Working a code alone in the back?

[Ridryder 911]

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.

I totally agree .. but that is the general standard of care. One has to also remember that EMS is business here, we even charge for pronouncement or declaration without transport. There are very few medical directors and services that want to "step out" and totally go for tying up units, and then placing the full responsibility and liability upon the EMS. (Have you seen the recent trend of pronouncing of live ones?)....

I believe it will be several years before field termination is the quote.. general standard. Remember, ECC/AHA only recommends and does not endorse nor discourage such practice. Until there is total encouragement as a standard, then there will not be an active change. It usually occurs only at most progressive EMS or Medical Directors.

R/r 911

[akflightmedic]

Ahhh the old days of working a code with just you and your partner.

For me, it was the first few years of my career but Rid and Dust may know what I am about to speak of.

Rural county service, cardiac arrest in the middle of no where. You grab the patient on a backboard, get in the truck, intubate and hook up to the vent while partner is compressing. After that is done, we then hooked up the THUMPER....whoo hoo what a treat that beast was. Now you got the Thumper compressing, the vent working, it is time to do your IV and start some drugs while your partner drives.

What a fun time codes were then....

[Ridryder 911]

Ahhh the old days of working a code with just you and your partner.

What a fun time codes were then....

Good old days? I believe if we were to be truthful there are still more of those that work codes than those that have field termination, especially in the rural setting.

R/r 911

[p3medic]

I would ask your medical director to consider a policy of not transporting pts without vitals. To do half assed cpr with one person in a moving vehicle for 25 miles is stupid, plain and simple. I would wager that survival of pts in that senario is close to 0%.

[triemal04]

The trauma termination protocol is for extended extrication times only. For most other trauma resuscitations, rapid transport is called for.

You work trauma codes? Really? Even in systems that still transport dead people, I thought that most had realized that the ROSC in trauma was something like .07% and let them be.

[firedoc5]

There's been a few times I was in back and the patient crashes on the way and you're stuck in the back. If you're still far enough out you can try and have someone meet up with you and jump in. But there's times where you're only a few minutes from the hosp. and there's no time. You just start in CPR. One day it happened to me and when we got to the ER there was assistance at the door and I just sat back in the rig trying to catch my breath. A buddy of mine (a doc) came out and asked me why the patient wasn't intubated and no meds were given. I knew he was just yanking my chain. So I flipped him off and collapsed back on the bench. He did buy me a steak dinner later.

[spenac]

My old 90 mile to hospital service had work them at the scene if not successful you terminated efforts, you did not transport.

[Niftymedi911]

No transporteh if they ainta circulatineh.

Our MD allows us to call it in the field. The, well most of the time normally transport is stared if its a Pedi arrest or someone who is a viable code. ( A good chance on bringing them back, ex: hypothermia or heroin OD. Otherwise BLS, ACLS, no ROSC, no transport. Signal 7. We still have to obtain orders from a doc via OMC, but once they say cease, its over baby.

Unless your like me, call em in the field, XX minutes later (while in the middle of cleaing the truck and restocking bags and report) they return with ROSC and respirations and walk out of the hospital X months later. The doc goes, guys WTF??? your seriously joking right??? Thats a negatory doc. Will never forget that day time call.

Or

PEA on arrival, then a something 20 minutes later I reached the bottom of my goodie bag with nothing but bi-carb left, say what the heck, and within a short few seconds, "Wait, I've got a cartoid".

[tinman694]

You can now work a code single handedly believe it or not. We just went to using the Autopulse on all the units (Sure beats the thumper! --yes I am that old)

Coupled with a vent, a partner who can help get things hooked up before leaving the scene, you can successfully work a code--and have a viable pt self perfusing on arrival at the ED--without killing yourself or the pt. in the process.

(NO trauma arrests with the Autopulse!)

Only issue I have is having to daily check off all the electronic crap we have in the unit now....so many batteries.....

Pretty much any time you arrive with asys or a trauma arrest (PEA under 40) you can get a call into the doc and call it--

Still do compassion codes for infants....

Any other reasons why you can't do it alone if you had to with the tech on board?

[brock8024]

I worked a trauma code and got them back. Pt crashed as we went to tube him in the back of the truck. Got him back and he lived 9 days and was a organ donor. It happends just not often.

I work in a really rural area, We cover a huge county and have to help cover other areas since most are just bls services. I am not bashing them but we are ALS. I have yet had to wrok a code alone but I know the day will come. I think you woudl have to think about it and sit it up in the back before you left so that you coudl do it.