Is CPR Performed on a Moving Ambulance Stretcher Effective?

[AZCEP]

I've got to think that even transporting a pulseless patient is a waste of time. Picking up a dead body, placing it into a vehicle, driving across town, and delivering said dead body to the hospital seems like a complete waste of resources.

I work 40 minutes from the nearest facility, and I refuse to beat on a corpse that long. I am willing to give them 20 minutes on scene, and decide from there. If we don't get a response to what we are doing, call them on scene. If we do, load them up and transport.

Good ACLS/BLS will do as much for a patient as an ER packed with doctors.

[TechMedic05]

AZCEP - I agree with you. good BCLS and ACLS makes a world of difference...however, once you've been on scene for 10-15 minutes, and say on your third round of Epinephrine...Heaven forbid you get a pulse back. now, instead of being 35 minutes from a hospital, you're now still at least your normal 40 minutes. I don't see why sitting on scene for the entire code is all that great of an idea. Especially if you do have a return of spontaneous circulation. does it happen often? No. Does EMS play by frequency? Shouldn't. Yeah, we don't do childbirth everyday, but many carry pitocin. We don't have traumas every day, but we carry traction splints. Not everything is about what does happen, but what could happen.

I, myself, wouldn't want to be at a family's house for 20 minutes, only to then be rushed about packaging and transport a then critical patient and leave any doubt to the family that I somehow delayed patient care.

EMS is still a part of a system. System is one third of our name. We are also not definitive care. I feel our number one priority is to deliver our patients to definitive care. If we happen to treat the patient appropriately and properly, all the better. That being said, the appropriate treatments, and continuing education are an extremely close second.

[Ridryder 911]

I understand what you are describing and agree some. But you must remember that there is less than <8-10% chance of survival to respond after being treated by EMS PTA to ER. (2000 AHA Fact Sheet) Most ER physicians are beginning to immediately cease all resuscitation measures if there has not been a change in ECG, or patient condition(s), thank goodness.

As one speaker at the ACEP meeting describes " EMS units needs to stop being hearses, with light and sirens there is nothing more that I can do, that has not already been done" (quotation mine). This dilemma is increasing more and more, even as lame as the AHA is at this time, they even recognize the need of terminating field resuscitation. With the new standards, this is to be recommended even more. Again, why increase costs to the families and tie up valuable ALS EMS units & ER beds? This is not calloused, but truthful. Some are also not aware of the cost.

Let's look at the normal code EMS $500-1000, arrived in aystole ER charges Arrival charge base charge $200 *Code called $400, Medications $300, Respiratory therapy $200, ER physician charge $200.. now we have a approximate total $2000 dollars for a non-viable patient. Remember medicare only pays 80%, so grandma on a fixed income is now responsible for at least $400-800 of the bill. Now she also has to pay funeral expenses of several thousands of dollars.. there goes next couple of months medicines for her...

Again, our action and treatment(s) effect more than just the patient. Reviewing protocols to give the best and effective care should be highly stressed. Especially as more & more volume of calls and more higher acuity level of responses are needed.

Be safe,

R/R 911

[AZCEP]

You said it yourself Techmedic, EMS doesn't get ROSC very often. This alone would make it more reasonable to not transport the corpse. If you don't get a response, and that can be as little as organized electrical activity, There is no good reason to initiate transport.

ACEP even published a position statement in this regard. 20 minutes, with a secured airway, vascular access, and good BLS being performed is reason enough to consider termination of efforts. Most can, and more should be able to determine when a code is going to respond, and when it won't. Or at least, have the idea that, just maybe it will be futile to start.

[chazmedic]

They call, we haul. I have resigned myself to this. :?

[Asysin2leads]

I agree doing compressions on a stretcher is not that effective, and we need to seriously reconsider how we run codes in the field.

My brother works in a rural area where the local squads are volunteer with long transport times, sometime plus 30 or 40 minutes, with only BLS capabiliities. When he was doing his medic rotations, he would tell how they'd bring in arrests they had been doing CPR on for 40 minutes or so and get quite upset when the doctor would immediately call it in the ER.

I think this is a good reason for a push to have paramedic response standard in all areas. EMS never operates in a vacuum, everytime we transport, lights and sirens or no, we put ourselves and the public at risk, and we are at an even greater risk when we are doing something like performing compressions in a moving ambulance.

In other words, I would much rather call 1,000 86 year old asystolic arrests in the field rather than ever have to explain to some 18 year old volunteer's family that he suffered brain damage when he went flying into the cabinents after a sudden stop enroute.

[firefighter523]

Does anyone else use a LSB? That is common practice where I work. Very convienient to take a litter with a LSB with all the goodies up to the door, grab the board, place pt on board, work code, place pt onto litter, while on board, good compressions while on litter. Works great!

[Dustdevil]

Does anyone else use a LSB?

Doesn't everybody? :shock:

The article did not specifically state that there was an LSB on the stretcher, so you're right. That does leave for us to speculate if one was used, and if not, how that skews the results.

[Nate]

I've noticed that in most ER's they don't put a backboard under the patient. :shock:

All of our codes get boarded with a c-collar (holds head/airway in alignment), and strapped down with quick straps (four to five "buckled" straps that attach to the board to hold the patient on).

I personally don't like to stay on scene and work a code. I work it long enough to get the patient on the board, and in my truck. Now I might sit in the truck and finish getting what ever I need to get done and a few rounds of drugs (we are usually with in 10 minutes of an ER). I usually stop and remind who ever is driving me that we don't need to drive like John Force. For some reason people think that when we have a CPR we need to drive in super dooper warp speed mode. :?

CPR while moving, it can be done, but I agree that it isn't the safest method. To be honest, that's why I'm always in the jump seat so I can see what all is going on, can access the patient, and push drugs as needed. Not to mention it has a seat belt. :wink: When we enter the ER I don't really see how the CPR/ventilation can be all that great rolling down the hall though.

We live, we learn, and things change eventually.

[AnthonyM83]

Only a few of you might remember the non-interrupted technique of CPR. There used to be at one time the compression technique to switch With the chest rescuer would change on 3 and the second rescuer would immediately get prepared with the hand intercepting on 4 & 5. Marathons used to be held to raise money for AHA and P.R. Demonstrating CPR was never interrupted for 24 hrs or so.. etc.

Wonder why AHA did not resuscitate that method since it was studied and approved successful... this would decrease the interruption period as well....

I was told by my FTO not to stop compressions during CPR, particularly with infants, just keep plowing through while the other rescuer ventillates at appropriate times. Would you guys agree with this?