What constitutes a SAVE

[spenac]

To be a save got to be leaves hospital basically intact.

But I've had some old medics tell me if you take credit for saves you've got to take blame for the deaths, just food for thought.

Never had someone leave hospital alive after cpr, but here with extended response times and no one doing cpr prior to arrival actually don't do cpr very often. I have only came up on one scene where cpr was in progress, patient had obvious signs of death so took a moment to correct law enforcements cpr and show them how to use their AED, then called it, patient had been down at least 20 minutes prior to law enforcement starting cpr.

[FormerEMSLT297]

22 + years in EMS,,, worked in NYC and several other counties around nyc,, now in MD,,, had hundreds of codes, had several true saves,, by which i mean survive to Discharge from hospital...

I had one save where the patient was V-fib,, shcoked a bunch of times and by the time we were wheeling into the ER, the patient was trying to pull out her E.T. tube. (THATS what I call a save)

Unfortunatly my agency defined a "save" as return of pulses,,,,, which often meant the patient was in the CCU on a vent and unconcsious... ( I really dont consider that a "save")

I think I can stated with a reasonable degree of certainty that if you dont get a return of pulses pre-hospitally you aint goin' to get it.

Except for those hypothermic patients and some other rare exceptions..

[Chief1C]

Patient can leave the hospital, and live a life free of having to be bed ridden or attached to some machine. Complicated, but basically, has a quality of life similar to what they had before the illness or injury.

I'd be satisfied if the patient had one last chance to say good bye to their family, to give them some closure.

[VentMedic]

I remember my first "save" many years ago. Through the years and countless bodies later, I have begun to look at "save" from a different angle. This also comes after working at an RT in "vent farms" which can range in size from 20 pt to 200 beds. Chronic ventilator pts literally fill hospitals that were once acute care but closed and sold to large Vent rehab companies. Unfortunately most pts are not to be rehabilitated. These places can make the old movie "COMA" look like a Disney G-rated flick. And then we have the ones that are now all pediatric...includes some of those "NEAR-drownings". I only call something NEAR when the child spits out the water and jumps back into the pool. And of course after countless codes where we went against the patient's wishes to appease the family. Heaven forbid on those terminally ill pts we would be successful enough to keep them alive on the ventilator for another day. I had one young medic tell me if it was more than 24 hours post code, it was a "save" according to the rules. I spared his life at that moment and that too should be considered a "save".

I now think of a save when I get a young couple to quit smoking for the sake of their new born preemie. Or, turning around an old COPDer by pulm rehab before they literally buy a vent. Or, get the pt to the cath lab before more myocardium is damaged. Or, the CVA pt treatment quick enough to have little or no permanent damage. Or, see someone come back from a traumatic brain injury. Or see someone who has lost some body part and still achieves their dream. Or, see a person whose severed hand is reattached successfully with >90% function return.

No matter how good our medicine is both outside and inside of the hospital, the outcome is still unpredictable and probably not always ours to question why....

[Just Plain Ruff]

wow what an incredible post. I've always thought that by doing what you said, keeping someone from smoking or everything else you said that I was doing something right but never thought about it in terms of a Save.

That's food for thought and also great thinking outside the box.

Vent, if you are interested in writing pm me and I'll talk to you about a proposition.

[spenac]

Vent like your post. We should focus on educating the public and maybe all of us will have saves that we will never know about.

[tniuqs]

Well interesting comments by all, but I have a bit of a different perspective, can you call a save doing monkey skills as in CPR, shoot a tube, bang a line in, push a preloaded drug according to a cook book ? Can not any Paramedic can do these things what is it that makes a Save to me means much more, perhaps a bit harsher view than most on this board.

So I submit this perspective for your review;

Preemptive treatment with a patient that ultimately WILL arrest, Yes the that BiPap (asthmatic or COPDer) applied and coached cheating that tube and vent, the Lasix for that Pulmonary Oedema, that RSI in the 13 y/o head injured patient that siezes and posture's on take off (and discharged to go back and play hockey the next season) and on to all your specific calls not just the V-Fib patient or CPR on arrival.

Vent Medic and I share a different point of view...yes the Vent farms, I bet my bottom dollar that because one single RT that decided that "This" one patient would NOT be allowed to give up and 5 months later decannulates that Trach...was it the Paramedic that saved that patient...maybe partly. We forget all of the others that make a huge difference to those potential patient's and their discharge to door, sometimes this proffession gets a very narrow view, we are just part of the team NOT the whole Team.

These as are many other situations could be considered saves (if there really is such a thing in the first place) I am of the opinion that the choices that were made at that critical time because it was Me that made that choice, to run with it or stay and make that difference. Now, my experiance in the "early days" was single Paramedic, single Pilot and NOT short distances and even sometimes with 2 patients, one trying to deliver and one with a real funky rhythm, these were the times (with no other support) that I made a postive diffence to an outcome...or the proverbial save. After all there really is no hard and fast line in the sand.....really is there?

cheers just my 2 cents CND.

[tniuqs]

wow what an incredible post. I've always thought that by doing what you said, keeping someone from smoking or everything else you said that I was doing something right but never thought about it in terms of a Save.

That's food for thought and also great thinking outside the box.

Vent, if you are interested in writing pm me and I'll talk to you about a proposition.

Oh yea, pick Vent guy....3 minutes late and one time zone away plus my 'hunt and peck' tecknique.

I don't a proposal to get run naked and drunk through the field of dreams...... foiled again!

Its that Canadian thing isnt it...LOL... Ruffems.

cheers

[VentMedic]

You are right tniuqs about the Paramedic's "save" that may have initiated this circle of life. Yes, some pts may advance to just a trach unit, then to a SNF and then to a nursing home. If the pt is mentally intact and has good family support they may go home with their ventilator. I would say that the way the pt responds to his new accessories would determine the quality of the save. If it gives the pt more time to say good bye or get his affairs in order, even better. That in itself can be worth it.

Of course, there are still all the patients back on the "farm". No disrepect intended to these individuals who now totally dependent on life support.

It is also interesting as to how differently some Paramedics/EMTs respond when they are called to transport a trach pt to a SNF. They're not always thinking this was someone's "save" but rather "nursing home call".

Just flipping the coin back at ya tniuqs Thanks for the good post for more thought

[Laura Anne]

I'd have to say my most memorable 'save'....actually my only one..... :roll: ......was approx a few months ago. 41yr old female with a bad family history but no history herself. Got called to her home where we found her sitting on a chair in the living room with a beer can next ot her. The look on her face and the statement, "I am going to die" made me move pretty damn fast! From dispatch to arrival at ER, the call took approx 11minutes. En route, I had to calm her down and told her to trust me. She asked me if she was going to die and I said, 'not on my truck'. Once at the ER, the patient went into V-fib after a few couplets. She was defibed 3 times before we got her back.

NOW.....the odd thing was the ER MD was talking to her when she went into arrest. An RN and I started CPR and she was conscious and telling us to get off her cause we were hurting her when we pushed on her chest. Both the RN and I jumped back, thinking "OH MY GOD" a wire was loose and we did CPR on a woman who had a stable rhythm.... nope. Our CPR was keeping her blood circulating enough that she was talking to us. When we stopped, she'd start to go unconcscious again. WEIRDEST THING I EVER SAW. Has anyone else ever experienced this??

OK, back on track....she ended up getting stablized in the ER and went up to the cath lab where two stents were placed in her and she made a full recovery. This was I guess the closest thing to save I have had. :shock: