how long is too long

[whit72]

I ll put a little spin on it. What if it was a 5 y/o

Would you load and go?

Would you work the code where you found them?

Would you work them for 45 minutes call the hospital and ask to cease your efforts?

Would they allow you to?

Or is the 5/yo worth the bumps and bruises, or busted skull you would receive while transporting to the hospital?

We can not cease CPR efforts in the field, whether they are 10 or 110. Do I always agree with it? No. Do I respect it? yes.

Is it ok to risk my life responding to the hospital with a drunk?

A broken arm?

A headache?

A CVA?

A MI?

The chief complaint is irreverent, nothing is worth me risking my safety responding to a call or to a hospital. That however is a job requirement.

I understand the risk.

[Just Plain Ruff]

whit, a busted skull on my hard head is definately not worth it no matter who it is.

If we transport, crash and kill or hurt everyone in the ambulance for basically transporting a dead body is not worth the price at any time.

So now you have a dead patient(they were that way when you found them), you have at least 2 if not more caregivers not on the street because they were injured trying to save someone.

We get into the hero complex, "Oh wer'e so proud of you that you got hurt while trying to save a 5 year old" or some other mushy garbage but in the end, the only one who is providing for my family is me and If I don't have to risk it I won't.

We can go all around the block saying what if it was a 1 day old what if it was your son, what if it was your mom or a 5 year old or whatever but that is playing the emotional card and at the end of the day - who is gonna take care of you??:? Not your company, not your patients and not your partner - YOU are.

I do not get into the arguments that what if it was a 5 year old - those are just knee jerk reactions.

[akroeze]

whit, a busted skull on my hard head is definately not worth it no matter who it is.

If we transport, crash and kill or hurt everyone in the ambulance for basically transporting a dead body is not worth the price at any time.

So now you have a dead patient(they were that way when you found them), you have at least 2 if not more caregivers not on the street because they were injured trying to save someone.

We get into the hero complex, "Oh wer'e so proud of you that you got hurt while trying to save a 5 year old" or some other mushy garbage but in the end, the only one who is providing for my family is me and If I don't have to risk it I won't.

We can go all around the block saying what if it was a 1 day old what if it was your son, what if it was your mom or a 5 year old or whatever but that is playing the emotional card and at the end of the day - who is gonna take care of you??:? Not your company, not your patients and not your partner - YOU are.

I do not get into the arguments that what if it was a 5 year old - those are just knee jerk reactions.

Well said

[Dustdevil]

Fair points, to be sure. However the analogy is a little shaky.

5 year olds don't often suffer cardiac events.

However, were I to respond to a 5 year old with serious chronic problems, confined to a nursing home bed, and who had suffered a cardiogenic cardiac arrest prior to my arrival, then yes... I would handle it the very same way.

Any difference in how the two would be handled would be due to the younger patient's physiological viability, and no other reason.

I don't get emotional about kids. That's why I chose paediatrics as a specialty.

[whit72]

So Ruff you don't respond to the hospital with a:

A broken arm?

A headache?

A CVA?

A MI?

I don't drive or expect a ride that is any different then the above complaints, then if it was a code. If it is, that is where your problem lies, not with the chief complaint

So you don't transport pediatric codes?

What I was trying to state do you believe there is a difference between them. I agree emotionally there is.

However if I am going to transport the 5 y/o. Why shouldn't I transport the 80 y/o?

[Dustdevil]

So Ruff you don't respond to the hospital with a:

A broken arm?

A headache?

A CVA?

A MI?

Again, an invalid analogy. The bottom line is, I don't continue to sit in front of the arcade game for half an hour after the screen flashes "Game Over."

What I was trying to state do you believe there is a difference between them. I agree emotionally there is.

You mean you disagree, because I said there was no difference.

However if I am going to transport the 5 y/o. Why shouldn't I transport the 80 y/o?

