Team Focused CPR

[MariB]

On ours whoever is there first starts, usually police, paramedic shows up in her vehicle and intubates by then an aed has been applied etc., ambulance right behind her. EMT takes over compressions while auto pulse is being brought in and then when ready we put the board under, and other EMT resumes to give first a break and first one takes over vent. Medic by then has a line in and we usually can analyze again if its been 2 minutes. Then the auto pulse is turned in and patient is loaded and medic works code in ambulance as she sees to.

If medic not around we don't have a line, we use king instead and then go for it after 3 shocks or no shocks.

Usually in er we continue autopulse and vents until doc decides what to do. Usually blood gases, epi, etc. We always continue CPR in er. It allows them to do what they need

I have only been on two codes but both were in a few minutes of hospital, we went ahead and transported both to hospital after analyzing.

[Arctickat]

Hmmm, medic intubates before the IV?

[MariB]

Hmmm, medic intubates before the IV?

depends, I've seen it both ways, there has been a time when they couldn't get a seal on a bvm, pt had something wrong with mouth. And even with oral it did no good. ..

If the ambulance is there she can go straight for the IV. If not, airway. Our medics respond to scene first. All the IVs and meds are on board.

I haven't been on enough codes to see what they do first and why.

I've shown up in the ambulance, she had a bag, was actually out with someone else and was waiting for IV supplies, other time she was on board with us, she was putting in IV while others were intubating . We have a couple on and the will work together sometimes.

Edited April 7, 2013 by MariB

[Richard B the EMT]

just like : NO ONE EXPIRES IN THE Operating Room.

It's always in recovery

But NOBODY ever dies in my ambulance!

They die in the ER.

[DwayneEMTP]

You know, I think that I've gotten ROSC on near half of the arrests that I've chosen to work. None have left the hospital that I'm aware of, but getting a pulse back hasn't been rare.

And I've heard the, "No one dies in my ambulance" my whole paramedic career, and have never really understood that. I've disconinued rescus attempts twice in the ambulance and chosen not to work a Hospice patient that coded during transport. I called into medical control and it was never an issue...

If honesty is vital in EMS then where is the advantage to working a dead body for 20 mins until you get to the ER where they can call it? I've heard a gazillion stories of leaving the BVM resting on their face, resting for 20 mins, and then resuming compressions before going into the ER so that the patient "didn't die in the ambulance"....what's the point?

[Richard B the EMT]

If honesty is vital in EMS then where is the advantage to working a dead body for 20 mins until you get to the ER where they can call it? I've heard a gazillion stories of leaving the BVM resting on their face, resting for 20 mins, and then resuming compressions before going into the ER so that the patient "didn't die in the ambulance"....what's the point?

There may be NO advantage, except hope. I was taught, in 1974, CPR was only 30% effective, but not doing CPR was 100% fatal.

As for leaving the BVM on and not doing CPR until getting to the ER? That's just not what I trained for, wouldn't accept from a partner, and wouldn't want such person's actions in my department. That type laziness gives a black eye to all EMTs and Paramedics, in my view.

[DwayneEMTP]

So you're saying that in all of your years on an ambulance that no one has ever died in your ambulance? That you've never continued CPR on a patient because they were in your ambulance, despite it being way past any possiblility of a resuscitation? Never had a DNR code in your ambulance, etc?

C'mon...how is that possible?

And it's not really laziness if you're 30 mins into a resusc transport, it's time to discontinue, but "no one dies in my ambulance" right? Does it make more sense to continue compressions and pushing drugs the other 20 mins to the hospital?

[ERDoc]

Keep in mind that he's in NY. We were not exactly the most progressive state when it came to EMS. We weren't as bad as NJ but not that great either. I think MAST finally came off the buses (yeah, I said buses) until around 2000.

[DwayneEMTP]

Ahhh...gotcha

[mobey]

I have had plenty (10+) patients die in my ambulance.

If a patient codes during transport we pull over & work it. The ER is not going to do anything I can't out here hours away from a major trauma centre, The science just does not support a rolling code.

I personally take no pride in abusing a corpse so I can chant these rediculous chest pounding mantras with the rest of the monkeys.