Needing fire on a cardiac arrest

[Arkymedic]

If it was obvious signs (ie decapitation, shooting, pulseless, apneic, decomp, etc) you did not start working them and called the coroner. If you started working them, you had to transport and work them until it was called. In some places the fight over stopping cpr and pronouncing is one and the same. In one ALS service I worked, we were double medic and were deputy coroners so we could pronounce someone. If it all appeared natural, we filled out the coroner's office report, called the funeral home, and signed the certificate later. If it was suspicious, we called the coroner and death investigator. At another "progressive" service in another state, if the 1st responders started CPR you must continue it until asystole was confirmed then you could stop. We would confirm death and notify LEOs that would in turn call the ME. If we started to work them, then we had to continue to work them and transport. Again, I agree that dead is dead and we should not be transporting without ROSC.

So if you responded to a scene where the patient was decapitated, do you have to work that patient ? Obvious death is obvious death, whether it is a cardiac patient that is not responding to ACLS, or it is a trauma patient that has been squished by an 18-wheeler. If you are in a rural setting, I imagine you probably dont have alot of ambulances to spare, so working a dead body for two hours doesnt make sense. Your Medical Director should be able to write a policy that allows you to stop CPR when it is appropriate to do so. You are not pronouncing them dead (thats the coroners job), you are just using your resources wisely.

[crotchitymedic1986]

ok, if you agree, why are you still transporting dead bodies ? Is there a written law in arkansas that cant be overturned ? Why cant your medical director write you a protocol that allows you to stop CPR after "x" amount of time ?

I am not trying to be confrontational, just trying to understand the situation.

[Arkymedic]

Part of the reason is that we ranked 50/50 in the US for healthcare and nobody real cares to fix that. Part of the reason is that we are about 10-15 years behind the curve and still carry drugs like Mannitol on our truck. Hell, my paramedic refresher application had a spot where the medical director had to sign off that I was certified in skills including MAST trousers. I haven't seen a pair on a truck in this part of AR since I graduated EMT-B in 2001. Part of it may also be the fact that some medical directors do not trust a service to perform skills or is not too impressed with what the service is doing. Most of the doctors are pissed when you bring them in anyway and as to a specific law, I need to do some research and will get back with you shortly.

ok, if you agree, why are you still transporting dead bodies ? Is there a written law in arkansas that cant be overturned ? Why cant your medical director write you a protocol that allows you to stop CPR after "x" amount of time ?

I am not trying to be confrontational, just trying to understand the situation.

[firedoc5]

The problem is that fire medics are more interested in getting back to the lazy boy than providing good medical care.

HHHHmmm, excuse me?

[spenac]

same here Doug. The greatness of rural EMS.

I'm over 90miles to the nearest hospital and have never done a rolling code besides when multiple patients and only did that less than10 minutes as had multiple patients in various states of dying. Triage required we let him stay dead and try and keep the others alive. Rural EMS should more than any other service have no rolling codes. Get ROSC then take them to hospital. If not call the funeral home. You had pulses so ROSC, yes transport and continue working. But no pulse, i.e. no ROSC we aint rolling. Lose pulse and need more CPR get the driver to stop and assist till pulse returns then continue. Pulse does not return run a complete code then turn over body to funeral home.

Driving dead people L&S is putting way to many people at risk.

[JPINFV]

HHHHmmm, excuse me?

You're excused, the lazy boy is over there ----->

...but seriously, how many of your coworkers would cheer if they were told that they could drop their medic cert tomorrow and never have to run another medical call in their life without losing a dime of pay?

[Arkymedic]

Crotchity, I cannot get a really good answer and since I do not have a Medical Director to discuss this issue with further, I will just digress on this one.

So if you responded to a scene where the patient was decapitated, do you have to work that patient ? Obvious death is obvious death, whether it is a cardiac patient that is not responding to ACLS, or it is a trauma patient that has been squished by an 18-wheeler. If you are in a rural setting, I imagine you probably dont have alot of ambulances to spare, so working a dead body for two hours doesnt make sense. Your Medical Director should be able to write a policy that allows you to stop CPR when it is appropriate to do so. You are not pronouncing them dead (thats the coroners job), you are just using your resources wisely.

[CBEMT]

There fixed it. Remember no rolling codes. They are dead so do not risk everyone else rushing to the hospital.

Pretty easy to be flip about it when you have that option. Some of us don't. For a month in the winter and all summer long, it's just me and a partner in a one-unit agency. Guess what? I get a code, I'm calling for Fire. I have zero inclination to carry the patient, monitor, medical bag, drug box, and suction down stairs and bag at the same time, then transport, with only one other person.

We won't even get into the 911 gig where I sometimes respond alone.

In short, "you don't need anybody else because you shouldn't be driving" is filed under the "easy for you to say" category.

[crazyemt5150]

Where do you guys work that you don't do CPR enroute? I've had 40 minute transports with CPR with the pt doing a mega code on me. Pulses, lost, v-fib, v-tach (with and without pulses) PEA/EMD, etc. Was I supposed to start and stop driveing?

I work in Bakersfield California where we have a ten to fifteen min transport time, we always transport unless there is obvious signs of death

[WolfmanHarris]

I work in Bakersfield California where we have a ten to fifteen min transport time, we always transport unless there is obvious signs of death

Just BLS or BLS and ALS?