Code Blue!

[Just Plain Ruff]

I had criteria that I put into play a long time ago while working in the field regarding cardiac arrests

1. Peds codes always went to the hospital if we started working on them.

2. Witnessed arrest and cpr in progress with less than a 5 minute drive to the scene - work and transport

3. Any arrest without cpr and greater than 10 minute drive to the scene - work on scene and call if appropriate

4. Trauma codes - work to the hospital

5. Any time it took me 20 minutes or more to get to the scene for any type of arrest - work on scene and call if appropriate

6. Any time it was over 20 minutes to get to the scene, no cpr or interventions done by first responders and the patient was asystole - didn't even work them other than quick look.

7. Cold water drowning - above criteria go out the window

Come on, if it takes 20 minutes to get to someone in asystole with no cpr or interventions done then they get a ride to the funeral home unless it's cold water drowning.

If the drive time back to the hospital was less than 5 minutes - no lights and sirens

Drive time greater than 5 minutes - l&s as appropriate

Of course all my criteria would be backed up by a call to the ER Doc and his advice requested. Most time's he/she agreed with me.

There are exceptions to every rule but those criteria

[AZCEP]

If I'm not mistaken, ACLS guidelines recommend ceasing resuscitation attempts after 20 minutes. Personally, I am willing to commit myself to 20 minutes on scene to try to get a response. If none is found, a quick call to medical control follows. The only patients that I'm transporting are able to push their own pulses.

If a patient codes in my ambulance, then efforts are started, otherwise they stay where I found them.

[StreetDoc2426]

____________________________________________________ = Dead,,,,call the coroner, do your paperwork,,,clear. NEXT

[Dustdevil]

3. Any arrest without cpr and greater than 10 minute drive to the scene - work on scene and call if appropriate

4. Trauma codes - work to the hospital

5. Any time it took me 20 minutes or more to get to the scene for any type of arrest - work on scene and call if appropriate

6. Any time it was over 20 minutes to get to the scene, no cpr or interventions done by first responders and the patient was asystole - didn't even work them other than quick look.

I am very leery of factoring "down times" and response times into the equation. The truth is, you really have NO idea how long the patient has been in arrest. Not only do bystanders/callers have a poor concept of time in an emergency, but they also have no idea when the patient went into cardiac arrest. Unconsciousness and cardiac arrest are not the same thing. So, the best you can possibly speculate on is how long the patient has been unconscious. How long he has been in arrest is a complete unknown to you. A lawyer (or your QC officer) is going to win that one really fast, and you're going to look really stupid.

If they don't have obvious signs of death, then they get their twenty or thirty minutes of care, regardless of how many minutes somebody thinks they've been "down."

[Just Plain Ruff]

Let me clarify Dust Devil man, All those criteria are relative and every code is different. Those rules were never set in stone they were guidelines in my "head" only.

Every code is different and I can't remember the last time that those were followed to the letter for me. It is situational. The only time I didn't work the patient were the times that they qualified as dead, rigor, decomp

Every code got at least some measure of ACLS but you can bet your butt I was on the phone with med direction on the ones I wanted and thought we could end early.

"just remember you can't kill em any deader"

[brock8024]

A couple of points.

1) with or with out L&S the ride in the back should not be hard for the medics back there. I think this was talked about a few times.

2) How would you explain in court that the patient was dead. Yes you gave the drugs and stuff but if a patient family member is crying saying you said stuff or was rude or acted like you did not know what you was doing I would think that would open a big can of worms. I mean we all should be professional but we all know those few people that act out of line or get to hyper during certain things that I think could ite you in the butt.

3) How are you going to explain in court that you transported granny 2 that is CTD and is going to code on you in the back of the truck but not the granny 1 that was already in arrest? I mean I know the reasons but will family members???

I think if you are going to call the code at the house alot should be done to prepare the family. I had to give a speech bout this last semister. What I have read is that we should let the family watch the code so that they know everything is being done. Act very very professional. Explain everythign that is going to be done and has been done. Then make sure you give the family member care after you have called the code. I would think that as long as everything went really really perfect then you should be ok. But that one time that it goes to hell in a handbasket then there might be a big lawsuit.

brock

[Just Plain Ruff]

You have to let the family know what you are doing. Tell them you are breathing for their loved one who is not doing it on their own and you are providing the pulse to the pt. who is not doing it on their own. Tell them that if you stop they will not start up or something like that.

Most families know when it's time

IF the family throws a huge fit about not transporting then by all means transport. Sometimes families take the news of the death better in an ER than at home. Plus some do not want to have the thought of Gramps dying on the living room floor.

Remember you have more than one patient(per se) when you work a code. You have the soon to be dead guy and those left over to go on.

Some people are good at breaking the news that their loved one has died but others are not.

[Dustdevil]

I'd like to see some protocols that agencies might have addressing your procedure for AFTER you call the code. Do you say "sorry" and bail? Do you wait for police or ME? What if their response is hours away? If that happens, you would have been better off transporting! So how do your agencies protocols address this so that you don't get stuck for extended periods of time on scenes waiting for other authorities?

[Just Plain Ruff]

I've always been fortunate to be able stay on scene an extended time if needed.

But I've always had LEO's there becuase that was the procedure. Code blue call and LEO's got called.

I will stay for the family until I get called out again. I do explain that I will stay there until I'm needed elsewhere.

Always worked for me.