New USAToday article

[Ridryder 911]

It is obvious some have very little experience of exposure of arrests. Is it truly compassion to perform resuscitation on a dead body? (yes that is what non viable patients are called) .. Whom are you really doing it for ? If you know, that they are going to immediately cease all resuscitation efforts upon arrival, really, what have you really done? ... I find this not only a tragedy against the family but highly unethical as well. Practicing (since you know NO +outcome is going to be achieved) should be regarded as such.

Okay, fine, don't read research and literature, you have just made my point on the need of education versus training...Believe it or not, one can actually be educated, & have clinical experience as well .. they call it knowledge! (I know it is scary, but it can really be done, even in EMS).

Want to know what EMS will respond to ? There are plenty of chest pains, MVC, diabetics, medical calls with illnesses that needs to be stabilized or treated before resuscitation measures have to be started. Do you not see the rise in call volume?

I am licensed as a health care provider.. and non-viable patients, no longer meet criteria for me to perform or treat. It now is in the hands of the medical examiner, or funeral home. The family, is now my patient, and I will give empathetic, emotional support and perform as a professional as a health care provider.

You may not care about the costs, the outcome, and again I ask who are you really doing this for.....?

R/r 911

[whit72]

Yeah I have no experience with arrests none. I have probably worked or been a part of working hundreds of codes. I dont know where you work but here I have protocols that simply state we work arrests unless obvious signs are present. Do I agree with it not always, Do I whine about it sometimes. Trust me I dont go out of my way to work pts. that are dead if there are signs of lividity injuries not consistent with life etc.. We dont work them thats fine. If there are not they get worked. Its not a problem for me to work someone, get to the hospital and have somone call it. Thats fine, thats my job, until it changes thats how it works. And as far as saying I work arrests for my benefit, if i didnt do another traumatic arrest in my life I wouldnt have a problem with it. As far as not working arrest pts. in the future I ll leave that up to the people with more then a one year class to decide. Its amazing I find so many paramedic experts on this board. When is the last time you had a paramedic as your medical control. there is a reason for that. RYDER I DONT MAKE THE PROTOCOLS I FOLLOW THEM, AND CONTRARY TO YOU OWN BELIEF IM SURE YOU DONT EITHER. No amount of research is going to change that. If you want to change the protocols get on ambulance board or go to medical school or somthing Dont tell me what I should do and not do, thats not for me to decide. ANd until you have an MD after your name you get to make those decisions.

[txemsdoc]

Are you advocating that patients who are in asystole (medical arrest) should not have an attempt at resuscitation by BLS or ALS?

And that bolded sentence is incorrect. A very few number of medical arrests without bystander CPR whose initial rhythm is asystole do respond to resuscitation and do have neurologically intact survival. If I was in my office, I could give you a percentage of my agencies experience. But say it is 2 out of 100.... is that worthwhile to you or not?

Chris

[whit72]

texasemsdoc, I didnt write that ridryder did. He dosent want to provide false hope for family members or run up unnesscary hospital bills. He dosent follow our protocols he has a set all his own, that he works with. and he works on the only ambulance in the country that dosent transport cuts and stubed toes, or non-emergencies, his is strictley used for true mi's. and other critical pts, all others are told to go by other means or told they are tying up the system for true sick people, like pediatric traumatic arrests that he dosent work. Oh yeah also emotion never enters into his work, he is completely above being effected by anything he does or see's.

By the way I dont have any problem with RIDryder,(really I dont) d I dont know the guy or girl and I am sure he is well respected in his field, but new ems professionals do not have the experience nor the knowledge to determine what should be worked and what shouldnt be, to fill their heads with facts like asystole never responds to tx and every arrest pt dies or working arrest pt is a waste of resources is flat wrong. EMS is a prtocol driven field for the simple fact that we dont posses the training needed or carry the equipment to determine what exactley is wrong with people. Thats why we transport to hospitals. Few states license prehospital providers for the fact that cowboys out there will make decisions beyond their scope because they read it in a clinical trial. and yes I am lic. pre hospital provider,and Someone who dosent always agree with the protocols but they do benefit more then they hurt.

[Ridryder 911]

[

Are you advocating that patients who are in asystole (medical arrest) should not have an attempt at resuscitation by BLS or ALS?

And that bolded sentence is incorrect. A very few number of medical arrests without bystander CPR whose initial rhythm is asystole do respond to resuscitation and do have neurologically intact survival. If I was in my office, I could give you a percentage of my agencies experience. But say it is 2 out of 100.... is that worthwhile to you or not?

Chris

If the patient has been documented having no resuscitation measures prior to arrival for an extended period of time or and the patient is confirmed in aystole (2 leads or more) or if the patient does not respond to ALS intervention, then yes!

Field termination or cessation is not new! This has been presented for several years even by the AHA/ECC and much emphasis in the development of sounded protocols for such. If it was only 2/100 it would be different. How much resuscitation efforts is made after a patient arrives in ER, when that patient has been in sustained aystole? There is no change in treatment and usually outcome.

As far as writing protocols, yes, actually I do write some of the protocols. We have committees with the medical control (physician) directly involved. He expects us to investigate, research, and validate such protocols. He definitely does not want "trained" followers, to just follow the steps. If this was the case protocols would never be challenged or changed for the needs of the medical community. This should be a team effort, with them as the captain or leader. He prefers not to have cookbook medics, and for us to use educated rationale judgement and decisions. He is quite aware, that protocols should be suggested guidelines only, and that each situation is unique. To be able to perform the needed care or to consult him when and if needed. Involvement of the medics of knowing why, how, and limitations are important. This should to be a team approach, not just "do as I say".

Again, we go back to education .. if everyone was properly educated NOT trained, then they could develop a more proper understanding on why certain resuscitation efforts are futile, and when they are not. Clinical exposure ( more than a couple hundred hours, and true in-depth education of emergency care is essential.

R/r 911

[whit72]

Whatever man I feel like im chasing my tail here. You either do or you dont work them which is it.

[Dustdevil]

Whatever man I feel like im chasing my tail here. You either do or you dont work them which is it.

Whatever his answer is, I am confident that it is the result of competent and educated clinical judgement, not what some cookbook tells him to do.

[whit72]

by cookbook you mean protocols? They are there for a reason, just like you as and RN dont make decisions without a doctors orders, or your standing protocols, If we didnt have a set guideline to follow we would have people running around doing whatever they wanted to. Lets face you and rid are the exception to the rule not the norm. We cant assume all paramedics and emt's have competent and educated clinical judgement.

[JakeEMTP]

We cant assume all paramedics and emt's have competent and educated clinical judgement.

But we should be able too. That is the whole point of the many, many discussions we have had here regarding education. Higher education = better providers.

[whit72]

Why would you think that. half the population is retarded they have to work somewhere why would EMs be any different.