What constitutes a SAVE

[Just Plain Ruff]

this is in direct response to a current thread that is going on regarding Cardiac Arrest Saves.

I'd like to see what everyone classifies as a save. I don't want to skew the replies any which way so I'm going to hold off on putting my definition of a SAVE out there till this gets a few replies.

I'm curious as to how my definition differs from the group.

I know this will come off as crazy but I'd also like for those who respond to put in their years of experience in healthcare in their response as well as the number of calls that your service runs each year.

This is in no way to downplay experience but it will give me and the group a little better understanding of where everyone is coming from.

Also include the number of SAVES that you consider as a SAVE.

I will post that now - I have been a part of 2 SAVES that fit my definition.

If you don't want to put your level of experience down that's fine but I'd like to get a good demographic. One other reason that I'm asking for level of experience and also System volume in order to have some good material for a journal article I'm going to write.

If this degenerates into a name calling nasty fest I'll ask the administrator to lock this topic. Please keep this civil. NO DISCOUNTING ANYONE ON THIS THREAD.

Thanks for the responses

[Pro_EMT]

I have heard of two deffinitions of a CPR save. Dont quote me on exact details. My squad adopts the Techinical CPR save deffinitions.

Technical CPR Save: Is CPR done in the pre-hospital environment. Were the patiant regains a pulse and can obtain a blood pressure by the time of ED arrival. The pt. has to also make it to be discharged out the the Emergency department whether to ICU, discharged or etc.

Real CPR Save: Pt. dead, CPR started Pt. some how makes discharge from hospital and continues a healthy and normal life.

[Medic2891]

I am of the opinion that a CPR save is one that leaves the hospital and has some type of regular life afterwards. I have been in EMS for 14 years and this has been the general definition that I have always followed. In my time as an EMT and then a Paramedic I think I have only 3 saves that meet this definition and of those one of them is actually a trauma code. I can try to give you more info if you would like, just let me know. [/font:349938f4f8]

[Ridryder 911]

In my definition and many others is defined as one has brain function and mobility equal to what they had prior to cardiac arrest. If one "regains a pulse" and never leave the hospital or remains in vegetative state is defined as a successful resuscitation, not a "save".

I have had maybe a thousand or more "successful resuscitations", however; saves probably less than 200 in thirty years. About the average of 10% or less of cardiac arrest.

R/r 911

[p3medic]

A save to me is a patient who leaves the hospital under their own power, neurologically intact, or with only slight deficit....I don't know how many i have had in my career, but I do know of 4 last year for sure.....

[Just Plain Ruff]

Ok, the responses pretty much speak for themselves.

My definition is one who leaves the hospital with nearly the same or the same neuro function and level of function in society that they had prior to the event.

I have worked over 100-120 cardiac arrest patients but only about 12-15 of them were fully resuscitated and survived to discharge and went on to lead relatively normal lives.

My experience is 15 years in EMS with most of those in rural areas where average travel times to scenes average around 15-20 minutes. Not many arrest patients get worked at those times unless someone is already doing cpr on them when we get there. Most we call on scene.

Those that I can remember were either in a urban environment or were witnessed arrests that were resuscitated immediately with defibrillation and pulses returned post shock.

The others that I can remember were 6 ped codes, 3 of which were cold water drownings and 2 were overdoses. The other was just found down. Kids have a little better survival rate I have found. They are so resiliant.

The numbers above do not count my codes that were in the ER and I was taking care of them.

I find that my save numbers mimic the general population. I can only really remember the names and faces of 4 of the people I've 'SAVED".

I'll pose another question to the group

How many of the codes you work do you work irregardless of how long they've been down? What I'm asking is that some of the new medics that I've been around have said no matter how long the down time I'm gonna work em. I argue the fact of long transport times and long drive to scene times but they argue that their instructor or someone told them about a fantastic down time that was resuscitated back to life so they are gonna work em. So what do you use as a guide on when not to initiate resuscitative efforts? How many minutes of down time do you give them before you decide not to work em?

[Medic2891]

Quite the interesting question you pose. For me, I would have to say that the determining time limit is different with patient history. Someone over 65 with a long history, and found with a 5-10 minute down time with no CPR or BLS only I might call right away if found in Asystole. Someone younger say 55 and under with little to no history and I might work someone with a 15-20 minute down time.

So unfortunately, I would have to say that this is a loaded question, and the answers will differ. But I would guess that the consensus might be similar to mine.

[Just Plain Ruff]

Yes the question is loaded but it's not a trick question.

Our standard was that if there was greater than a 10 minute drive to the scene and no cpr was in progress on arrival we'd do a quick look and if asystole one crew would call the ER doc and explain the situation and see if he wanted the code to be worked. Usually with a downtime of 10 minutes or greater(that's just drive time to the scene - it didn't constitute actual down time prior to our arrival) then we'd probably do one round of ACLS and then relay to the doc the results and more than likely we'd cease efforts.

All bets are off with peds, young adults, drownings or overdoses. Other kinds also. It was a presentation and history, and pt. response to acls driven. But if the patient is 85 years old and has a cardiac history with a 10 minute down time they usually only got 1 round of acls and then field cessation. sometimes 2 rounds.

If the drive time was greater than 30 minutes which many times it was then if they were in asystole they were not worked unless the extenuating circumstances in previous sentence were present.

[Ridryder 911]

I usually look the circumstances too. Dependent on hx. and actual documentation time of confirmed being down. I might add sometimes, it is dependent on the situation of outside factors of family, crowd, and special circumstances. It is hard to "flag" someone, with 30 angry family members in the "wrong side of town".

We are revising our protocols make them more liberal and user friendly. With multiple options, dependent on the medic discretion. Usually, documented and confirmed time >10-15 minutes in aystole we can declare, or special circumstances (where the medic perceives any resuscitation is futile)we can get a verbal DNR if the patient is aystole or agonal rhythm. This is becoming more routine even on shorter responses and those with an outstanding medical history or aggravating factors.

R/r 911

[paramedicmike]

As has been said, the only save that counts, the only save you can count, is one where the patient walks out of the hospital neurologically intact. You can't count anything else as nothing else counts as a save.

In all my years in EMS, I have never had a save. So don't die around me...you might not come back!

As for the decision to work a code, as has been mentioned, it's totally situationally dependent. I have made the decision to not work codes based on history and presentation. I have made the decision to work codes because if I didn't I'd be the victim of some mob lynching.

-be safe