Koolaid for ROSC

[FL_Medic]

The simple Newsweek link is

http://www.msnbc.msn.com/id/18368186/site/newsweek/

I see you've done some serious research on the topic. Duke University was a leader in some of the data collection and articles published. I heard one of their physicians speak at an ATS meeting.

Intratracheal cooling will probably be the most practical for EMS if we can perfect a method. Liquid perfluorocarbons might not be the best for pre-hospital right now.

I haven't read through all of your protocols yet.

What are you using to chill the patient?

I'm not... yet. Unfortunatly I just learned of this procedure last week.

[Just Plain Ruff]

flmedic great research and good citations. Excellent

I still am not sure what we in the EMS field can do in relation to this study. I think that right now our getting them to the hospital that is equipped with the ability to cool them down or to put them on bypass is key for survival if the hospital can do this type of thing.

If there are no hospitals in the area that can accomodate the requirements then I think that many patients will continue to not survive or suffer adverse outcomes.

I will re-read all you posted as the info is really good.

Do you work in the EMS system you have cited? If so you work in quite a progressive system and you should be very proud.

Feel free to pm me if you want to chat more, I think we could discuss this in more depth via pm's or phone calls.

[FL_Medic]

flmedic great research and good citations. Excellent

I still am not sure what we in the EMS field can do in relation to this study. I think that right now our getting them to the hospital that is equipped with the ability to cool them down or to put them on bypass is key for survival if the hospital can do this type of thing.

If there are no hospitals in the area that can accomodate the requirements then I think that many patients will continue to not survive or suffer adverse outcomes.

I will re-read all you posted as the info is really good.

Do you work in the EMS system you have cited? If so you work in quite a progressive system and you should be very proud.

Feel free to pm me if you want to chat more, I think we could discuss this in more depth via pm's or phone calls.

I don't work in for this system, although my system is progressive.. I guess we missed the jump on this treatment. You are correct though, the hospitals in your system have to be in on it for the procedure to work. Wake EMS has supervisor vehicles (Expeditions I think) who respond to every cardiac arrest. In the supervisor's truck is a small cooler with NS in it. The pt is cooled with the NS via IV as soon as they regain a pulse. This method has shown the best pt outcome. I plan on speaking with my medical director myself after I organize all the research I can find. After I convince him I will be on the phone with every hospital to find out what can be done to get this rolling here in Lee County. I think if I really convince my MD & our protocol comittee we can work together on it.

[VentMedic]

Are you talking about Lee County, Florida?

Do you know how many hospitals and systems you have in that large county? That's a lot of medical directors (ED and ICU), P&P review boards, nurse managers, budget planners for extra equipment and staff (several hundred to over 1000 nurses) to get on the same page. The P&P for nursing is quite extensive. They also may have to allow for additional staff since hypothermia protocol patients may be 1:1 during the 1st 24 hours depending on the policy. Regular post code patients rarely are 1:1 staffed. A single hospital could probably get the P&P approved and implimented quickly. A few hospitals are probably doing hypothermic protocols but also on a case to case basis. Even with our ready-to-go protocols, not all of our ED or ICU physicians want to implement the protocol. Our doctors also like to do a little neuro assessment while we're implementing the protocol.

Those hospitals that don't want to play, are you going to bypass them? How long will it take to get LC EMS paramedics adequately trained? That's quite a project you've got ahead of you.

[FL_Medic]

Are you talking about Lee County, Florida?

Do you know how many hospitals and systems you have in that large county? That's a lot of medical directors (ED and ICU), P&P review boards, nurse managers, budget planners for extra equipment and staff (several hundred to over 1000 nurses) to get on the same page. The P&P for nursing is quite extensive. They also may have to allow for additional staff since hypothermia protocol patients may be 1:1 during the 1st 24 hours depending on the policy. Regular post code patients rarely are 1:1 staffed. A single hospital could probably get the P&P approved and implimented quickly. A few hospitals are probably doing hypothermic protocols but also on a case to case basis. Even with our ready-to-go protocols, not all of our ED or ICU physicians want to implement the protocol. Our doctors also like to do a little neuro assessment while we're implementing the protocol.

Those hospitals that don't want to play, are you going to bypass them? How long will it take to get LC EMS paramedics adequately trained? That's quite a project you've got ahead of you.

Actually Lee Memorial has baught out every hospital but 1 now, and the last one is where my medical director works. One hospital that I know of tried hypothermia briefly, but I'm not sure of the protocol they use. Neuro exam will be hard on the paralyzed patient. I think cath lab would be the one procedure that would be performed on these patients while they were still CHILLED. It is quite a project, but the outcome is well worth the work.

