Needing fire on a cardiac arrest

[Arkymedic]

I have had to run several codes by myself in the back and no protocols allowing for pronouncing in the field. One service I worked for had thumpers, but there was no training provided on them, so it took forever to set them up.

Ok answer me this have you ever seen a physician in the emergency room working a cardiac arrest by himself, NO for one while he is getting ready to intubate, you have a nurse doing compression, normally a nurse starting a line and so forth. Once again I'm not trying to start anything but just get a grasp on how other companies work. I work for a private ambulance company and we don't have firemedics here. I have always seen a firefighter ride in with the crew on the way to the hospital. I have even seen a captain ride in just to help

[crotchitymedic1986]

Why couldnt you use a second ambulance crew ?

[Doug]

Where do you guys work that you don't do CPR enroute? I've had 40 minute transports with CPR with the pt doing a mega code on me. Pulses, lost, v-fib, v-tach (with and without pulses) PEA/EMD, etc. Was I supposed to start and stop driveing?

[p3medic]

No, you shouldn't have started driving in the first place. Its one thing if they arrest in transit, but if they are dead on scene, work them till there not dead or call it. I realize local protocal will vary.

[Doug]

My point was that I've worked long codes where there is no obvious "This is futile" moment. Doing 40 minutes of CPR/ACLS in truck in transit as opposed to working for 40 minutes onscene, maybe getting something, now I have a 40 minute ride still to go. A good safe driver and safe practices in back (including going needleless) and you have no reason to not work on way in.

[Arkymedic]

I have had a code that took us 55 minutes to get there running L/S at 0300 and then we had to transport back to the hospital due to no death in the field protocol being approved and the single first responder not being able to ride .

Why couldnt you use a second ambulance crew ?

[Arkymedic]

same here Doug. The greatness of rural EMS.

Where do you guys work that you don't do CPR enroute? I've had 40 minute transports with CPR with the pt doing a mega code on me. Pulses, lost, v-fib, v-tach (with and without pulses) PEA/EMD, etc. Was I supposed to start and stop driveing?

[crotchitymedic1986]

You guys need to get your medical control to change your protocols. There is no reason to start CPR on someone that has been down 40 minutes, nor is there a reason to do CPR for 40 minutes, unless it is a cold water drowning. you are wasting time and resources, and putting lives at risk for no reason.

[Arkymedic]

Crotchity, In Arkansas a lot of the county coroners refuse to sign EMS off as Deputy Coroners so most counties here do not have death in the field protocols and for the record I agree with absolutely everything you said and questioned it frequently.

You guys need to get your medical control to change your protocols. There is no reason to start CPR on someone that has been down 40 minutes, nor is there a reason to do CPR for 40 minutes, unless it is a cold water drowning. you are wasting time and resources, and putting lives at risk for no reason.

[crotchitymedic1986]

So if you responded to a scene where the patient was decapitated, do you have to work that patient ? Obvious death is obvious death, whether it is a cardiac patient that is not responding to ACLS, or it is a trauma patient that has been squished by an 18-wheeler. If you are in a rural setting, I imagine you probably dont have alot of ambulances to spare, so working a dead body for two hours doesnt make sense. Your Medical Director should be able to write a policy that allows you to stop CPR when it is appropriate to do so. You are not pronouncing them dead (thats the coroners job), you are just using your resources wisely.