First Full arrest

[jwk]

It makes sense to me. It's not a technical or academic term, but colloquially I think everyone knows what it means.

Some just have to nitpick over the silliest things.

And I find it somewhat startling that many of you consider an arrest to be a "routine call" and think it's stupid if someone finds it to be stressful. Maybe it's because you're so protocol driven and Remi and I and others see things from a different perspective or function under a different set of rules. I find this statement especially absurd, but again, maybe I just have a different perspective since I don't ride a truck any longer:

"Arrest calls are one of the most scripted, algorithmic treatments you can perform and by nature it should have the least emotional aspect".

If you're not emotionally impacted at a loss of life, you've got no business doing what you're doing IMHO.

 

[akflightmedic]

Please feel free to present a scenario where a "full arrest" is not the most routine or scripted call? Something other than saying "nuh uh".

I gave a very real alternative scenario to what is less scripted and non routine. Can you dispute that part or just choose to ignore it to make your unsupported point?

I was speaking from a very rehearsed point of view, if you know ACLS front and back and have "relative experience" there is typically no freezing. It is all muscle memory and protocol driven. Again, dispute me with facts or scenarios...I am more than happy to learn.

At no time did I say it was stupid to be stressed. Please feel free to quote me accurately instead of implying otherwise.

And again, to make a generic statement that if I am not emotionally impacted then I have no business doing the job, some people might argue the opposite. Just food for thought.

 

[Chewy20]

Some just have to nitpick over the silliest things.

And I find it somewhat startling that many of you consider an arrest to be a "routine call" and think it's stupid if someone finds it to be stressful. Maybe it's because you're so protocol driven and Remi and I and others see things from a different perspective or function under a different set of rules. I find this statement especially absurd, but again, maybe I just have a different perspective since I don't ride a truck any longer:

"Arrest calls are one of the most scripted, algorithmic treatments you can perform and by nature it should have the least emotional aspect".

If you're not emotionally impacted at a loss of life, you've got no business doing what you're doing IMHO.

Please explain how it's not an easy call medicine wise? You literally go down a check list until you get ROSC or TOD.

If you were emotionally impacted by all calls your personal life would be freaking terrible. THOSE are the ones who should not be in this business. Not the other way around.

God forbid someone not get stressed out when they are in charge of a call. No room for them in medicine!

This world has way to many soft people.

 

[Seirende]

There is a whole new interdisciplinary field of study devoted to human factors psychology that would strongly disagree with you.

Intelligent and well-trained people do in fact "freeze up", forget things that they have memorized cold, and make stupid mistakes during critical periods. There are things that can be done to deal with it, and review probably never hurts, but drinking red bull and re-reading the ACLS algorithms probably isn't the solution, because the problem isn't usually lack of knowing what to do.

Remi, would you mind pointing me toward some good reading material or other resources on this subject? Particularly, "things that can be done to deal with it." Pretty please and thank you with sugar on top.

 

[Carlos Danger]

Remi, would you mind pointing me toward some good reading material or other resources on this subject? Particularly, "things that can be done to deal with it." Pretty please and thank you with sugar on top.

It isn't something I've spent time studying myself, but it is something that I see reference to more and more. The FOAMed community is pretty big on it.

You can find plenty with a quick Google search. Here's a good example: http://emcrit.org/guest-post/flow/

 

[Carlos Danger]

Please explain how it's not an easy call medicine wise? You literally go down a check list until you get ROSC or TOD.

If you were emotionally impacted by all calls your personal life would be freaking terrible. THOSE are the ones who should not be in this business. Not the other way around.

God forbid someone not get stressed out when they are in charge of a call. No room for them in medicine!

This world has way to many soft people.

I suppose it's easy to say that arrests are no big deal when the only expectation anyone has of you is that you show up and follow a simple written algorithm for 20 minutes and then call a doctor for permission to cease your efforts. As long as your documentation states that you did what the protocol says you are supposed to do, then it's all good, and it's not your problem, right? I get that. That's a damn good technician.

But many people are emotionally impacted by certain calls. I think people with a strong conscience and an ability to connect to others tend to make the best providers by far. Anyone can memorize a protocol book on basic emergency treatment, after all, so that's not what makes an admirable provider. But hey, maybe I'm just too soft or too new to get it.

 

[SeeNoMore]

Congragulations on keeping your cool and getting the job done on your first arrest. It's easy to say that cardiac arrests should not be stressful , but I think we have to remember that everyone reacts differently to calls, especially when you are new.

 

[Chewy20]

I suppose it's easy to say that arrests are no big deal when the only expectation anyone has of you is that you show up and follow a simple written algorithm for 20 minutes and then call a doctor for permission to cease your efforts. As long as your documentation states that you did what the protocol says you are supposed to do, then it's all good, and it's not your problem, right? I get that. That's a damn good technician.

