Transporting full arrest

[d_miracle36]

I was wondering how many other services if any transport cardiac arrest pt's. Under our protocol we can discontinue, but it seems fround upon at the service i work for. Most people say if theyre going to work it then they transport, if not they just call it. I believe that we should work it until we deem efforts futile. If you do decide to work it and not call it do you determine it geographically? as in if your 5 minutes from the hospital you transport?

 

[Medic Tim]

In Maine all codes are now to be worked on scene. After 20 min of ALS you can call it. If you do transport it is no light or sirens. Basics and intermediates have to call olmc.

In NB we do 5 rounds on scene. If no defibs and transport time is greater than 10 min we can call it with olmc consult. In witnessed traumatic arrest if there is no ROSC after 5 rounds we can call it right there.unwitnessed we don't run. In NB we don't use any drugs on codes. ... haven't for the past 4 years.

 

[akflightmedic]

I only work half arrests, those full ones are just too much effort.

 

[Veneficus]

Never a simple solution.

It sounds like it is more of a question of organizational culture than sound practice.

There are some important things to consider.

First as always, seen safety. In some places, calling a pt dead on scene is a really bad idea. (as in a threat to your life and health.)

If that is the case, scoop that corpse into the ambulance and make your way out of there.

But recognize that when you bring a corpse to the ED, it takes up resources and generates a bill. (a big one)

So in the interest of survivors, if the patient is dead, call them dead and let the grieving process start without another heavy financial blow.

Resuscitation in the back of a moving vehicle really doesn't lend to effect CPR, so with the exceptions of scene safety and penetrating trauma, it is just an unjustifyable risk to the providers and bystanders.

If you can work it to the end and call it on scene (by whatever method your agency demands) it is a much better choice.

No exceptions for kids. If a kid has decompensated to dead, with the exceptions of maybe penetrating trauma (a very long shot) or cold water immersion (more realistic) that kid is not coming back.

Again, providing false hope and an even larger bill takes a toll on survivors. In some instances it can break up families and put people on the street.

In a stressful event like a loved one arrested, the calm logic of an EMS provider is much more beneficial to all than an emotional decision.

If you are not aware, if you do not transport, then you likely will not be paid anything. This is something many US EMS agencies wrestle with. So there may be some downward pressure because of the economics of it.

The other issues are the relatively unconfident or incompetent provider. I have noticed providers who are not experienced or well educated tend to be rather equally emotional as distraught family.

"Brave are those who face great challenges, braver still are those who face the unknown."

In fairness it is not their fault. During stress they revert to what is comfortable, and let's face it, when you are uncomfortable with a patient, the number one strategy in medicine is to punt on first down.

Doctors do it all the time, how could you expect anything different from EMS providers?

Working in a medical capacity (even a physician extender) requires that sometimes you must report unpleasant news. An amateur attitude runs/hides, a professional attitude steps up to the plate and does what needs to be done.

 

[Veneficus]

I only work half arrests, those full ones are just too much effort.

You must be having a really good day, you are in rare form.

 

[Shishkabob]

My agency works on scene, with a few exceptions, such as refractive V-fib (these get transported to a STEMI facility as part of an ongoing study) or an arrest in a public setting. Those that DO get transported, go non-LS, with the Lucas device doing the pumping.


I've had 4 arrests in the past 3 weeks, only 1 got transported, and that's because it was in a busy supermarket parking lot on the side of a busy road.





I can do 99.9% of what hospitals can do in a medical arrest, and confirm death with uniform certainty, therefore, no reason to transport.

 

[WuLabsWuTecH]

Our protocols allow medics to call it based on certain criteria. They can of course choose to transport L&S (or not) at their discretion for safety issues or for other extenuating circumstances.

Medics cannot call trauma arrests or hypothermic arrests in the field.

Basics do 3 rounds of CPR with the AED and intubate or use other invasive airways if they have the manpower and time to do so (in Ohio basics can intubate). In arrests, basics are generally NOT allowed to run an EKG unless online medical control explicitly asks for it. After 3 rounds, if ALS is still not on scene, head towards the hospital and ask for ALS enroute if feasible. If not, CPR/AED all the way to the hospital, intubate if you get a chance to have it done for the hospital. Intermediates do pretty much the same thing except they are also asked to start a line for the hospital is possible. Intermediates also can hook up an EKG I believe.

We do not stop the truck for the AED b/c we use a Lifepack in Advisory mode and we do not need to do so, and therefore our response time to the hospital is shortened.

In reality, I've never known a basic squad that couldn't either get a medic on scene or out the door and ready to intercept in the 15 minutes they are doing CPR/AED on scene. I've also not ever seen a basic squad that actually had time to intubate or consider asking the hospital to run an EKG (why do we want to run an EKG in the field again during an arrest?)

