Entrapment and resuscitation

[shelvpower]

hi I would just like to know, if you as BLS ambulance is first on scene at a mva with only one patient (entrapped) and the patient doesnt have a pulse/not breathing but no visible injuries, will you try to start resuscitation attempts in the vehicle or what will your procedures be? I take it as a emt-b in the USA you cant pronounce a patient...

 

[Medic Tim]

In a blunt trauma arrest where the pt has not vitals there are many areas that will allow ems .... Even basics to call it( sometimes with Olmc contact)

Where i am we only run trauma codes if it is witnessed and within 5 min of the hospital .

If the pt needs extrication and has no vitals ... They are dead.

 

[TransportJockey]

Here that would be a 'wait for ALS to show up, cause they're dead dead' situation

 

[NomadicMedic]

Yep. Pronounced. Can't do effective CPR in a car, can you?

 

[RescueRider724]

We would contact med command and the doc would pronounce via vitals and an explanation of the situation (i.e. heavy entrapment, pt is U, no vitals present). If a medic is on scene that is not on a ALS Ambulance (FF/Paramedic) they also can back everyone down to a recovery operation rather than life rescue.

 

[NJEMT95]

EMTs in NJ cannot pronounce a person dead unless there are "obvious signs of death." But since entering the vehicle could pose a threat to my safety, I would wait for ALS to arrive to pronounce.

 

[Handsome Robb]

EMTs in NJ cannot pronounce a person dead unless there are "obvious signs of death." But since entering the vehicle could pose a threat to my safety, I would wait for ALS to arrive to pronounce.

Entrapped, pulseless and apneic would qualify as injuries incompatible with life for me. That's how I'd call it at least.

 

[ZombieEMT]

EMTs in NJ cannot pronounce a person dead unless there are "obvious signs of death." But since entering the vehicle could pose a threat to my safety, I would wait for ALS to arrive to pronounce.

Entrapped, pulseless and apneic would qualify as injuries incompatible with life for me. That's how I'd call it at least.

As an EMT from New Jersey, I would say obvious death also. I think the rules in New Jersey are sketchy though, becuase we can decide that a patient is obviously dead but can not officially pronounce.

 

[mycrofft]

Follow your protocols and don't endanger yourself.

 

[NJEMT95]

As an EMT from New Jersey, I would say obvious death also. I think the rules in New Jersey are sketchy though, becuase we can decide that a patient is obviously dead but can not officially pronounce.

Right, so the pt is dead to the extent that we don't need to treat as BLS, but not officially dead until ALS gets there to pronounce.

 

[shelvpower]

Another scenario: You arrive on scene with a single vehicle rollover with only one patient that has been ejected, patient is pulseless and not breathing with no visible trauma. Will you resuscitate or pronounce patient.

 

[TransportJockey]

Another scenario: You arrive on scene with a single vehicle rollover with only one patient that has been ejected, patient is pulseless and not breathing with no visible trauma. Will you resuscitate or pronounce patient.

Depends on downtime. I had a call a few weeks back where it was four hours after the accident that we got on scene.
My current service if we rolled up on it rigjt after the wreck would probably work him. Our trauma arrest guidelines state bilat chest tubes and pericardiocentesis if there's mechanism for it on presentation

 

[DesertMedic66]

Another scenario: You arrive on scene with a single vehicle rollover with only one patient that has been ejected, patient is pulseless and not breathing with no visible trauma. Will you resuscitate or pronounce patient.

As a BLS unit I would be forced to work the arrest and wait for ALS or contact med control.

As an ALS unit if the patient is in PEA <40 then we can call them on scene without having to contact med control

 

[Gurby]

Our trauma arrest guidelines state bilat chest tubes and pericardiocentesis if there's mechanism for it on presentation

That's really cool. Do you have an ultrasound on the helicopter? Or is it just, "well, they're pretty much screwed anyways, may as well give this a shot and see what happens"?

 

[TransportJockey]

That's really cool. Do you have an ultrasound on the helicopter? Or is it just, "well, they're pretty much screwed anyways, may as well give this a shot and see what happens"?

What helicopter? That's ground 911... And usually it's done without ultrasound with us... We all have done cadaver lab rotations and manakin practice with it, and if you're not moving around it's a pretty straightforward (but still dangerous) procedure. And if the patient is in arrest to begin with you're not going to make them worse.

 

[Tigger]

Another scenario: You arrive on scene with a single vehicle rollover with only one patient that has been ejected, patient is pulseless and not breathing with no visible trauma. Will you resuscitate or pronounce patient.

Usually someone that has been ejected looks like err well err...they've been ejected?

 

[Carlos Danger]

Another scenario: You arrive on scene with a single vehicle rollover with only one patient that has been ejected, patient is pulseless and not breathing with no visible trauma. Will you resuscitate or pronounce patient.

Adult blunt trauma arrest = dead

 

[Akulahawk]

Another scenario: You arrive on scene with a single vehicle rollover with only one patient that has been ejected, patient is pulseless and not breathing with no visible trauma. Will you resuscitate or pronounce patient.

Pulseless / apnic in the setting of trauma = dead. Someone that's very, very freshly dead may be able to benefit from Bilat chest tubes, intubation, REBOA...

 

[Gurby]

What helicopter? That's ground 911... And usually it's done without ultrasound with us... We all have done cadaver lab rotations and manakin practice with it, and if you're not moving around it's a pretty straightforward (but still dangerous) procedure. And if the patient is in arrest to begin with you're not going to make them worse.

Saw FP-C in your sig and no ground service I'm familiar with is anywhere close to being in that ballpark of scope of practice, so I assumed. I've seen MD's be unsuccessful with pericardiocenteses using ultrasound, so I assumed it must be a fairly difficult (and obviously very high stakes) procedure. Then again I suppose the stakes are lower when your patient is already in cardiac arrest and probably not saveable anyways.

 

[TransportJockey]

Saw FP-C in your sig and no ground service I'm familiar with is anywhere close to being in that ballpark of scope of practice, so I assumed. I've seen MD's be unsuccessful with pericardiocenteses using ultrasound, so I assumed it must be a fairly difficult (and obviously very high stakes) procedure. Then again I suppose the stakes are lower when your patient is already in cardiac arrest and probably not saveable anyways.

No worries lol. I work for a company that does fixed wing at three bases and also runs one town's EMS in frontier texas. Universal scope and guidelines between them.