Prehospital Cardiac Save at the pre-Inagural Event

[BEorP]

Until you find out the person left the hospital in basically the same shape as before having cardiac arrest I can not call it a save. I am happy that they gave the person a chance but until we see the patient walk out of hospital they are still dead. This is one of the great flaws in EMS. To many claim saves for people because they did not die in the ambulance. I also tire of the statement nobody dies in my ambulance. If you are doing CPR they are dead. Just because you wheel them into the hospital to let the doctor pronounce they were dead already. And that brings me to another complaint, doing CPR while the ambulance is moving. It is impossible to do quality CPR and is against current AHA guidelines.

Nicely put.

 

[Ridryder911]

First lesson in life, you did not save anyone. You just so happened to be there at the right time to place pads upon him and the machine did what it was supposed to do.

So you raised the shirt and place the pads and pushed the button... wow! Not really surgery, really is it?

I am irritated by kids acclaiming or trying to compare themselves to medical professionals in which they are NOT!

Yeah, I know all about Medical or EMS Explorer programs. I myself started working in the ED as one probably before your parents were born. Even was a Post Advisor and District Chairperson for about ten years. I was foolish and finally learned differently. Exposing kids to harmful events and responsibilities had more consequences than the benefits; even though out of the Post three became physicians and four became nurses and five entered EMS. We also had two that years later displayed PTSD... all because they were not emotionally able to be exposed to such.

Its a great program to train and slightly expose the profession but should NEVER be responsible for direct patient care!

Now, let me ask you this. Are you prepared to be sued? Is your parent's willing to finance their house and your college education for your "save"? You just admitted on a national forum that the pads were out of date. This is a Federal violation alike medication being out of date and technically you can be sued for knowing and willing to operate the device with such attachments. Yes.. you! It does not matter that it worked, they still can sue. How do we in medicine really... really know that there might not have been a malfunction due to pit of date device? Yes, I doubt it would occur .. but yes, it could.

Feel like a hero now? You have just demonstrated why kids should not be responsible. Checking equipment and being responsible to state that you will not be responsible to use equipment until appropriate changes occur.

It takes much more than just taking a class or even passing a test. Critical thinking skills are essential in this profession. Most of these cannot occur until of the age of 25. Not that does not in all but in the general population. Hence the same reason insurance rates decrease at such age.

I welcome all youth or anyone to explore the EMS profession. Learn what it incorporates to be a good medic, prepare to enter the profession and good points as well as pitfalls. Being informed is essential, it is that it is a serious profession that needs to be performed by adults. Alike any other medical profession, EMS is NOT an exception.

R/r 911

 

[bstone]

Rid,

You have zero proof to demonstrate those developing PTSD did so by anything they saw in your Explorer post, driving down the street, an abusive uncle or a bad dream. I did Law Enforcement Explorers for 4 years as a teen. We were constantly doing ride alongs, training with the riot team (we were the simulated rioters) and on the street doing crowd/parking control during 4 July and when the carnival came to town.

Loved every second of it. Had I not done EMS and medicine for my career I surely would have done LE.

I saw plenty of bloody fights, violent arrests, crazy people etc. I was 14 when I started the post and 18 when I left to go away to school. None of it left me traumatized. Perhaps some people it would, but I knew ahead of time that LE and EMS can be scary. I was prepared mentally for seeing injured and dead people.

That said, I am hugely in favor of Fire and EMS Explorers. I am going to get involved in it locally and encourage full EMT-B training.

 

[Shishkabob]

Am I the only one that read the "first responders" part in his OP?

Now, I may be wrong, but isn't MFR a level of healthcare providers, trained to, dare I say, provide a basic level of health care? And my guess is, they also had a CPR cert to BE said MFR's?


Uh-oh, trained people helped?! What has this world come to?!

 

[daedalus]

Rid,

You have zero proof to demonstrate those developing PTSD did so by anything they saw in your Explorer post, driving down the street, an abusive uncle or a bad dream. I did Law Enforcement Explorers for 4 years as a teen. We were constantly doing ride alongs, training with the riot team (we were the simulated rioters) and on the street doing crowd/parking control during 4 July and when the carnival came to town.

Loved every second of it. Had I not done EMS and medicine for my career I surely would have done LE.

I saw plenty of bloody fights, violent arrests, crazy people etc. I was 14 when I started the post and 18 when I left to go away to school. None of it left me traumatized. Perhaps some people it would, but I knew ahead of time that LE and EMS can be scary. I was prepared mentally for seeing injured and dead people.

