Melbourne MICA
Forum Captain
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Arrested Pts
With the current level of training, education and equipment provided to ambos and the effectiveness of the new ILCOR CPR guidelines, the time is now long passed where resus measures in hospital are considered the definitive care in the arrested pt.
Surely the only reason to transport to hospital is for post arrest management.
This is particularly true given we have now been given much clearer guidelines as to our role, responsibilities, where our authority to make decisions begins and ends and what is reasonable to expect given the various arrest situations that can arise.
As far as I can see, there are only three things we need to do in an arrest (not including drug choices etc).
1. Make a clinical determination as to the pts viability for a resus attempt.
2. Achieve the goal you set yourself by making that determination - achieve output state.
3. Having done this, move the pt on to the hospital for post resus management using tools, equipment, expertise and drugs that we cannot provide nor utilise.
I posted some stuff along these lines in the RSI thread from a while back. All things being equal there are very few occasions where you do active resus in the truck. If you have to do CPR in the truck, either the pt has rearrested, has just arrested or is a paediatric arrest all of whom are transported except the obviously deceased.
A stable platform to work on, space to work in and enough hands so the arrest protocol can be worked through.
Its not the battlefield so we don't have to race away from the incoming mortar rounds with our arrested pt in tow all the while giving substandard care.
Do it at the scene, get it right, get them going and get them there.
MM
With the current level of training, education and equipment provided to ambos and the effectiveness of the new ILCOR CPR guidelines, the time is now long passed where resus measures in hospital are considered the definitive care in the arrested pt.
Surely the only reason to transport to hospital is for post arrest management.
This is particularly true given we have now been given much clearer guidelines as to our role, responsibilities, where our authority to make decisions begins and ends and what is reasonable to expect given the various arrest situations that can arise.
As far as I can see, there are only three things we need to do in an arrest (not including drug choices etc).
1. Make a clinical determination as to the pts viability for a resus attempt.
2. Achieve the goal you set yourself by making that determination - achieve output state.
3. Having done this, move the pt on to the hospital for post resus management using tools, equipment, expertise and drugs that we cannot provide nor utilise.
I posted some stuff along these lines in the RSI thread from a while back. All things being equal there are very few occasions where you do active resus in the truck. If you have to do CPR in the truck, either the pt has rearrested, has just arrested or is a paediatric arrest all of whom are transported except the obviously deceased.
A stable platform to work on, space to work in and enough hands so the arrest protocol can be worked through.
Its not the battlefield so we don't have to race away from the incoming mortar rounds with our arrested pt in tow all the while giving substandard care.
Do it at the scene, get it right, get them going and get them there.
MM
