So how does ALS work in California?

Removing intubation from a system that really only intubates dead people is a no brainer. If they were practing advanced airway managemnnt, I'd say it would be more of an issue, but they tube arrests. Use an SGA.

http://file.lacounty.gov/dhs/cms1_206321.pdf
 
DEmedic said:
Removing intubation from a system that really only intubates dead people is a no brainer. If they were practing advanced airway managemnnt, I'd say it would be more of an issue, but they tube arrests. Use an SGA.

http://file.lacounty.gov/dhs/cms1_206321.pdf
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I'm not really clear if they are even intubating arrests very much -- or at least not until the first round drugs are in (if I'm not mistaken): http://file.lacounty.gov/dhs/cms1_206097.pdf

Seems like they may as well just use rescue airways...
 
EpiEMS said:
I'm not really clear if they are even intubating arrests very much -- or at least not until the first round drugs are in (if I'm not mistaken): http://file.lacounty.gov/dhs/cms1_206097.pdf

Seems like they may as well just use rescue airways...
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I don't intubate until well after my first round of drugs are in.... By choice.

But they consider a King an advanced airway, so they often use that instead of an ETT.
 
EpiEMS said:
I'm not really clear if they are even intubating arrests very much -- or at least not until the first round drugs are in (if I'm not mistaken): http://file.lacounty.gov/dhs/cms1_206097.pdf

Seems like they may as well just use rescue airways...
Click to expand...

We can't intubate arrests until they've been receiving oxygen for 6 minutes. They either get an OPA and NRB or BVM until then.


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Handsome Robb said:
We can't intubate arrests until they've been receiving oxygen for 6 minutes. They either get an OPA and NRB or BVM until then.


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You don't ventilate arrests at all for six minutes if using the adjunct/NRB combo?
 
MonkeyArrow said:
You don't ventilate arrests at all for six minutes if using the adjunct/NRB combo?
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http://www.ncbi.nlm.nih.gov/m/pubmed/19660833/

I was in San Joaquin Conand they had a presentation regarding Passive Oxygenation Insufflation and they had pretty remarkable numbers regarding improved outcomes in areas that switched from BVM ventilation


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MonkeyArrow said:
You don't ventilate arrests at all for six minutes if using the adjunct/NRB combo?
Click to expand...

Nope. If it's a presumed hypoxic etiology they are ventilated with a BVM or if fire is already using a BVM when we arrive we continue to use it otherwise it's passive oxygenation for 6 minutes.


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Handsome Robb said:
Nope. If it's a presumed hypoxic etiology they are ventilated with a BVM or if fire is already using a BVM when we arrive we continue to use it otherwise it's passive oxygenation for 6 minutes.


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From a purely operational perspective, do you find it easier/keeps your mind on the compressions + electricity?
 
EpiEMS said:
From a purely operational perspective, do you find it easier/keeps your mind on the compressions + electricity?
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We run dual medic and pit crew CPR so they're covered pretty well. To be honest I haven't run an arrest since I moved here outside of scenarios. With that said they do our scenarios as realistic as possible and it definitely made it easier to focus on the most important parts being optimized.


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EpiEMS said:
From a purely operational perspective, do you find it easier/keeps your mind on the compressions + electricity?
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It does for me. It requires little effort to set up and prevents gastric inflation which is appreciated.
 
Tigger said:
It does for me. It requires little effort to set up and prevents gastric inflation which is appreciated.
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Makes good sense to me. If I were working a BLS-only arrest, and I had the option, I'd probably throw on the NRB and NC, with an OPA + bilateral NPAs til ALS showed up (<10min in my PSA).
 
The idea is that good CPR creates enough chest compression/expansion to cause a large enough pressure gradient to make passive oxygenation effective.


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Handsome Robb said:
The idea is that good CPR creates enough chest compression/expansion to cause a large enough pressure gradient to make passive oxygenation effective.


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Click to expand...
So no need to apply an NRB and/or NC? Or are they still going to (plausibly) have some benefit?
 
Lol you could create a whole separate thread on passive oxygenation for full arrests.
 
EpiEMS said:
Makes good sense to me. If I were working a BLS-only arrest, and I had the option, I'd probably throw on the NRB and NC, with an OPA + bilateral NPAs til ALS showed up (<10min in my PSA).
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We do the "superplug" here, which is two NPAs and an OPA. No one can prove its actually more effective than an OPA and proper positioning but I do as I am told and it makes intuitive sense I suppose.
 
EpiEMS said:
So no need to apply an NRB and/or NC? Or are they still going to (plausibly) have some benefit?
Click to expand...

It's NRB only. We place an EtCO2 cannula but no O2 source to it.


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I'm somewhat curious about SoCal EMS lol. Do I really want to trade my Texas medicking for AMR-San Bernadino County or Hall or Liberty-Ridgecrest or something? I mean, I haven't called for orders in two years.

I mean, I grew up out there, and I do miss it. But I also like guns and freedom and no state taxes.
 
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