When the er falls apart on a code

[paramedicmike]

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.

It's called medical command. If you decide to work a code on scene and you don't get any changes despite your interventions, call the doc and ask for permission to stop. You're not calling anything. You're just ceasing resuscitative measures. It'll either be the doc on the phone making the call or the coroner when s/he shows up.

That's even if you decide to work the code in the first place. Your assessment when you initially arrive on scene should tell you if a code is "potentially viable" or not. If it's not, then why go through the measures?

Transporting a cardiac arrest is one of the dumbest things EMS does. It's just outright stupid. Lights and sirens and crazy driving for a dead person who will stay dead? Where's the logic in that?

Anyway, back to the topic of the ER staff falling apart...

-be safe

[Arkymedic]

It's called medical command. If you decide to work a code on scene and you don't get any changes despite your interventions, call the doc and ask for permission to stop. You're not calling anything. You're just ceasing resuscitative measures. It'll either be the doc on the phone making the call or the coroner when s/he shows up.

That's even if you decide to work the code in the first place. Your assessment when you initially arrive on scene should tell you if a code is "potentially viable" or not. If it's not, then why go through the measures?

Transporting a cardiac arrest is one of the dumbest things EMS does. It's just outright stupid. Lights and sirens and crazy driving for a dead person who will stay dead? Where's the logic in that?

Anyway, back to the topic of the ER staff falling apart...

-be safe

I was being sarcastic as to the state and variations of EMS per service and per state. In AR many services are required to continue cpr if it is in progress and if measures are started, transport is required as well. Here in OK we may stop with Med Ctrl approval and we must notify PD or SO of all DOAs and the ME's office must be contacted on every death by LE.

[VentMedic]

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.

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.

No IV?

Also, the only reference to airway was bagging so it is unclear if there was an ETT in place.

It almost sounds like this patient was BLS'd in without any IV or meds to begin with. If this was an ALS crew, did they not have other means of establishing access? The doctor could also have offered an alternative instead of having the RNs wasting time now on a peripheral on a really dead patient. If the ED was expecting a little more from an ALS team and was presented with a lot less, that can throw everything off. Of course, it is probably best to expect less and be delighted when there is more done. In the ED, we usually take bets on how much is done depending on the crew coming in. So, it goes both ways for the abilities of the different providers.

Maybe the ED doctor likes to run things his/her way and creates chaos whenever on. Unlike EMS where you have the same partner everyday, staff in the hospital may constantly change as does the ED doctors. As spenac stated, any EDs may have to use agency RNs and/or doctors to solve their staffing problems. I myself hate working with some "fill-in" rental docs. The doctor may have his/her own perceived ideas about who should do what from the way it is done in another hospital and try to change things. Nothing ever goes well unless we can get them to leave the bedside for awhile and let the regular staff RNs and techs do their thing.

[spenac]

Unlike EMS where you have the same partner everyday,

Where? I do a 96 starting monday and work with 3 different partners. 2 of them work great. The other one I just can not seem to get on the same page with.

[VentMedic]

Where? I do a 96 starting monday and work with 3 different partners. 2 of them work great. The other one I just can not seem to get on the same page with.

Bummers! Some of our partners have been together longer than their marriages.

[JakeEMTP]

No IV?

Also, the only reference to airway was bagging so it is unclear if there was an ETT in place.

It almost sounds like this patient was BLS'd in without any IV or meds to begin with. If this was an ALS crew, did they not have other means of establishing access?

Excellent point Ventmedic, as usual. Yeah, that's what I thought when I read the opening post. Unless the patient coded approx. 1 min out, one would think IV would have at minimum, been established.

If in fact the pt. was BLS'd in, another reason to have ALS only service.

I have witnessed this " Keystone Cops" version of a code in the ED. It isn't pretty but as mentioned previously, different MD's do things their own way and nobody know WTF their particular role should be. To many cooks spoil the broth, so to speak.

[Ems1997]

i guess i should just feel fornate not to have this happen to me in my er. Here we have to run the calls unless they have been down for a while or they have dnr papers.

[boeingb13]

I did forget about the airway, the crew had a king tube in place, which was pulled by the doctor. He intubated right afterwards.

[VentMedic]

I did forget about the airway, the crew had a king tube in place, which was pulled by the doctor. He intubated right afterwards.

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

King airway and no IV?

You're not saying this patient died and it was the ED's fault? The pt's odds weren't that good coming in. It looks like the ED had to start from scratch by establishing an IV and intubating with a stable airway tube. How clear was this made on the radio that this was being BLS'd in? If that was clear then yes, the ED staff should have been more prepared. As I mentioned before, they should expect the least amount of stuff done in anticipation instead of assuming the best.

Not to distract from whatever was going on with the ED staff, but, what was the level of certification of the EMS crew?

[boeingb13]

The point of the story was that there were no set jobs for each person to be doing. There were 3 medics on the ambulance in the back. The guy was fairly big, and I believe it was a short transport, with that said, by no means am I making excuses for the crew.