Team Focused CPR

[ERDoc]

I wish I could say that no one dies in my ER. There is a lot less paperwork that way.

[Richard B the EMT]

Someone correctly pointed out that I work(ed) in NYC, the city that is a law unto itself. For the uninitiated, on a typical day, no call is more than 15 minutes away from an Emergency Room (except my own community, following the closure of the Peninsula Hospital Center). Specialty Centers, such as Trauma and/or Burn Centers, can be up to 45 minutes away, WITH lights and siren, and no traffic.

(for further definitions as to NYC being a law unto itself, PM me)

[mobey]

I wish I could say that no one dies in my ER. There is a lot less paperwork that way.

Which is funny, because a code is the shortest paperwork I do.

[scubanurse]

Keep in mind that he's in NY. We were not exactly the most progressive state when it came to EMS. We weren't as bad as NJ but not that great either. I think MAST finally came off the buses (yeah, I said buses) until around 2000.

I was trained on MAST pants in 2005 in Maryland. They were taken out of protocol the next year I believe though.

[Emergency Laughter]

Did I hear correctly? Someone actually stopped compressions etc etc and waited until they pulled up to the ER and then started again? That boggles my mind. (a full five minutes passes while I stare at nothing and experience my mind boggling) I have a pretty strict rule that nobody dies at my kitchen table, but other than that people have pretty much died every imaginable place I can think of, including the back of the rig, and I've never started up a code again just for show??? There had to have been mass paparazzi there or something....I can see maybe giving the BVM a couple squeezes in between signing autographs....but.....wow. WTF?

[ERDoc]

Which is funny, because a code is the shortest paperwork I do.

Code that makes it (even if there is nothing left of the brain) is a phone call to admit and a standard dictation. A code that doesn't make it means a call to family, a call to the ME (who never calls back very quickly), a longer than normal dictation, filling out death certificates, a call to the PMD, and filling out organ donation forms as well as ME contact forms.

I was trained on MAST pants in 2005 in Maryland. They were taken out of protocol the next year I believe though.

I would have expected better from a state that has Baltimore Shock/Trauma.

Did I hear correctly? Someone actually stopped compressions etc etc and waited until they pulled up to the ER and then started again? That boggles my mind. (a full five minutes passes while I stare at nothing and experience my mind boggling) I have a pretty strict rule that nobody dies at my kitchen table, but other than that people have pretty much died every imaginable place I can think of, including the back of the rig, and I've never started up a code again just for show??? There had to have been mass paparazzi there or something....I can see maybe giving the BVM a couple squeezes in between signing autographs....but.....wow. WTF?

I'm a little surprised at stopping/starting compressions also. We all know at some point that someone is not going to make and in the hospital we unofficially have "slow codes." You go through all of the motions but don't put much effort into it. It is always for the family's benefit, not ours nor the pt's. These are usually the pts that are dead, have no DNR and the family wants everything done. I've heard of codes where the meds were injected into the mattress instead of the IV. I would never agree with that and for all I know it is just urban legend. Let's face it, a family that is unreasonable at the bedside is going to be unreasonable in court when they sue you. I still remember the 90+y/o lady who weighed about 80 pounds that I took care of in the CCU. Multisystem organ failure after a cardiac arrest at home. She was trying to die but her body wouldn't let her. Labs got worse every hour, urine output down to 0. She finally starts coding but responds to a minute or two of compressions. Attempts are made to make the family understand the futility of the situation but they still want everything done. Finally they are witness to her coding and as soon as they see what CPR really looks like they decide she wouldn't want that and ask us to stop.

[scubanurse]

I would have too but it's also a state that didn't allow basics to use a glucometer or combi-tube/king airway. Not sure what all has changed but it's not a progressive system. Colorado allows basics to do more than MD did.

Here is their 2013 protocols http://www.miemss.org/home/LinkClick.aspx?fileticket=Tz5wGQYZrKI%3d&tabid=106&mid=875 Page 144 breaks down skills by provider level and EMT's still don't have standing orders for glucometers, laryngeal airways, IV's/fluid, and a few others.

[medicgirl05]

"Here's my medical director's number. You are more than welcome to give him/her a call and discuss his/her choice of protocols."

Luckily, our medical director is also the doctor in charge of the nursing home. I have had her explain our protocols to them. They are not very smart. I have gotten to the point that if we work a code, I have all nursing staff leave the room because they mess with our stuff and get in the way more than anything else.

[MariB]

I was trained on MAST pants in 2005 in Maryland. They were taken out of protocol the next year I believe though.

State to state might be different, but as of 2012, they are being taught for National Registry Skills and written

I would have too but it's also a state that didn't allow basics to use a glucometer or combi-tube/king airway. Not sure what all has changed but it's not a progressive system. Colorado allows basics to do more than MD did.

Here is their 2013 protocols http://www.miemss.org/home/LinkClick.aspx?fileticket=Tz5wGQYZrKI%3d&tabid=106&mid=875 Page 144 breaks down skills by provider level and EMT's still don't have standing orders for glucometers, laryngeal airways, IV's/fluid, and a few others.

ohhhhhhhhh

[DwayneEMTP]

MAST isn't a station, nor an option for a random at NR skills stations, at least for paramedic.

I've proctored several of them, so I'm pretty confident about this...