I mean dispatched to find a party in cardiac arrest, treated and transported with no ALS intervention in the field.

 

[firetender]

If you arrive at a scene to find a pulseless and apneic human being, you get them to the ER with a pulse and maybe breathing, too, and they get transferred out of the ER to anywhere other than the Morgue, sure, I'd call that a save. You brought them back long enough to move out of the Emergency stage and into the Admission stage; a Gold Star for you!

And the whole idea of "recognizing saves" I would expect is a rarity. It does not make good business sense to heap recognition on a medic for performance when what you really want to do is fire him/her for not washing the truck!

 

[catskills]

Let assume the Pt was discharged from hospital.

I am not sure you answered my question.

Is it a save EMT-Bs working on Pt unresponsive with pulse, not breathing and use of BVM, OPA, NPA, and suction is what kept the Pt alive for over 15 minutes until medic arrived and was able to successfully intubate Pt after a number of tries. Is this considered a save?

Is a save only reserved for cardiac arrest where CPR is required to be considered a save?

I am talking about recognizing the EMT-B in a formal setting with a plaque.

Honest opinions are welcome.

Obviously you still want them to wash the truck after they are recognized for the save.

 

[catskills]

Given the high number of Pts, I don't consider an unresponsive PT for hypoglycemia should be considered a life saving event. Yes many time you have to perform rescue breathing but usually it is for a short time before the IV is started and medic gives them a shot of glucose. Many times these Pts will RMA without going to the hospital.

If we handed out life saving plaques for every hypoglycemia Pt then every award diner we would be handing out so many life saving awards that it would not mean much.

 

[VentMedic]

Given the high number of Pts, I don't consider an unresponsive PT for hypoglycemia should be considered a life saving event. Yes many time you have to perform rescue breathing but usually it is for a short time before the IV is started and medic gives them a shot of glucose. Many times these Pts will RMA without going to the hospital.

So only the really cool heroic acts like CPR count? What would have happened to the hypoglycemic patient without intervention? Hypoglycemia can result in severe brain damage as well as death.

If we handed out life saving plaques for every hypoglycemia Pt then every award diner we would be handing out so many life saving awards that it would not mean much.

Patient care is more than just a few really cool heroic acts. It seems like some in your company may know the importance of what you do and how even being there for the hypoglycemic patient can make a difference to the patient. Granted, I think the plague thing might be a little overboard as those in very busy services would need a warehouse just after a week to store them. It is part of your job but if your company wants to recognize what you do for the patients, let them. Sometimes small communities do value each and every one of their citizens and regardless of how small your effort was, someone may have appreciated it.

 

[reaper]

I don't think you should be getting a plaque, for doing your job! Whether you save a person or not, that is why you are on the truck! Does a surgeon get an award for doing their job? They do what is expected in their line of work.

 

[firetender]

If saving a life involves an award program that praises one individual, let's reserve that for the civilians.

When it comes to a save by trained personnel, it's all an illusion because there is rarely ONE person involved. If a BLS crew keeps one alive until an ALS crew gets there and the ALS crew gets them to the hospital alive and the ER staff gets them to an ICU, GOD gets the plaque.

If you end up spending a lot of time micro-analyzing each call to determine WHO pulled it off, then the purpose of the award is lost because someone who deserves to feel they contributed is brushed aside in favor of what boils down to choosing a body to place an award on.

The only plaque I'd want is for the night I went up against every doctor in the regional medical center -- including the Medical Director, refusing to transport a spine injured patient to a (dismal!) VA hospital until he was stable for transport. For them, it was a Buff and Turf, for me, it was an "All-in!"

 

[AKidd]

I don't know if I am in the minority - I may well be, but I am not the type to hurt my shoulder patting myself on the back. If I do something outstanding, then an "atta-girl" from the MD might be nice - maybe put it in writing and toss it in my file for the next performance eval. Otherwise, "I" was not responsible for a save - I had a partner, and colleagues, and the ED staff, and ICU staff to credit for their contribution. Granted, this is within the service - but it sounds like the OP was trying to figure if they were entitled to "credit" for a "save" because they had to maintain for 15 minutes until ALS arrived.

