Do you have what it takes to work a code?

[emtfarva]

Working a code for the benefit of the family? Really, what purpose does that serve other than giving false hopes?

I was taught that when a child has coded, not only is the child your Pt but also the Pt's Parents. I would work the code in the truck not in front of the Parents. The same thing with ?sids case. I would try to give a very smooth ride for an arest Pt. I would also try to let PD drive the Pt's family to the Hosp.

 

[medic417]

Because, Children might have a better survial rate. You also might need more speicalized equipment. Then again it is the same as an adult. Maybe more of treatment for the Parents.

No PALS is just like ACLS. You work them until you get ROSC or you call it. Again only reason to be rolling is for organ donation and that is done no L&S.

 

[ffemt8978]

I was taught that when a child has coded, not only is the child your Pt but also the Pt's Parents. I would work the code in the truck not in front of the Parents. The same thing with ?sids case. I would try to give a very smooth ride for an arest Pt. I would also try to let PD drive the Pt's family to the Hosp.

And that has fallen out of favor in recent years, because of a variety of reasons that I'm sure Rid will comment on.

 

[Aidey]

Fallen out of favor or not, we can only do what our protocols say, and my protocols say you will transport all pediatric code patients unless they have rigor, lividity, or "injuries incompatible with life".

 

[medic417]

Fallen out of favor or not, we can only do what our protocols say, and my protocols say you will transport all pediatric code patients unless they have rigor, lividity, or "injuries incompatible with life".

Sounds as if it is time to meet with the medical director and discussing bringing protocols up to current standards. If it does not say transport L&S I would take them till it was changed but do it safely and at the speed limit as patient is dead no need to rush nd risk harming self or others.

 

[amberdt03]

Education!!!!!!!!

I prefer your definition of a save to the fire departments of a save being getting them to the hospital for the doctor to call it.

First you need 2 people besides the patient. A third person is great but not required. More than 5 and people are in the way big time.

You need a means to deal with cardiac electrical system, could be as simple as an AED.

High quality compressions with very limited interuptions.

Drugs have actually per Dr. Bledsoe not been proven to actually increase likelyhood of recovery but hey I want to play so I want all my ACLS drugs.

Intubation equipment. Including Cric kit in case.

Heat packs.

Chest decompression kit. OK big word for 14g long caths.

BVM

At least 2 IV's/IO's but see drugs above.

Luck

OK does that get us started. But w/o specific cause hard to say.

And very important work it on scene there should be no diesel bolus' on a code. It is against current guidelines. And endangers the public for a dead person.

i've only worked one code, so obviously i'm not an expert, but i was working a part time job just doing first aid at a flea market when i got a call for someone passing out. now i was the only person with any medical experience there, so i immediately radioed the office and said i need an ambulance now(yeah i was bit nervous:unsure luckily fd was already on the way(only had to do 2-3 rounds of compressions and they were walking in) they immediately carried her over the the cot and loaded her up and they let me go with them. there was 1 ff/emt, he drove, and 3 ff/medics in the back plus me. it was a bit crowded, but i found that having the 3 of them seem to make the work easier. 1 started a line and pushed drugs, 1 was tubing, and the other was setting up the monitor to see what rhythm she had. no compressions were being done while we were moving, which surprised me but i had only been an emt for about a year with no real experience. a couple minutes after transport 1 shock was applied and pulse was restored. made it to the hospital with a pulse, but still unresponsive. when we left she was trying to buck the tube. don't know what happened to her after that. hope she's alive, considering she was 26 at the time.

now i have a couple of questions
1. what is a good number of people to be in the back working a code?
2. how many people actually do compressions while moving?
3. how long do you work a code before you start transport?

 

[medic417]

now i have a couple of questions
1. what is a good number of people to be in the back working a code?
2. how many people actually do compressions while moving?
3. how long do you work a code before you start transport?

1. No more than 5 people and that is tight in an ambulance. 3 is best.

2. We do not do rolling codes.

3. We do not do rolling code so unless we get pulse back we do not transport.

 

[Ridryder911]

i've .

now i have a couple of questions
1. what is a good number of people to be in the back working a code?
The least the number the better. No more than three. Two that can switch compressions, and me to administer med.'s and monitor.
2. how many people actually do compressions while moving?
One is usually all you can place on a chest .

