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Lee County (FL)

Discussion in 'EMS Employment' started by AtlasFlyer, Apr 15, 2017.

  1. FiremanMike

    FiremanMike EMS Coordinator

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    We've had 2 arrests in the last year who were in persistent v-fib and ultimately survived with a CPC of 1.

    I've heard of such "no rosc, no transport" policies, and I'm ok with the theory behind it, but feel it should be amended to add persistent shockable rhythm (as ours is)
     
  2. GMCmedic

    GMCmedic Forum Lieutenant

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    Why amend it? We know CPR in a moving ambulance is inadequate, and we know patients in refractory vfib with high quality CPR are regaining ROSC ~50 minutes in with good neurological outcomes. If anything I would ad dual sequential defib. That data for termination/conversion of refractory vfib is good.

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    NomadicMedic likes this.
  3. NomadicMedic

    NomadicMedic formerly DEmedic

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    I'd love to see some good studies on DSD. Admittedly, I haven't searched very deeply, but only found a porcine study that was "meh".
     
  4. GMCmedic

    GMCmedic Forum Lieutenant

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    Most studies only have 7ish patients which for obvious reasons its hard to go off of. I was skeptical because the survival to discharge is dismal but the ROSC data is pretty good. Ive been told there is a study out of the NW (washington maybe) that had 11 patients and was trending towards better survival rates. I havent had an opportunity to look for it yet.



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  5. RocketMedic

    RocketMedic Just Like Otters!

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    There's a certain power that comes from having a scope of practice that allows you to effectively manage pain and resolve serious problems. It is a significant obstacle to moving. For example, the other day, I ran a forearm fracture. In a lot of places, that's BLS, due to design or culture or paramedic laziness. I used fentanyl and ketamine to give that kid a great, pain-free ride. Most agencies would have allowed me a small dose of fentanyl and allowed me to "take the edge off", but being able to go from 10/10 to 0/10 instead of 7/10 is a powerful thing.
     
  6. FiremanMike

    FiremanMike EMS Coordinator

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    My point is that one shouldn't stand for a universal "you will not transport until you get ROSC" policy when there is data to support the idea that folks in persistent shockable rhythms are viable, despite being pulseless at the time that the "go/no-go" decision is made.
     

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