We know what it's like bringing the prolonged arrest to the hospital after ROSC, they usually don't walk out, now could you imagine increasing the possibility of those true saves by that much?

[VentMedic]

I'm going to hit you with some of the questions and statements that those of us who work in the "Condo to Heaven" (aka Florida) have got to ask.

How many codes are brought to each hospital ER daily?

I know I have averaged 2 - 5 per 12 hour shift easily during season in the ED. Sometimes at least half of those would make it to the ICU with a heart beat.

Are you going to activate the protocol on every body?

The obese and the very old?

When the mean age for some of the retirement communities is 87 (and most are still on the golf course), what a too old? Nursing home patients that are still full codes?

Yes, there is a younger population there, but the wealth and power is still older.

Are you going to be ready when it hits the news that somebody's loved one didn't get the new and fabulous remedy to death? People love to read stuff like that.

What is your on scene and travel time to the nearest hospital in code? I know Lee County is a large geographical area but also has many hospitals.

One of the reasons we hesitate initiating the protocol is poor prognosis. If the person is in very poor health, well known to the hospital and/or very elderly, the physician will talk to the family before we continue with more heroics.

[FL_Medic]

I'm going to hit you with some of the questions and statements that those of us who work in the "Condo to Heaven" (aka Florida) have got to ask.

How many codes are brought to each hospital ER daily?

I know I have averaged 2 - 5 per 12 hour shift easily during season in the ED. Sometimes at least half of those would make it to the ICU with a heart beat.

Are you going to activate the protocol on every body?

The obese and the very old?

When the mean age for some of the retirement communities is 87 (and most are still on the golf course), what a too old? Nursing home patients that are still full codes?

Yes, there is a younger population there, but the wealth and power is still older.

Are you going to be ready when it hits the news that somebody's loved one didn't get the new and fabulous remedy to death? People love to read stuff like that.

What is your on scene and travel time to the nearest hospital in code? I know Lee County is a large geographical area but also has many hospitals.

One of the reasons we hesitate initiating the protocol is poor prognosis. If the person is in very poor health, well known to the hospital and/or very elderly, the physician will talk to the family before we continue with more heroics.

I don't know how many codes are averaged throughout the county daily, maybe 4-10.

There is exclusion criteria for patients:

Age > 16

Not obviously pregnant

Temperature > 34 degreed C

No pain response

Intubated with ETCO2 > 20

There is no peak age in Wake EMS' protocol, but that may be something to look into as well as the obese patient. I personally wouldn't be telling the family member why they didn't recieve it, but it would probably be explained "he had a medical condition that contradicted the treatment".

This should be a standard of care, and as many patients should recieve it as possible, it is not difficult logisticly or by skill. Our paramedics as you probably know are allready highly skilled and expected to know alot due to our progressive protocols. We would probably do it like we do all new training, teach it at a mandatory in service training and then test on it.

Our transport times can be as much as 25 - 30 minutes on ground, less for post-arrest flying code 3 to the nearest facility, and we use air transport if the ship is available for post arrests.

the prognosis is much better than without the hypothermia, that is the whole point of what I am doing. After researching this you can't honestly say you wouldn't want your loved one(God forbid) cold & FAST after regaining a pulse.

[flight-lp]

The simple Newsweek link is

http://www.msnbc.msn.com/id/18368186/site/newsweek/

I see you've done some serious research on the topic. Duke University was a leader in some of the data collection and articles published. I heard one of their physicians speak at an ATS meeting.

Intratracheal cooling will probably be the most practical for EMS if we can perfect a method. Liquid perfluorocarbons might not be the best for pre-hospital right now.

I haven't read through all of your protocols yet.

What are you using to chill the patient?

We are using cooled NaCl, Versed and Vec to control shivering............I'll try to post the protocol tomorrow. So far it seems to work well, most of the hospital seem to be on board.

[VentMedic]

Have you stayed around to see what the core temp is on arrival with just the cooled NaCl?

At least that is easier and can be discontinued discretely once inside the ER if the discision is made not to continue the protocol.

But, how would you feel if you knew the hospital wasn't carrying on with something you thought worth while to start?

Age > 16

Not obviously pregnant

Temperature > 34 degreed C

No pain response

That's most of our population.

[FL_Medic]

We are using cooled NaCl, Versed and Vec to control shivering............I'll try to post the protocol tomorrow. So far it seems to work well, most of the hospital seem to be on board.

Yes, someone from Houston, I heard they are starting it there. If you come accross any research that can help me let me in on it. When did you guys start?