Working a code alone in the back?

[akflightmedic]

Poor word choice trying to describe what went on to those not there. It was my partner's turn to be in back and it was my "curiosity" which prompted the monitor placement.

There are many lazy and incompetent medical providers of all levels as we have discussed ad nauseum. And remember, in many parts of Florida, 70 is young...very young!!

[Richard B the EMT]

Can I make a comment from the BLS area? Even if not, here I go.

(lol)

I worked both Vollie and proprietary EMS, prior to municipal EMS employ, and we didn't have, either because there was no ALS yet in the geopolitical area, or we didn't employ them, the relative luxury of Paramedics available.

On the Vollies, back in the early 1970s, we could either be as few as 2 persons, or as many as 4, on the ambulance. If we started CPR, we'd simply get the patient onto the streacher as quickly as possible, on top of a "CPR Board", continued CPR to the ambulance, either with a "Positive Pressure" valve-mask, or a non-disposable BVM (Bag Valve Mask), and transport L&S, trying for the "Ride that's a Glide". Dispatch would be notified via radio of our ETA, and would telephone the ER that we were inbound.

Same deal with the proprietary ambulance services I worked for, except the answering services that acted as dispatch at night sometimes did not place the call to the ER, and the ER crew would be caught unaware that we had a Cardiac Arrest. Their first inkling at the ER was an ambulance pulling up on them with the siren at full scream at the doors to the ER.

The old NYC Health and Hospitals Corporation EMS (around when I started with them in 1985), and then the FDNY EMS, due to the multiple layering of response, always had either a Paramedic team, another BLS crew, or even an engine company, to lend a hand, and, of course, allow the paramedics to do the ALS "Thang" while BLS pumped, and then drove the ALS ambulances to the ER (ALS in the back of one of the vehicles, and BLS driving both vehicles).

Sidenotes: One of the founding officers of my Volunteer Ambulance Corps was from the first class of Paramedics that the NYC HHC EMS put out.

Even as my VAC was formed, due to our perceived lack of municipal BLS ambulances, the HHC CUT BACK on the number of ambulances in the Rockaways area, from 4 to 2! Their reasoning was they were not needed, as there now was a volunteer ambulance service working in the area!

The Rockaways communities didn't get ALS until, perhaps 1978, claiming that due to call volume being "low", ALS wasn't financially reasonable. This, despite Queens County having 1/3 the nursing homes in the city overall, and half of them being in the Rockaways communities, if you can believe it.

FDNY EMS currently runs 4 BLS and 2 ALS ambulances in the Rockaways, and one of those ALS units is also the HazTac unit, for Hazardous Materials calls in the Rockaways, and the southern half of Queens County. Summertime, for day and evening tours (not overnight), we have a "supplemental" BLS unit, staffed by overtime "volunteers", meaning we don't usually mandate for overtime to staff this unit.

[Harold1]

In Aruba we work a code alone in the back quite often, when back-up is unavailable or more than 20 minutes away.

We focus on good BLS, intubation and defib, leaving the meds for the ER. In 90% of the cases wo don't know it's a code untill we get there, so back-up won't be on the way untill we get on scene. Sometimes I even take un-trained people on-board to do chest-compressions, by showing them first how to do it, and giving them instructions on the way. It's not that we have a choice.

[babyblade6]

We resuscitate all our patients on scene and only transport them when Return of Spontaneous Circulation is obtained. We have the ability to stop resuscitation without Medical control and this usually happens after 20 minutes of good quality ACLS resuscitation. There are special situations where we will continue for a longer period eg. Paediatrics, drownings, hypothermia etc. We have also not had good results with Trauma resuscitations here, except when there is an obvious reversible condition for eg. Hypovolemia that can be sorted out, but it is usually multi-trauma here involving more than just one body system. We initiate CPR in all patients that are in any initial rhythm except for Asystole. (Except if good bystander CPR was initiated prior to our arrival). The main problem we have here in South Africa is our long response times ranging anywhere from 7 - 15 minutes which as you know makes all the difference in a resuscitation.

[Novisen]

If you have the LUCAS device and the Boussignac tube you can focus on medications......

http://www.jolife.com/doc/Gillis%20The%20u...008%20p-ERC.pdf

http://www.jolife.se/images/movies/view.ph...&height=288

http://www.buffalohospital.org/ahs/news.ns...wspage/LUCAS_08

[mobey]

problem we have here in South Africa is our long response times ranging anywhere from 7 - 15 minutes.

Don't be discouraged, many services have longer times than that.

I once ran L&S for 35min to get to a quad rollover at the edge of our boundry!

[akroeze]

Don't be discouraged, many services have longer times than that.

I once ran L&S for 35min to get to a quad rollover at the edge of our boundry!

Where I used to work 30mins was our response time 90% of the time!

[babyblade6]

Wow, then we are indeed fortunate! This is one reason I love this forums! Reality check when we can realise the different situations and challenges that every country deals with! We also have our long response times in the vicinity of 30 - 45 minutes but it does not happen on every call!

[Harold1]

It's not uncommon for us to have a response time of 30 - 60 minutes when things get heated up in the city.

[CaliMedic209]

babyblade you resuscitate ALL your patients on scene!! i wanna be where you are when i die.. just kidding just kidding i know what you meant..