But many people are emotionally impacted by certain calls. I think people with a strong conscience and an ability to connect to others tend to make the best providers by far. Anyone can memorize a protocol book on basic emergency treatment, after all, so that's not what makes an admirable provider. But hey, maybe I'm just too soft or too new to get it.

Most of my arrests have gone on for about an hour unless we got ROSC back. What else would you like me to do? Do you have some magic wand that others in EMS don't for their arrest protocols?

People can be as emotional and let it affect them as much as they want. I choose to not let stuff get to me, and just do my job. Has nothing to do with compassion. I'll show all the compassion in the world to a family or a pt that needs it.

 

[akflightmedic]

Suave post Remi...while I am a strong advocate for us to be clinicians...managing a cardiac arrest is fairly technician level. As I said in earlier post, I am welcome to learn, so bring me a scenario where an arrest is not technical and I am all for humble pie. But for all intents and purposes, it is a script which rarely varies.

I stand by the more emotional and difficult calls are the ones where they are fixing to die as opposed to the ones who are already dead. In the code scenarios, more often than not, your patient is the family present as opposed to the expired patient.

But hey, maybe I am new too and have zero empathy...

Maybe I should quit the biz...

 

[Carlos Danger]

Most of my arrests have gone on for about an hour unless we got ROSC back. What else would you like me to do? Do you have some magic wand that others in EMS don't for their arrest protocols?

People can be as emotional and let it affect them as much as they want. I choose to not let stuff get to me, and just do my job. Has nothing to do with compassion. I'll show all the compassion in the world to a family or a pt that needs it.

This will probably be my last post on here. Site gets more ridiculous every day.

No one said anything about it being OK for a person to "be emotional and let it affect them". I don't know where you got that from.

The point was that there is a lot more to managing a critical situation properly than following a written protocol. Most new people understand that there is more to being good at running an arrest than knowing and executing ACLS - and because they know they don't have those skills, it makes the situation very stressful. Add the fact that many newbies have never been involved with death in a professional capacity, and it can be overwhelming.

Once you gain experience of course, it becomes less and less stressful. Once you've done it 100 times, it's routine, and other problems can arise from that.

But just telling a newbie "codes are easy, you just follow ACLS" is pretty shortsighted and supports the "technician" mindset that so many on here are constantly complaining about.

 

[Seirende]

It isn't something I've spent time studying myself, but it is something that I see reference to more and more. The FOAMed community is pretty big on it.

You can find plenty with a quick Google search. Here's a good example: http://emcrit.org/guest-post/flow/

Thanks, that actually looks lovely and helpful. I always enjoy EMCrit.

 

[MonkeyArrow]

Suave post Remi...while I am a strong advocate for us to be clinicians...managing a cardiac arrest is fairly technician level. As I said in earlier post, I am welcome to learn, so bring me a scenario where an arrest is not technical and I am all for humble pie. But for all intents and purposes, it is a script which rarely varies.

I hope you mean that a cardiac arrest in the field is technician level. Ideally, there are multiple "clinician" interventions that I strongly believe will become more prevalent and standard of care in the future for arrest management. PAC placement for Left Ventricular End Diastolic Pressure measurement for hemodynamically-titrated pressors, bedside echo for every code, immediate A-line and CVC placement, the consideration and implementation of mechanical circulatory support, PCI with CPR, administration of thrombolytics, mechanical thrombectomy in the IR lab for PE, etc. Is that something that can be done in the field? Not now, no. But in an ED with a physician, a code surely should not be run the same way it is in the field, following an algorithm. Also, if you have a progressive ED and have mechanical CPR devices, transport decisions would need to arise from the clinician level.

 

[akflightmedic]

But just telling a newbie "codes are easy, you just follow ACLS" is pretty shortsighted and supports the "technician" mindset that so many on here are constantly complaining about.

I agree somewhat with you but making it more than what it is does just as much injustice as well. I stand by my statement that the majority of the arrests are exactly that...technician level with the understanding as I stated that majority of everything else is clinician. Additionally, the patient is the family more often than naught...which is something we are shorted in during our education process, of how to deal with these situations.

As for Monkey's post...read the thread...no one was talking invasive hospital procedures or things that will not be seen in the streets for 10+ years.

 

[Jim37F]

Colloquially, we use the term "full arrest" here for full cardiac and respiratory arrests. Nitpicking full arrest vs. cardiac arrest is like nitpicking "Code 3" vs "Priority 1" or whatever local term people use (How many times have people here had to quantify that their Code 2 means no lights/no sirens cause someone from a different region's Code 2 means emergency lights activated, etc vs how many people here are honestly confused by what the OP meant by "full arrest"?)


