Transporting a Cardiac Arrest?

Mitchellmvhs

Mitchellmvhs

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So, I just got hired by Doctor's Ambulance my first ever job in EMS which is owned by AMR and they run majority IFT for Orange County, but do 911 in Laguna Beach from what I could find out and I just had had my PAT done today and I go in for orientation on Friday. Kinda a weird question, but I was wondering how do you actually transport a code? I mean obviously you start CPR, AED, ETC. but how would you actually transport them? Do you stop CPR to load them onto the gurney or when you're loading the PT? Just something I've always though about. How would you keep compressions going while also moving them?
 
In most normal EMS systems outside California, you do not transport unless you get ROSC.

I cannot speak to what CA does as the years have proven they do almost everything differently. :)
 
Transporting a cardiac arrest is generally a bad idea because it interrupts compressions moving the patient and the quality of chest compressions goes down during transport. If it is done, it is best done with a Lucas device so compressions only get interrupted to put the device on. There is very little to no benefit transporting a cardiac arrest. It surprises me how frequently people do it still and how it is still standard of care for most places. Might as well blood let as well.

*CA still treats it like the gold standard. :(
 
Aprz said:
There is very little to no benefit transporting a cardiac arrest. It surprises me how frequently people do it still and how it is still standard of care for most places. Might as well blood let as well.
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General rule but there are exceptions. If there is a suspected reversible issue that is treatable at a hospital reasonably close then transport may be warranted. Some of our facilities do intra-arrest PCI. I still think there is an argument for transporting some trauma codes
 
If you're BLS, you basically have 1 choice and it's about how quickly you get ALS and the patient together in the same place. If it's quicker to transport than to call for ALS backup, you transport. If ALS backup can get there in the same amount of time or less than it would take for you to transport, you stay there and get ALS there.
 
OP,
As you can see California is behind in a lot of ways when it comes to EMS. In the particular system you are talking about you are going to just do your best to not interrupt compressions. The reality is arrests are transported much more frequently in SoCal, and this leads to poor ineffective compressions being done. You aren’t in a area where you’re going to leave without ALS getting there. Other areas this is a possibility but it won’t be at Doctors.
 
You as BLS working in Los Angeles and/or Orange Counties, you're pretty much doing what the Fire Medic tells you to do. Whether you stay and play, or transport doing compressions will not be your call.

Now remember, they're largely teaching Stay and Play for cardiac arrests. If you find yourself first on scene (even if its an IFT and you have to be the ones to call Fire), you do CPR, stay and play on scene, till LACo or OCFA or whoever shows up. Work the patient where they are. (Though it is entirely permissible to drag a Cardiac Arrest patient out of a narrow hallway/off a soft lumpy bed/etc into a room where they're on a nice firm surface and you have room to work).

If you're dispatched to a reported Cardiac (Full) Arrest, bring your backboard with you to scene. If you transport the patient will be on the board. No need for C-collar, you're not doing Spinal restrictions, the board is to provide a firm surface to do CPR on vs the gurneys soft mattress (also easier to carry a patient out if you need to leave the gurney outside).

Hopefully thats more of a precautionary method if you need to do CPR after a patient who has ROSC codes again enroute. But just in case the medic decides to transport a working arrest, then yeah basically you'll be interrupting compressions to load onto the board, carry board to gurney, load board and patient onto gurney.
Someone will be "riding the rails", standing on the bottom rail of the gurney doing compressions while its being moved to the ambulance (or from ambulance into ER) and once again compressions interrupted to load/unload gurney from the ambulance.

Hopefully you won't actually have to take part in that procedure. When I was with McCormick working with LACo, we were definitely doing a lot more Stay and Plays vs loading and going with arrests, so hopefully short of any of the special circumstances some of the other posters mentioned, you won't have to do that at all.
 
Your first sentence is at least three sentences, or a compound punctuation nightmare. Start there.
 
Akulahawk said:
If you're BLS, you basically have 1 choice and it's about how quickly you get ALS and the patient together in the same place. If it's quicker to transport than to call for ALS backup, you transport. If ALS backup can get there in the same amount of time or less than it would take for you to transport, you stay there and get ALS there.
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This. This. THIS!!!!!
Jim37F said:
If you're dispatched to a reported Cardiac (Full) Arrest, bring your backboard with you to scene. If you transport the patient will be on the board. No need for C-collar, you're not doing Spinal restrictions, the board is to provide a firm surface to do CPR on vs the gurneys soft mattress (also easier to carry a patient out if you need to leave the gurney outside).
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respectfully disagree. bring the collar in with you. once the patient is intubated, put a collar on them, if for no other reason than to ensure the tube/airway doesn't get kinked as you are moving the patient.
 
