Transporting Code Blues/Cardiac Arrests

[zippyRN]

Ok, to all those who wish to play Coroner and call them in the field: Why do you load and go with traumatic arrest instead of working them for 20 minutes and then calling them dead ? A traumatic arrest has a less than 1% survival rate, much less than those cardiac arrest patients your are calling "dead", which have about a 10% chance depending upon where you live ?

And P.S.: The quality of prehospital intubation is far less than that of Anesthesiologists, but we still try. The same argument could be made for IVs started enroute.

again asking simple question questions ... ( which i note have been ignored from my previous post)

1. after 20 minutes of ALS in the field what does transporting a normothermic adult patient without " special considerations" achieve ? especially if they are asystolic despite all links of the chain of survival and enough epi/ iso to make a steak walk out the door and start mooing ... you have delivered the full range of care to this patient

2. does a traumatic arrest fall into the criteria of 'special circumstances' ... and are we talking blunt or penetrating ? and why does that make a difference ?

as for resourcing in hospital Codes - anything more than 5 or 6 people total is a cluster-feck waiting to happen

the best codes i've worked have had 4 providers hands on all of whom are ALS providers and all of whom can manage airways, defibrilate and do IVs ... and a 5th person as a runner who might get hands on for the odd 2 minutes of compressions.

in the ED we only ever had 4 or 5 people hands on - that was our rules as it kept the cluster fecks to a minimum - 2 ED nurses, 2 ED Docs ( one middle grade or senior , one junior) and the anaesthetist ( plus the aforementioned runner). that said we as a dept were known for 'throwing out' extraneous Doctors from trauma calls or making them stand in the corner behind the line and observe.

Edited December 19, 2010 by zippyRN

[DwayneEMTP]

in the civilised world of EMS the idea of not transporting unless you get ROSC or there are clinical reasons pointing to special circumstances ( hypothermia, drowning, paeds , strong clinicla evidence of something which is correctable but not in the field) has been floating about for about that long.

You know Zippy, its almost time to put you into the troll catergorgy I think. I'm getting curious to see if you're even able to create a post that doesn't simply boast on your country or insult ours. Always with infantile spelling, grammar and capitalization of course. (Edit:: of course after creating this post I discovered that you actually had created a few posts that did more than brag, so my apologies for the above comment. Not removed as others might have already replied to it, though of course the presentation remained childish. I'm not clear how you feel comfortable being so cocky about your system when it appears that those in your system are unable to create written communications at the adult level?)

Ok, to all those who wish to play Coroner and call them in the field: Why do you load and go with traumatic arrest instead of working them for 20 minutes and then calling them dead ? A traumatic arrest has a less than 1% survival rate, much less than those cardiac arrest patients your are calling "dead", which have about a 10% chance depending upon where you live ?

And P.S.: The quality of prehospital intubation is far less than that of Anesthesiologists, but we still try. The same argument could be made for IVs started enroute.

Yikes brother. You are terribly behind the times.

Transport a traumatic arrest? No man, not for any reason that I can think of, in fact I can't even think of any special circumstances that would cause me to work them, much less transport them. And I'm not playing coroner, I'm following standard of care in my area that is following science based medicine.

Run with arrests, good CPR in a moving ambulance, giving the family hope that everything that could be done has been done, all of those concepts are archaic. Of course Zippy actually discovered them all and his country had been following his example for 30 years...just sayin'.

You need to try and stop being so judgmental and angry and take this opportunity to discover that you have a lot to catch up on and be happy that you have a bunch of people here that would be more than happy to help you do so.

Dwayne

Edited December 19, 2010 by DwayneEMTP

[zippyRN]

You know Zippy, its almost time to put you into the troll catergorgy I think. I'm getting curious to see if you're even able to create a post that doesn't simply boast on your country or insult ours. Always with infantile spelling, grammar and capitalization of course.

Why am I a Troll?

- Because I challenge the received wisdom?

- Because I'm looking at a system which is acknowledged to be broken from the outside and feel no need to defend it ?

- Because I've pointed out that some problems have been solved elsewhere and 10 -20 years ago ( does that make Kiwimedic a troll for pointing out the Kiwis have been talking about field cessation of resus for the past 15+ years ?

Dwayne, your obviously an intelligent chap and care about developing Pre-hospital care and paramedic practice, if you want to start a war start it with the 'we don't need no steekin' book learnin' types rather than those who offer an alternative perspective , removed from the in country socialisation of EMS.

dwayne, have a pink icecream ...

Save the grammar fascism for somewhere it's appreciated.

[Just Plain Ruff]

The last time I scooped a trauma code and hauled ass to the hospital is when the guy coded on us when we were putting him in the ambulance.

