NO CPR is better than moving CPR...true or false?

[STXmedic]

I don't want to turn this into a transporting forum but I don't understand when people can say they would have no problem not responding and transporting code 3. If you have a CVA who need to get to the ED for thrombolytics within the allotted time to give the meds. There could be a hour window of when it started and people want us to most on down to the ED stopping at lights and sitting in traffic. I understand that many accidents happen while going lights and sirens but that is the nature of the business. Firemen go into burning buildings cops catch bad guys and ems performs CPR in the back of a moving ambulance while breaking normal traffic laws.

Are there times that a patient should get to the hospital quickly? Sure. Without starting a debate on thrombolytics, I'll buy that example. Traumatic injuries with need for emergent stabilization and surgery are another. However, running emergent tends to be used far more often than is actually appropriate.

When it is used, it should still be done appropriately. Running 15+ miles over the speed limit, shooting through controlled intersections, and with unrestrained passengers in the back is not appropriate. What good are you to your patients if you never make it to the hospital. What good are you to your family if you're killed in the back of an ambulance while straddling and doing compressions on an already dead patient.

A good fire department calculates risks and benefits before deciding to make entry into a fire. If they don't, they're wrong. It's unsafe. A police officer does not blindly charge into a house after an armed suspect without backup and a strategic plan. If they do, they're wrong. It's unsafe. Equally, an ambulance should not blindly put themselves in danger (driving emergent with a patient) without calculating risks and benefits, and taking measures to increase their safety (seatbelts, at least as much as possible). If they do, they're wrong.

The young, cavalier, head-first attitude needs to go (not directed at you, just in general). However, it's a painfully prevalent personality that likely will not go anywhere as long as EMS stays in it's current form.

Edit: Well, Vene beat me to pretty much my entire post... :lol:

 

[CPRinProgress]

Because we are old people who know it doesn't save much time, make a difference in outcome, and have either personally been hurt or know people who have been hurt or killed from driving code 3, despite it not making a difference.




There are only a handful of illnesses where minutes matter, and it is more often a question of distance than speed. Stroke is not one of them. While there is a guidline for using thrombolytics, the effectiveness is in question and at 3 hours (or 4 depending on the guidline you are using) 6 if you are using direct arterial application, at 3 hours and 1 minute nobody is going to withhold the medication. Nor at 3 hours and 15 minutes, nor at 3:30. Probably not even 3:45. Despite what you are told as a student, medicine is not black and white.



No it is not. It is an outdated ignorant and reckless attitude.



Firemen do not go into all burning buildings. There is a risk assessment on whether or not the risk is worth the reward.

Police has a number of escalating options and safety measures to minimize their risks as well.

We have studies showing that CPR while moving without an assist device does not work well. Which means you are doing nothing for the patient while risking yours and others lives for that same nothing.

That type of attitude makes you a danger to everyone around you.

I understand what you are saying but time is definitely save in more suburban and rural areas. When there is a combination of long travel times but enough traffic to slow us down I believe that that time could be important to a persons survival and complications after hospitalization.
I also realize that medicine is not black and white and that doctors might not withhold thrombolytics at even 3:45 after onset but that time might reduce the effectiveness of the meds.

 

[Veneficus]

I understand what you are saying but time is definitely save in more suburban and rural areas. When there is a combination of long travel times but enough traffic to slow us down I believe that that time could be important to a persons survival and complications after hospitalization.
I also realize that medicine is not black and white and that doctors might not withhold thrombolytics at even 3:45 after onset but that time might reduce the effectiveness of the meds.

Rather than think and believe, why don't you look up the research done on it?

 

[CPRinProgress]

Are there times that a patient should get to the hospital quickly? Sure. Without starting a debate on thrombolytics, I'll buy that example. Traumatic injuries with need for emergent stabilization and surgery are another. However, running emergent tends to be used far more often than is actually appropriate.

When it is used, it should still be done appropriately. Running 15+ miles over the speed limit, shooting through controlled intersections, and with unrestrained passengers in the back is not appropriate. What good are you to your patients if you never make it to the hospital. What good are you to your family if you're killed in the back of an ambulance while straddling and doing compressions on an already dead patient.

A good fire department calculates risks and benefits before deciding to make entry into a fire. If they don't, they're wrong. It's unsafe. A police officer does not blindly charge into a house after an armed suspect without backup and a strategic plan. If they do, they're wrong. It's unsafe. Equally, an ambulance should not blindly put themselves in danger (driving emergent with a patient) without calculating risks and benefits, and taking measures to increase their safety (seatbelts, at least as much as possible). If they do, they're wrong.