Don’t be too down on CA, we are similar here in Texas
 
depends on where in Texas. i've heard some places are very progressive, while others are still in the stone ages (*cough Houston fire*)
 
DrParasite said:
depends on where in Texas. i've heard some places are very progressive, while others are still in the stone ages (*cough Houston fire*)
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HFD is a miracle of progress in some ways Compared to certain places, anyways.
 
Akulahawk said:
If you're BLS, you basically have 1 choice and it's about how quickly you get ALS and the patient together in the same place. If it's quicker to transport than to call for ALS backup, you transport. If ALS backup can get there in the same amount of time or less than it would take for you to transport, you stay there and get ALS there.
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I don't really think transporting an arrest is appropriate. Things that work: chest compressions and electricity. Things that do not work: chest compression in moving ambulances, with a single provider to boot.

Stay and await ALS.
 
What is the etiology of arrest?

A massive LCA occlusion isn’t going to get fixed outside of cath lab.

A kidney patient with a K of 11 isn’t going to live without emergent dialysis.

A uterine rupture or ruptured eptopic isn’t going to survive without emergency surgery.

A ductal dependent heart that is closing isn’t going to live without PGE.

There are many arrest calls that are clearly non-survivable, and there isn’t a good reason to transport those. Some arrests however are only viable in the presence of a major hospital, and pretending that the handfull of resuscitation medication on the ambulance is equivalent is quite presumptuous.
 
Peak said:
What is the etiology of arrest?

A massive LCA occlusion isn’t going to get fixed outside of cath lab.

A kidney patient with a K of 11 isn’t going to live without emergent dialysis.

A uterine rupture or ruptured eptopic isn’t going to survive without emergency surgery.

A ductal dependent heart that is closing isn’t going to live without PGE.

There are many arrest calls that are clearly non-survivable, and there isn’t a good reason to transport those. Some arrests however are only viable in the presence of a major hospital, and pretending that the handfull of resuscitation medication on the ambulance is equivalent is quite presumptuous.
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I believe @Tigger response was in regards to a BLS unit transporting an arrest as opposed to waiting for ALS.
 
Rano Pano said:
I believe @Tigger response was in regards to a BLS unit transporting an arrest as opposed to waiting for ALS.
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Pretty much. A BLS transport with a single provider in back isn’t going to help fix reversible causes.
 
Tigger said:
I don't really think transporting an arrest is appropriate. Things that work: chest compressions and electricity. Things that do not work: chest compression in moving ambulances, with a single provider to boot.

Stay and await ALS.
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Most places that have ALS available will have it quickly available, generally more quickly than scoop and run. I have had situations where I could (basically) call 911 and have an ALS unit at the patient's side, it would be in 8 minutes and I've had the patient at the ED in less than 4 minutes from my arrival on scene. Most of the codes I had when I was a Basic were ones that resulted in me waiting for ALS to arrive. My point is that Basics absolutely have to know their load and get there times and response times for their areas so that they can make that judgment call appropriately. They also have to be well trained enough to recognize the problem early enough on that they can call for an additional resource (ALS) before things get to where they have to do compressions...
 
Rano Pano said:
I believe @Tigger response was in regards to a BLS unit transporting an arrest as opposed to waiting for ALS.
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My comment wasn’t directed at @Tigger

It is a general comment about field arrest. We know that epinephrine has very limited efficacy in adult arrest, and most pediatric arrest needs more respiratory intervention than cardiac. If high quality ventilation can be performed as well as good CPR, the difference between a BLS crew with an AED and igel versus an ALS crew quickly becomes blurred.

I also think that we are quick to dismiss the importance of post arrest management. How quickly we can initiate targeted temperature management, get to cath lab, offer high quality ventilatory support, and so on makes a massive difference in quality of life for survivors.

I also don’t buy that high quality CPR can’t be done in the back of the bus. I don’t think that an arrest can be ran with a sole BLS provider. However for example if a BLS engine and BLS bus are on scene and a hospital is less than 10 minutes away, and an ALS bus is still a good distance away, then it can make more sense to transport BLS with 3 guys in the back then have an extended period of time before ALS gets on scene.
 
Peak said:
I also don’t buy that high quality CPR can’t be done in the back of the bus. I don’t think that an arrest can be ran with a sole BLS provider. However for example if a BLS engine and BLS bus are on scene and a hospital is less than 10 minutes away, and an ALS bus is still a good distance away, then it can make more sense to transport BLS with 3 guys in the back then have an extended period of time before ALS gets on scene.
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It certainly cannot be done safely for the providers. Also:
www.ncbi.nlm.nih.gov

A Comparison of Chest Compression Quality Delivered During On-Scene and Ground Transport Cardiopulmonary Resuscitation

American Heart Association (AHA) guidelines recommend cardiopulmonary resuscitation (CPR) chest compressions 1.5 to 2 inches (3.75–5 cm) deep at 100 to 120 per minute. Recent studies demonstrated that manual CPR by emergency medical services (EMS) ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
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