That said, I am hugely in favor of Fire and EMS Explorers. I am going to get involved in it locally and encourage full EMT-B training.

Now that I have some back up points of view, ill toss myself back into the rink.

Many of my colleagues, one whom just left my house after crying about ten minutes ago, suffer immensely from the pyschiatricly disabled children we see, the critically ill and dying children we treat, and see just how far life can actually go down the toilet. The one that just left my house is taking an SSRI, and so am I. This profession is harmful to adults, imagine subjecting a developing mind to it. Also bstone, you claim the kid is mature. That may be true, but he is still a teenager with a developing frontal cortex, and therefore no matter how mature, is prone to make rash and inappropriate decisions based on his biology.

Medical doctors do not allow children to participate in their care, surgeons do not have children helping in the OR, Echocardiographers do not let children produce imaging studies. No children are even interested in echocardiography because there are no lights and sirens.

bstone, we are at the point that will make or break us. Most medical doctors want to let the united states public know that EMS is a complete hoax, and they want to show the public studies that demonstrate we make no difference in patient care. I will provide you with names and contact information for these physicians if you wish. I will show you their studies as well. If we do not shape up, embrace evidence based practice, unify our education and create a professional EMS instead of rescue first aid squads, etc, we will be dismantled. I am serious, this is not an inflammatory post.

They are going to take our advanced scope away from us, and send us back to the days of scoop and go. We need to shape up. Having children as providers just gives them a whole new side to shoot at us.

 

[bstone]

Daedalus, thought you said were exiting this conversation? Or did I read that wrong?

Edit: yes, you did say it:
Link:
http://www.emtlife.com/showpost.php?p=117879&postcount=17

 

[XxBigBrotherxX]

You did a really good thing job as a First responder. Im also very young(18). And i've noticed how alot of older EMTs really come down on us so hard as if we are not capable of performing well just because of our age. They have it in their hearts and minds that we are irresponsible and immature. Thank you for being just another example of how special and capable we are. once again, good job!!

 

[daedalus]

Daedalus, thought you said were exiting this conversation? Or did I read that wrong?

Edit: yes, you did say it:
Link:
http://www.emtlife.com/showpost.php?p=117879&postcount=17

I decided to rescind that

You can make smart sounding responses, but you did not address my post.

We have wonderful resources on this board, and if you berate them and argue with them after their years and years and years of experience and years of education, they might just leave one day. Instead of arguing with empty replies to someone who could teach you so much, we should try and learn.

I am all for an intellectual debate, but the anonymity of the internet for some reason causes such hostility. I am not sure why! I cannot imagine us speaking to eachother's faces like we do on this forum! I very much praised the OP for his enthusiasm and encouraged him to excel professionally, but we do not hold hands in patient care! If someone uses bad equipment or preforms a procedure incorrectly, we need to instruct them in no sugar coated words how things need to be done, because very lives are at stake. You say you want to be a physician, just wait until you get into residency, or your first time in the OR! You are going to be ripped apart and for no good reason other than you are a student. This is how medicine was and what it will always be.

Patient care is a very serious responsibility. Our EMT code of ethics requires us to act against threats to public safety.

 

[daedalus]

You did a really good thing job as a First responder. Im also very young(18). And i've noticed how alot of older EMTs really come down on us so hard as if we are not capable of performing well just because of our age. They have it in their hearts and minds that we are irresponsible and immature. Thank you for being just another example of how special and capable we are. once again, good job!!

As an EMT-B you may not be qualified to make such an assessment of the provision of medical care.

 

[redcrossemt]

What is wrong with having Explorers or Red Cross volunteers ASSIST EMS at the first aid stations?

Just as a note, the Red Cross First Aid program I manage provides medical first response services at all sorts of special events. Our team leaders are experienced MFRs, EMTs, medics, and RNs; and they are assisted by first aid/CPR trained volunteers. Everyone is 18+ years old. Many are 30-50 years old and have years of EMS and hospital experience.

We do assist EMS once they arrive, but we often care for patients for extended periods of time while waiting for them - especially during the high demand events we serve at. Our program has a medical director, SOPs, medical protocols, a CQI and CE program, and is well-equipped at the first responder level.

