how long is too long

[donedeal]

How long would you spend on scene of a cardiac arrest? A rescue company called our hospital tonight requesting dr's orders to discontinue cpr. They had been on scene at a nursing home working an 80 y/o female for 40 minutes. Wouldnt you load and go in a situation like that, intubating, IV and giving meds en route? I see no reason why they would stay there and do compressions for 40 minutes. Put on the pads, see if its shockable, if not, then get the hell outta there and to definitive care at a hospital.

[Dustdevil]

Wouldnt you load and go in a situation like that, intubating, IV and giving meds en route?

No.

I see no reason why they would stay there and do compressions for 40 minutes.

Maybe you will once you become a paramedic. Or once you have had your skull broken in a pointless code-3 wreck.

Put on the pads, see if its shockable, if not, then get the hell outta there and to definitive care at a hospital.

ACLS is definitive care for cardiac arrest, assuming there is no underlying medical or surgical problem.

[hfdff422]

I do think 40 minutes is a little long for on scene time. By that point you could have performed every available procedure 3 or 4 times. But the ER is going to do little else in that situation, it just seems counter-intuitive to not transport once you have done what you can.

[akflightmedic]

How long would you spend on scene of a cardiac arrest? A rescue company called our hospital tonight requesting dr's orders to discontinue cpr. They had been on scene at a nursing home working an 80 y/o female for 40 minutes. Wouldnt you load and go in a situation like that, intubating, IV and giving meds en route? I see no reason why they would stay there and do compressions for 40 minutes. Put on the pads, see if its shockable, if not, then get the hell outta there and to definitive care at a hospital.

You are making a rather large assumption about what you percieve to have happened. First off, the standards are changing. No longer do we make a mad dash to the ER with every cardiac arrest patient. It is futile and pointless in most cases. How long was the patient down prior to their arrival? What was their response time? By this I dont mean when they got on scene cause then it takes several more minutes to gather equipment and arrive at the patients bedside. What rhythm was the patient in when they hooked up the monitor? What is the patients history? Hmmm, an 80 year old in a nursing home (not very viable me thinks). So instead of delivering top notch immediate care at the bedside, you rather them load and go doing haphazard compression and ventilations, very interrupted mind you just so they could load the pt in the truck and then haul ass to an ER, even though there is no need to haul ass with these types of patients, recklessly endangering the crew and other people on the roads(who are not dead mind you) only to arrive at the ER, have the doc and nurses play for 5 minutes and then call it? Is this the scenario you would prefer? Did I mention that during transport, you are also wanting them to now intubate in a more cramped position, possibly creating more attempts and further delaying definitive airway, starting an IV again incresing chance for error, not to mention the major hazards anytime needles are involved and all for what?

I also enjoyed the comment of definitive care at a hospital. Yes that is true for other situations(CVA, trauma,etc) however, a cardiac arrest requires ACLS. I do believe that is the same ACLS provided by docs and nurses at the ER.

Finally, I commend them for their actions. Why bother transporting a body? By not transporting, they freed up their unit for other calls, plus they did not burden the receiving facility by tying up a bed either. Some other patient that is alive was able to be seen quicker as there was one less bed taken by a dead body. Not only that, the patient recieves no final bill from the ER, the funeral home can come pick her up directly. Great job!

[Just Plain Ruff]

40 minutes is about the right amount of time to spend on scene of a cardiac arrest unless you are 5 minutes from the hospital.

I would much rather be on scene doing these things than in the back of a bouncy ambulance, trying to hold on for dear life because the EMT gets to run HOT!!!!

Because you seem to have such a strong opinion of things and how things are done here is what I recommend

Get a driver and go out to a large parking lot in your jurisdiction. Get all your stuff ready for a code and put a Cpr dummy in the back of your ambulance. Have that driver start to drive like he was running hot to the hospital.

Now begin your code. Do cpr in the ambulance, Try to intubate and try to start an IV.

If you can do that without being bounced around, thrown around and all that, come back here, post again and tell us that you would rather do it in the ambulance.

After you have healed from your bruises and bumps and scrapes from your fun ride in the back of the ambulance, now go and run the same code on the floor of your station and tell me which you would rather do.

Your opinion will change when you become a medic.

[akroeze]

How long would you spend on scene of a cardiac arrest? A rescue company called our hospital tonight requesting dr's orders to discontinue cpr. They had been on scene at a nursing home working an 80 y/o female for 40 minutes. Wouldnt you load and go in a situation like that, intubating, IV and giving meds en route? I see no reason why they would stay there and do compressions for 40 minutes. Put on the pads, see if its shockable, if not, then get the hell outta there and to definitive care at a hospital.

What more would the hospital do for this person than a fully ACLS Paramedic unit?

[donedeal]

No.

Maybe you will once you become a paramedic. Or once you have had your skull broken in a pointless code-3 wreck.

ACLS is definitive care for cardiac arrest, assuming there is no underlying medical or surgical problem.

As a senior member of the emt city community and an experienced Paramedic, I would expect you to explain your answer. I think of this website as a teaching/learning community. Experienced Paramedics and EMTs can extend their working knowledge of EMS to new, inexperienced individuals. If what I stated was incorrect, please explain why. Your answer, as a member of this community, fellow EMS worker, and role model was extremely disappointing.

[donedeal]

Alright, these explanations make sense and I stand corrected. I have no idea the circumstances of the situation. She could have been in arrest for 40 minutes before they even got there. I can also imagine that intubating in the back of an ambulance is a lot more difficult than in a room. But what about the fact that the nursing home is about a block away? Would that change anything?

[akflightmedic]

Irrelevant.

Again it all depends on the questions that I posed and the reasoning is still the same. Dead is dead!

[Dustdevil]

As a senior member of the emt city community and an experienced Paramedic, I would expect you to explain your answer. I think of this website as a teaching/learning community. Experienced Paramedics and EMTs can extend their working knowledge of EMS to new, inexperienced individuals. If what I stated was incorrect, please explain why. Your answer, as a member of this community, fellow EMS worker, and role model was extremely disappointing.

Okay, I admit that my answer was not as long-winded and boring as many answers I give here. But I would disagree that I did not explain my answer. I pointed out that the care being provided by the medics is the most definitive care available (which should be understood to mean that it should not be delayed), and that transport is unnecessarily dangerous to the crew and everybody around them. I could go on with a lot of anecdotal stories to support those facts, but I am trying to get more directly to my points these days. My fingers are getting arthritic in my old age.

If you need further proof of the dangerous nature of code-3 runs, I have several scars and a 6 inch stack of my own x-rays, CAT scans, and MRIs that I can show you.