If it is a situation of a civilian organization offering an award - I can't be responsible for their choice (I have accepted a couple) but within the service, if there is a score card, I truly hope it is informal. If you are in this line of work for the credit or glory, it may well explode in your face as the desire for recognition exceeds rational thought. It is nice to be thanked for doing your job - even nicer if it has been a tough call, but to hinge your worth on it... is a slippery slope.

 

[18G]

I've from time to time pondered this same question since we hear all the hype about EMS saving lives... for a cardiac arrest save, in my opinion the patient must be discharged from the hospital and return to good quality of life. Merely getting a pulse back does not count as a save... to me that is a prolonging of death.

I think conditions like hypoglycemia qualify for saving a life. As already mentioned, what happens if the patient does not receive early intervention by EMS? We don't perceive hypoglycemia as anything "important" because we get called early on, get there, and the patient responds immediately to the interventions. But really, if those interventions are not performed, the patient is not looking too good, right?

Nobody questions the possibilities of early CPR to improve chances but in reality, without advanced care of ALS and a hospital ED, the patient's chances of a successful recovery without major deficits dwindles from very slim to nil.

I'm not quite so sure about this anymore when talking about survival from cardiac arrest. The current science is saying that early and continuous CPR WITHOUT unnecessary interruption and early defibrillation is what is most likely to save a person in cardiac arrest. No other intervention is more important or takes a higher precedence than quality, uninterrupted CPR and defibrillation. Both of which are considered BLS. Not maintaining a constant cerebral and coronary perfusion pressure has been found to be very detrimental.

It's also worth mentioning that the drugs we give in cardiac arrest have not been proven to increase actual survival. Epinephrine has been found to result in a greater ROSC, but not survival to discharge. And to my knowledge nothing solid has proven the real benefit of atropine either. It's a makes sense and cant hurt, but only help kinda drug when given in cardiac arrest.

 

[VentMedic]

I'm not quite so sure about this anymore when talking about survival from cardiac arrest. The current science is saying that early and continuous CPR WITHOUT unnecessary interruption and early defibrillation is what is most likely to save a person in cardiac arrest. No other intervention is more important or takes a higher precedence than quality, uninterrupted CPR and defibrillation. Both of which are considered BLS. Not maintaining a constant cerebral and coronary perfusion pressure has been found to be very detrimental.

It's also worth mentioning that the drugs we give in cardiac arrest have not been proven to increase actual survival. Epinephrine has been found to result in a greater ROSC, but not survival to discharge. And to my knowledge nothing solid has proven the real benefit of atropine either. It's a makes sense and cant hurt, but only help kinda drug when given in cardiac arrest.

We don't interrupt CPR either in the ED but we are not going to with hold medications either. And, patients don't always just spontaneously wake up after ROSC and get some discharge instructions to be on their way. We do have a lot of saves if the timing is right for all the resources but it may still involve an extensive hospital stay while hooked up to medications and technology.

 

[CAOX3]

Everyone plays a role in "saving a life" from the bystander performing CPR on a total stranger, to the BLS provider, ALS provider an ultimatley the ER staff.

What I find most interesting is after all the advances in medicine the bystander still plays the most critical role in survival of the cardiac arrest patient.

 

[Scout]

Are you looking to see what calls are life saving? or when do yoyu get to record a "save"

As in simple ETOH vomiting on back, I pop along and turn them into recovery position,, ie they would have aspirated should i not have been htere.

or

when is an arrest a save?

 

[Seaglass]

Far as I'm concerned, going around saying that my job description is saving lives is total whackerism. I've yet to "save a life" on a code, but I've "saved" plenty from vomit aspiration and the like. So what? I'd be a terrible EMT if I hadn't.

When does your agency recognize a life saving event?

We don't. Too hard to determine. The most we might get is a thanks from the patient, but that's up to the patient, and we get those for some very routine calls anyways.

 

[CollegeBoy]

I think we need to look at emt_angel25's signature:

~There are 2 types of people in this job those who love the job, and those who love the glory, which are you?~

Now we are seriously having an arguement here on what constitutes saving a life?