New USAToday article

[AZCEP]

Might I suggest we spend a little more time communicating with the living about the chances of meaningful survival instead of abusing a corpse. Yes, the newly dead are valuable learning tools that should be used when it is reasonable. No, we should not be transporting a body that is not responding to our treatment.

The fact remains that the longer the heart is not pumping blood, the lower the chance of a meaningful recovery. Perhaps if we would spend more time teaching the public to perform chest compressions when they are needed, instead of pissing up the rope of wanting more ALS providers, we might make some real progress. All the paramedics on the planet won't help when the blood isn't moving for 6-8 minutes before they arrive.

We don't need more ALS, we need more bystanders that are willing to move a cardiac arrest victim's sternum 1-2 inches toward the vertebral column to make an honest improvement in outcomes.

Might I also mention, www.circulationaha.org, look at the information that is provided and understand that if medicine didn't change occasionally, we would still be doing brain surgery on our kitchen tables.

[Scaramedic]

...if medicine didn't change occasionally, we would still be doing brain surgery on our kitchen tables.

Oh yeah! Well I guess in the Big City you do your brain surgery on the coffee table!

Seriously though, I agree that termination of resuscitation protocols should be in place. This is coming from a Medic who had an amazing asystole save, 5 min response, No CPR, asystole on arrival, converted to Sinus and walked out of the hospital a week later. She was young (30 something) and got really lucky.

There should be criteria for cessation of efforts though, age, medical history, etc. Not just 10 minutes and call the code. Like others have said, there is no reason to transport a corpse lights & sirens just to have the Doc call the pt in the ER.

Peace,

Marty

:joker:

[AZCEP]

We tried the coffee table for a while, but the patient kept rolling off of it.

[Ridryder 911]

) MEDICAL ARREST PT'S RARELY LIVE. TRAUMATICS NEVER DO. Does that mean we dont work them NO, we do it as much for the pt. as we do for the family that is present, if we cant save them we can give their family the piece of mind of knowing everything possible was done for their loved one.

Actually yes, it does mean we DO NOT WORK THEM ! Don't where you have been, but actually since about the late 80's more and more EMS are terminating arrest. As well, very few services any more have traumatic arrest protocols.. if they are wise, they too would have termination protocols.

Now, that you have worked them and gave the family "false hope" not, a piece of mind as you described, then demonstrated how foolish you were when the physician immediately terminates the code upon arrival to ER. They will appreciate that $3000 ER bill as well. You must be doing it for yourself, not the patient, again studies have shown dead is dead as well family members tend to deal better with immediate empathetic declaration of death. Not having false hopes presented, only to be let back down, your care should addressed to the family & their emotional needs, they are now the patient.

I highly suggest you quit using anecdotal feelings and become involved in medicine. This means research, and studies. Cardiac arrest that is either without prior resuscitation and is in aystole (true) as well as traumatic arrest do not respond to resuscitation measures. Period. Even AHA, cites that termination and strict guidelines on when resuscitation should be continued, in the legal section of the ECC recommendations.

R/r 911

[whit72]

If I hear you quote another study, Do you ever base you decesions on experience or do you just run around scenes quoting journals and studies you have read, or tell the two younger brothers who justed watched their brother hit by a car, and tossed 60 ft well guys sorry we dont want to give you false hope, Do you want a 5,000 dollar bill from the ER. ITs better if you just deal with it now, you will be better in the long run. Now stand over here please and try not to stare at the sheet over your dead brother. Yeah I am emotional and passionate and I get pissed, and angry and thats what makes me damn good at what I do.

[AZCEP]

If I hear you quote another study, Do you ever base you decesions on experience or do you just run around scenes quoting journals and studies you have read, or tell the two younger brothers who justed watched their brother hit by a car, and tossed 60 ft well guys sorry we dont want to give you false hope, Do you want a 5,000 dollar bill from the ER. ITs better if you just deal with it now, you will be better in the long run. Now stand over here please and try not to stare at the sheet over your dead brother. Yeah I am emotional and passionate and I get pissed, and angry and thats what makes me damn good at what I do.

Really need to look at all of the available information before you make value judgements. When you allow emotions to cloud your thinking, you only make bad decisions.

[JPINFV]

Evidence based medicine beats emotion based medicine any day of the week and twice on Sundays.

A "save" isn't a "save" unless they are discharged with decent brain activity. Just because you got a pulse back doesn't make it a save. There is no need to waste resouces (EMS, hospital, etc) so you can play hero abusing a dead body. I volunteered a bit (about 6 months [i was in the program for 2 years, but on different units] and one during my EMT clinicals at a different hospital) in a local ER. I saw a relitivly fair number of dead (asystole) bodies come in being abused by paramedics. Every body that came in in asystole left in asystole.