I can't recall the last time that I transported a trauma code. Many years.

Emtpoceit, you are a SCARY PERSON what with your other posts.

Sent from my SPH-D700 using Tapatalk

[JakeEMTP]

Who works Trauma codes? Look man, like Dwayne said, you need to do some serious catching up.

Intubations are great, but another poor example. The AHA doesn't even deem them necessary any more. Good, quality CPR, 2 minutes @ a rate of 100/min, will allow enough oxygenated blood to flow to the brain for some time. Also, if you can't start an IV on the run, you don't need to be in the ambulance, period. But we're discussing whether or not to transport a code. The need to start an IV in route is moot because that should have already been done while we worked it on scene.

Do me a favor and post where your located so I can avoid that particular corner of the world. You're scaring me.

[CBEMT]

Who works Trauma codes?

Until somebody changes the rules? Everybody in my state, unless they meet the usual Biological Death criteria. Basically, if they're warm and relatively intact, they go.

Trauma codes are a required station at our final practical (starts with a BLS trauma assessment, eventually degenerates into a code, etc).

If you think that's backwards, wait'll you find out what our Biological Death criteria for pediatrics doesn't include.

Edited December 19, 2010 by CBEMT

[DwayneEMTP]

Why am I a Troll?

- Because I challenge the received wisdom?

Where has this happened? You've simply taken the one poster which everyone in the thread disagrees with and used him as the standard of care for our system. Ridiculous.

...

- Because I'm looking at a system which is acknowledged to be broken from the outside and feel no need to defend it ?

If that was the case then I wouldn't really have any idea what you're looking at or refusing to defend, now would I? It's not that you refuse to defend it, it's that you seem unable, in too manyof your posts, to comment on it without the, "Oh, poor children" tone and yet consistently show yourself to perform at an intellectual/logical level well below that of many that are created in the system that you lament. I'm not ashamed of my system, nor my education but you're hypocrisy gets tiring.

...- Because I've pointed out that some problems have been solved elsewhere and 10 -20 years ago ( does that make Kiwimedic a troll for pointing out the Kiwis have been talking about field cessation of resus for the past 15+ years ?

No, not in my view. He used it to show how far out of date the posters thinking is. You would have used it, while shedding a tear for us poor ignorant souls, as a benchmark to try and show that your system is 20 years ahead of ours. Maybe it is, but you're not a good example of that superiority. It just seems to me that if you're going to consistently crow about your systems superiority then you should make some effort to show that you are actually worthy of working in it.

Dwayne, your obviously an intelligent chap and care about developing Pre-hospital care and paramedic practice, if you want to start a war start it with the 'we don't need no steekin' book learnin' types rather than those who offer an alternative perspective , removed from the in country socialisation of EMS.

Awesome example. I truly have no idea what the above sentence was mean to communicate. You may have to dumn it down for me.

Save the grammar fascism for somewhere it's appreciated.

Why is it so difficult for you to understand that it's not fascism? It's simple, intelligent, professional adult presentation? In our medically 3rd world country our basics manage it, our paramedics manage it, our docs and nurses seem to be excellent at it, why is it that you find it so overwhelming?

And what part of this being an educational forum don't you get? We learn, we teach, we set an example for those that come after us. Easy right? I can't imagine how a 4th grade presentation fulfills any of those things.

Simple really.

Dwayne

[Richard B the EMT]

Why do we do the CPR? On one hand, it might be the local protocols we are working under. On another, it might truly be an emotional thing.

The call came in as a cardiac arrest. I am BLS, and responded as such, and the ALS arrived on scene within seconds of us. We rode the elevator together. BLS handled the CPR, ALS did the IV, drugs, EKG, and the contact to the OLMC. When it became apparent that we were not going to have a good outcome, a family member went across the street to the church for the priest, for giving the final absolution rites, and as comfort to one family member who was obviously not going to take the bad news too well.

After working on the patient for over a half hour, OLMC allowed us to discontinue efforts. The priest did his tasks of the final rites (I'm of a different religion, but understand it can be comforting to family members), we cleaned up the expended supplies, and, after leaving the deceased in the attendance of the NYPD awaiting the Medical Examiner's team, I heard the aforementioned family member asking his family and the Padre to call 9-1-1 again, to get another ambulance, and another opinion!

FYI, this was before the EMS/FDNY merger, and AEDs were not yet in the BLS protocols

[Richard B the EMT]

Edited due to accidental double-posting.

Edited December 20, 2010 by Richard B the EMT

[Kiwiology]

Richard, with the upmost respect to your decades of experience .... just because you have a "local protocol" does not mean it is necessarily the best thing to do in the particular case.

CPR may or may not be appropriate.