LVAD AWARENESS for Paramedics/EMT/EMS Ambulance Companies. 911 PROTOCOL?

[LVADone]

Josh,

Thanks again for being willing to share... this is a awesome resource.

I've known of LVAD's prehospitaly in my area for over 5 years now. Haven't had the chance to transport a LVAD patient yet... but it is going to happen sooner or later.

Not only does the hosptial notify the primary EMS agency, the hosptial and/or the primary EMS agency notify their backups. In recent months, I've been aware of 3 patients living in my second-due area, and one that attended daily rehab sessions in my first-due.

We've also discussed the potential need for aeromedical transport for these patients to the LVAD center, in at least one case making a helicopter being placed on standby part of the dispatched response for an EMS call at that residence... we are located about 30-45 minutes by ground to the various LVAD centers.

Something I haven't seen yet - when the LVAD recipient leaves the house, they MUST have a trained companion with them - the companion is supposed to know how to troubleshoot the pump and be able to assist responders if needed... MAKE SURE TO LISTEN TO THAT PERSON! They are a subject matter expert... and you aren't.

Jon

Hi jon...thanks for sharing that and the protocols. There is no doubt that the LVAD recipient will be more common place in the world... for many reasons...bottom up and top down perspectives... thats for another post

But we are finding LVAD regulations vary state to state regarding if they should be alone at times and or drive a vehicle alone at times as it will be impossible to be with a trained companion at all times... my wife, mother...children are all trained. However i and my hospital come from the school that LVAD recipients should take control and know more than most... thats why on my blog i wrote the LVAD CREED

In Utah they actually have "automobile driving tests" for LVAD patients/recipients where they literally shut off the LVAD as you drive to see if you can handle pulling the vehicle over and deal with the weaning LVAD...

Anyway... it is my prediction that the LVADer will be out and about... alone eventually and i hope the rest of the world doesnt treat them like zombies

thanks for your great perspective on this

josh

 

[berkeman]

My son(he is an EMT) is in process of ordering Med ID for me that i will wear around my neck... currently hospitals are trying to figure out the "proper" info to place on the Med ID...

so much to note: Patient has Heart pump implanted, patient has NO PULSE patient has no recognizable blood presure... No chest compressions... it goes on

But currently i do carry papers with me explaining my condition should i be found and unable to talk...

thanks

If you are unresponsive, I don't generally check for papers. I do check for bracelet and anklet IDs. Get one soon please! Thanks for the thread.

 

[LVADone]

If you are unresponsive, I don't generally check for papers. I do check for bracelet and anklet IDs. Get one soon please! Thanks for the thread.

I just got home from a dinner with a THORATEC (manufacturer of the HEARTMATE ll LVAD) representative...

Among many questions i raised, Medical ID was raised and type was a concern. Neclace bracelet anklet...etc they are suggesting LVAD recipients should wear neclace or anklet as the Bracelet can get hung up on one of the LVAD wires and damage it in everyday use...

So thanks for your concern and it makes sense that papers arent effective as emt/paramedics arent allowed to flip through someones bag or wallet.

thanks!

 

[reaper]

Trust me, if you are found unresponsive with an LVAD attached, I am going through wallet,pockets, and any bags. Long before I look at a necklace.

I want real info on the device, not a short sentence. The best thing to put on the ID tag, is the phone number for the LVAD support!

 

[LVADone]

Trust me, if you are found unresponsive with an LVAD attached, I am going through wallet,pockets, and any bags. Long before I look at a necklace.

I want real info on the device, not a short sentence. The best thing to put on the ID tag, is the phone number for the LVAD support!

Nice... i like your feisty passion... to save a life... it will eventually be protocol for LVADrecipients to showcase the number of their LVADsupport team on the equipment that we are wearing... i do already, taped to my batteries and controller around my waist.

the Paramedic, who brought me to the hospital, kept in touch with me everytime he had to transport someone to the hospital... she would even call up my nurse to see how i was doing... conflict of interest to get keep in touch with a patient you transported? i dont know, but it was folks like her that gave me more drive...

