Needing fire on a cardiac arrest

[ParamedicOfCalifornia]

I don't think you need to give them a chance when doing so involves transporting L&S with an unbelted provider doing CPR in the back. We have to transport medical arrests in Ontario as a PCP unless your service is participating in ROC's TORIT study. Hopefully this study will change that.

If after running my whole SCA algorithm there is no ROSC what are the chances of that changing? Is their chances of survival higher than the chances of myself, my partner, another motorist or bystander being injured in an MVA while we run L&S? I don't think so.

not going to lie your post is all truth but round here its L&S for that kinda stuff its all about getting them there but i do have to say this.... my partner and i have a different way of driving L&S with a code... Its with alot more precaution and slower speeds... we dont do 75 with a CA in the back... in fact most of the time it ends up just above the speed limit with the ability to clear an intersection a little faster... the opticoms we have work like a charm.....

[JPINFV]

it is a fact in the system i run in.... its just how we run things but i wouldnt say its the best practice because as everyone knows the system is different every where you go..... while we run code to the hospital here you guys may have a standard that says hey do cpr throw down 2 rounds and a get a tube and your done..... as i said its less than 1% this person is going to even get a pulse back.... but around here we just have the load and go policy and procedure in place.... we can leave them under certain circumstances but for the most part if not obvious we transport

Has anyone ever questioned this practice to your county EMS committee/ county EMS agency or has it just been accepted as a fact of life? If it's not a best practice, then why are you guys doing it? Alternatively, what makes your treatment regime so limited that the hospital has more to offer a patient in cardiac arrest than the paramedics (please list specifics)?

[ParamedicOfCalifornia]

Has anyone ever questioned this practice to your county EMS committee/ county EMS agency or has it just been accepted as a fact of life? If it's not a best practice, then why are you guys doing it? Alternatively, what makes your treatment regime so limited that the hospital has more to offer a patient in cardiac arrest than the paramedics (please list specifics)?

The hospital can do more in way of advanced procedures that only doctors can do.... central lines.... cardiac massage.... etc...... no one really questions it we just do what our protocol says to do.... We are actually not limited we our one of the more open ems systems in that we can do alot with out ever asking its really nice..... as i said protocol is protocol is protocol

[brentoli]

no one really questions it we just do what our protocol says to do.... We are actually not limited we our one of the more open ems systems in that we can do alot with out ever asking its really nice..... as i said protocol is protocol is protocol

I love Kool-Aid.

[WolfmanHarris]

Are you aware of how effective those procedures are during an arrest? Or whether they are ever used in an arrest in the ED? (I have only a passing knowledge of this, so I'm not being entirely rhetorical)

My understanding of ACLS, including a quick refresher of the algorithms right now found nothing we cannot do.

Furthermore, my understanding is the more research is done, the more we realize that none of this stuff works all that well to begin with. With early defib and early, PROPER CPR being the key to survival there is no justification for crappy CPR en route. With the SCA survival rates, there is even less for trying to do it in a moving vehicle putting yourself and those around around you at higher risk of dying than your patient has of surviving. (Once again I wish I had stats to back this one up, but a google search found no cited statistics.)

I accept that you, I and others have to transport patients who have no business being in a moving ambulance. It's the nature of our systems at the moment. I'm hopeful that mine will be changing in the near future. You should be pushing for the same.

[JPINFV]

The hospital can do more in way of advanced procedures that only doctors can do.... central lines.... cardiac massage.... etc...... no one really questions it we just do what our protocol says to do.... We are actually not limited we our one of the more open ems systems in that we can do alot with out ever asking its really nice.....

Just curious, when was the last time you observed any of those procedures being done on a patient you brought in that was in cardiac arrest when you made patient contact?

as i said protocol is protocol is protocol

Protocols change.

[Dustdevil]

The hospital can do more in way of advanced procedures that only doctors can do.... central lines.... cardiac massage.... etc...... no one really questions it we just do what our protocol says to do.... We are actually not limited we our one of the more open ems systems in that we can do alot with out ever asking its really nice..... as i said protocol is protocol is protocol

A little contradictory there. You can do a lot without asking, so why can't you do central lines? We were doing those in the field in the mid 1980s in Texas. But seriously, how often are you completely unable to get a peripheral IV on your arrest patient? And how many of those arrest patients are likely to benefit from anything you could slam into that central line even if you could insert it? You have a very slight chance of doing some good with that central line in the field. You have almost zero chance of doing any good with it over half an hour later in the ER. If your ER is doing it, it's just for the sake of practice, I assure you. Heart massage? Again, if you are seeing this done to your arrest patients in the ER, it is strictly for the sake of practice. So, unless you lack transcutaneous pacing in your ambulance, what exactly does the ER have for a medical arrest that you do not, and that has an honest chance of making a difference after greater than thirty minutes down? I've spent nearly as much time in the ER as I have on the streets, and I'm sorry, I just don't see it.

I understand how those of us still living in the 20th century might still be practising our craft under the old skool notion that there are all these magical interventions that the hospital possesses that will resurrect the dead if we can just get them there. Old habits die hard. But for crying out loud, people, it's been nearly thirty-seven years since Johnny and Roy were taught that nonsense. It's a new century, and medicine has progressed with the times. Why EMS FAILS to progress along with it is a sad, sad question to be answered. GROW UP! Grow up as a professional, and grow up as a profession in general. We are not saving these people doing the same old thing we have always done. Unless you bastardise (read: fake) the numbers like the a-holes in Seattle, the numbers show that we simply are incapable of resurrecting the dead. We're not only not saving these people, we are literally killing ourselves trying. WTF? Stop it! It's worse than stupid. It's expensive and dangerous for zero return. Seriously... just stop it.

[crazyemt5150]

Are you honestly suggesting that your patient has a prayer in the world of a good outcome after stopping CPR (poor and constantly interrupted chest compressions are worthless) for the 5-15 minutes it takes to get to the hospital?

So how is it poor and non consistent cpr when you tx with more that just a medic thats why its important for a firefighter or someone else to go. While the paramedic is performing his duties the firefighter is pumpin on the chest from the time we load up until the time we arrive to the hospital. Most of the time your not racing but driving nice and slow being aware of the bumps and everything. The only time you should stop is to check to see if there is a rhythm and to shock

[crazyemt5150]

ok, if you agree, why are you still transporting dead bodies ? Is there a written law in arkansas that cant be overturned ? Why cant your medical director write you a protocol that allows you to stop CPR after "x" amount of time ?

I am not trying to be confrontational, just trying to understand the situation.

Our protocol for a ca is work a pt for thirty mins. Where we work its 3 to 4 mins arrival, why stay on scene for another 25 mins, when you possibly could get something back under the right circumstances

[p3medic]

It is damn near impossible to provide effective chest compressions in a moving ambulance, no matter how many fire fighters you take with you. The way to resucitate someone is to do it at the scene. The patient shouldn't be moved until you have ROSC. If you are under protocol that you MUST transport, then spend 30 minutes on scene. If you don't have ROSC in that time, you never will, and you can move the patient to the ambulance and drive safely to the hospital with as poor CPR as you like because it won't make a difference, but dragging a corpse to the truck and beating feet, trying to run a code in a moving ambulance is ineffective at best.