Short handed during arrest

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True, it could have been something else.

He either does not trust EMS as a rule or maybe that particular crew.

Or since ED docs are typically paid X amount for seeing X number of patients and +bonus for any patients above said X number, then it simply could be to bump his daily stats.

Just sayin...............................
 
Here in TN emts can start ivs... we run emt/ medic trucks so once my partner goes up front to drive I have to do everything... no fun compression devices here... its nice to have help when you can get it but alot of times your it... you do the best you can
 
Bluestar said:
Here in TN emts can start ivs... we run emt/ medic trucks so once my partner goes up front to drive I have to do everything... no fun compression devices here... its nice to have help when you can get it but alot of times your it... you do the best you can
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You can't have a firefighter or two ride in with you?

We are spoiled one FD is ALS the two others are ILS with the random few BLS providers. Makes for a lot of people with the ability to help out with more than just CPR although we are the medical authority and don't usually let FFs do airways or IVs unless they established them PTA or are in the process of establishing it when we show up.

I'll let them do the assessment all day every day though and stand back while paying attention :P
 
usalsfyre said:
Sizz, the answer to your question is not to transport cardiac arrest unless there's a ROSC. Even with three people you can't do effective CPR during transport.
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I agree with this, we very rarely will transport a cardiac arrest. But in the event that we do, we put them on the Auto-Pulse, grab a FF/FR to drive, I will intubate and hand airway control off to the EMT-B, then I will take care of the monitor/defib/drugs.
 
I had to do this a few months back. Had 2 cops doing CPR onscene - that worked well. For transport, I was in the back by myself w/ my EMT driving. Autovent + Crappy CPR + ACLS for 5 min transport. And code called on arrival at ED.

*Note - wasn't my choice to transport. Had, um, a difference in opinion with OLMC - I wanted to call it, he didn't.

Due to a wierd glitch in territory, we didn't have FD onscene, and I wasn't going to special call them out and wait 10 min to do the transport.

_____



Now my service has a Lucas as well as the Autovent. Codes have gotten easier.
 
How about "get more help"? Is that not available in your community? In a hospital, they use 5-8 people to manage an arrest. Why would we try with any less if there was a choice?

In our system, we use the "pit crew" concept where everybody has a job and sticks to it. One person is the "code commander," watches the monitor and leads the action. Another handles airway. 2-3 firefighters rotate continuous, uninterrupted compressions. Another medic starts two IOs and pushes the medications.

I should add that we dispatch 2 ambulances and a supervisor to all codes, along with a BLS first response engine company with 4 people. With this, we are able to get 35-40% successful resuscitations.

And we don't transport people with CPR in progress, except in VERY unusual circumstances.
 
CH100 said:
I should add that we dispatch 2 ambulances and a supervisor to all codes, along with a BLS first response engine company with 4 people. With this, we are able to get 35-40% successful resuscitations.

.
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you talking ROSC ? if not what do you consider successful?
 
CH100 said:
How about "get more help"? Is that not available in your community? In a hospital, they use 5-8 people to manage an arrest. Why would we try with any less if there was a choice?

In our system, we use the "pit crew" concept where everybody has a job and sticks to it. One person is the "code commander," watches the monitor and leads the action. Another handles airway. 2-3 firefighters rotate continuous, uninterrupted compressions. Another medic starts two IOs and pushes the medications.

I should add that we dispatch 2 ambulances and a supervisor to all codes, along with a BLS first response engine company with 4 people. With this, we are able to get 35-40% successful resuscitations.

And we don't transport people with CPR in progress, except in VERY unusual circumstances.
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In a perfect world that's awesome. The OP stated he's in a rural area where "more help" can be a long way away.

I said it to someone else in here but I'll say it again, dispatching that many units to an arrest seems like a bad utilization of resources. 2 man ambulance crew plus a 3-4 man engine crew is more than enough hands IMO. 9 people seems like total overkill and a lot of standing around.

30-40% successful resuscitations is a pretty high rate and if it's true I applaud you and your service. Just getting ROSC doesn't necessarily make it successful though.
 
Successful resuscitation means "left the hospital neurologically intact."

Why is some number "too many"? If more people on scene = greater success, what's the problem? If it was your mom or dad, wouldn't you want them to have the greatest possible chance? That's our standard of care (besides the science) - how would you want YOUR loved one treated?

There are quite a few separate tasks to be done, and it helps to have people dedicated to them. That way, you DON'T interrupt compressions, somebody DOES notice that the O2 tank is running low, there IS somebody to get an extra battery for the monitor, and there are more brains on the scene to make sure that nothing gets forgotten or overlooked. Can you imagine someone suggesting that you run a code in a hospital with 1 MD, 1 RN, and several people to do compressions? Not anyplace I'd want to be!
 
phideux said:
grab a FF/FR to drive.......
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I REALLY dislike the concept of having someone driving an ambulance who does not regularly drive an ambulance, isn't familiar with the vehicle, doesn't know its handling or where the buttons and switches are, etc.

Prefer (greatly) to call another EMS folk to drive!
 
CH100 said:
Successful resuscitation means "left the hospital neurologically intact."

Why is some number "too many"? If more people on scene = greater success, what's the problem? If it was your mom or dad, wouldn't you want them to have the greatest possible chance? That's our standard of care (besides the science) - how would you want YOUR loved one treated?