God Bless the 1st responders!

 

[LVADone]

We have a LAVD program at one of our local hospitals, and we also have about 10 pages of LAVD protocols in our books, including step by \.

Sorry I stole your question, i somehow missed it.

You're welcome to share them, Sasha.

I didn't think of there being a hand-pump. Another thing that's good to know.

I have done some reading up on LVAD's and emergency situations.

This is something that each provider needs to research and talk to you system about the treatment of these pt's.

I'm definitely interested in the 911 protocol in place to revive LVAD patients. Please post it when you find it!

Awesome, thanks for the info. I will pass this along to everyone in my fire department and the ambulance crew.

I wish all my patients took this much initiative to be informed and proactive about their conditions and interventions.

Very interesting post, I'm sure 90% of the EMS community would be flustered on a patient like this. Interesting post.

I know very little about them. Look forward to learning more. In the meantime, I have a few quick questions:

How long is the battery life away from the base unit?

If your home experiences power failure, will the disconnection alarm still work to alert you?

Can the system you wear tolerate severe heat/cold, getting wet, etc.?

You brought up a great topic that makes me wonder:

Edgar Allan Poe, one of our finest American writers, had epilepsy. It drove so much of his writing, and a consistent fear for him was that he would be in a neighboring town where no one knew him, suffer a seizure, be taken for dead and buried. (He actually had a system installed in his coffin so he could let the medics know they goofed!)

It's be great if more people like yourself would post here, letting us know of those anomalies of treatment or disease medics might encounter and where. Maybe there should be a thread specifically dedicated to this so everyone on this site could have easy access.

More than anything, Thank You for your appreciation, and blessings to you and yours.

Does this mean that you are on a transplant list?

tonight i learned from THORATEC that"chest compressions" are not officially ruled out. But used as a last resort

i guess it can be found on the thoratecU.com website... which i havent gotten into yet ;-)
thanks

 

[MedicSupv]

Well,

I have done some reading up on LVAD's and emergency situations.

First you have two types of LVAD's. You have the Heartmate design, like the OP has. That is a continuous flow pump and does not produce pulse or BP.

Then you have a Pulsatile pump. These do have pulses and BP's.

Almost all pumps come with a manual pump, for back up. This is to be tried before Compressions are used. If it comes to that point, compressions may be used as last resort.

A pt with an LVAD will still show a sinus rhythm on the monitor. The left ventricle is the only part effected by the pump.

This is something that each provider needs to research and talk to you system about the treatment of these pt's.

We have a cardiac rehab facility in our fire district and have gone for extensive training on these pumps. The majority of the patients that have had recent fitting of the devices will have the Heartmate II pump. This is the newest technology and considered permanent. Lithium batteries that last 3-4 times longer than the other pumps. They do have spare batteries and a hand pump, if the patient carries them as instructed. They do not always have the batteries with them.

Under no circumstance is the patient to get chest compressions with these pumps. You normally have an AICD/Pacer implanted at the same time or prior to the pump. Not all patients have this, it's dependent on the right ventricular function, however most do. Therefore, you normally get a wide complex and it could be a sinus rhythm or a tachacardia, but it should be a wide paced rhythm. Again, every patient is different, but vaguely stating a sinus rhythm may mislead a provider as far as what they are looking for.

You can take a blood pressure if you have a doppler device, there are inexpensive units out there that are worth getting if you have a facility in your district as ours. We have found that the average bp is between 72-80mm Hg. Again, that may fluctuate, ask the patient, they should know if they are alert.

If the patient is conscious and appears to be mentating and perfusing, don't worry about the pulselessness of the patient. If they look in distress, treat them as so, expiditiously. Take the extra transport time to the proper facility if stable, the outcomes are much better.

