how long is too long

[whit72]

Vs-er wrote:

whit72 - I hope your service (you work in Boston?) does not respond to scene or return to hospital L+S for all patients. I kind of get that impression from your post. I also hope that your service does not transport/work obviously dead patients, SIDS or anywise to an ER.

I work on the outskirts of Boston. Not Boston EMS. As far as responding to to the hospital its on a case by case basis.

Yes we work obviously dead pts. I particularly enjoy the ones that are decapitated. No I like the ones that when you pull them out of the chair they stay in the chair position. Those are always fun and interesting codes to work. Come on man......

However if care is initiated on a cardiac arrest pt (without obvious signs) that care is continued to the hospital.

[Just Plain Ruff]

I agree, every ped code unless they were obviously dead, I've worked to the hospital. L&S yes.

[vs-eh?]

However if care is initiated on a cardiac arrest pt (without obvious signs) that care is continued to the hospital.

So you always transport medical adult cardiac arrests, regardless of anything (obvious death aside) as an ALS provider? Do you always transport traumatic arrests?

85 year old, unwitnessed arrest (but not with "obviously dead signs"), asystolic, intubated, IV, 3 rounds with no change, 20 mins of ACLS done. You still transport this patient in your service?

Seems kind of antiquated if you ask me.

Your physicians must have very little trust in their paramedics.

[whit72]

I don't make the rules.

[paramedicmike]

So is that what you're saying? You don't make the rules so you transport *everything*?

-be safe

[whit72]

I transport calls for service. If they called they go, whatever my opinion of their injury or illness is. I don't attempt to talk people out of transport to the hospital, I don't point out other possible means of transportation. They called they want to go with us they go.

We transport arrest pts. that care is initiated.

People on this board whine, cry and complain about the education standards of EMS personnel. Then you expect a medical control physician to just take your word for it. I don't think so.

It has nothing to do with trusting your providers. What it has to do with is a MD giving you the OK to cease resuscitation efforts, and opening his hospital, the ambulance service, and himself to possible litigation.

We live in a sue happy era. When you can order a hot coffee, spill it on yourself, then sue and win, because the hot coffee you ordered was to hot.

Do I agree with transporting every arrest pt(without obvious signs)we encounter. No. Do I understand the reasoning behind it? Yes.

If you don't have to transport arrest pts. that don't respond to treatment. Thats fine. Good for you.

I have to transport arrest pts when care is initiated.

[Ridryder 911]

We understand that Whit, I would hope EMS would have at attempt to "inform"and "educate" patients of what warrants the need of transportation of EMS and what does not as well.

Yes, a lot of the cardiac arrest maybe transported and hopefully more and more EMS will have DNR after failed attempts of resuscitation efforts. Personally and even scientifically there is no difference in performing a "code" in the field, than in an ER room. Actually. resuscitation efforts in hospitals have a lower success rate. So time is irrelevant.

R/r 911

[akroeze]

I don't make the rules.

But do you try to get them changed?

[brock8024]

This interesting to see how people feel about this. The two services I have worked for we transported everything unless they had all the signs of death. I know in the area I live that the paramedics at one service can call arrest at the scene but they have a protocol to go by. Pretty much the pt has to be in asytole for 30 mins of ACLS care. There has to be a ETT in place, can not be any other airway. You also have to have a IV either canula or IO. If at anytime you shock the pt they get transported. If the family wants them transported then they are. If it is out in public then they get transported. I think it works well.

As far as a baby or a kid goes, I agree with others on here. Yes emotions play a role in what we do sometimes, but if it was a termly ill kid with no DNR then I would be more likely to work them at the nursing home or at their home as long as family was ok.

I sometimes think that by transporting we give the family false hope. I mean if they see us taking them they might think oh they are getting better. Or there is another medical bill that did not need to be there. I mean we charge them for the ambulance ride and the hospital charges how much for a code, only to call it 5 mins later. And we knew that was going to happen. So sometimes we do more harm than good.

Brock

[Asysin2leads]

I don't think its strange that the rescue company did not initiate transport prior to contacting telemetry. However, ideally, after spending 20 minutes on scene you should be on the horn with telemetry. Again, that is an ideal situation, and the day I run into a code that is going anywhere close to ideally, I'll be sure to let all of you know. Perhaps this woman was in a megacode situation and went through a bunch of different rhythms while they were on scene. Doctors tend to get annoyed when you call them up saying "Hi, I'm on scene with a 80 year old female in asystol...wait, wait, I mean a ventricular...nope, its ummm a PEA, wait, I mean..." Generally stabilizing the patient's rhythm is necessary before contacting telemetry, and if the patient goes through a couple of different rhythms, you gotta do what you gotta do. 40 minutes does seem excessive prior to telemetry contact, but who knows what happened on scene. Shit happens. Thats why we have EMS.

In regards to transporting, say this question was on the legal/ethics portion of your EMT or Medic test.

TRUE OR FALSE:

It is ethically correct to take a family that has just suffered the loss of a loved one, give them false hope, endanger the crew and the family following you, possibly saddle them with unwieldy ER and ICU bills, and take a limited ALS resource out of service for not only transport but BBP decontamination to transport a non-viable cardiac arrest victim.

A. True.

B. False.

(Hint: Not A)