Code Blue!

[Guest]

Alright, here's my lil rant for the day.

Who's brilliant idea is it to make it common practice to rush VSA patients (specifically cardiac arrests) lights and sirens to hospitals? More specifically, what's with the rush to move these patients to a hospital to be pronounced on arrival?

I understand that if yes, the patient still has a pulse but is in respiratory arrest and "circling the drain" or the cardiac arrest is a result of sudden/severe trauma, but lately, pretty much all of the codes I've worked on were elderly patients found by family and have had ACLS started on scene. I still really can't wrap my head around why we rush off an asystolic arrest (who's probably been that way for an hour or so) only to be greeted by a full code team at the hospital and the patient pronounced.

Yes, this is a sore spot for me, and I'm sure many of you out there have your own opinions, but, in ALL honesty, would it really be that bad to run a cardiac arrest into the hospital without the use of emergency warning systems? Food for thought and to be thrown around the table

Zach

[northernmedic]

We discontinue 99.9% of our codes in the field in Vancouver unless there is some kind of extenuating circumstance.

[Guest DELETED]

DELETED

[Dustdevil]

Who's brilliant idea is it to make it common practice to rush VSA patients (specifically cardiac arrests) lights and sirens to hospitals? More specifically, what's with the rush to move these patients to a hospital to be pronounced on arrival?

The literature, statistics, and evolving standard of care are on your side, my friend. Do some research and lay the results on your clinical coordinator's desk. Hopefully he will see the light and approach medical control with a recommendation to update your protocols.

There are certainly occasionally extenuating circumstances that might dictate a transport. And there are those rare circumstances that might actually dictate a rapid transport. But yeah, you're right. Most of them are transported simply because it is what we have always done, not because of medical necessity.

Of course, I'll tell you what would stop this nonsense real quick. If the insurance companies decide that transporting dead bodies is not medically necessary and stop paying for it.

[EMS49393]

Thom Dick wrote an article about this same topic that appears in the Dec. 2005 JEMS. Great article, valid points.

Personally, risking countless lives by blaring sirens and spinning lights for a dead body seems ridiculous to me. On the flip side of that argument, there have been a few news stories about "survivors" lately. Paramedics have pronounced people only to have them wake up later in a morgue. Could there be a reason why the ER physicians are wanting to see these bodies before they call them dead? The doctors should trust that paramedics know what dead is, by the same token, we need to prove that we know what dead is. The recent negative publicity isn't going to help our case for more liberal field termination of cardiac arrest protocols.

Don't you wish you had the power to cut up licensing cards sometimes? :violent1:

[Guest]

First things first ... no, we're not transporting code 5 patienst down here Medibrat (regardless of what you may hear ) What I'm referring to is those situations where you find your patient in asystole with an unknown downtime. ALS is begun, but even after the round of drugs, there's still no change. Why are we still running them code 4 (for our American friends, that would be L&S) to a hospital just because ... ?

Quite honestly, I don't mind the actual transport knowing the patient will be pronounced, but why run it on a 4? How would your service react if you transported this cardiac arrest with CPR in progress as well as all other pertinent interventions but no lights or sirens? Would make a smoother ride and easier for the providers in the back.

As a sidenote, how many of your VSAs are actually in shockable rhythms on your arrival? So far, I've only seen 2 patients in Vfib, both were re-arrests on handover to the ER and both had been paced during their original arrest due to short downtimes. Unfortunately, both of these patients were shocked back into asystole and pronounced.

Zach

[Doczilla]

I think that regardless of the presenting rhythm or reported down time, cardiac arrest victims should be transported non-priority traffic unless your agency is BLS only. Even in a V-fib arrest, what will the ER do that can't be done in the field? Loss of pulse in the field is essentially an exclusion criteria for thoracotomy, and that's probably the only thing that can be done on a code that can't be done by a medic (and it's only done for trauma). The whole point of having paramedics carry ACLS drugs is so they can treat codes in the field.

Transporting these patients hot endangers the lives of the medics and the public for no real benefit. If transport is to be initiated, it should be done routine traffic. Otherwise, there is some thought to working the code at the scene, and if no response in 30 minutes of ACLS, then terminating in the field.

There are some exceptions:

1) Airway problems, like you can't get one.

2) Reversible cause, such as hypothermia.

3) Pulseless gravid female, when emergent c-section may be considered to save the baby.

4) Positive response to therapy, i.e., now they have a pulse.

5) Man with gun threatens to kill you if you don't.

'zilla

[Ridryder 911]

If you are going to that extreme of not transferring emergency transporting.. then get protocols to cease the resuscitation effort. Don't play !.. Either treat the patient as a emergency .. can't get worse than no pulse... or cal it in the field.. be done with it. Sorry, working my butt off doing compressions and giving medications .. bagging etc for additional 10 minutes or greater does not make sense.

Be safe,

R/r 911

[mediccjh]

If you are going to that extreme of not transferring emergency transporting.. then get protocols to cease the resuscitation effort. Don't play !.. Either treat the patient as a emergency .. can't get worse than no pulse... or cal it in the field.. be done with it. Sorry, working my butt off doing compressions and giving medications .. bagging etc for additional 10 minutes or greater does not make sense.

Be safe,

R/r 911

Unfortunately, for whatever reason, my Regional Medical Director is against this. I tried arguing the point with him that we're doing the same thing in the streets that they are gonna do in the ER, but to no avail.

I love having the ability to cease efforts in NYC and NJ.

[jw-c152]

Some great points... but wasn't this beat to death in a recent thread?

Don't mean to try to end your discussion, Zach, but you'll find a lot of this info already discussed if you do a search for it.

P.s. Where in Ontario do you work? I'm in that service just to the east of T.dot