working codes in the field

[el Murpharino]

the only benefit i can see from your call was i gather from the arguments on scene that there were a number of people from your agency about. at the very least you can swap out the guy doing compressions frequently enough to ensure good cpr.

other than that, wait on scene for als for 25 min? no sir not in my world. thats 25min closer to the er. 25min closer to transfer of care. 25 min closer to marking back in and maybe helping somebody i can actually save.

im sure R/r has the stats on bls codes. if als coded are statistically almost pointless, were do bls codes rate?

I understand the point of getting patients to definitive care, but if you've watched ER personnel work a code, it's no different from what we do prehospital - in most cases. Heck, most of the times they work it about 5 minutes, and call it. True, this is after we've worked the code for 20+ minutes...most ER docs would call it in that case.

Additionally, while you're trying to get your patient off the ground and on the backboard or stretcher, you're either stopping compressions, or at best performing inadequate compressions. How much time does that take? That could be time better spent performing proper CPR, perfusing the tissues, and at giving your patient some chance. Most of the new CPR/ACLS guidelines are advocating proper compressions as well.

 

[Jon]

I understand the point of getting patients to definitive care, but if you've watched ER personnel work a code, it's no different from what we do prehospital - in most cases. Heck, most of the times they work it about 5 minutes, and call it. True, this is after we've worked the code for 20+ minutes...most ER docs would call it in that case.

Additionally, while you're trying to get your patient off the ground and on the backboard or stretcher, you're either stopping compressions, or at best performing inadequate compressions. How much time does that take? That could be time better spent performing proper CPR, perfusing the tissues, and at giving your patient some chance. Most of the new CPR/ACLS guidelines are advocating proper compressions as well.

EXACTLY... if the ED is only going to work the code for a few minutes and then call it... why do we run this extreme risks of an emergent transport with 2 or more providers, NOT WEARING SEATBELTS, working on a dead body in the back of the rig?

The risks are great, and the benefits are slim... so why do we do it?

 

[skyemt]

so, to summarize what i think i've learned on this thread so far...

CPR while moving the pt to the rig, and while on the rig, are ineffective... should not even bother.

code should be worked on scene until ROSC, then transport...
if after about 20 min and two rounds of meds, call it (ideally)...

if BLS crew only, after "edison medicine", with no ROSC, it is prudent to transport to intercept ALS, as they need meds...

sound reasonable so far?

 

[JPINFV]

if BLS crew only, after "edison medicine", with no ROSC, it is prudent to transport to intercept ALS, as they need meds...

I'd have to disagree here. Since CPR is ineffective generally when moving relative to the Earth (i.e. moving stretcher or moving ambulance), codes don't get better with time, and there is a growing amount of literature that Basic crews can successfully withdraw resuscitation (see earlier article), if you don't get ROSC with defibrillation [no shock advised], then the patient is dead and paramedics won't really be of much help either.

 

[skyemt]

I'd have to disagree here. Since CPR is ineffective generally when moving relative to the Earth (i.e. moving stretcher or moving ambulance), codes don't get better with time, and there is a growing amount of literature that Basic crews can successfully withdraw resuscitation (see earlier article), if you don't get ROSC with defibrillation [no shock advised], then the patient is dead and paramedics won't really be of much help either.

i think i see your point...

if CPR is really no good during any kind of transport, than you are basically ending any chance of ROSC by moving them anyway...

so in the process of trying to save them by getting them to the ALS meds, you are dooming them by providing useless CPR by moving them...

is that your point?

 

[JPINFV]

Essentially. Which brings back to the Autopulse thread (even though I was going more for safety in that thread).

 

[skyemt]

Essentially. Which brings back to the Autopulse thread (even though I was going more for safety in that thread).

i have to admit, after research provided on these threads, and reflecting for a while, that i have changed my original thoughts (which were apparently wrong) and now agree...

only issue: our BLS protocols require us to transport after analyzing the rhythm with the AED three times... that means transporting after approximately six minutes post our arrival, which seems to be in conflict with the current trend... those are our protocols, however.

 

[JPINFV]

Well, there are a lot of issues with protocols nation wide. How many protocols still call for trendelenburg? (cliff notes:not supported by experimental evidence. Needs new thread to discuss though) Then there really is the CYA issue. Unfortunately, an ambulance crashing while transporting a dead body gains a lot less attention than a paramedic declaring a live person dead. Of declaring death without working a patient [obvious signs of death] is completely different than terminating resuscitation [where the patient has been treated unsuccessfully].

Granted, Los Angeles thinks that their medics are too stupid to read a 12 lead [apparently Southern California is still stuck in the days of Emergency!]. (paragraph 13)

 

[fightin17]

Were i work the pt has to have a pulse to transport. If they have to pulse we keep working them on scene till medical control says to stop and call the death.

 

[uselessmedic]

Codes

We can call them on the scene if they are in asytole and have veinous pooling of blood, If not we work them. Most of the Drs in our area are afraid to give the orders to call one before getting to the ED.

 

[MSDeltaFlt]

Due to issues that arose on the ground service I work part time, if we arrive on scene of a code (without signs of obvious mortality), we are to work it for 20 min, then call med control and advise. Med control will either allow us to call it in the field or have us transport.

My state has the highest ER MD liability ins than anywhere in the country and the delta has the highest anywhere in the state. Go figure.