Needing fire on a cardiac arrest

[crazyemt5150]

It is damn near impossible to provide effective chest compressions in a moving ambulance, no matter how many fire fighters you take with you. The way to resucitate someone is to do it at the scene. The patient shouldn't be moved until you have ROSC. If you are under protocol that you MUST transport, then spend 30 minutes on scene. If you don't have ROSC in that time, you never will, and you can move the patient to the ambulance and drive safely to the hospital with as poor CPR as you like because it won't make a difference, but dragging a corpse to the truck and beating feet, trying to run a code in a moving ambulance is ineffective at best.

Ok so answer me this!! So if doing cpr while transporting is so ineffective then how come there are so many times and so many stories of people getting pulses back during transport. That right there sounds to me like effective Cpr. If it wasn't effective I don't think they would of got pulses back

[WolfmanHarris]

Were they running the arrest on scene, shocked a V-fib or V-tach that converted into NSR but wasn't perfusing? Were there compressions bringing up rate and pressure so that they were perfusing again?

Anecdotal evidence is meaningless in the big picture and keeps us stuck on doing something the old way because we've seen it work once or twice.

But I think they point you're missing is that in this big picture, these patients stay dead and that by transporting them doing crappy CPR in the back we're not only not going to change that, but we're more likely to kill ourselves or others in an MVC en route than we are to change their outcome.

[crazyemt5150]

Were they running the arrest on scene, shocked a V-fib or V-tach that converted into NSR but wasn't perfusing? Were there compressions bringing up rate and pressure so that they were perfusing again?

Anecdotal evidence is meaningless in the big picture and keeps us stuck on doing something the old way because we've seen it work once or twice.

But I think they point you're missing is that in this big picture, these patients stay dead and that by transporting them doing crappy CPR in the back we're not only not going to change that, but we're more likely to kill ourselves or others in an MVC en route than we are to change their outcome.

I don't think its crappy cpr. I do think that if it was crappy cpr there would be protocol clearly stating to not do cpr during transport. I also believe that the american heart association who makes the CPR regulations would also state DON"T DO IT

[akroeze]

I don't think its crappy cpr. I do think that if it was crappy cpr there would be protocol clearly stating to not do cpr during transport. I also believe that the american heart association who makes the CPR regulations would also state DON"T DO IT

They DO say that! (Bolding mine)

http://circ.ahajournals.org/cgi/content/fu...2/24_suppl/IV-6

Transport of Patients in Cardiac Arrest

If an EMS system does not allow nonphysicians to pronounce death and stop resuscitative efforts, personnel may be forced to transport to the hospital a deceased victim of cardiac arrest who proved to be refractory to proper BLS/ACLS care. Such an action is unethical.

This situation creates the following dilemma: if carefully executed BLS and ACLS treatment protocols fail in the out-of-hospital setting, then how could the same treatment succeed in the emergency department? A number of studies have consistently observed that <1% of patients transported with continuing CPR survive to hospital discharge.

Delayed or token efforts, a so-called "slow-code" (knowingly providing ineffective resuscitation), that appear to provide CPR and ACLS are inappropriate. This practice compromises the ethical integrity of healthcare providers and undermines the physician-patient/nurse-patient relationship.

Many EMS systems authorize the termination of a resuscitation attempt in the out-of-hospital setting. Protocols for pronouncement of death and appropriate transport of the body by non-EMS vehicles should be established. EMS personnel must be trained to focus on dealing sensitively with family and friends.

[p3medic]

Ok so answer me this!! So if doing cpr while transporting is so ineffective then how come there are so many times and so many stories of people getting pulses back during transport. That right there sounds to me like effective Cpr. If it wasn't effective I don't think they would of got pulses back

[crotchitymedic1986]

P3, I think you can make an arguement about quality CPR at the scene and enroute to the hospital, as it is variable to the person(s) performing it. I think the greater point is that if you do not convert them immediately, any conversion you get later, will probably not result in a viable patient being discharged from the hospital (unless it is a cold water drowning).

If it was witnessed, and you had immediate bystander CPR, and you want to continue the code, so be it. I think statistically it is a waste of time, but alot of things we do in ems are a statistically a waste of time.

[spenac]

I think statistically it is a waste of time, but alot of things we do in ems are a statistically a waste of time.

Arguing between crotch and spenac is statistically a waste of time. At least thats what 86.47302% of 0.026738% of EMTCITY readers think.

[Dustdevil]

The sad truth is that a lot of these futile runs to the ER are taken only because a whacker crew refuses to be cheated out of a chance to run code 3. It's kind of the reverse of the firemonkey phenomenon, where they pronounce living patients only because they refuse to be cheated out of an hour of time in their recliner chair.

[iMac]

You have to remember that not all services have ALS nearby. If there are no sign of rigor, pooling or others obvious signs of death as per the local protocols I worked at, you CANNOT stop. The closest hospital was 40 mins away on the best of days so was ALS. ALS then go their 20 mins to change things around before finally deciding whether or not it was it. But as far as my level of training goes, I worked it until we got at the hospital.

As for fire help, I agree that you can do without BUT why not use them if they are there? Extra hands to do compressions, vent, lift. By all means as far as I'm concerned they can go at it I have no problems with it. Sure another thread could be started about the costs of using them on calls where we could do without etc, etc. I have only worked 1 code where it was just me and my partner and even tho we managed, extra hands would have been used.

[stcommodore]

In those "no als, long transport" situations PA protocals have a section that cover even this. It says something to the effect of if the AED continues to suggest "no shock advised" and you've done x rounds of BCLS then contact command for field termination.

On the other part of the topic, you really need more then 2 providers to work a cardiac arrest correctly. We know the current protocals call for the person doing compressions to be rotated often so its impossible for two people to do everything necessary in a Code and rotation doing CPR. In my county ems and city ems expierence we get support by either another squad, Engine Company, or both on a cardiac arrest.