Transporting Code Blues/Cardiac Arrests

[Bieber]

So, the topic is cardiac arrest and transport! Here are your questions:

1.) Do you transport cardiac arrests?

2.) Do you WANT to transport cardiac arrests?

3.) What are the benefits gained?

4.) What are the risks?

5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation?

I'll answer the first two questions now, and the rest after some of you more experienced folks have weighed in. In the system I work in, we work asystole codes and then call to terminate resuscitation if there's no rhythm change or return of spontaneous circulation after we've done our three rounds of atropine; all other rhythms, we transport after we've gotten our frontline meds in. I would rather we did NOT transport ANY person without a pulse, however that's not the standard currently held by my service.

[JTpaintball70]

Unfortunately my service transports codes. I hate it and feel that it's dangerous for the crew and not beneficial at all for the patient. If I had my way, all codes would be worked on scene and only tansported if ROSC was regained on scene.

[medicgirl05]

In my service we don't transport cardiac arrests unless there are special circumstances(pedi, hypothermia, etc)

Im happy with that. With termination in the field it is much more personal than in the hospital where family doesnt get as much of a relaxed grieving process. When you terminate at home you have the benefit of familiar surroundings. After we tell the family and are waiting for the JP or funeral home, I am able to do whatever the family needs of me. Ive made phone calls to other family members, changed bedsheets, made coffee, unsaddled horses...Plus theirs the safety issue of not tranporting going code 3 with distressed family following.

There are risks of terminating in the field but in the 5 years that Ive worked in EMS I've never any any consequences. Knock on wood!

I dont see a reason to transport ALL code blues but sometimes if the family is angry about the death or if there is any blame associated with the death then we transport. Its my desicion as the lead medic and it is a desicion that I do not take lightly.

Im looking forward to seeing posts from other services.

[DwayneEMTP]

These answers from my previous service, as they don't strictly apply to the service I work at.

I also think it depends on the type of service. ALS/ALS, ALS/BLS, or BLS/BLS trucks? I don't believe that BLS should call an arrest short of obvious signs of death and even then, to include decay, especially if they have very short transport times.

These guidlines can also reflect the amount of respect that a med director has in his/her medics as well. If s/he thinks they're schmucks, then you're going to be working all of your codes to the ER.

1.) Do you transport cardiac arrests?

Only with ROSC, or if they're really cold.

2.) Do you WANT to transport cardiac arrests?

Only as stated above, or in the rare case where evaluation on scene would be dangerous because of possible violence.

3.) What are the benefits gained?

With the exception of those cases above, you gain a CYA (cover your ass) level of comfort. It also allows you the benefit of not having to deal with the family of the pt, and/or possibly removes you from danger.

4.) What are the risks?

Possible unnecessary needle sticks, death by MVC.

5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation?

Cold arrests, ROSC, provider safety issues, should be transported. All others, and in my opinion, yes, this also includes children, should be left on scene and attention redirected to the families.

Dwayne

[Kiwiology]

1) No

2) No

3) None

4) Lots

5) Some secondary arrests (hypothermia, advanced pregnancy and certian overdoses only)

Edited December 12, 2010 by kiwimedic

[spenac]

No we do not transport the dead. Now in saying that there are exceptions such as continued electrical activity (PEA) and danger to the crew. But transport is done slow none of that bat of hell stuff.

[EMT155]

OK... to answer:

1.) Do you transport cardiac arrests? Yes, unless it's obvious death

2.) Do you WANT to transport cardiac arrests? Personally, yes, because I'd rather let the ED deal with the family. Also, I've had a few saves over the years that may not have been if we hadn't kept them viable to the hospital.

3.) What are the benefits gained? Again, personally, not having to deal with the family, it provides psychological first aid for the family to give them time to consider the outcome, CYA factor (thanks Dwayne), It 'looks good' for your service (not sure how better to put that, but it shows a life saving effort for lack of better words)

4.) What are the risks? Really, not that different from any other ALS transport, and a priority response to the ED does not by any means include a balls-to-the-wall approach. You make your best time taking into account road and traffic conditions.

5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation? Yes they should be transported IMHO as cited above.

Jim

[fiznat]

1.) Do you transport cardiac arrests?

Some. We leave obvious deaths at the scene, along with those with asystole/rigor/lividity/etc. If the patient is asystole but warm/no rigor or lividity etc we will work on scene and then call to presume death. All others we transport.

2.) Do you WANT to transport cardiac arrests?

I think our current system is reasonable.

3.) What are the benefits gained?

Benefits gained with what? Transporting those we do? Some come back. Not transporting those we dont? Avoid unnecessary transport, futile care, etc.

4.) What are the risks?

Same as all calls.

5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation?

As noted above, I think our current system is reasonable.

[Chief1C]

1.) Do you transport cardiac arrests?

If they meet protocol criteria for resuscitation to be attempted.

2.) Do you WANT to transport cardiac arrests?

If they meet protocol criteria for resuscitation to be attempted.

3.) What are the benefits gained?

In the past two months, we've had two cardiopulmonary arrests (rural, significant distances between stations and patients, and patients and hospitals), one had ROSC, and is living with the same quality of life as they had before. Perhaps a little more careful.

4.) What are the risks?

Other than the guy standing up, what's the difference? In complete honesty, and don't respond to this, keep it to yourself, so nobody's employment status is at risk. How often are you properly restrained while transporting a patient, in the patient module? My arms aren't abnormally short, nor am I suffering from a disability, and belted, I can't reach the patient. You can what if the safety of transporting in an ambulance, to death.

5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation?

I guess my response would be different if we had Advanced Life Support nearby. So, I won't answer this one. I can't explain what EMS is in my eyes, b/c the values clearly are vastly different.

[Kiwiology]

I remember in Mobile Intensive Care Officer class way back in 1994 being told that transporting cardiac arrests has no value ...

*checks calander, hmmmm