3. how long do you work a code before you start transport?
As soon I can quit. Cardiac arrest has < 6% chance of survivial. If possible and there is any way not to even work it, I'll do that. Most resucitation efforts are futile unless good CPR was started & continued until ALS/ EMS arrives or the patient coded in front of you.

If possible obtain an DNR if no ROSC.
R/r 911

 

[MSDeltaFlt]

Codes are a no brainer. They can't get any worse. Death is pretty final.

After two rounds of med.'s and good compressions; if no results time to stop. The main emphasis is preventing a code from occurring. Now that my friends, is the hard part.

R/r 911

I had a brief discussion with a friend today on what it takes to be able to successfully resuscitate a coded patient.

Rather than launch into a tirade I figure I would open the discussion by asking everyone out there what you think is specifically required. (I know a few will say education, please be more specific for the newer members)

Please keep in mind for this a successful “save” is survival to discharge neurologically intact enough to not get sent to a “skilled nursing home.”

Of course my opinion to come later.

True ACLS is code prevention. In order to guarantee a successful "save" as you listed requires Someone much more powerful than you or I, my friend.

 

[amberdt03]

2. how many people actually do compressions while moving?
One is usually all you can place on a chest .

Ridryder911
thanks smarty, lol. let me rephrase the question. compressions while moving, yes or no?

 

[Ridryder911]

I was taught that when a child has coded, not only is the child your Pt but also the Pt's Parents. I would work the code in the truck not in front of the Parents. The same thing with ?sids case. I would try to give a very smooth ride for an arest Pt. I would also try to let PD drive the Pt's family to the Hosp.

Here's the deal. Never work or change treatment for yourself. This is what you are doing. It is not about the patient. Chances are it is about you not being able to handle the death and telling the grieving family. Guess what; they already know. Adding unnecessary hope is horrible. I have seen many family members have hatred towards EMS staff when the physician describes that the child had been down to long. Family members may feel that EMS staff did not know their job well enough or disrespected their child's body.

Now, I personally believe it is unethical, immoral and near just prosecutable to work an infant just because over zealous EMT's cannot handle their job.

Sure, most EMT's believe they are doing the right thing, when in fact they make the matter worse. Yes, watching EMT's performing CPR may give false hope and thanks to your heroic efforts now will have a $10,000 bill + autopsy bill, pathology bill..add another $5,000. Thanks Mr. & Ms. EMT. Now add that to the $10,000 funeral expense. So let's see so far; $25,000 because of your heroic action. When in fact a simple.. "I'm sorry"... would had surfaced enough.

Make your appearance short & sweet. Be careful of what you say.. they will remember it for the rest of their lives. It is a crime scene, (really it is) and if possible get professional counselor or clergy that are trained on what not to say and what to do.

We must remember in EMS, that is our job to ensure that consistency occurs.

To answer CPR with movement of stretcher. You bet. If you stop, why continue? You have lost all ATP build up and increased chance of morbidity.

R/r 911

 

[AJ Hidell]

This, of course, is all much better understood by professional providers who have an educational foundation in the social and psychological sciences. You cannot competently treat patients or their families if you do not understand them. That is why such an education should be required of anyone entering the EMS field.

 

[ffemt8978]

This, of course, is all much better understood by professional providers who have an educational foundation in the social and psychological sciences. You cannot competently treat patients or their families if you do not understand them. That is why such an education should be required of anyone entering the EMS field.

And yet it was a volunteer that initially pointed this out in this thread...

 

[Scout]

Do i have what i takes,

BTH my input into the equation is one of am i lucky on the day.

 

[mperkel]

Here's the deal. Never work or change treatment for yourself. This is what you are doing. It is not about the patient. Chances are it is about you not being able to handle the death and telling the grieving family. Guess what; they already know. Adding unnecessary hope is horrible. I have seen many family members have hatred towards EMS staff when the physician describes that the child had been down to long. Family members may feel that EMS staff did not know their job well enough or disrespected their child's body.

Now, I personally believe it is unethical, immoral and near just prosecutable to work an infant just because over zealous EMT's cannot handle their job.

Sure, most EMT's believe they are doing the right thing, when in fact they make the matter worse. Yes, watching EMT's performing CPR may give false hope and thanks to your heroic efforts now will have a $10,000 bill + autopsy bill, pathology bill..add another $5,000. Thanks Mr. & Ms. EMT. Now add that to the $10,000 funeral expense. So let's see so far; $25,000 because of your heroic action. When in fact a simple.. "I'm sorry"... would had surfaced enough.

