New USAToday article

[Ridryder 911]

Wouldn't this be more of an issue with QA/QI programs instead of HR? If the medics aren't receiving enough calls to keep certain skills current and fresh, then either pull them from the book or offer more frequent refreshers with CMEs. This is where I believe it's up to the service in co-operation with the base hospital/medical director to do some research and tailor the needs of the medical protocols to the community.

peace

Shhhhh.... that makes too much sense!

R/r 911

[whit72]

Good solid CPR, airway managent (not necessarily intubation), electricity and rapid transport to ER, thats what saves arrest patients. Those are BLS skills, on average bls CPR calls arrive at the facility almost 10 mins quicker. Ten mins. thats a lifetime in arrest pts. Face it medics dont focus enough on CPR there to busy screwing around and intubating incorrectly (lol sorry I had to say it) Rapid defib and CPR is the most important aspect in a cardiac arrest and EMT's provide that now. If I had a dollar for every time I was second truck in on a code open the doors and there are two medics not doing CPR or doing one handed cpr. I absolutely agree with the tiered system it is very affective. Those cities also encourage bystander CPR that is huge if CPR is started within the first minute of arrest the save rates will be higher. I believe they also have the highest rate of AED placement for public use. Defid within the first minute, That is going to save more patients then having 200 paramedics on the streets.

[JPINFV]

Of course I've never figured out why medics even transport full arrests. The doctor at the hospital isn't going to be pushing any different drugs anyways. The patient that was last seen an hour ago and is warm and in asystole on arrival is dead. No amount of lights, sirens, or letters behind your name is going to change that. L/S transport of dead bodies puts the public at risk.

[chicagoambo]

we leave asystole behind, 2 rounds of drugs then adios.As for utilizing special paramedics to run only cardiac calls, how about urban traffic?What then?Thats why Als engines work,immediate service,not 10 minutes from now!How to fix the stats( cook the books)in these superior systems.Accurate saves? Definition of a save?

[Dustdevil]

Thats why Als engines work,immediate service,not 10 minutes from now!

That is a non-sequitor assumption. The patient needs ALS. Whether it comes from a fire truck or an ambulance is not particularly significant. If it weren't for fire chiefs constantly trying to siphon off EMS dollars for their department, there would be more money to simply put more ambos on the street, negating the need for ALS engines.

Your solution is the problem.

[Ridryder 911]

Good solid 1)CPR, airway managent (not necessarily intubation), electricity and rapid transport to ER, thats what saves arrest patients. Those are BLS skills, on average bls CPR calls arrive at the facility almost 10 mins quicker. Ten mins. thats a lifetime in arrest pts. Face it medics dont focus enough on CPR there to busy screwing around and intubating incorrectly (lol sorry I had to say it) 2) Rapid defib and CPR is the most important aspect in a cardiac arrest and EMT's provide that now. If I had a dollar for every time I was second truck in on a code open the doors and there are two medics not doing CPR or doing one handed cpr. I absolutely agree with the tiered system it is very affective. Those cities also encourage bystander CPR that is huge if CPR is started within the first minute of arrest the save rates will be higher. I believe they also have the highest rate of AED placement for public use.3) Defid within the first minute, That is going to save more patients then having 200 paramedics on the streets.

Hmm... would you like to cite your resources?

1. Need to review current ECC standards

2. Same as above, rapid defib is no longer emphasized, like it was. Please referred to new 2005 AHA guidelines

3. Again, where did you come with up with number ... or did you pull that out of your arse?.. By the way it is defibrillation, and again current standards recommend one to two minutes of CPR before defibrillation.

I highly suggest you read the current literature and standards, and take a new BLS for Healthcare Provider course, for AED as well. Many things have changed since February.

Be safe,

R/r 911

[PRPGfirerescuetech]

Of course I've never figured out why medics even transport full arrests. The doctor at the hospital isn't going to be pushing any different drugs anyways. The patient that was last seen an hour ago and is warm and in asystole on arrival is dead. No amount of lights, sirens, or letters behind your name is going to change that. L/S transport of dead bodies puts the public at risk.

I've always kind of wondered this myself.

Is it a trust issue with medics?

[Ridryder 911]

I've always kind of wondered this myself.

Is it a trust issue with medics?

Actually there is several emergency physicians addressing this issue calling " EMS should not be hearses and transporting dead bodies with L/S" ... hopefully, we can accommodate and increase education levels, so more decision can be made like this.

R/r 911

[chicagoambo]

You're right, we should have 100 ambo's instead of the 59 we have but that would be politically bad so we have Als engines!I agree it would be better to have more ambo's but reality in this city is justification of fire jobs and always will be since the paramedics are 10% of the union.To be selfish and worry about our own families is how our Als program was created, now its expanding faster than hell.Is that good ?No I know there are better solutions but not here!We are here originally to protect fireman and guess what , we still are but this time its with union dues and not advanced medical care!

[whit72]

[align=justify]

Journal of amrerican heart association 2005 AHA CPR guidelines

Defibrillation Plus CPR:

A Critical Combination

Early defibrillation is critical to survival from sudden cardiac

arrest (SCA) for several reasons: (1) the most frequent initial

rhythm in witnessed SCA is ventricular fibrillation (VF), (2)

the treatment for VF is electrical defibrillation, (3) the

probability of successful defibrillation diminishes rapidly

over time, and (4) VF tends to deteriorate to asystole within

a few minutes.1

Several studies have documented the effects of time to

defibrillation and the effects of bystander CPR on survival

from SCA. For every minute that passes between collapse and

defibrillation, survival rates from witnessed VF SCA decrease

7% to 10% if no CPR is provided.1 When bystander

CPR is provided, the decrease in survival rates is more

gradual and averages 3% to 4% per minute from collapse to

defibrillation.1,2 CPR can double1�3 or triple4 survival from

witnessed SCA at most intervals to defibrillation.

If bystanders provide immediate CPR, many adults in VF

can survive with intact neurologic function, especially if

defibrillation is performed within about 5 minutes after

SCA.5,6 CPR prolongs VF7�9 (ie, the window of time during

which defibrillation can occur) and provides a small amount

of blood flow that may maintain some oxygen and substrate

delivery to the heart and brain.10 Basic CPR alone, however,

is unlikely to eliminate VF and restore a perfusing rhythm[/align].[/align][/align]

I must be missing somthing...... In the system I work in yes 10 min quicker. Yes I tend to just pull things out of my ass.... LEts see AHA is constantly changing their guidelines for CPR and DEFID and a has the survival rate ever been higher then 5%. RYDER with all your statistics why dont you find out what the survival rate for arrest pts was 50 years ago, and now bet it hasnt changed much. The facts is in my experience (will use that because I cant quote from numerous meaningless studies) MEDICAL ARREST PT'S RARELY LIVE. TRAUMATICS NEVER DO. Does that mean we dont work them NO, we do it as much for the pt. as we do for the family that is present, if we cant save them we can give their family the piece of mind of knowing everything possible was done for their loved one.