There are quite a few separate tasks to be done, and it helps to have people dedicated to them. That way, you DON'T interrupt compressions, somebody DOES notice that the O2 tank is running low, there IS somebody to get an extra battery for the monitor, and there are more brains on the scene to make sure that nothing gets forgotten or overlooked. Can you imagine someone suggesting that you run a code in a hospital with 1 MD, 1 RN, and several people to do compressions? Not anyplace I'd want to be!
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My thought is too many chiefs and not enough indians. If you have a rock solid "chain of command" then it works just fine but if you have people freelancing on scene it creates more problems than it helps.

Once you have your airway, 3/4 lead, pads, and IV in place there isn't that much to do. 3 people rotating on compressions, medic or their partner is playing with drugs and electricity while someone gathers H/A/M as best they can. Sorry, I left out BVM but we cheat with a vent :ph34r:

I'd like my loved one to be treated to the best of the provider's ability. That doesn't always correlate to the number of providers present for the resuscitation.

I work as an intermediate and am almost finished with medic school, you work as a medic and I admit you have more experience and know more than I do, seeing as I'm young and dumb at 22, but I still don't see the point of having an exorbitant amount of providers on scene being all that beneficial.

I'm not doubting your numbers but I'd love to see a source seeing as the national average for survival to discharge of prehospital cardiac arrests is well below 30-40% You guys must have one awesome public access AED and education program going wherever you are.

edit: I wholeheartedly agree with you about unfamiliar people driving the ambulance. No one drives our units except our staff, that doesn't include PD or FD personnel. The intermediate drives and the medic works + 1-2 FD riders if we need them. Or visa-versa for an BLS/ILS call that the I can attend.
 
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In our system, paramedics aren't chiefs - they are clinicians. While all are qualified to serve as "team leader," our "way" is that one person serves as team leader, and all others fall in to defined parts.

Your response really clarifies the difference. "Once you've got the airway...." That suggests that things are done sequentially, and that once done, they are done. That's not our approach. They guy who does the airway STAYS with the airway.....and out of the way of the guy who does the drugs (who does them via IO down by the feet). And we want the guy calling the shots to focus on running the code - not pushing buttons on the monitor, or anything else.

Since we're in NC, NASCAR is a big thing here. We actually talk about, and use, the "pit crew" concept - each member has one and only one focus during the event. We don't want to have anybody do airway, then do something else. And if there are available people, somebody will have the protocol and the "cardiac arrest checklist" in their hands, making sure that every option is considered. And when pulses come back, we have a "post ROSC checklist' that we use too - including waiting 10 minutes before moving the patient to a board, stretcher, ambulance, etc. (because most re-arrests occur in the first 10 minutes, and you don't want to be going down the stairs when you need to start over).

It's different - but it seems to work pretty well.:rolleyes:
 
The "too many chiefs and not enough indians" line was a metaphor...

I'm not trying to say what you do is wrong.

We don't "set it and forget it" when it comes to the airway, but it isn't difficult for me to drop a King tube, confirm placement, secure it, attach the ETCO2, set the vent, place an OG tube through the port on the king and attach it to suction. Once that's set we have a quantitative measurement of ETCO which is easily monitored by the person who is in charge on rhythm checks along with decompression of the stomach via the OG tube. The airway is constantly monitored. We just multi task.

It sounds like you have an awesome setup where you're at and I'm not bashing it by any means, I was just adding my thoughts seeing as this is a public forum :rolleyes:

I also have a pretty good idea of where you work from the description you provided and if I'm right it's a system that I have always been interested in working in.
 
CH100 said:
How about "get more help"? Is that not available in your community? In a hospital, they use 5-8 people to manage an arrest. Why would we try with any less if there was a choice?
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This is kind of a bad example, as Wake Paramedics are far better at running codes in my experience than the hospitals, no matter how many people they have.
 
Actually, that IS the example. We routinely have 8-9 people on the scene of a code - in Wake County. 9E1 dispatch gets an engine company (3-4), an ambulance with 2, and two "others" (either another ambulance, an APP, or a District Chief) for 2-3 more.
 
8-9 wow:wacko:

we usually have 3/4 once. I've found any more than 4-5 to be a crowd unless you need a hand with extrication
 
the_negro_puppy said:
8-9 wow:wacko:

we usually have 3/4 once. I've found any more than 4-5 to be a crowd unless you need a hand with extrication
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Extras rotate through CPR. Meds and monitor get dedicated providers, and airway may cycle a bit just so no one gets tired of ventilating. Transport is done after ROSC with about 4 in the back of the truck. It has never felt to me like too many people. Fire arrives onscene first in most cases, so a minute or two shaved off of CPR times can make a difference.

You also have to remember that some of the Wake County protocols necessitate the extra units. You can't do a double-sequential defib without a second LP12/15, and only supervisor units carry chilled saline and etomidate for induced hypothermia.
 
We could have 3 available trucks a mile away from a code and only 1 truck will be sent. If we are lucky police might show up within 10 to 15 min. We would get in trouble going to help out the other truck unless they called for a lift assist
 
Medic Tim said:
We could have 3 available trucks a mile away from a code and only 1 truck will be sent. If we are lucky police might show up within 10 to 15 min. We would get in trouble going to help out the other truck unless they called for a lift assist
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That is just silly!

Why would you get in trouble for assisting a crew during an arrest?

Decrease the workload on your crews, increase the quality of care for your patient?

I understand needing units available but isn't that mutal aid is for?

Sorry for the rant, but good gosh that makes no sense if you have available crews that close.
 
hhhhmmmmmmmm.........Let's see.... Lucas synced with the vent leaves me able to work an arrest on my own. I can push drugs, and monitor my PT while my equipment does all of the work. In most cases my partner has nothing to do but drive.
 
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