Robbyemt

To get your panties in an uproar over the ER staff's rate of compressions is a moot point. If you delivered your pulseless/apnic pt to the ER, chances are they are already dead and nothing they or you do is going to change that. FACT: a human performing chest compressions is only about 20% effective at best. Secondly, even with the best compressions, you cannot create the negative pressure to effectively circulate oxygen to the brian. The bottom line is, if your doing manuel compressions for more than a half hour, you have a brain dead pt. (normal core temp) So if it makes you feel good, NICE JOB!! But you really are just going through the motions until someone has the brains to call it. The only good outcome would/could be some organs that have been perfused enough for transplant. That being said, our entire fleet has these chest compression machines called the "Auto Pulse". It is a device that Zoll has bought the patent on and is available for about $17000 per unit. The compressions delivered by these units are second to only a strong healthy heartbeat. I have personally used the device on almost a dozen pts and had some code saves with no brain injury what-so-ever. Some of these arrests have been as long and longer than an hour. I am not going to toot my own horn as to how long I've been doing this or how great our company is because it just doesn't matter. Until these devices become standard of care, you will continue to bring dead bodies to the ER. So the next time some over zealous nurse jumps in and takes over compressions, just let them think they're dong a great job and leave it at that. You and everyone involved will all be better for it. Rob NYSEMT-P

New York State's Vehicle and Traffic Law #1104. operate your vehicle with "due regard" for any and all other traffic on the roadways. Exactly the reason why it will always be your fault in the event of an accident. We respond HOT to 99% of all our calls only to transport COLD to the ER. We have to honor our contracts which have a 6 minutes response time so HOT it is. We only get downgraded if a chief gets on scene and has enough common sense to do so which is not that often. Even more ridiculous is when we go with one town that has 2 different fire companies and we start COLD, get upgraded to HOT, then get cancelled once their rig responds. This happens on a regular basis so when they upgrade us, nobody bothers turning on the lights because we know what's going to happen. Like the boy that cried wolf. That's the politics of EMS at work. Rob

OK Dirtdevil, Let me shed some light on this and maybe this will clear some of the confusion I started. (Unintentionally)I show up to work in uniform with a better attitude than any person you ever knew or know. I have over 15 years in EMS and more in the fire service. When people get relief from me or relieve me, they know what I expect from the condition of the truck to the conditions of quarters. As far as taking calls, my reputation speaks for itself. If I'm in the field or at an ER, I'm asked to assist in many situations that need an experienced and confident professional. Whether it's from a fellow worker, a custodian, a nurse or an MD. It may be with something as simple as finding a linen cart or getting an IV or somethng as difficult as an intubation. That being said, I don't always re-read what I post because I TYPE fast (can't you tell?) and I am quite a busy guy. It seems most of you DID take my post from a different perspective or just the wrong context. The others that jumped on that bandwagon just might not have an open mind either. With that information you can clearly understand that with my first pt, not only did we make a difference, we almost brought the guy back. There were others on scene that attempted intubation and other skills that were successfully done by me and my partner. The accolades were many from all involved. BUT that's my job and that's what I do. The second call for the OD again, was handled with the upmost professionalism and respect for a POS abuser of the system that doesn't know if Batman and the Boy Wonder took her to the ER or Jesus himself. BUT, that's my job and that's what I do. Lastly, the 2 poor soles that consciously chose to drive in a reckless manner, under the influence, on a winding road that would not support speeds of which they were attempting to accomplish, were DRT. It didn't matter who showed up, other than Jesus himself, or how professional or with whatever attitude, no difference was made. However, I did go out of my way to make sure that anyone that didn't need to see such horror,was kept from the scene. A camera man from 200 yards away could not be stopped nor did I know he existed. Oh, last to lastly, the DOA we took after that was just that. Once again, it really didn't matter to that pt what attitude or how clean shaven I was. Because (you guessed it) THAT'S MY JOB AND THAT'S WHAT I DO. Rob Good day now.....I love Willie Wonka

You obviously have some issues.....how do you interpret my post as "whining"??? I thought it was a good shift. The point was exactly that Genius! Your not going to make a difference everytime you take a call. Rob