 

[MedicSupv]

Question for LVADone

How are you doing? It's been a year since your last post, just curious.

 

[LVAD FRIENDS]

Hey Josh AKA LVAD ONE. I am another LVADer that found this site. I was married to a Medic and have quite a few as my friends.I am also one of maybe 2 LVAD patients in my County. I am suprised that the Company she works for doesnt deem it a necessity to train their employees about the requirements of LVADs. I am not comfortable having someone responsible for me that doesnt know whats going on.Not an Expert but the basics would be nice. From what I have read you know about the lack of BP's,pulses and Heartbeats. But do you know to look for that Little Black escape Bag we carry whenever we leave home?Dont transport us without it,it contains 2 batteries and an extra controller that might come in handy. Feel free to ask me questions ,as I told some of my EMT friends they arent unEducated about LVADs most are under educated.Ask ,I love to talk about it.It's kept me alive since May 5,2010, while I await a transplant.

 

[bstone]

For your viewing pleasure:

http://www.youtube.com/watch?v=I4r5_3uS0Nc

 

[bhawthorne]

LVADs in Massachusetts

Thanks so much for this thread. I know it is nearly a year old, but as an EMT in Massachusetts, I just saw that VADS have been added as a special consideration in our standard treatment protocols (Appendix W of our protocols at the mass.gov website /eohhs/docs/dph/emergency-services/treatment-protocols-1001.pdf). I can't wait to get some training about this, since nothing in the treatment protocols or on the Thoratec website actually shows me what a patient with a VAD installed looks like! The protocols tell me what to do if I encounter a patient with a VAD, but give no hints as to how I would know.

From the hints on the Thoratec website, I gather that there is some sort of device strapped to outside of the patient that drives the internal device. Loads of great diagrams of how the internal device works, but no pictures of actual patients with the device. All of the medical provider data is aimed at doctors and nurses in a hospital setting, with nothing I could see for pre-hospital emergency care of the VAD patient.

Does anyone have any hints as to where I could find this info, while I wait for our service to roll out training on the new protocols?

 

[bw2529]

One of my "discharge agreements" from the hospital was that my Hospital MUST speak with my local:

Fire Dept

Ambulance Corp (covering 911 calls in my nieghborhood)

Police Dept

This way when my address pops up, they already know of my implant and already know what to do as the hospital sent them information.

My concern is if an LVAD patient is enjoying his day in another community and collapses... what can/will the paramedics do there. Its probaby a safe bet for LVAD recipients to carry a "User Manual" with them until this LVAD is a common household word like Dialysis...;-)

thanks

Kudos to your hospital for doing that. I have to admit, I had no idea what an LVAD was before your post (I'm an EMT-B student).

Thanks for the education, and for inspiring me to want to do more research on the subject!

 

[medicdan]

I just attended training at M&M this past week on LVADs, very cool! We are now doing more and more discharges of LVAD patients from a designated ?installation? center, for cardiac and non-cardiac complaints of LVAD users. In fact, I transported in the last week, one of whom had an intrinsic rhythm of V-Tach. We used our monitor, but it alarmed the entire way.

LVADone, do you have the HeartMate II? Has anyone here seen a different model or RVAD/BiVAD?

 

[Ramis46]

This is an Awesome Thread, And After reading over it, i didn't notice, or maybe just read over it without knowing, Your on a list for a new Heart, and on your blog you kinda have a little deal about getting ready for a heart, but i was kinda wondering how much physical activity from normaly walking to a slight jog or bike ride does the LVAD allow you to participate in.
We do have a gentlemen in our area with one since last year, and we got a pampflit of what it was for study material. you can imagine that there is some stressors when our closest heart center is over an hour by ground, and in the midwest weather is unpredictable during the best seasons. That being said was there another site (that again i didn't see that talks about emergancy protocals anf trouble shooting for the LVAD).

Thanks for the thread.