Make your appearance short & sweet. Be careful of what you say.. they will remember it for the rest of their lives. It is a crime scene, (really it is) and if possible get professional counselor or clergy that are trained on what not to say and what to do.

We must remember in EMS, that is our job to ensure that consistency occurs.

To answer CPR with movement of stretcher. You bet. If you stop, why continue? You have lost all ATP build up and increased chance of morbidity.

R/r 911

I'm only an EMT-B, just wondering though, how do you know when to say that "I'm sorry" part. To my understanding, I am not medically trained yet to determine that. If their is a chance I could keep working that ped and bring them into the hospital for a doctor to save them, then I would. I would just hate to see EMTs take this advice, and not doing anything on scene, just leave and the person would have no chance. I don't think for me it would be the fact of 'breaking the bad news', more of I wouldn't feel comfortable stopping treatment on scene, unless I am 100% there is nothing else that can be done.

 

[mxjagracer]

That depends on your level of training. At the paramedic level there is little to no difference in care available in the ER compared to what we can do in the field. We all work with the same ACLS guidelines and once we get through that it's over. Like medic417 mentioned the H's and T's are something we need to work through and there's a couple of them that we simply cannot (at this point) test for or correct in the field but for the most part we can do everything that the hospital can do. ACLS is the bread and butter of what makes a medic, a medic.

Our service does not initiate transport of a PNB patient unless it is due to a hypothermic event.

Not exactly true. As far as doing everything the hospital can. YES, we do both work off of ACLS. A nurse ALONE, could legally only do what we do. But, they do have the advantage of.... A DOCTOR!!!! The doc has the ability to push whatever they want in whatever dosage they want (depending on how lazy/or determined they are). That is a HUGE difference...

And, the heat pack thing? I hope thats not just precautionary!! Shoot. Here in the ghetto, we would be lucky to have heat packs on our trucks!!! And talk about really hating the "not dead till they are warm and dead" theory!! It is bum-cicle R US up here. For us its an iv bag hanging by the heater vent off a coat hangar someone brought from home... So... yea, they teach us knowledge of signs and symptoms so that we can limit possibilities in the field. And Hypothermia, I would think would be right up there with Hypoxia with the difficulty to diagnose in the field....h34r:

 

[mxjagracer]

Here's the deal. Never work or change treatment for yourself. This is what you are doing. It is not about the patient. Chances are it is about you not being able to handle the death and telling the grieving family. Guess what; they already know. Adding unnecessary hope is horrible. I have seen many family members have hatred towards EMS staff when the physician describes that the child had been down to long. Family members may feel that EMS staff did not know their job well enough or disrespected their child's body.

Now, I personally believe it is unethical, immoral and near just prosecutable to work an infant just because over zealous EMT's cannot handle their job.

Sure, most EMT's believe they are doing the right thing, when in fact they make the matter worse. Yes, watching EMT's performing CPR may give false hope and thanks to your heroic efforts now will have a $10,000 bill + autopsy bill, pathology bill..add another $5,000. Thanks Mr. & Ms. EMT. Now add that to the $10,000 funeral expense. So let's see so far; $25,000 because of your heroic action. When in fact a simple.. "I'm sorry"... would had surfaced enough.

Make your appearance short & sweet. Be careful of what you say.. they will remember it for the rest of their lives. It is a crime scene, (really it is) and if possible get professional counselor or clergy that are trained on what not to say and what to do.

We must remember in EMS, that is our job to ensure that consistency occurs.

To answer CPR with movement of stretcher. You bet. If you stop, why continue? You have lost all ATP build up and increased chance of morbidity.

