Transport Ventilators usage for 911 response

[spenac]

http://www.progressivemed.com/estylez_item.aspx?item=11684

Something like that great. It's what we use. Not near as complicated as it looks.

One of those darn puppy lung poppers that many services carry, no thank you. http://www.progressivemed.com/estylez_item.aspx?item=88400

[Bernhard]

I just had a quick look around the internet, but couldn`t find the whole DIN EN 1789 sheet - but every site I searched mentioned an emergency vent with PEEP on its list for rigs that apply to DIN EN 1789 Typ C (or did you mean it`s not generally necessary, only with Type C rigs?).

OK, I stand corrected! Sorry Vorenus, and sorry to the others for misleading you all.

I have the european EN1789 standard here at my desk and first read only in the "airway management section", wondering myself since I don't know a german ALS ambulance which has no such respirator. Now I read the full standard again and found it in the "treatment of life threatening situations" section, one page further on...

...and here it is: "automatic ventilation device (EN 794-3)", mandatory for type C ambulances (however, not for type A1/A2 and B ).

Sorry again. Vorenus is right, at least with european type C ambulances, which most ALS units in Germany are (and probably in other European countries as well but I don't know much about ambulances there).

EDIT: the editor turns a "B )" (without space) unintentionally into a smily face. Nice, but not much informative...added a space between.

Edited May 31, 2012 by Bernhard

[WolfmanHarris]

I'm appreciate the intent of introducing a transport vent onto the Ambulance for freeing up hands during hot calls, but I wonder if the better, easier, more adaptable solution is to allow crews the personnel resources they require (for some services)? For example, where I work we have more than 40 vehicles on the road at a given time covering about 1 million people over 680 mi sq (1760 km sq). We have been granted essentially carte blanche by our management to request additional resources when required and are not questioned by them or dispatch on the why. If I want another pair of hands in the back I can take a medic off another unit (transport or RRU) and/or take a FF. In contrast, a friend of mine working at a rural county service with 6 vehicles covering 134000 people (~72k urban, rest rural/remote) over 1485 mi sq (3840 km sq) they can't request ALS back-up until they make pt. contact regardless of dispatch information and back-up, if available can be an extended period of time away.

At my service, even in the more rural areas with transport times of ~45 minutes, back-up is still only ten minutes away and FD closer than that. With crews having the ability to bring whatever resources they need a ventilator is a hard sell, especially with the manpower freed up by the LUCAS 2. At my friend's service, a transport vent might make way more sense than attempting to coach two Volly FF's with first aid and variable knowledge and experience with critical patients.

I don't have any familiarity with transport vents or respirators though so I'm only able to speak to the logistics side. For those like Chbare with the RRT or CCT background, if you had to pick a device, place it on the 911 trucks of a large service (20+ trucks), provide effective education to the crews and be the best choice in reliability and ease of use for a low frequency high acuity skill, what would you choose?

[chbare]

The 754 has a rather interesting and possibly harmful if not uncomfortable pressure support like quality when in SIMV.

[Bernhard]

With crews having the ability to bring whatever resources they need a ventilator is a hard sell, especially with the manpower freed up by the LUCAS 2.

Since we have the LUCAS2, too, we simply attach it and the ventilator and can go outside for a talk, a smoke or an occasional beer, just as the patient and his machinery making itself out. Really cool.

No kidding: it's not alone about freeing hands but in the first place about accurate inflation and using somewhat basic ventilation parameters you don't (easily) have when bagging by hand, at least not in a regular rhythm and accuracy over the time. Intubating & ventilating is rather common here, not only in CPR cases but in trauma scenarios as well (RSI). Then after first few cycles with bagging the automatic ventilator is attached.

Ressources aren't the main topic, here in Germany on critical patients mostly at least 4 providers are on scene (1 physician with his driving EMT plus 1 medic with his EMT partner from the ambulance) - plus a random number of trainees, volly first responders and/or firefighters. Additional ressources are only ~15 minutes away. Never called them for single patient treatment, though (only for lifting manpower, but rarely). And I have to admit, we rarely do CPR in the back of the rig (where we even would have 2 providers then: the physician and the medic, the EMTs are driving their vehicles) - usually, if no ROSC on scene, a patient is declared death right there (exceptions exist, and I still know former times were we transported nearly every body).

I don't have any familiarity with transport vents or respirators though so I'm only able to speak to the logistics side.

I don't have any familiarity without them - they've been there since I started in EMS >25 years ago. So I (and Vorenus) might be just blessed on this.

[spenac]

The 754 has a rather interesting and possibly harmful if not uncomfortable pressure support like quality when in SIMV.

It's not the perfect machine but it definitly beats the puppy lung poppers many services carry. Every vent I have every seen has some sort of issue if not handled correctly.

[WestMetroMedic]

my view is that out isn't the amount of resources you have available to you, but more of a safety issue.

How many of us actually wear our seatbelt in the back of the truck? Its hard to do your job while wearing a seatbelt. I wear mine about 75% of the time and suspect I am one of about 5% of people who do and only because I saw a video of a friend of mine almost die when he was in an ambulance rollover.

How many of your first responders step into the back of the truck and at first instinct reach for their belts? None. I love my first responders, but get them out of the truck a they are dangerous.

Putting a vent is a truck that is already carrying an automatic CPR device virtually eliminates the need to leave your seat during a transport. There isn't any more complexity than that.

The other advantage of a vent is that if it can do SIMV, then you can add BiPAP to your truck. I'm working on a research study proposal right now on that premise. CPAP is great but BiPAP is better. Duh.

Sent from my DROID RAZR using Tapatalk 2

Edited May 31, 2012 by WestMetroMedic

[firemedic37]

This has been the subject of discussion for sometime in my area. In the State of Iowa a Automatic Transport Ventilator can be operated by the EMT through Critical Care Paramedic Levels. The Automatic Transport Ventilator is defined as having two or less variable settings (Rate and Volume). At the Critical Care Paramedic Level you get Enhanced Ventilator (ICU Ventilator).

Now here is the scary part, no where in the EMT course is there a chapter or even a lab on Automatic Transport Ventilators let alone skills labs. Now I understand that the service should ensure that the EMT is competent in it before allowing them to use it. Now in the Paramedic course there is a whole chapter on it and a hands on lab (at least mine did). And at the Critical Care Level there were three days of ventilator settings and blood gases.

The problem has become that patients that need an enhanced ventilator have been transported on the Automatic Transport Ventilator and yes it causes problems but they don't care. Like they say they only have the patient for a few hours . . . These are the services that lack critical care paramedics and management that recognizes the need for an advanced level of care.

Back to the question, yes transport ventilators can and should be used in the field if the appropriate level of training has been met and maintained. Should ICU ventilators be used in the field on 911 calls? No, there are too many unknowns to be setting and adjusting all the parameters and the cost for these ventilators are very high compared to the transport ventilators.

[chbare]

However, many of the newer transport ventilators are able to provide many of the same functions as a hospital ventilator. For example, the LTV-1200, CV4, Oxylog 2000 and EnVe are all transport ventilators that provide complex modalities and at least limited to full graphics capabilities.

[croaker260]

We use the Care-vent ATV plus on all of our rigs. We cover just over 1000 sq miles, but most of our 300K is in a relatively narrow band of real estate.

http://www.otwo.com/prod_atv.htm

Decent gas/pressure operated vent. Like the eagle and LTV better, but this is not bad.

regardless, no vent is idiot proof, and playing "knob-ology" with a vent without understanding the pulmonary and hemodynamic effects will cause major problems.