When the er falls apart on a code

[boeingb13]

Ten o'clock in the morning in the ER, were doing clinicals. Call comes in over the radio, rescue is coming in with a cardiac arrest eta 2 mins. We start heading to the room to get everything ready, the rescue shows up and their coming towards the room bagging the pt and doing compressions. We get him over to the table where I continue compressions.

At this point I watch as the biggest jumble of people unfolds in the room.

Everyone is supposed to have a job to do, but at some point everyone except the paramedic students (us) forgot what they were supposed to be doing.

The dr is calling out " who is getting the drugs ready" and you hear " I was but now im trying to get a iv established" No one is doing anything in any order, people are just jumping around the Dr is calling for meds and people are literally bumping into each other.

When it was all said and done the Dr pronounced the pt.

It just amazes me how a ER of trained nurses and a Dr could fall apart like that.

Ive worked codes in 2 other hospitals in town during clinicals, and while on duty, and they all went perfect, or as perfect as you can go. Everyone had a job, and the Dr knew what was going on at all times. So where does the blame fall, on the Dr for not controlling the scene, the nurses and techs for not keeping to their jobs, or the hospital for not doing frequent training to prevent things like this from happening?

[jsadin]

Training. If they practice these scenarios together, they'll know what to do without thinking about it and they'll find the flaws in their methods (and hopefully correct them).

I've seen that cluster f*** in ER's before and I know patients have died because of it. Not good.

[spenac]

This is usually a training problem. I have seen when the regular docs are here codes go smoothly. I have seen the rent a docs and rent a nurse get a major mess going.

But it really doesn't matter that much. Even on a perfect code that happens prehospital the person is pretty much toast. Odds are extremely slim they will live to leave the hospital.

[jsadin]

The problem is, if they screw up codes they'll most likely screw up other stuff too.

[mediccjh]

It's amazing how 2 Paramedics and 2 EMTs can run a cardiac arrest better than most doctors and nurses.

[AZCEP]

It's amazing how 2 Paramedics and 2 EMTs can run a cardiac arrest better than most doctors and nurses.

This is because there is actually very little education time spent teaching doctors or nurses how to perform this task. Paramedics and EMTs are exposed to cardiac emergencies almost daily from the beginning of their training.

Could the foul ups come from having so many people available to help that everyone loses track of their assigned tasks? Just a thought.

[ncmedic309]

I've seen similar circumstances in the hospital and more so in the field. It's usually due to a lack of leadership / control by the person running the code and an overall lack of communication from the group. I'll tell you from personal experience - once you lose control of a situation like that - you don't get it back - it's a cluster from that point on. The key is to establish that control and communication early on and keep it going.

[paramedicmike]

Not to direct attention away from the ER staff, but why was a cardiac arrest transported anyway? That might be the first part of the problem.

-be safe

[spenac]

Not to direct attention away from the ER staff, but why was a cardiac arrest transported anyway? That might be the first part of the problem.

-be safe

Good point. Work them in the field. If they respond take them to the hospital. If they don't call the funeral home.

I have only worked two codes going down the road. One coded when we had multiple patients in the ambulance. Worked a few minutes and called it. Never stopped the ambulance. The other was a hostile environment so we loaded and drove the 3 - 5 minutes to the hospital and continued running the code in the ER. It is just not a good thing to do. Run L&S to transport a dead person.

[Arkymedic]

Not to direct attention away from the ER staff, but why was a cardiac arrest transported anyway? That might be the first part of the problem.

-be safe

Because Mike as you well know, not every service is allowed to stop and call in the field. This varies state to state and service to service. Many services in AR do not have death in field protocol but my last one did as we were all sworn deputy coroners for that reason.