Working a code alone in the back?

[Fox800]

Luckily I have had first responders to ride along in the back on all the codes I've worked. I realize that in some systems you and your partner may be the only ones that show up to a cardiac arrest. Assuming your partner is an EMT and you are a paramedic, how are you supposed to get all of your medications pushed while doing good compressions and bagging (assuming you have no vent). Do you focus on compressions and ventilations (good BLS at the expense of getting your IV meds pushed at the right time) or do you just juggle everything and try to do it as best as you can?

[mobey]

hmmm......Never really had the problem. *Mobey wonders why he is replying then*

Anytime we haven't had enough hands we just called Fire to "Bang and Blow".

If no one was available we worked them in thier house till all drug protocols were peaked out, then Paramedic can do CPR till we hit the hospital.

[Fox800]

Hmm I can understand that. Would give most of our code drugs (vasopressin, amiodarone, atropine, etc) then after that the drugs would be pretty infrequent (2nd round of vaso, bicarb). Of course it would be more difficult in a traumatic arrest situation where you had to load and go very quickly. THAT would be hell to work alone in the back. The 911 service I work at has toys to make things easier if you are alone (EZ-IO, transport ventilator), but the transfer service I do PRN work for doesn't.

[BEorP]

I don't mean to take the thread off track, but if there is an EMT-P there, why are you transporting cardiac arrests? Normally this should be not needed. ACLS is ACLS whether it is done in the field or in the hospital. I know that there will be times when you do need to transport such as when someone arrests on the way to the ED or maybe if you cannot obtain IV access, but generally this should not be the case.

[Ridryder 911]

I don't mean to take the thread off track, but if there is an EMT-P there, why are you transporting cardiac arrests? Normally this should be not needed. ACLS is ACLS whether it is done in the field or in the hospital. I know that there will be times when you do need to transport such as when someone arrests on the way to the ED or maybe if you cannot obtain IV access, but generally this should not be the case.

In the U.S. very few services have field termination guidelines other than traumatic arrest or not to work fresh codes and then those that are allowed are specific to aystole prior to arrival . As well, many do not have the luxury of spending 20 minutes on the scene to work the code and then call/pronounce it and await for M.E. another few minutes, etc.. Although, recommended it is not the usual guideline as of yet in most areas.

Maybe in the future more and more would adhere to such practices.

R/r911

[Just Plain Ruff]

been there done that. It's not easy but you do the best you can.

[steph1030]

workin a code alone def sucks but u do what u gotta do to preserve life (hopefully...)

[Mateo_1387]

In the U.S. very few services have field termination guidelines other than traumatic arrest or not to work fresh codes and then those that are allowed are specific to aystole prior to arrival . As well, many do not have the luxury of spending 20 minutes on the scene to work the code and then call/pronounce it and await for M.E. another few minutes, etc.. Although, recommended it is not the usual guideline as of yet in most areas.

Maybe in the future more and more would adhere to such practices.

R/r911

I agree ACLS is the same in and out of the hospital. Plus it never really made sense to me to risk yourself running emergency traffic to the hospital with a dead person.

I don't see how one person can do CPR in the back of an Ambulance and still complete ALS skills and expect a recusitation. If it were me in that case I would work the code onscene untill back up arrives, even if that means you and your partner just doing CPR untill other hands can arrive.

[Fox800]

Both services to have provisions for termination of resuscitation. For a medical termination, the pt. has to have been in asystole the whole time, with 20 minutes of efforts going since the start of ALS interventions (either IV in place or ETT in place). The trauma termination protocol is for extended extrication times only. For most other trauma resuscitations, rapid transport is called for.

Assume you are on a private transfer ambulance called to a nursing home the next county over (in a rural area). It is 1AM. You are walking down the hall to where your patient is. Your patient deteriorates to cardiac arrest soon after you make contact, but before you load them into your ambulance. You elect to start running the code on this patient. Your private service's HQ is about 40 miles away and the nearest hospital is 25-30 miles, so backup is out of the question (needless to say, the county gov't would not take kindly to a private service running code 3 to back you up). Your options are to work the code with your EMT-B partner and transport them with you in the back, or call the county 911 service to take the pt. The county 911 service would also have a paramedic/EMT truck, with the paramedic riding alone in the back. Needless to say, this county doesn't really have a first responder base.

What would you do?

[akroeze]

woah woah, wait.... you folks transport people who aren't ROSC?

Wow.... that's just.... wow...

Obviously there will be exceptional cases but to be transporting all arrests despite having done all of ACLS is just.... well, dumb.