Why are people still transporting Adult medical codes?

[Cookie]

Back in the day of dark ages we had to transport them because the only person who could determine death, unless it was obvious like decapitation was the Dr. That was also pre Zoll's or any of the monitors we have now. Today we are fortunate to have the medics that can pronounce death. We do have to realize that there are some EMS organizations that are still operating in those dark ages and thats too bad.

[Just Plain Ruff]

No it's 100% hero factor. jk

[ERDoc]

It's due to the popular misconception that there is some magical treatment held only at the hospitals which has mysteriously been left out of the hands of the medical providers in the most crucial position to make a significant difference to patient's suffering from out of hospital cardiac arrest, the potency of which is so great that it overrides and undoes the irreparable damage that results from ceasing CPR to transfer patients from scene to the ambulance and the additional damage incurred by poor CPR in the back of a moving vehicle.

What I would consider an ideal system: ROSC or bust, or in special situations where there might be some treatment or diagnostic measure not commonly carried on ambulances due to prohibitive costs or other factors that could possibly make a difference, place that tool (be it iStat, equipment for non-routine resuscitative procedures such as a portable ultrasound for in field pericardiocentesis, etc) on a supervisor's vehicle OR if that isn't possible then at minimum a mechanical compression device in its stead to ensure that either the specialized treatment comes to the patient or that transporting the patient to the specialized treatment does not compromise CPR--which holds precedence over all other treatments, save for defibrillation with which it is on par.

Zmedic, while transporting a patient to the hospital to perform those diagnostic tests may be helpful in uncovering reversible causes of the cardiac arrest (though in my opinion not as good as bringing those tests to the patient), it's meaningless and useless knowledge to know what the cause (reversible or not) of the arrest was if by the time the patient reaches the hospital their heart and brain are shot from the inadequate CPR en route. You can reverse the arrest, but you'll only be bringing back a brain-dead body.

Good points Beiber. Unfortunately, even when they do show up in the ER, the 5H5Ts almost never get looked for because by the time they would be availble, the code is over.

[Chris Smith]

That's even worse to see people LSB a gun shot wound. There is evidence to totally contraindicate that on so many levels.

[Kaisu]

That's even worse to see people LSB a gun shot wound. There is evidence to totally contraindicate that on so many levels.

Help me out here.. what is LSB?

[tcripp]

long spinal board...it seems to be the new rage in acronyms

and, of course, head blocks are now CIDs...who knew...

[Kaisu]

headslap..

yeah.. old shit dies hard... and even harder in some parts of the country than others. So much depends on the involvement/interest of your medical director. If you have a doc that really cares about EMS and his patients and has the time to devote to staying on top of the evidence it is reflected in ongoing education and progressive protocols.

This is by no means a one way street. If medics are interested in ongoing education and learning, they can bring things to the attention of a medical director that is open to it.

This site is a wonderful resource for that. How often do we learn about something really great in another part of the country (or the world) and then shake our heads at how woeful our area is? How many of us actually muster up the evidence and take it to our medical director? How many of us have a medical director we are comfortable doing that with?

If we don't do it, why not? If we are not comfortable doing it, why not?

I think these are two ways in which we can make a lasting and positive contribution. So why don't we?

[armymedic571]

The same reason ER doctors order a CT on every patient with a bump to the head, the LAWYERS. The public has been educated by TV and Movies that every patient magically is saved in the ER. Medics have been sued for failure to transport because the family believed they took away their only chance of survival.

Is it right ? No

And then occasionally you read that story where medics declare someone dead, and then have to go back and work the patient when the coroner or funeral home found a pulse or saw the patient breath.

Not that your assessment is not incorrect, but why whould the mainstream Pre-hosptial provider have to lower themselves to a few lazy bums that passed their exam?

Because we have too, not much else there

Unfortunatley we transport most dead people because OLMC are unwilling to call a patient over the phone. OLMC doesnt trust their medics

You live in a sad system. But you are part of the problem. You have paradigmitis. Give up, its the way its always been.......

Dude, don't give in to the dark side......

This and this, sort of.

I think there is a misunderstanding in the public that there is more that can be done at a hospital then in the field, and services think that transporting the dead decreases the possibility of a suit because "EMS didn't help my dad/mom/sister/dog, the let him die"

Or for concerns of provider safety...I've had more then a few codes where the living get physical with EMS because they think we are giving up

Also, I'm in NJ, ain't to much progressive EMS 'round these parts, squads still backboard off MOI. one service requires c-spine in all GSW

Another excuse. Isn't part of your job as a provider to EDUCATE the public. Also, find the research and present it to your peers, and Medical Director. Maybe they are lazy and just don't want to do the research?

[jonas salk]

Currently in Ontario we are phasing in our latest batch of medical directives, which includes medical TORs for BLS providers. Three no-shocks and we're on the phone getting the order. This new directive came about after a multi-year trial with several services in the province, where one of the questions the researchers were looking at was how patients families would react. What they found was that the majority of families preferred having the pronouncement done in the home. Families that had their loved ones transported, only to be pronounced within minutes of arriving, were mostly frustrated and reported having a sense of false hope that was destroyed once they arrived.

[Kaisu]

Currently in Ontario we are phasing in our latest batch of medical directives, which includes medical TORs for BLS providers. Three no-shocks and we're on the phone getting the order. This new directive came about after a multi-year trial with several services in the province, where one of the questions the researchers were looking at was how patients families would react. What they found was that the majority of families preferred having the pronouncement done in the home. Families that had their loved ones transported, only to be pronounced within minutes of arriving, were mostly frustrated and reported having a sense of false hope that was destroyed once they arrived.

Sounds interesting. Do you have the study? Can you link to it?

thanks