the 100% directionless thread

chaz90 said:
Sigh. Just heard a cardiac arrest dispatched on the radio with a <1 minute ALS scene time and only 4 minute scene time for BLS. Rapid emergent transport of the still arrested patient to a hospital 6 minutes away. Sometimes I feel like I'm fighting a losing battle.
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Wont that get QAd to death there? That's ridiculous. I don't care if you're across the damn street from the hospital, you're signing their death warrant and taking any chance at life they possibly had away by doing that.

Our protocols don't have a set time that we have to work, it's expected that we work for 20 minutes but nothing says I can't work for longer so I'm going to start following the EBM and work for 40 minutes before calling for termination orders once I go back. I never transported CPR in progress before anyways but it was always after 20 minutes we'd call.

I'm wondering what QA would say if I got ROSC and they re-arrested and I continued to work on scene and ended up terminating. I'm sure Fire and some of my coworkers would have a cow.
 
chaz90 said:
Sigh. Just heard a cardiac arrest dispatched on the radio with a <1 minute ALS scene time and only 4 minute scene time for BLS. Rapid emergent transport of the still arrested patient to a hospital 6 minutes away. Sometimes I feel like I'm fighting a losing battle.
Click to expand...

I just looked at a article on ems1 about how we are expected to stay on scene for a adult for 20 mins and why we should do the same for children. What do you guys think/do? Do you stay on scene for a child in cardiac arrest for 20 mins or get moving ASAP? Or does it just depend on the situation?
 
Handsome Robb said:
Cabelas is a dangerous store...took every ounce of my self control to not get a credit card there today as well as not spending all my money.

Bought myself a little early birthday present though, I couldn't help myself. Never been a knife guy but I like this little guy. Wish it was assisted opening but at $25 bucks I can't complain. Was actually going to buy a boot knife but they didn't have one that would fit in my 5.11s and I didn't like any of them that they had anyways. Call me a whacker but I already have too much crap in my pockets at work.

Next on the list is a small flashlight that has a pocket clip since mine does not have one.

hute7ygy.jpg
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Gerber knifes are great! I won one at a ems conference 7 years ago and it still cuts like its brand new!
 
Fire51 said:
I just looked at a article on ems1 about how we are expected to stay on scene for a adult for 20 mins and why we should do the same for children. What do you guys think/do? Do you stay on scene for a child in cardiac arrest for 20 mins or get moving ASAP? Or does it just depend on the situation?
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Stay on scene unless you can do cpr in a moving vehicle. Which most can't.
 
Fire51 said:
I just looked at a article on ems1 about how we are expected to stay on scene for a adult for 20 mins and why we should do the same for children. What do you guys think/do? Do you stay on scene for a child in cardiac arrest for 20 mins or get moving ASAP? Or does it just depend on the situation?
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Our protocols (ALS and BLS) suggest working arrests on scene for at minimum 6 minutes prior to transport, which is still obviously far too short. It's a constant battle. Most of our ALS providers understand the goal of working arrests on scene to ROSC or termination, but some still believe the LUCAS is simply a device to allow transport of arrest patients.

I continue to be an often annoyingly vocal advocate of working our arrests on scene regardless of where we are and don't transport when it's my call. Many BLS providers in the three districts where the hospitals are located seem to believe we should continue to load and go with arrests as we heroically "ride the rails" with manual compressions into the ED. I'm not trying to be demeaning to anyone, and I genuinely think increased education and cooperation with BLS could lead them to understand why we do the things we do and how we can all work together on scene to better care for our cardiac arrest patients. Seriously, this whole issue is one of my biggest frustrations in my daily work life and something I wish I could fix.

For pediatric arrests, we universally run screaming to the local ED. I've not yet had one here in Delaware (knock on wood!!!), but that seems to be the commonly accepted reaction during a pedi arrest. I can somewhat understand that there are often different considerations in a pediatric scenario, so I'm not 100% convinced rapid transport of these patients with certain interventions first performed on scene or en route isn't appropriate.
 
Handsome Robb said:
Cabelas is a dangerous store...took every ounce of my self control to not get a credit card there today as well as not spending all my money.

Bought myself a little early birthday present though, I couldn't help myself. Never been a knife guy but I like this little guy. Wish it was assisted opening but at $25 bucks I can't complain. Was actually going to buy a boot knife but they didn't have one that would fit in my 5.11s and I didn't like any of them that they had anyways. Call me a whacker but I already have too much crap in my pockets at work.

Next on the list is a small flashlight that has a pocket clip since mine does not have one.
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I have a slightly larger version of that (paraframe) and have brought it to work every day for four years now. It recently acquired some rust spots after a poorly planned cold water challenge, but aside from that I lurve it.
 
Tigger said:
I have a slightly larger version of that (paraframe) and have brought it to work every day for four years now. It recently acquired some rust spots after a poorly planned cold water challenge, but aside from that I lurve it.
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Have you contacted gerber about the rust spots? I've had several friends who said their customer service is amazing
 
Good morning everyone. I couldn't sleep so I thought I would poke around here for a bit. Hope everyone is having a quiet night.
 