The young, cavalier, head-first attitude needs to go (not directed at you, just in general). However, it's a painfully prevalent personality that likely will not go anywhere as long as EMS stays in it's current form.

Edit: Well, Vene beat me to pretty much my entire post... :lol:

I agree that lights and sirens are used too often, just the other day I responded to a nosebleed code 3 that was probably inappropriate but when we went to a code and PD on scene are only doing basic cpr with no airways or anything like that I feel its appropriate to respond code 3

 

[STXmedic]

I agree that lights and sirens are used too often, just the other day I responded to a nosebleed code 3 that was probably inappropriate but when we went to a code and PD on scene are only doing basic cpr with no airways or anything like that I feel its appropriate to respond code 3

Convince your PD guys to keep AEDs in their unit, and they'll be providing every treatment proven beneficial. Then you can be comfortable when they're the only ones on scene

 

[CPRinProgress]

Rather than think and believe, why don't you look up the research done on it?

Well from experience of transporting to multiple hospitals both lights and sirens and not it is a fact that we get places faster code 3 the risk. I do agree that the risk out ways the benefit.

 

[Veneficus]

I agree that lights and sirens are used too often, just the other day I responded to a nosebleed code 3 that was probably inappropriate but when we went to a code and PD on scene are only doing basic cpr with no airways or anything like that I feel its appropriate to respond code 3

I'll help you start.

http://www.ncbi.nlm.nih.gov/pubmed/10225645

http://www.ncbi.nlm.nih.gov/pubmed/10155532

 

[CPRinProgress]

I'll help you start.

http://www.ncbi.nlm.nih.gov/pubmed/10225645

http://www.ncbi.nlm.nih.gov/pubmed/10155532

I see your point but in this article it is said that most collisions that involve emergency vehicles were cause by the other vehicle it also says that intersection present the most risk to emergency vehicles so it would be beneficial for all ambulances to be equipped with lights that change lights to green when entering an intersection. Teaching the public about how to respond when an emergency vehicle is coming toward them would also be beneficial, maybe add part of a drivers test.
http://www.emergencydispatch.org/articles/warningsystems1.htm

 

[Veneficus]

I see your point but in this article it is said that most collisions that involve emergency vehicles were cause by the other vehicle it also says that intersection present the most risk to emergency vehicles so it would be beneficial for all ambulances to be equipped with lights that change lights to green when entering an intersection. Teaching the public about how to respond when an emergency vehicle is coming toward them would also be beneficial, maybe add part of a drivers test.
http://www.emergencydispatch.org/articles/warningsystems1.htm

That is one device to help with safety.

Keep reading the studies, all of the ones relating to patient outcome show that the time saved makes no difference.

 

[Brandon O]

Not to get too involved with this, but (as always) there is a certain fallacy in only considering effects on mortality. Did you save a life by getting a patient with pain, nausea, respiratory distress, or anxiety to the hospital faster? Probably not. Were their symptoms alleviated sooner? Good chance.

In what other contexts in life do we only care about people dying? Next time your wife comes home crying because she got a flat tire and had to change it in the rain, try telling her: "Did you die? No? Then who cares?" Lemme know how that goes.

 

[CPRinProgress]

That is one device to help with safety.

Keep reading the studies, all of the ones relating to patient outcome show that the time saved makes no difference.

I will pt most of these studies are about transporting from scene to hospital but I would like to see some data on responding to the scene responding to a code is time sensitive add well as other things that only ALS can do. ALS for me is for the whole county so it could take them some time without l & s I'll look for some papers written on that.

 

[CPRinProgress]

Not to get too involved with this, but (as always) there is a certain fallacy in only considering effects on mortality. Did you save a life by getting a patient with pain, nausea, respiratory distress, or anxiety to the hospital faster? Probably not. Were their symptoms alleviated sooner? Good chance.

In what other contexts in life do we only care about people dying? Next time your wife comes home crying because she got a flat tire and had to change it in the rain, try telling her: "Did you die? No? Then who cares?" Lemme know how that goes.

I agree because most of these people we transport have hours of time without care that they could survive. But if we can help relieve the pain than I think that is worth the risk.

 

[BeachMedic]

I will pt most of these studies are about transporting from scene to hospital but I would like to see some data on responding to the scene responding to a code is time sensitive add well as other things that only ALS can do. ALS for me is for the whole county so it could take them some time without l & s I'll look for some papers written on that.