I just want to be clear that our volunteers are responsible and I assure you that when our AED pads expire, they get replaced by those volunteers (whether they are an 18 y/o MFR or a 50 y/o CCEMTP-RN). It's obvious that there are some problems with this particular Explorer program and I don't want the Red Cross lumped in with them.

 

[Vonny]

Aed pads

I just want to be clear that our volunteers are responsible and I assure you that when our AED pads expire, they get replaced by those volunteers (whether they are an 18 y/o MFR or a 50 y/o CCEMTP-RN). It's obvious that there are some problems with this particular Explorer program and I don't want the Red Cross lumped in with them.

Well Said

I am also a Red Cross (Irish) Ambulance Unit Leader / Emergency Medical First Responder and I agree with you. We train our volunteers very well and nobody under 18 would be trained to use and AED.

The pads on an AED have an expiry date for a reason, if you use pads that have lost their adhesive quality even a little bit then you are not going to get good contact with the skin and so you may not get effective conduction. Also depending on where the AED is stored they are affected by cold/hot temps.
An AED should be checked at least once a week in a community program and the pads checked for damage or expiry.

Now to play the devils advocate: The young responders who used the expired pads did get a result, they got a pulse after three shocks, this is the desired result of using an AED and so their efforts were affective and they should feel very happy about that.

Whatever caused the cardiac arrest is beyond the control of those responders and they should not be held responsible for a bad outcome if the patient does not "Walk out of the hospital" restored to pre arrest condition.
As far as we know they did not harm the patient and they gave him/her their best chance of surviving what after all was a death.

At least now the patient has a chance to walk anywhere again and thats all you get is a chance.

Its all very well for more highly trained people to sit at their computers write about what they woulda coulda shoulda done but if it was me on the ground and my only chance was expired pads I would say YES YES YES use them on me.

 

[Kendall]

Now to play the devils advocate: The young responders who used the expired pads did get a result, they got a pulse after three shocks, this is the desired result of using an AED and so their efforts were affective and they should feel very happy about that.

Whatever caused the cardiac arrest is beyond the control of those responders and they should not be held responsible for a bad outcome if the patient does not "Walk out of the hospital" restored to pre arrest condition.
As far as we know they did not harm the patient and they gave him/her their best chance of surviving what after all was a death.

At least now the patient has a chance to walk anywhere again and thats all you get is a chance.

Its all very well for more highly trained people to sit at their computers write about what they woulda coulda shoulda done but if it was me on the ground and my only chance was expired pads I would say YES YES YES use them on me.

Couldn't have said it better.

While expired equipment or supplies is a serious issue, using expired equipment is still better than nothing. I can't give the evidence but I've heard of studies suggesting that using epi-pens past expiry that is still clear in color and of precipitate is perfectly acceptable. AED pad expiry is for the conduction gel and is based on statistics of the breakdown; the average time it takes for the material to breakdown. It could truly expire and be unsafe to use long before the printed date or long after. How expired were the pads? I'm sure that if there was something visibly wrong with the pads they would not have been applied.

The intended purpose of an AED is for the lay provider to administer a defibrillation attempt prior to EMS/ALS arrival. It does not matter that the provider was legally not an adult, they were trained to perform a task and pressed the shock button when the machine told them to. They were fortunate to have an ROSC and I congratulate them! They must have done something right!

Younger EMS providers are something that people are just going to have to get used to. They have the same education, the same certification, have gone through the same processes that everyone else has to be where they are. For those of you who have young providers working at your respective services, they're even under the same medical director! That being said, nothing can replace experience, so why hold young providers back from gaining that experience? Why hold them back from developing into the EMT-P, physicians, RN's etc of tomorrow?

The reality of it is that EMS can not become recognized as a profession until there are things like evidence based practice, degree based education programs and diversification of scope. Emergency Medical Services as a whole is not and will never become a profession. There are too many variables involved for that to happen. EMS is a diverse and continuously dynamic field with differing requirements based on the geographics and demographics of the area is serves. Paramedicine is what will become the profession. There will always be basic level providers in some capacity that will typically be the first on scene as its not practical to have highly skilled and professionally recognized individuals respond to every call.

I do not think that this is the appropriate time or place to criticize young providers and it is not the professional thing to do.

 

[Ridryder911]

Here is the problem. We allow excuses! Instead of using kids providing care true EMS professionals should had been providing care.. nothing less. Do we allow kids to be in a surgical theatre? NO! There is a reason, immaturity and lack of life experience and having the capability of making rationale decisions. This is scientifically proven, not just anectodotal.