-Wu

 

[Veneficus]

I've also not ever seen a basic squad that actually had time to intubate or consider asking the hospital to run an EKG (why do we want to run an EKG in the field again during an arrest?)

-Wu

Because if you can tell the doctor it is a flat line or a rhythm with "no shock advised" he may call it on scene for you?

 

[Epi-do]

Traumatic arrests, we can call immediately. The thought is that your "typical" trauma patient is young and healthy, so if the injury was severe enough to kill them, they aren't coming back.

All other adult arrests, we work on scene for 30 minutes and then can call them if there is no ROSC. The exceptions are scenes that are deteriorating and leaving the body there becomes unsafe for the crews onscene, or arrests occurring in public places.

We have to transport all peds arrests that are deemed "workable". (I don't agree with this line of thought, but am expected to follow policy. Therefore, if I am unfortunate enough to have a peds arrest, it will be transported.)

 

[Veneficus]

respectfully, but for discussion

Traumatic arrests, we can call immediately. The thought is that your "typical" trauma patient is young and healthy, so if the injury was severe enough to kill them, they aren't coming back.

I don't agree with this thinking.

(It sounds like it came from a military doctor.)

I would think the type of traumatic arrest would matter more as the survivability while poor are considerably different between blunt and penetrating. (of course it means you must be in reasonable distance to a capable trauma facility.)

We have to transport all peds arrests that are deemed "workable". (I don't agree with this line of thought, but am expected to follow policy. Therefore, if I am unfortunate enough to have a peds arrest, it will be transported.)

I do not understand this context?

Workable?

As I said...

Realistically that is hypothermia or a long shot at penetrating trauma.

Please what is your definition?

 

[Epi-do]

I don't agree with this thinking.

(It sounds like it came from a military doctor.)

I would think the type of traumatic arrest would matter more as the survivability while poor are considerably different between blunt and penetrating. (of course it means you must be in reasonable distance to a capable trauma facility.)

I have only been on one traumatic arrest since being a medic, and it was a shotgun blast to the chest. That particular time, we did transport and work the arrest, because we thought the hysterical woman next to him was his wife, even though PD was there, it was still completely chaotic, and due to extenuating circumstances, it was the safest option for us, the crew.

I have yet to see the new protocols in print, but rumor has it, they are going to differentiate between blunt and penetrating trauma with regards to calling it immediately on scene. Because we also have a clause that states "paramedic/emt discretion" we can still work a traumatic arrest, if we choose to do so. I was simply stating we have to option to immediately call it, if we choose to do so.

I do not understand this context?

Workable?

As I said...

Realistically that is hypothermia or a long shot at penetrating trauma.

Please what is your definition?

Sorry. Poor word choice on my part. I meant any ped that didn't have obvious signs of death. It would be the same criteria as we use for adults. The difference is that we are given the option of working the adults on scene, but all peds have to be transported once CPR is started, regardless of the circumstances of the arrest.

All hypothermic patients, regardless of age, would be transported.

 

[WuLabsWuTecH]

Because if you can tell the doctor it is a flat line or a rhythm with "no shock advised" he may call it on scene for you?

Ah, I did not know they could do that. I mean, I guess they can't because basic squads are not supposed to be hooking up EKGs in the field... <_<

But good to know that some places have that capability

 

[Veneficus]

Ah, I did not know they could do that. I mean, I guess they can't because basic squads are not supposed to be hooking up EKGs in the field... <_<

But good to know that some places have that capability

In some places basics are permitted to attach EKG leads and print a strip for the hospital.

If you have a monitor capable of transmitting the printout, even more valuable.

 

[WuLabsWuTecH]

In some places basics are permitted to attach EKG leads and print a strip for the hospital.

If you have a monitor capable of transmitting the printout, even more valuable.

Vene,

We are allowed to run EKGs for the hospital and fax them over a modem to the hospital. Usually this is a requirement before we are allowed to use Nitro off the truck b/c if we bottom out their pressure, we can't start an IV to get it back. However, in an arrest, Basics are not allowed to attach a 12 lead unless a medic is also there. I'm assuming there is a very good reason for this, I just don't know what it is!

 

[usalsfyre]

I'm assuming there is a very good reason for this, I just don't know what it is!

I think your assuming too much...

 

[Veneficus]

Vene,

We are allowed to run EKGs for the hospital and fax them over a modem to the hospital. Usually this is a requirement before we are allowed to use Nitro off the truck b/c if we bottom out their pressure, we can't start an IV to get it back. However, in an arrest, Basics are not allowed to attach a 12 lead unless a medic is also there. I'm assuming there is a very good reason for this, I just don't know what it is!

Because a 12 lead on an arrested patient is pointless?

Maybe they are hoping you are hooking up the AED?

But if you have people hanging around, a 3 lead with "no shock advised" that can be faxed to the hospital could probably save a lot of people a lot of grief. (and a bill)