Protocols Update

[Richard B the EMT]

Keeping you advised, I just got a copy of this order, and thought I'd share with the rest of you. As always, remember that this is FDNY EMS Command protocol, your local area might have protocols that are in direct opposition to this one, so always follow your local protocol(s).

As per an operations order dated April 23, 2010, from the FDNY EMS Command, Bureau of Operations:

BUREAU OF OPERATIONS

EMS COMMAND ORDER 2010-071

April 23, 2010

REMOVAL OF RESQPODS

1

1. GENERAL INFORMATION

1.1 Based on the analysis of cardiac arrest resuscitation data, the Department has determined

that the ResQPOD impedance threshold device (ITD) has not performed as expected.

1.2 Effective immediately, ResQPOD ITDs shall no longer used during resuscitation efforts

and be removed from FDNY ambulances and ALSEPs. Paramedics shall remove all

ResQPOD ITDs from the Paramedic Medical and Trauma Kits.

1.3 Station Officers ensure that all personnel are made aware and comply with this directive.

2. REVOKED PROCEDURES

2.1 Office of Medical Affairs Directive 2010-01, ResQPOD Impedance Threshold Device

BY ORDER OF THE CHIEF OF EMS COMMAND

[46Young]

Keeping you advised, I just got a copy of this order, and thought I'd share with the rest of you. As always, remember that this is FDNY EMS Command protocol, your local area might have protocols that are in direct opposition to this one, so always follow your local protocol(s).

As per an operations order dated April 23, 2010, from the FDNY EMS Command, Bureau of Operations:

Interesting.

Was this decision based on the city's own cardiac arrest data? Or was it from studies from other regions?

Would you be able to provide the names or links to such studies if that is the case?

[WolfmanHarris]

The study done in Ontario by Rescu (prehospital research group at UofT) found that ITD's increased ROSC but did not affect survival rates. The results haven't been published yet but from what I understand the preliminary results are attributing the increase in ROSC more to the close monitoring and feedback of CPR and ventilation that was done during the study rather then the ITD itself.

Rescu ROC PRIMED Study

And if you scroll down the main page to "What's New" on the left side, you'll find part way down the pdf's for the suspension of the trial and the early results. I scanned the published articles section and couldn't find a PRIMED article yet, so I imagine they haven't published just yet.

Edited April 25, 2010 by docharris

[Chief1C]

I used that thing with an Elder valve and a NuMask. Expensive, but mine was free. All I do is write to them, not email, or call, and ask for information and/or a product sample package... and I get it. Patient still died, but their color improved greatly. Though, it was just as good with the Elder and NuMask, since it forms a perfect seal, I could use my other hand to catch the CPR do-er and slap the wall repeatedly and yell "easy on the brakes (name) we got people standing up back here"

Elder Valve, is an oxygen powered resuscitator, with a low volume pressure, that vents when it meets resistance. When we tested them to determine if it would be useful, it had the same results as two people operating a BVM. One keeping a seal, one squeezing the bag. The pros are; you can make a better seal, since your hands are over one another, less oxygen is wasted into the surrounding air, and it has a filter. Cons, it needs oxygen to run, and if you're low, it won't work, also expensive as it's 2009 demand technology.

[Richard B the EMT]

Interesting.

Was this decision based on the city's own cardiac arrest data? Or was it from studies from other regions?

I have no idea

Would you be able to provide the names or links to such studies if that is the case?

Me? No, but somebody else already has, if in part.

The study done in Ontario by Rescu (prehospital research group at UofT) found that ITD's increased ROSC but did not affect survival rates.--

Rescu ROC PRIMED Study

And if you scroll down the main page to "What's New" on the left side, you'll find part way down the pdf's for the suspension of the trial and the early results. I scanned the published articles section and couldn't find a PRIMED article yet, so I imagine they haven't published just yet.

[CBEMT]

Are the results not satisfactory because the device itself doesn't work ad advertised, or is there user error involved- ie bagging whenever you feel like it instead of watching for the light.

I think you'd need to work on that before you throw the baby out with the bath water.

[HERBIE1]

Well, it makes sense to me- especially with the latest CPR guidelines from AHA. The protocol de jour seems to now demphasize ventilations in lieu of more aggressive chest compressions.

Besides, one of the studies I saw said that the end point was getting the person to an ICU bed post arrest, and the stats were essentially no different for a patient who had that device, vs one who did not. The study also did not address neurologic function, or survival rates, so I'm surprised NYC adopted the device as quickly as it did.

[Richard B the EMT]

I'm surprised NYC adopted the device as quickly as it did.

For the record, I have no part of the decision making in the FDNY EMS Command, just turning in field review paperwork on new equipment being field tested by us. In some defense of them, I can only presume they were trying to be proactive, as opposed to reactive, in starting out with the new protocols and equipment.

[HERBIE1]

For the record, I have no part of the decision making in the FDNY EMS Command, just turning in field review paperwork on new equipment being field tested by us. In some defense of them, I can only presume they were trying to be proactive, as opposed to reactive, in starting out with the new protocols and equipment.

I know Richard- it wasn't a slam on you or FDNY EMS. I agree it's nice when your organization is proactive- and gawd knows mine is not. By the time we get "new" protocols, equipment, or medications, they are usually obsolete by industry standards.

It just seems that in this case, the evidence was anything but overwhelming that this device was a good idea. No harm, no foul though, I guess.

[vs-eh?]

We had the ITD's removed from the car's months ago. We were involved in the study that docharris quoted and the doctors spoke to us often and we recieved feedback on individual cases.

In general, the consensus was that while ROSC's increased, survival to discharge did not. Ergo, more money wasted on transports, ICU beds, etc without a meaningful result for patients returning home with a "quality of life".