In regards to PTSD, yes we did have proof that it was directly related to the EMS Explorer program and thus the reason it was discontinued after two decades. One does not have to have direct hands on to understand an profession. Millions of other professions do not require such.. again a another mythical fallacy we want to continue to pursue. Unlike LEO or even Fire Service (suppression) where one can determine what they will be exposed to. As well do really have to have patients exposed to non-professionals?

Medicine is a serious matter and not a hobby. Go to school, receive your education with several of hundreds of hours of clinical experience, enter the profession and gain experience in both life and clinical expertise. By this time, one will have some life experience, maturity and ability to make critical decision making.

One can exclaim all they want on how a some can do and not do. I do understand both sides. I started working in a ER at the age of 14 and became a Paramedic at 17. So I do know the dilemma well. It does not make it right though.

Let's be a profession.. this means having professionals being required instead of having an excuse. We will NEVER respected or have the intergrity until we do so. As well, our patients deserve better.

R/r 911

 

[medic417]

Here is the problem. We allow excuses! Instead of using kids providing care true EMS professionals should had been providing care.. nothing less. Do we allow kids to be in a surgical theatre? NO! There is a reason, immaturity and lack of life experience and having the capability of making rationale decisions. This is scientifically proven, not just anectodotal.

In regards to PTSD, yes we did have proof that it was directly related to the EMS Explorer program and thus the reason it was discontinued after two decades. One does not have to have direct hands on to understand an profession. Millions of other professions do not require such.. again a another mythical fallacy we want to continue to pursue. Unlike LEO or even Fire Service (suppression) where one can determine what they will be exposed to. As well do really have to have patients exposed to non-professionals?

Medicine is a serious matter and not a hobby. Go to school, receive your education with several of hundreds of hours of clinical experience, enter the profession and gain experience in both life and clinical expertise. By this time, one will have some life experience, maturity and ability to make critical decision making.

One can exclaim all they want on how a some can do and not do. I do understand both sides. I started working in a ER at the age of 14 and became a Paramedic at 17. So I do know the dilemma well. It does not make it right though.

Let's be a profession.. this means having professionals being required instead of having an excuse. We will NEVER respected or have the intergrity until we do so. As well, our patients deserve better.

R/r 911

Bravo. Good show old chap. Excellent post. W/O a major change in attitude this can never be a True profession.

 

[TgerFoxMark]

I hate to be the :censored::censored::censored::censored::censored::censored::censored:. but as someone who has had to deal with rid, for being under 20, a while back.

Rid, whats your opinion of a lifeguard. min age 15. they are trained to remove people from water safely and with full precautions if needed. CPR is also part of the training. I started here, as a lifeguard and i think many of have done this job.
I'm no longer a teen, but i still am a bit of a wacker. Less so than when i joined thank god. (yes, rid. I SOLD off the ambulance, however i am restoring a 1971 Cadilliac ambulance)
I feel like these young adults did an excellent job, and exactly what they were trained to do. i commend them on an ROSC. it actually gave this person a fighting chance. I give them Props on that.

Now on the issue of the AED. Its not their fault that the pads were expired. it is the fault of whoever signed the maint. slip saying it was ok. but on a side note, i would personally rather have an AED with expired pads used on me, than no AED at all.

just my $0.02

 

[bstone]

In my home country, Israel, becoming an EMT-B (or the Israeli equivalent) is something which a huge group of teens do every year. I have friends who have been volunteering on their local ambulances since age 15. They are professional, serious and competant. A lot of them go on to become medics in the army...at age 18. Some on this thread would still consider 18 "children". The truth is they are anything but.

 

[Ridryder911]

I hate to be the :censored::censored::censored::censored::censored::censored::censored:. but as someone who has had to deal with rid, for being under 20, a while back.

Rid, whats your opinion of a lifeguard. min age 15. they are trained to remove people from water safely and with full precautions if needed. CPR is also part of the training. I started here, as a lifeguard and i think many of have done this job.
I'm no longer a teen, but i still am a bit of a wacker. Less so than when i joined thank god. (yes, rid. I SOLD off the ambulance, however i am restoring a 1971 Cadilliac ambulance)
I feel like these young adults did an excellent job, and exactly what they were trained to do. i commend them on an ROSC. it actually gave this person a fighting chance. I give them Props on that.

