DOA?

[Asysin2leads]

I wish the DOT could expand the rules to include traumatic arrests as DOAs, something like "cardiac arrest from a traumatic cause", but then of course you'd have to define a traumatic cause and then you'd have the what if guy asking "Well, how do you know for sure..." and all that, but especially in rural areas, if you weigh the time and money spent, not to mention the extreme risk it presents to the rescuers and EMS involved, anything that could allow us to pronounce traumatic arrests in the field is worth it to me. Sure, we'd be treading on thin ice sometimes, but thats what makes prehospital care so much fun.

[JPINFV]

^

You have a problem of causation there. Is the cardiac arrest because of the accident or did the cardiac arrest cause the accident?

[windsong]

The display of measures from Cardiac after a certain amount of time if pending and does bring someone back, what would the outcome be? To be in a vegetative state but I've heard that people who've been far worse than that have better outcomes.

[Asysin2leads]

Well, let me ask you this, what are the chances the 34 year old who is found in cardiac arrest in a motor vehicle accident went into a sudden cardiac event that is reversible with ALS, let alone BLS? I'd say slim to none, but at least a great deal less than the chance of the ambulance transporting him to the hospital crashing and killing all aboard.

[JPINFV]

Well, let me ask you this, what are the chances the 34 year old who is found in cardiac arrest in a motor vehicle accident went into a sudden cardiac event that is reversible with ALS, let alone BLS? I'd say slim to none, but at least a great deal less than the chance of the ambulance transporting him to the hospital crashing and killing all aboard.

Not that I'm arguing, but you could you that argument for just about every cardiac arrest, traumatic or medical. What's the point of transporting someone who is is pulseless when you're going to get to the hospital and the MD is just going to do the same drugs you are?

[Dustdevil]

What's the point of transporting someone who is is pulseless when you're going to get to the hospital and the MD is just going to do the same drugs you are?

That throws an assumption into the equation that invalidates your analogy.

Who said you are transporting only for the hospital to do the same thing you are doing? The reason you should be transporting is for the hospital to take over and institute definitive care on your resuscitated patient. That is the opposite of a trauma situation, so the analogy doesn't quite work.

[JPINFV]

Umm, what other treatments would an MD offer for an asystolic patient (every code I've seen in the hospital [i'll admit, sample size is small) came in in asystole and left in asystole)? Also, if the patient has been resuscitated, then they aren't in cardiac arrest anymore. I'm not saying "don't treat or transport," but driving code three with a clinically, if not physically, dead patient outside of special situations (i.e. hypothermia, etc) is not going to benefit the patient.

[Asysin2leads]

To answer your question, the reason you give the drugs to a patient who needs them when the hospital will give them the same is so they will get them quicker. In some aspects, you are right, I'd like to also see a person who is 98 years old in arrest be left alone as well, but we can't just stop working everybody.

However, I think that who we work does need to be reevaluated, and it is to some extent. Even in my relatively short career I've gone from orders to push high dose epi and bicarb in every asystolic arrest prior to termination to just pushing bicarb to just calling it if there has been no change in the rhythm after standing orders, and I think its a great thing.

How about this for a traumatic arrest protocol?

BLS:

1. If patient was in arrest when found, has no evidence of hypothermia, has a patent airway, and has had no ROSC for the duration, and the AED has given three successive "No shock indicated", and telemetry has been contacted, patient may presumed to be unsalvagable and no further action is necessary.

Of course, the problem here would be that it would rely on checking for the presence and/or absence of a pulse. It could be possible to pronounce a person with a weak, nearly unpalpable pulse, and we have the hypothetical dumbest BLS provider in the world on scene who couldn't find his own pulse if he tried. The AED would indeed still say "no shock indicated", but because it was detecting a regular heart rhythm.

ALS:

1. If the patient was in arrest when found, has no evidence of hypothermia, has a patent airway, and has had no ROSC for the duration, and the EKG monitor shows asystole in 2 leads, patient may be presumed to be unsalvagable and no further action is necessary.

All right, so I don't have all the answers. The reason I think there needs to be more lienency in pronouncing traumatic arrests is because while I may work and live the big city, I'm a country boy at heart, and I know there are a great deal of rural communities in the nation who's BLS ambulances are transporting dead people who are going to be pronounced as soon as they reach the ER, risking ambulance crew members and the general public in their efforts, and that needs to change. Of course, we could just push for making all ambulances in the US equipped with paramedics, but lord knows we wouldn't want that.

[fallout]

My protocols for field termination basically say:

1.) Dependent Lividity

2.) Decomposition

3.) Decapitation

4.) Visibly destroyed brain matter

5.) Destroyed thoracic contents (aka the heart and lungs)

6.) Injuries incompatible with life (catchall, used with online medical consult for someone who is doesn't truly fit the above criteria but is highly unlikely to survive)

Even a BLS crew can use that.

Unfortunately, we haven't arrived at a protocol for sudden cardiac arrest that allows BLS to terminate resuscitation, though we are expected to get ALS to intercept us in the event of cardiac arrest, so to some degree this is a non-issue.

[hfdff422]

BLS should never be able to call sudden cardiac arrest unless there are signs incompatible with life- it is too easy to pass the EMT-B class.