The front of the ambulance is much safer than the back of the ambulance. Saving time driving to a scene probably has the same negligible effect on Pt outcomes as driving code from a scene.

When responding keep in mind that there are lot of experienced people responding to your posts. They've been doing this job/or have done this job for a long time and know what the job entails. They know CVA treatments and modality and have taken a lot of pt conditions into consideration before responding.

With that said, in my opinion no amount of Pt pain is worth the risk of my or my partner's safety.

 

[CPRinProgress]

The front of the ambulance is much safer than the back of the ambulance. With that said, saving time driving to a scene probably has the same negligible effect on Pt outcomes as driving code from a scene.

What I am saying is that the time spent in the ambulance from scene to hospital might be small but even if it were long they are still getting care but in the time it takes us to get there when almost no care is being provided would be more crucial then the time from initiating bls and als to definitive care

 

[BeachMedic]

What I am saying is that the time spent in the ambulance from scene to hospital might be small but even if it were long they are still getting care but in the time it takes us to get there when almost no care is being provided would be more crucial then the time from initiating bls and als to definitive care

You seem like a compassionate person who wants to help people and ease suffering; but like myself, you've got to learn to think more about the bigger picture.

How often does saving five minutes of driving time make a significant difference in the Pt's eventual outcome? How important is it that we practice our job in the safest manner possible?

 

[CPRinProgress]

You seem like a compassionate person who wants to help people and ease suffering; but like myself, you've got to learn to think more about the bigger picture.

How often does saving five minutes of driving time make a significant difference in the Pt's eventual outcome? How important is it that we practice our job in the safest manner possible?

Well I don't know about compassionate but I believe that despite pt outcome just the perception of people that ems is no faster than driving themselves so they might not call for an ambulance I'm not saying that we should do unsafe things to keep the perception that emt's and medics are better than normal people but we should be keeping a reputation of being able to provide care when needed

 

[Rialaigh]

Well I don't know about compassionate but I believe that despite pt outcome just the perception of people that ems is no faster than driving themselves so they might not call for an ambulance I'm not saying that we should do unsafe things to keep the perception that emt's and medics are better than normal people but we should be keeping a reputation of being able to provide care when needed

This would be a HUGE benefit. If people learned that an ambulance is not a lights and sirens fast way to get straight back to a room and get prompt treatment then maybe they would start driving themselves in when they are calling for something that is not a true emergency. I would love for this to happen

 

[CPRinProgress]

This would be a HUGE benefit. If people learned that an ambulance is not a lights and sirens fast way to get straight back to a room and get prompt treatment then maybe they would start driving themselves in when they are calling for something that is not a true emergency. I would love for this to happen

You would still get the people that just want a free ride but I'm talking more about people that might not be aware of how bad a situation is. Do you want people driving that are having a diabetic emergency, that would cause more accidents.

 

[STXmedic]

I see your point but in this article it is said that most collisions that involve emergency vehicles were cause by the other vehicle it also says that intersection present the most risk to emergency vehicles so it would be beneficial for all ambulances to be equipped with lights that change lights to green when entering an intersection. Teaching the public about how to respond when an emergency vehicle is coming toward them would also be beneficial, maybe add part of a drivers test.
http://www.emergencydispatch.org/articles/warningsystems1.htm

Does it matter who caused the accident? It's still an accident.

I have an opticon on my unit, it is not without problems. It doesn't always change the light. It has a habit making all the lights glitch. I believe there was even a case in Houston where two trucks were using the opticon at opposing intersections, both turned green and the trucks wrecked into each other.

There are already campaigns in place to try and get people to slow down and/or move over. It doesn't work. It's even a law here that you must move over a lane or slow down when passing an emergency vehicle with lights on. People don't care.

 

[Veneficus]

Not to get too involved with this, but (as always) there is a certain fallacy in only considering effects on mortality. Did you save a life by getting a patient with pain, nausea, respiratory distress, or anxiety to the hospital faster? Probably not. Were their symptoms alleviated sooner? Good chance.

In what other contexts in life do we only care about people dying? Next time your wife comes home crying because she got a flat tire and had to change it in the rain, try telling her: "Did you die? No? Then who cares?" Lemme know how that goes.

But what are you willing to risk to make them feel better faster?

Your life, a limb, your career, your physical health? Your partnerts? The innocent bystanders?

Reducing suffering faster are not benefits that justify such risks.