Fire51 said:
I just looked at a article on ems1 about how we are expected to stay on scene for a adult for 20 mins and why we should do the same for children. What do you guys think/do? Do you stay on scene for a child in cardiac arrest for 20 mins or get moving ASAP? Or does it just depend on the situation?
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this along with doing cpr on scene for a minimum of 40 mins....
makes me rolls my eyes because its just not practical. the 4 or 5 people on scene cycling CPR that long will basically result in crappy CPR so whats the point? ER has plenty of 'fresh' people that can do it.

but to answer your question, it depends, for me, peds will almost always be transported. hand me the kid and lets go situation, they have better chances of recovery than an adult and the ER has more resources and tests they can do to figure out why the kid is in cardiac arrest. and adult in a nonshockable rhythm gets worked on scene until we can call it. (20 mins, 3rds epi, consult with base). not a hard and fast rule but thats how i do it.
 
Angel said:
this along with doing cpr on scene for a minimum of 40 mins....
makes me rolls my eyes because its just not practical. the 4 or 5 people on scene cycling CPR that long will basically result in crappy CPR so whats the point? ER has plenty of 'fresh' people that can do it.

but to answer your question, it depends, for me, peds will almost always be transported. hand me the kid and lets go situation, they have better chances of recovery than an adult and the ER has more resources and tests they can do to figure out why the kid is in cardiac arrest. and adult in a nonshockable rhythm gets worked on scene until we can call it. (20 mins, 3rds epi, consult with base). not a hard and fast rule but thats how i do it.
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In the 911 system I ride with an arrest gets the nearest medic, an ambulance for transport and a truck for manpower. That's 6 people at a minimum but more likely around 10-12.
 
Angel said:
this along with doing cpr on scene for a minimum of 40 mins....
makes me rolls my eyes because its just not practical. the 4 or 5 people on scene cycling CPR that long will basically result in crappy CPR so whats the point? ER has plenty of 'fresh' people that can do it.

but to answer your question, it depends, for me, peds will almost always be transported. hand me the kid and lets go situation, they have better chances of recovery than an adult and the ER has more resources and tests they can do to figure out why the kid is in cardiac arrest. and adult in a nonshockable rhythm gets worked on scene until we can call it. (20 mins, 3rds epi, consult with base). not a hard and fast rule but thats how i do it.
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I have more people on scene (4) than would be available in the ED to work the code... and what tests are they going to do on a pediatric patient?
 
Angel said:
this along with doing cpr on scene for a minimum of 40 mins....
makes me rolls my eyes because its just not practical. the 4 or 5 people on scene cycling CPR that long will basically result in crappy CPR so whats the point? ER has plenty of 'fresh' people that can do it.

but to answer your question, it depends, for me, peds will almost always be transported. hand me the kid and lets go situation, they have better chances of recovery than an adult and the ER has more resources and tests they can do to figure out why the kid is in cardiac arrest. and adult in a nonshockable rhythm gets worked on scene until we can call it. (20 mins, 3rds epi, consult with base). not a hard and fast rule but thats how i do it.
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If properly cycled that is more than enough people for proper CPR.
 
Angel said:
this along with doing cpr on scene for a minimum of 40 mins....
makes me rolls my eyes because its just not practical. the 4 or 5 people on scene cycling CPR that long will basically result in crappy CPR so whats the point? ER has plenty of 'fresh' people that can do it.

but to answer your question, it depends, for me, peds will almost always be transported. hand me the kid and lets go situation, they have better chances of recovery than an adult and the ER has more resources and tests they can do to figure out why the kid is in cardiac arrest. and adult in a nonshockable rhythm gets worked on scene until we can call it. (20 mins, 3rds epi, consult with base). not a hard and fast rule but thats how i do it.
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Have you seen ER's work arrests? I would rather be in the parking lot with medics doing pit-crew until ROSC was established and stable if it were me in arrest haha. The hospitals don't have some magic tool to increase odds unless the PT is a STEMI alert and near a cath lab, then I would try and transfer.
 
Damn it! I hate when I'm eating "boneless" fish and I find one little bone halfway through my meal while I'm chewing. It makes me get all paranoid and wonder what other little bones are in there. And I lose my appetite. It's always those farmers market type places that try to prepare fish in front of you that this happen in...
 
I love the smell of GI bleeds with c-diff in the morning!
 
First day back to work tomorrow! I wish it were on the box but gotta do some classroom stuff first.

I've worked all my pediatrics on scene and transported all but one but there were extenuating circumstances. It's a culture thing that peda get transported but it's definitely not a grab and go situation. Kids that arrest generally don't come back but if they have a chance it's with you, your partner and other coresponders on scene not 10-20 minutes later in the ER after that same amount of time with crap compressions thus causing crap perfusion. Maybe I'm more comfortable doing it because I've ran so many in my short career as the PIC. FWIW our ERs work codes, pediatric or adult, very efficiently. Also, with 4 people cycling compressions appropriately that's 2 minutes of work with 6 minutes of rest, plenty of time to recover provided you're not in absolute gosh-awful shape. Especially on a ped, peds CPR is nowhere near as tiring as adult CPR.

I keep talking about it but damn I feel good after my RX topical cream with an anesthetic, NSAID and two muscle relaxers in it plus 10 minutes of traction all after a massage from my lady.

My headache is finally gone for the day.

Almost as good of a way to end the day as drinking an ice cold brew or two.
 
@MonkeyArrow

I know the feeling. I hate that! Same with boneless anything. Another thing that gets me is a hidden chunk of fat in a steak.
 
Became a closet smoker during medic school. Really trying not to let that happen again. Ugh so stressed out.
 
That moment when you're stuck in parking lot speed traffic thinking it might have something to do with the Cal Trans arrow board signs up ahead, but then 4, no now 5 CHP units pass by on the shoulder lights and sirens. ..what the heck is going on on the 210 in Arcadia?!?
 
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