Transport Ventilators usage for 911 response

[FireEMT2009]

I have been thinking about the usage of transport ventilators in 911 response. Not just for the normal vent patients but for patients that are intubated in the field, using them to free up manpower to help with critical patients instead of keeping someone constantly bagging the patient. (Of course this would fall under the proper traning for usage, maintanence, pathophys, etc.)

My theory is that it might help free an extra set of hands in the back of a truck and allow the ALS provider to use his BLS/ALS partner in another part of patient care while the ventilator does the ventilations, while under constant capnography, SpO2, etc. monitoring to ensure effectiveness of ventilations.

I am just curious on what ya'll's thinking is on this topic. All opinions and advice are welcome. I am excited to see where this thread will lead and what new ideas, or education will come out of it.

FireEMT2009

[Kiwiology]

Sounds great, would prevent dyscarboxaemia through hypo/hyperventilation which is potentially disastrous and extremely bad for the injured brain and an asthmatic patient

[FireEMT2009]

Yea that is one of the big pluses that I was thinking of when I had the theory hit me, especially when you get someone bagging with a critical patient that gets caught up in the action taking place or gets anxious and looses rhythm and rate of his ventilations.

Anything else you would like to add Kiwi?

[Kiwiology]

Anything else you would like to add Kiwi?

Only that I am totally, without fail, the most awesome person in the entire world up in the right now

Not really ....

[systemet]

I am just curious on what ya'll's thinking is on this topic. All opinions and advice are welcome. I am excited to see where this thread will lead and what new ideas, or education will come out of it.

I think it's a good idea --- but I also think that most of us lack a really solid background in ventilator management. If you just throw in a cheap volume-cycled CMV ventilator where you just set a minute volume and a respiratory rate, the thing's going to alarm off half the time, not really be useful on a lot of sick patients, and perhaps cause as many problems as it solves, especially in inexperienced hands.

My knowledge in this area is pretty weak, but I bet someone like chbare would have some good input.

[Bieber]

I think it would be great, but I see two primary obstacles standing in the way of it:

Cost: I'm not sure how much a ventilator costs, but I know it's obviously enough to be prohibitive to many services--especially those with large fleets.

Knowledge: This is a secondary obstacle, because I firmly believe that EMT's and paramedics are capable of acquiring and correctly applying any new subset of knowledge and skill with the right education and training, however it ties into my first point in that it is costly to provide the right amount of education and knowledge to that many individuals. The other thing is the need for it to be done routinely so that we don't forget how to do it. I remember going over ventilators during paramedic school and playing with several different models of them and learning a lot about how to properly use one. Could I use a ventilator now? Not a chance.

[Vorenus]

It`s really not that big science to operate an emergency respirator. It`s only more accurate than constant bagging, and it`s easier to acchieve the sought oxygen to be transported into the pat. It`s really just like bagging a patient, you also have to be concerned about volume, frequency, pressure - but it`s much harder if done manually with a floppy bag device - so I can`t really see why so many of you seem to be that honour-struck towards a respirator (as I´ve read before).

Now, with one of those fancy, huge ICU vents with the many buttons - that`s obviously a different story.

Around here, anyone has (must have) an emergency respirator on the rig. We`ll get a new Medumat Transport (digital display an all, but weighs like a ton) in a few months.

Edited May 30, 2012 by Vorenus

[chbare]

I prefer the term ventilator over respirator. Unfortunately, it is quite easy to screw a person up on a ventilator. The science of ventilator management is quite complex and if you've never been through a rigorous course on ventilator management, it's truly difficult to understand what I mean. This also includes transport ventilators. Transport ventilators are becoming quite complex and many services are using graphics packages.

[Bernhard]

I'm with Vorenus: german ALS units usually have automatic transport respirators on board and it's common to use them on intubated patients. It's no big hassle for the transport time we usually expect (<1h), makes hands free and provides continous ventilation at desired rate without getting tired. Known brands here are "Weinmann Medumat" and "Dräger Oxylog".

Only correction to Vorenus' posting: it's not a "must have", european standard EN1789 doesn't require an automatic transport respirator on ambulances (and the old german standard before 1999 didn't as well), but somehow they are available since I could think EMS-wise...

On ICU units there are far more advanced respirators needing more knowledge about intensive care ventilation, since the patients often have specific parameter settings which should be continued on transport. That's not an issue in normal ALS emergency respiration.

[Vorenus]

Only correction to Vorenus' posting: it's not a "must have", european standard EN1789 doesn't require an automatic transport respirator on ambulances (and the old german standard before 1999 didn't as well), but somehow they are available since I could think EMS-wise...

I just had a quick look around the internet, but couldn`t find the whole DIN EN 1789 sheet - but every site I searched mentioned an emergency vent with PEEP on its list for rigs that apply to DIN EN 1789 Typ C (or did you mean it`s not generally necessary, only with Type C rigs?).

EDIT: Btw, it`s not only about getting your hands free (although that is comfortable) - it`s really difficult to keep a steady rate of ventilations when only bagging, especially while moving the pat. around, as well as it`s hard to keep up a continuos pressure level.

Edited May 30, 2012 by Vorenus