Now on the issue of the AED. Its not their fault that the pads were expired. it is the fault of whoever signed the maint. slip saying it was ok. but on a side note, i would personally rather have an AED with expired pads used on me, than no AED at all.

just my $0.02

As a lifegaurd you are not considered a healthcare provider rather a rescuer. I realize there are EMS associated w/lifeguard but in the general sense your primary job is to retrieve and administer first-aid care until the professionals arrive to assume medical care.

I did not say they did not do a good job, but let's be professional and not brag or boast upon just being at the right time & right place. Really, how hard was it to attach pads and push a button? Lucky, it worked. What would happened if it did not? What if the pads would not conduct or the AED did not deliver enough or too much joules? Who is responsible then? Sorry, it is as much the provider as it is the maintenance company.

There is an expiration date for a reason. You get caught giving any medication or using any device past such; it will be your arse. Remember you are supposed to check for expiration dates as part of your daily inspections and before any usage or administration. As well, if the pads were expired; I can assure you the AED was not up to the new standards also. Now, that raises another potential liability.

Folks, medicine is a very serious matter. The courts and trial attorneys would have a field day. All it would take is someone to have read about this and tell the family. Can this rescuer ensure that the device was callibrated and was really up to par? Again, the burden of proof is up to the rescuer. Does the Explorer Post have malpractice insurance or would the parents of the resuer have to pay the costs? Sorry, the Good Samitiran Act will not cover in this event due to there was a contractual agreement that they would act if called upon. Again, medicine is NOT a hobby! When you play as a big dog; be prepared to be judged alike and with other professional providers. This is why it is for professionals.

* In regards to restoring the ambulance that is neat. I enjoy seeing the old classics.

R/r 911

 

[daedalus]

If explorers want to be treated as professionals, than they should get the whole responsibility that comes with it, including having to be sued or arrested when they screw up, and tried as adults.

UPADAT: A private investigator and attorney visited my station today to question a crew about a patient that had died. I am positive it had nothing to do with them, but you see, the lawyers do not see it that way.

 

[Vonny]

Folks, medicine is a very serious matter. The courts and trial attorneys would have a field day. All it would take is someone to have read about this and tell the family.
R/r 911

Very true!
Never admit your mistakes or rule bending in an open forum, big brother is always watching.

 

[Veneficus]

Congrats to the OP and comrades for a job well done!

I was trying to avoid looking at this thread, honest.

I was a fire/ems explorer at 14 years of age. (around the same time as the pyramids were built)

Within 2 weeks I had my AHA HCP CPR card and within my first year at the time what was called "first responder." By the time I was 16 I probably saw more than most adults who never get near emergency service. I wouldn't trade it for the world and encourage others interested to the same.

But here are some things to consider:

How young are many olympic atheletes? (especially gymnasts and figure skaters?) Many of them are "tutored" and do not go to school as many of us did. By the time they are 17 they probably have 10 years in a sport where a mistake could mean permanant injury or death. You cannot harm a dead person by doing cpr. As well, my card was the same as any provider.

What about child actors?

All of us who are(were) explorers or cadets chose to be in an adult world. We gain our life experience at a rapid rate, by being involved. The responibility and demands are at least equal to any 18 year old, often more so because we have had to constantly prove ourselves with a stricter criteria. While many people in high school were out partying and being kids, I was at the FD. Studying, responding, and doing as much s:censored::censored::censored::censored: work as could be heaped upon me. I was there for holidays, birthdays, and while others were having "family" days, It certainly wasn't play time.

I don't think I have PTSD. Infact, my life is pretty good.

Anyway, if I could get the hospital to open up an explorer post, we would have one. (at least 1) it is not for everyone. But there are many paths to success in life. Please don't begrudge mine and my junior collegues because it was not yours. Maybe even be nice to the people trading their "normal" childhood for their dedication to the job.

For the legal arguement, yes I was considered an agent of the FD, yes they had insurance to cover me and any mistakes I might have made. (which assuradly would have been my last day if I made one)How many MDs, RNs, Medics, or other "healthcare providers" with more life experience get to make 0 mistakes?

When EMS is a medical profession somebody please let me know. Despite the best efforts of many, including myself, it is still a skilled trade. Seemingly more so everyday I read about some other IV, EKG B***S*** cert or merit badge ITLS, PEPP, AMLS, or ABLS course.