[whit72]

If you read the earlier posts, I understand the survival rates all to well, But we do work arrests period until the protocols change, up till now they havent, And I will continue to work a pt if I feel it benefits their family members or the pt. within my protocols. Without regard for the studies and the journals or the fact that I might run up and upaid bill for a for profit hospital. When they stop allowing pts. on welfare to have elective plastic surgery. I will consider the fact that I might be wasting taxepayers money By the way who do you people transport you dont want to transport stub toes, or hand lacs, or non emergent pts. you dont want to transport arrest pts.you must have pretty slow days, to ponder all the research. And yes emotion sometimes factors into my day, if it dosent for you your a liar, do I make decisions based on it maybe, but everyone is treated in the way I would want my loved one treated if they were in that situation, if you call that emotion too bad, if you dont like it too bad, if you got a problem with it too bad. I dont work 14 yo arrests pts to be a hero, but I dont leave them laying in the street either. I take a refresher every two years and when the protocols change I honor them, But I dont waste my time sitting there saying, well here they dont transport arrest pts, or there they get to do this or that, I went to school for a year I dont claim to be or try to be more then I am. And I sure as hell am not worried about a couple of paramedics who have a problem with the way I do my job. I dont have a cushy EMS job I can barely pay my bills half the time I dont sit on any boards or conduct any research, all I do is show up every day and try to leave it a little better then I found it.

[northernmedic]

We don't transport anything without a pulse unless it is a hypothermic arrest. Asystolic blunt trauma arrests we don't even start. traumatic arrests in a PEA get worked where they are but unless you get some kind of ROSC it gets discontinued. reality is almost all of them stay dead.

[JPINFV]

If you read the earlier posts, I understand the survival rates all to well, But we do work arrests period until the protocols change, up till now they havent,

They have in some places, apparently. I know ALS in my area can terminate resuscitation after talking to med control (arrests are a mandatory contact anyways).

And I will continue to work a pt if I feel it benefits their family members or the pt. within my protocols. Without regard for the studies and the journals or the fact that I might run up and upaid bill for a for profit hospital.

This scares me. Do you still practice fluid resuscitation for trauma patients? Do you still use MAST pants? How about leeches (yes, I know leeches are used for wound care post surgery, but it really isn't used that much)? There is a reason those aren't used anymore, and it is those studies that you are decrying. If EMS is going to be viewed seriously in the medical profession, then it needs to get its act together. We need to start using science to guide our treatments instead of giving into emotion.

When they stop allowing pts. on welfare to have elective plastic surgery. I will consider the fact that I might be wasting taxepayers money

I agree with no plastic surgery. Viagra should be a no-no too (except pulmonary HTN)

By the way who do you people transport you dont want to transport stub toes, or hand lacs, or non emergent pts. you dont want to transport arrest pts.

Different reasons why people don't want to transport. The stub toe isn't an emergency and can be taken POV or taxi to the hospital. The ambulance should be available for critical patients.

The arrest shouldn't be transported (generally speaking). Yes, work it till you get a pulse or asystole. Recognize that asystole is dead, though. The ambulance should be available for live patients.

you must have pretty slow days, to ponder all the research.

Or maybe some people are dedicated and take a little bit of time to gain a better picture of emergency medicine. We let science be our guide.

And yes emotion sometimes factors into my day, if it dosent for you your a liar, do I make decisions based on it maybe, but everyone is treated in the way I would want my loved one treated if they were in that situation, if you call that emotion too bad, if you dont like it too bad, if you got a problem with it too bad.

I don't want my loved one taken out of my home, abused, tubes shoved in every orifice, and left to die in some hospital where the staff would like nothing better then to get rid of my loved one so that they can actually treat someone who needs help. Furthermore, any system that transports every arrest forfeits the right to complain about holding the wall or being diverted away from a hospital. That extra bed that you're patient needs might just be holding that asystole arrest that was brought in earlier.

I dont work 14 yo arrests pts to be a hero, but I dont leave them laying in the street either.

Because a hospital can treat a dead body better then the coroner?

I take a refresher every two years and when the protocols change I honor them, But I dont waste my time sitting there saying, well here they dont transport arrest pts, or there they get to do this or that, I went to school for a year I dont claim to be or try to be more then I am. And I sure as hell am not worried about a couple of paramedics who have a problem with the way I do my job. I dont have a cushy EMS job I can barely pay my bills half the time I dont sit on any boards or conduct any research, all I do is show up every day and try to leave it a little better then I found it.

I believe it is important to know what other places are doing. Maybe you can be the one that finds a new protocol and suggests it for implementation? The more you know, the better you can treat your patients. Just because I'm BLS doesn't mean that I can't limit myself to the questions and information learned in my 120+change basic class. While my treatment is limited, my understanding can be used as a guide of if I need medics, how much O2 should I give, etc. Just as an ALS provider can do the same.