R/r 911

OH SWEET JESUS!!!!! This is the difference between the big city and the 'burbs! Technically, a baby not breathing should have an appearance from scout (police) first. But heres your question. You risk the life of a child because of the chance that it might be a crime scene? NO! We had an incident this summer where we already had a priority 2 asthma in the truck. The call went out, literally 2 blocks away, for a baby not breathing. Given the quality of the crew that was coming, and the distance they were coming from, we elected to grab the baby and bring him outside immediately. I had to go into the apartment myself, where I found an obviously deceased baby, lying on its back on the couch. I was greeted by the father, sitting next to the baby on the couch, who thought that a cool handshake, and a melancholy "hey, how you doin?" was in order. Obvious shady activity. But here are your options.... 1. Take the baby, depend on your memory (or if you write it down) of what the scene looked like, or the attitude of the parents, for when you get called to court. 2. Leave it and just walk out "quick and quietly" to preserve a potential crime scene. 3. Insist that the baby is deceased to the parents who are DANGEROUSLY outrageous and threatening to kill you if you dont do something (hoping that scout beats ray-ray and pookie to the scene). And did I mention that scenario #2 probably ends in a good old fashion *** whooping too, if not a good ole game of chase the ambulance so some *** whoopin can commence. Both 2 and 3 end result in *** whoopin. In case you missed that.

Its called hollywood cpr. You do what you have to do to remove the pt. from public view. You dont leave the dead guy and his detached leg with his motorcycle in the middle of a five lane road. People dont need to see that. The same as people dont need to stand over their rigor, mottled infant until the police show up an hour later. Get it out of the public view and priority 4 it to the hospital. The only exception for this we make is death at old age, in a residence. WITH a calm family.

I have gotten many more threats of bodily harm on scene for doing, or not doing something that the multiple bystanders on scene (without a high school GED, let alone medical training) did or did not see fit, than I have thank you for trying your best from the family at the hospital. But I'll take those few thank you's over the threats anyday.....

 

[Sasha]

I'm only an EMT-B, just wondering though, how do you know when to say that "I'm sorry" part. To my understanding, I am not medically trained yet to determine that. If their is a chance I could keep working that ped and bring them into the hospital for a doctor to save them, then I would. I would just hate to see EMTs take this advice, and not doing anything on scene, just leave and the person would have no chance. I don't think for me it would be the fact of 'breaking the bad news', more of I wouldn't feel comfortable stopping treatment on scene, unless I am 100% there is nothing else that can be done.

Many people have no chance already! Unwitnessed arrest has a really crappy prognosis. Here's a study, which can be found here: http://www.ncbi.nlm.nih.gov/pubmed/2240722?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

OBJECTIVE: Numerous studies have shown initiation of bystander CPR to significantly improve survival from prehospital cardiac arrest. However, in emergency medical services (EMS) systems with very short response times, bystander CPR has not been shown to impact outcome. The purpose of this study was to determine the effect of bystander CPR on survival from out-of-hospital cardiac arrest in such a system. DESIGN: Prehospital, hospital, and death certificate data from a medium-sized metropolitan area were retrospectively analyzed for adult, nontraumatic cardiac arrest during a 16-month period. RESULTS: A total of 298 patients met study criteria. One hundred ninety-five arrests (65.4%) were witnessed, and 103 (34.6%) were unwitnessed. Twenty-five witnessed victims (12.8%) were discharged alive, whereas no unwitnessed victims survived (P less than .001). Patients suffering a witnessed episode of ventricular fibrillation/tachycardia (VF/VT) were more likely to survive (21.9%) than were other patients (2.0%, P less than .0001). Among witnessed patients, initiation of bystander CPR was associated with a significant improvement in survival (20.0%) compared with the no-bystander CPR group (9.2%, P less than .05). Bystander CPR was also associated with improved outcome when witnessed patients with successful prehospital resuscitation were evaluated as a group; 18 had bystander CPR, of whom 13 (72.2%) survived compared with only 12 of 38 patients with no bystander CPR (31.6%, P less than .01). CONCLUSION: Our data revealed improved survival rates when bystander CPR was initiated on victims of witnessed cardiac arrest in an EMS system with short response times.

If the person has been down for any amount of time, chances are you're not going to be able to do anything for that patient. Brain cells start to die after six minutes of no oxygen, those brain cells cannot be brought back. If you by chance get a ROSC, the person is going to be severely incapacitated and vegatative, which may leave the family incredibly bitter towards you. Shows like ER and House give people a false sense of what they think is going to happen, it's your job as an EMT to be more realistic than that. It's nice to think we can actually save people from arrest but the outcome is very grim.

Ask when they last saw the patient alive. 8pm last night? Chances are the patient was dead long before you got there. Rigor, lividity? Is there a shock indicated?