Given a valid analogy, and all things being equal, I wouldn't transport either of them. Here's a valid analogy for ya: If I don't transport SIDS (which I usually don't), why would I transport the 80 year old?

[Just Plain Ruff]

Whit you wrote:

So Ruff you don't respond to the hospital with a:

A broken arm?

A headache?

A CVA?

A MI?

My response - of course I respond to the hospital with the above. What I don't do unless I say it happens is responding code 3 back to the hospital. Why???? Maybe we just got our signals crossed.

Well

1. Broken arm - stupid reason to respond code 3 back to the hospital

2. Headache - again see above

3. CVA - depends on the situation to respond code 3 back to the ER - 90% of my patients that have cva's didn't warrant a transport to the er code 3

4. MI - why stress an already stressed heart. I know time is muscle and brain but if we give them all the meds and do the checklist and 12 lead they would benefit from a rapid but not code 3 transport.

Have you ever looked in your patients eyes when you are running code 3 - there is a scared look that you can bet is transferring over to stress on their cardiac system.

There are only a three types of people that I will risk my life for - myself, my children and my family. To me no-one else is worth not coming home to other than the three types of people I just mentioned.

[whit72]

I believe it is a valid analogy.

You stated earlier:

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. Laughing

I agree with not transporting a cardiac arrest pt that hasn't responded to treatment. Thats fine.

I agree I have sustained injuries, one requiring surgery. I however disagree that, the nature of the call was the predetermining factor.

I believe the chief complaint is irrelevant. It should also be irrelevant to your driver or partner. A safe and competent ride to the hospital should not factor in the nature of the call.

I know it does, but it shouldn't.

As far as pediatric pts. You are the exception to the rule, rather then the norm. Most EMS professionals are scared shit less dealing with pediatric pts. Emotion does factor into their decisions.

It shouldn't but it does.

My point was that chief complaint shouldn't factor into what type of ride you get to the hospital. The 30 seconds you save riding the curbs, driving over front lawns , and dodging telephone poles isn't worth the risk involved. Cardiac arrest or broken toe. Also if any of my partners ever used the words running hot, or had a tape in the ambulance labeled responding music(don't laugh). The biggest decision he would have to make is how to remove my foot from his ass.

The truth about the responding music, I had a fill on my truck, when I was checking the truck I noticed a tape labeled responding music. I immediately took it out, placed it on the ground and smashed it about 30 times with the 12lb sledge-hammer we carry. I got a one-day rip. He got a valuable lesson about EMS.

[vs-eh?]

The original posters patient was being worked on for about 20 mins too long if that was all ALS care...

All adult cardiac arrest patients should be worked on scene by ALS and if no change (i.e. stays dead with no ROSC at any point) after appropriate ACLS measures they should be pronounced.

Exceptions for possible transport...

- A readily apparent situation/condition is on this patient (6 H's 6 T's and others) that you cannot treat on scene and can be effectively treated in hospital within a reasonable time frame (usually this will be brought to the MD's attention and still could be their decision)

- Family refuses to let the patient be pronounced/is not comfortable with it. I have never heard/seen this happen, but I suppose it could

- The arrest happens in a public place +/- vicinity to hospital.

This applies to all arrests, witnessed (by EMS or other) or not. The vast majority of adult cardiac arrests can be worked on scene by an ACLS provider with even the most basic ACLS drugs and will receive the same tx as any hospital.

I would be surprised if any services here are allowed to work a pediatric arrest on scene and call for pronouncement, regardless of etiology, unless you have huge transport times. I am talking about viable patients here (i.e. not obviously dead, SIDS or otherwise). Ped. arrest oxygenate/intubate, first round of drugs and start to move...

whit72 - I hope your service (you work in Boston?) does not respond to scene or return to hospital L+S for all patients. I kind of get that impression from your post. I also hope that your service does not transport/work obviously dead patients, SIDS or anywise to an ER.

[p3medic]

I don't think he works in Boston.....