Why are people still transporting Adult medical codes?

[Just Plain Ruff]

Point# 3. Using your logic, I assume you never start IVs in the back of a moving ambulance, cause I can assure you I can find 10 EMTBs who will not be able to do it.

I can find around 8 thousand EMT-B's in Missouri that cannot start an IV int he back of the ambulance as well since they are not TRAINED on that skill.

[Vorenus]

Nope, they actually suck in American style ambulances too.

Yeah, didn`t want to sound like I was stating the different. Just wanted to get down on the point, that we`d have to stand the whole time while doing CPR, without ANY support for balance.

[Happiness]

I guess I should make myself clear on our protocol. This is a stay and play protocol if I appeared to say that I scoop and run that was not my intention. I do have the ability to not start, to stop and to carry on as long as I follow the criteria of the protocol. I have stayed on scene for 30 min or longer depending on what is happening with my patient, but I will admit that the pt that came back so to speak we got 3 no shocks and were able to get him to the hospital where he got the drugs needed, and so you know this particular pt was down for 40 mins.

It is a know fact that CPR is less effective in the back of a moving ambulance but I was trying to point out that, that fact was not going to be a deciding factor in my decission to transport. I dont know about others but I believe my life long passion of horse back riding and also being a commercial fisherman has given me an awsome scense of balance, and I also fit well between the stretcher and the bench seat, just my size i guess.

My years of experience is 16 years now but to be honest I only remember doing about 10 actual CPR calls there is probably more if I really thought about it.

[ERDoc]

Well I guess reguardless of any study about CPR in the back of an ambulance it is not going to make me stop performing it. Bad CPR is better than no CPR. To those who are saying it is of no benifit to start CPR so that you can feel like you did everything possible or that it creates a false sense of hope for the family members I call BS. First of all if I as a medic do not feel I have done everything I possibly could in the call then I am going to feel that I have failed and personally I dont like that feeling, and as for the false hope for the family I would rather the family think I did every thing for their loved one, and to give the family some credit they are probably very well aware the person will probably die.

The one and only time that I have seen a person be revived (he later died) it gave the family time to say good bye to the loved one, and to them it was important.

No offense happiness, but that sounds very hero-complex of you. Why can't you do everything for the pt in their house? What can we do differently in the ER than you can do in the field?

http://www.ncbi.nlm.nih.gov/pubmed/8629788

http://www.ncbi.nlm.nih.gov/pubmed/12385613

I believe there was also a very recently publish article, though I can't find it right now, that showed that familes actually preferred out-of-hospital termination. IIRC, the reasons given were time to be with the pt in their home, financial considerations, desire for/of the pt to die at home. If I get some time, I'll see if I can find it.

[p3medic]

My system has similar survival to discharge rates as Croaker, and interestingly enough, we work patients where we find them, on a hard, non moving surface. Transport before ROSC is almost always a bad idea.

[DFIB]

Well I guess reguardless of any study about CPR in the back of an ambulance it is not going to make me stop performing it. Bad CPR is better than no CPR.

Comment deleted due to redundancy/

Edited December 13, 2011 by DFIB

[Happiness]

OK did you guys read my #63 comment....................I do work the code at the scene but there is a time when they get transported. I follow the protocol and if I get 3 no shocks on my Defib then Im transporting it is the way it is. I have not started CPR on other calls and the coroner is called, because they meet another set of criteria. If I gave you the impression that I scoop and run I dont..............If I start my CPR/AED protocol I have to run it to the end, if I dont its at the house I stay and so you know Im transporting the dead guy anyways because we have no coroner here to do it for us.

No offense happiness, but that sounds very hero-complex of you.No offense taken, it isnt hero complex it is that I know in my community you take them to the ER. Now if I worked in a big city my views might change but who knows Why can't you do everything for the pt in their house? I do what I can again refer to #63 I have stayed on scene for lengthy time periods What can we do differently in the ER than you can do in the field? Well the most important thing I can not do in the field is give cardiac drugs and Im pretty sure the faster those are given the better the results. Am I correct on that assusmtion.

http://www.ncbi.nlm..../pubmed/8629788

http://www.ncbi.nlm....pubmed/12385613

I believe there was also a very recently publish article, though I can't find it right now, that showed that familes actually preferred out-of-hospital termination. IIRC, the reasons given were time to be with the pt in their home, financial considerations, desire for/of the pt to die at home. If I get some time, I'll see if I can find it. If that is the case where ever they did the study right on, but come to my native community and you will not get the same results.

So lets throw this into the pot and have alittle stir. They have put all these public AED's in our bus stations etc...........It is a proven fact that if a person is shocked, the sooner the better the higher chance of survival to the ER. But by making it to the ER dosn't mean they are actually going to pull through because the If the heart is damaged for what ever reason the shock dosn't make it all better right, and alot of them die. Now dont get me wrong because when you have one person survive it is all worth it in the end.

[romneyfor2012]

It is just one of those things that we need to change that we never have because we are lazy in EMS. It is rare that we fix anything in our industry unless a government agency/regulator demands it, or an insurance company decides to pay for it or quit paying for it.

[Vorenus]

Happi:

"Well the most important thing I can not do in the field is give cardiac drugs and Im pretty sure the faster those are given the better the results. Am I correct on that assusmtion."

I`ll have to do a little bit of searching before I can give you the actual study, but when I attended a lecture about the ERC guidelines 2010 (by a very competent and prominent Doctor), part of it was promoting some studies that led to the new guidelines. One of the studies showed, that cardiac drugs have actually a very marginal effect on the outcome of CPR.

EDIT: I couldn`t find the actual study (in full wording), but there`s an article about it at the site of the American College of Emergency Physicians

In short, there are some higher chances of actually achieving ROSC, but when it comes to a possible hospital discharge the difference between pts. who recieved ACLS drugs and the ones who didn`t shows only an increased chance of 1,3% for the ones who got cardiac drugs.

Similiar in neurological outcome - the difference is only 1,7 % (on the upside for the pts. with cardiac drugs).

Edited December 13, 2011 by Vorenus

[Vorenus]

Stupid me forgot to include the link to the ACEPs page and I can`t edit anymore, sry.

Here it is: http://www.acep.org/content.aspx?id=47466