I agree, from a protocol, training, check the block step by step sort of way, this is one of the easiest most straight forward calls. However, honestly, think back to YOUR very first full (cardiac) arrest. Probably when you were brand new, maybe only a few weeks/months in EMS? Maybe hadn't actually ran a truly critical call yet, or more than one or two yet? Were you really all that calm at the time, "Oh sweet, a nice easy call" and just relax and do your thing? Sure I can look back with hindsight and say my first full arrest I performed fairly automatically, did my compressions, squeezed the bag, read off numbers of the monitor, sounds easy peasy, except I was pretty much wild eyed "Yikes this is actually happening!" flood of adrenalin and the like. I'm willing to bet most people are the same. After all, isn't a pediatric resuscitation a by the book, step by step call that should be just as easy, yet how many comment that's one of the most stressful calls a medic can run, especially a new one?

Having that emotional, "oh snap, this is real" "scared" response and successfully following your protocols are not mutually exclusive.

 

[Chewy20]

I can honestly say I don't get the adrenaline rush people talk about on calls. My first arrest was boring. EMS doesn't do that for me. I have asked partners if that was normal for a new guy or anyone multiple times. Perhaps it's just being a basic, who knows. But thankfully I have other things in life to fill that rush.

Normal or not, that's the way my brain handles "stressful" calls. Which I can be thankful for as I highly doubt I will ever have to deal with some sort of PTSD like some providers do.

Also, I will still stand by arrests in the field as being easy medicine wise.

 

[Tigger]

Suave post Remi...while I am a strong advocate for us to be clinicians...managing a cardiac arrest is fairly technician level. As I said in earlier post, I am welcome to learn, so bring me a scenario where an arrest is not technical and I am all for humble pie. But for all intents and purposes, it is a script which rarely varies.

I stand by the more emotional and difficult calls are the ones where they are fixing to die as opposed to the ones who are already dead. In the code scenarios, more often than not, your patient is the family present as opposed to the expired patient.

But hey, maybe I am new too and have zero empathy...

Maybe I should quit the biz...

All about this.

Realistically, it is an unlikely feat for EMS to successfully resuscitate most of pulseless patients we respond to. While there is something emotionally taxing about being faced with an often unsurmountable challenge, it is (for me), not the same as being unable to the stop cascade of events that lead to someone's death when you are in a position to potentially do so. While I am impacted by loss of life and how it effects the survivors, I also don't think it's particularly callous to take some shelter in the numbers, most people who die remain death. That's not an excuse to do anything but our best and actually use critical thought, like what should be done on all calls.

And then there's the whole arguing to argue part. Welcome to the internet.

 

[ViolynEMT]

My first cardiac/full arrest (whatever ) was only scary when I was told that was what we were going to. It was also my first l & s call, so I was just a bit uptight about it, but once I got there and was told to get on the ground and relieve whoever was in the process, it just felt natural. I didn't feel eyes on me at all and I just did what I was trained to do. It was a "pleasant surprise" that I wasn't nervous or uncomfortable at all.

 

[ViolynEMT]

https://www.facebook.com/video.php?v=874560215971943

 

[jwk]

Some just have to nitpick over the silliest things.

And I find it somewhat startling that many of you consider an arrest to be a "routine call" and think it's stupid if someone finds it to be stressful. Maybe it's because you're so protocol driven and Remi and I and others see things from a different perspective or function under a different set of rules. I find this statement especially absurd, but again, maybe I just have a different perspective since I don't ride a truck any longer:

"Arrest calls are one of the most scripted, algorithmic treatments you can perform and by nature it should have the least emotional aspect".

If you're not emotionally impacted at a loss of life, you've got no business doing what you're doing IMHO.

I tend to be more blunt - Remi states things a little less abrasive than I do.

I clearly stated that I look at things from a different perspective. Where I am, protocols are pretty much just suggestions. An arrest in my world is anything but scripted and algorithmic. My differentials for causes of cardiac arrest are likely quite different than many of yours. I don't mean to suggest that everyone should decompensate if they have a patient die - but if you don't pause for a moment and think to yourself, "...well damn, that sucked..." then again, I think that's a problem. It's one thing to be emotionally detached, which is an important quality to have - it's quite a different thing to be cold and indifferent.

 

[ViolynEMT]

Being able to "keep your head on straight" and not think about the fact that someone just died after all is done are two different things. I stay cool and collected while it's happening, because that is what I have to do in order to do the right thing. I may feel really bad afterwards. Staying cool doesn't equal having no emotions.