It's much more cruel to give the family a sense of hope when you know there is little to no chance. If it makes you feel uncomfortable, oh well. Suck it up, big girl/boy panties, you're there for your patient, your patient isn't there for you. Sometimes the patient's family know the patient is dead when they call, they just simply don't know what else to do.

 

[Sasha]

You risk the life of a child because of the chance that it might be a crime scene? NO!

Sorry, I'm rereading and I still don't see where he said that you let a child die based on the fact it's a crime scene. The child is already dead. It's probably obviously dead.

Hollywood CPR is BS. You are doing nothing but playing with the emotions of the family. Be a health care provider and explain to the family when dead is just dead, and there's nothing that you would do except cave the child's chest in.

(without a high school GED, let alone medical training)

And? That doesn't necessairly mean they're dumb. Tone down on the judgement a little bit, okay?

was greeted by the father, sitting next to the baby on the couch, who thought that a cool handshake, and a melancholy "hey, how you doin?" was in order. Obvious shady activity.

Not everyone grieves with tears and shouting and crying. Perhaps he didn't know how to respond. Again, sometimes people know and accept it, they just don't know what else to do.

 

[Ridryder911]

I'm only an EMT-B, just wondering though, how do you know when to say that "I'm sorry" part. To my understanding, I am not medically trained yet to determine that. If their is a chance I could keep working that ped and bring them into the hospital for a doctor to save them, then I would. I would just hate to see EMTs take this advice, and not doing anything on scene, just leave and the person would have no chance. I don't think for me it would be the fact of 'breaking the bad news', more of I wouldn't feel comfortable stopping treatment on scene, unless I am 100% there is nothing else that can be done.

Did they not teach you obvious signs of death? Not medically trained enough to determine that then you need not to be in the business. Seriously, that is part of your job! Your chance of doing that is higher than performing CPR. Wait until the physicians grabs you in the hall and chews your arse out then reports you for not doing the right thing.

Remember, the job is NOT about you !

OH SWEET JESUS!!!!! This is the difference between the big city and the 'burbs! Technically, a baby not breathing should have an appearance from scout (police) first. But heres your question. You risk the life of a child because of the chance that it might be a crime scene? NO! We had an incident this summer where we already had a priority 2 asthma in the truck. The call went out, literally 2 blocks away, for a baby not breathing. Given the quality of the crew that was coming, and the distance they were coming from, we elected to grab the baby and bring him outside immediately. I had to go into the apartment myself, where I found an obviously deceased baby, lying on its back on the couch. I was greeted by the father, sitting next to the baby on the couch, who thought that a cool handshake, and a melancholy "hey, how you doin?" was in order. Obvious shady activity. But here are your options.... 1. Take the baby, depend on your memory (or if you write it down) of what the scene looked like, or the attitude of the parents, for when you get called to court. 2. Leave it and just walk out "quick and quietly" to preserve a potential crime scene. 3. Insist that the baby is deceased to the parents who are DANGEROUSLY outrageous and threatening to kill you if you dont do something (hoping that scout beats ray-ray and pookie to the scene). And did I mention that scenario #2 probably ends in a good old fashion *** whooping too, if not a good ole game of chase the ambulance so some *** whoopin can commence. Both 2 and 3 end result in *** whoopin. In case you missed that.

Its called hollywood cpr. You do what you have to do to remove the pt. from public view. You dont leave the dead guy and his detached leg with his motorcycle in the middle of a five lane road. People dont need to see that. The same as people dont need to stand over their rigor, mottled infant until the police show up an hour later. Get it out of the public view and priority 4 it to the hospital. The only exception for this we make is death at old age, in a residence. WITH a calm family.

I have gotten many more threats of bodily harm on scene for doing, or not doing something that the multiple bystanders on scene (without a high school GED, let alone medical training) did or did not see fit, than I have thank you for trying your best from the family at the hospital. But I'll take those few thank you's over the threats anyday.....

Hollywood CPR? Wow! What poor description of medical negligence! Sorry, don't enter the damn house without LEO! You better believe I'll leave the man in the middle of the road. What I am going to do transport a D.O. A. to where? Yeah, let's place an EMS unit out of service to transport a body!...Our police would have our arse for even moving it. Hey, here's an idea; cover the body and allow the M.E. tansport or a funerall home hearse or van.

I do undestand the dilemma. I have worked in the city. The reason I no longer will. Sorry you work in a crappy place. Yet, again why I always avoid cities.

R/r 911