Well for those of us who want to make a difference every shift/tour, this deffinitely wasn't one for the books. We started off with a trouble breathing that upon arrival update was "fire is working a code". WTF! Who was on the other end of that phone call....the 80 year old wife. She wasn't even near the guy. She was kinda watching him from accross the room and luckily had a phone near her. All went well and we actually got pulses back for almost 2 hours. The guy had a poor EF (25%) so he wasn't long for the world anyway. We also have the Auto Pulse form Zoll. If anyone hasn't seen these things, you might want to look into them. They work awesome and I highly reccomend using them. Those of you "old school" people that think your compressions are as good as any machine, are absolutely in denial. We would leave the thing running and the guy was moving with eye movement and breathing on his own. Once we would shut it off, the guy woud go in the toilet. It was working like an LVAD. They tried doing manual compressions but they just didn't compare. The unit lasted almost 2 hours with same battery, which I was really surprised at. He eventually succomed. Second call was OD that bought a room at CPEP in the county ER. After trying to settle down for a little nap, we got banged out for an MVC/rollover. Now, we go second unit in because the "dingers" have it set up so if they don't want to be bothered with transport, they turf it off to us. YES, you guessed it, this was a "glory call" so they were out in full force. Funny thing is, they never cancelled us because we weren't sure how many patients we had. Upon arrival we see one vehicle on its roof and first on scene is giving conflicting reports as to number of victims. As you may noticed, I changed from patients to victims. We had one body still belted and mostly concealed in the wreckage but their head was exposed as well as part of an arm. There was significant trauma to the skull with open fracture and a good portion of fluid was draining. You didn't have to look hard to notice some pasta looking material kinda splattered on the portion of the collasped roof that was next to the head. As I climbed under to check for pulses, which I was pretty sure there wasn't a chance, I could look through the car at a tunnel which was formed from them striking the pole roof first. This was absolutely amazing. The roof collasped down on the occupants and completely separated the interior of the car into to separate cavities. I explained this to the fireman that this was no accident or should I say, this was an act of stupidity gone horribly wrong. Looking over the rest of the scene/car, we had a compound fractured forearm exposed with a hand dangling from another location on the opposite side of the car. At this point you couldn't see any other part of a body and you couldn't tell if this belonged to the other occupant or if this was a second victim. I used my CSI experience and determined that we had two diffent colors of nail polish and they didn't match. Victim number 2 had a warmer extremity but no pulses. The fire department was setting up for extrication but I knew we weren't transporting anybody...or any bodies. After about 20 minutes they popped both doors and we exposed a cavity that encapsullated a body that had it's life come to a horrible end. Severe head trauma to corresponding side of where the roof got displaced and multiple angulated fractures to every extremity with a rotated pelvis. This was our priority victim and they were no better off than victim number 1. Both victims were left on scene for medical examiner and we got out of there in less than an hour. I find no reason to hang around on these scenes. Get your ass back in service so your cover cars can get back to their perspective posts. Two hours later we got another call for the "unresponsive with pre-arrival instructions being given". You have to love the dingers that will do CPR on a washed up piece of driftwood. Come on poeple!! When were they last seen? Body warm or cold ? If they're warm, can you open the jaw? I don't expect the vollies to be that in depth but if you don't check these things you really aren't doing your job. 4 of 5 patients deceased. What a shift so far. We ended up taking another transport for 10 day long "illin". I had my partner babysit that one and I was 10 and 2. As fast as the shift went, it wasn't very rewarding to say the least. We did make it on the local news coverage because one of the dingers let the news through the road block. They actually had footage of the extricatoin which was not supposed to happen. Somebody got their ass chewed off for that. Well that ended my tour and we had to get right back at it in 12 hours. Don't anyone worry about me or say they're sorry...I don't get that. Why do people that have nothing to do with a situation, appologize for it???? Life goes on and we just fix what we can and thank people for their stupidity. Afterall, That's our job security isn't it?? Have a good day and stay safe out here. Rob

I'm in Western NY and we still have them on our rigs but I think they took them out of our protocos. Good question ... I will look into it. Now to answer question about using them... I have used them on a trauma/ejection/rollover pt that had multiple fractures and low BP. They worked great. The discussions flip flop whether or not you are causing an excellerated compartment syndrome and doing more harm than good. Secondly, you don't want to overload these patients with fluids either. Optimally you would like to have whole blood for replacement therapy but now we're going to a whole new level or care. Rob I was watching a old Squad 51 (Emergency), and they put mast pants on a patient for unstable BP with hip trauma. In Michigan we dont carry them any more. anyone still carry them/ have it in your protocols. Just wondering?