A.R.T.

VentMonkey · Sep 27, 2016

https://health.ucsd.edu/medinfo/training/crs/training-program/pages/default.aspx

I just caught wind of this through a Rivco paramedic buddy of mine. Apparently it's going to replace AHA in REMS fairly soon.

Any of the Riverside guys feel free to elaborate.

Any other systems out there doing this as well?

EpiEMS · Sep 27, 2016

VentMonkey said:
https://health.ucsd.edu/medinfo/training/crs/training-program/pages/default.aspx

Interesting stuff. Pretty tremendous claim: They purport to have "reduced the incidence of cardiopulmonary arrest by almost 50 percent" in the inpatient setting, and have seen "survival from out of hospital cardiac arrest [increase]...50 percent following ART training". That being said, it doesn't strike me as being fundamentally different from ACLS, etc., it's just more comprehensive and integrated.

VentMonkey · Sep 27, 2016

Tremendous indeed. I'm interested to hear anyone's take on in who has actually had exposure and/ or experience to it, and their thoughts are on it.

DesertMedic66 · Sep 28, 2016

First time I am hearing about this but who knows. As of right now (at least last I knew) we don't even have our own medical director for the county. We are using ICEMAs medical director under a mutual aid agreement. AMR is also going to be getting a new medical director in the next year.

Since the start of last year we implemented the pit crew CPR with non stop compressions and ventilations on every 10th compression. Focused has move away from intubation being the gold standard for full arrests and now it is on whatever airway a provider can get without having to stop compressions.

Summit · Sep 28, 2016

Looks like a systems approach full of buzzwords, promises, and you have to show up and pay to see the content. I'm sure it works way better than not having a systemic approach. No links to research results? Sounds like a money maker!

VentMonkey · Sep 28, 2016

So the story I am getting is that this is being implemented by their county contracted FD already (Cal Fire). Apparently it was pushed by the county's previous medical director before he left the position vacant (red flag number one, IMO).

It's a CCR-style sounding approach with less emphasis on ETI (nothing new here), and no defbrillation on a shockable rhythm with an ETCO2 less than 20 cmH2O.

I don't know if the county contracted ambulance service is going to implement it as well, and I also don't know if this has to do with Cal Fire's approach (or lack there of) of prehospital EMS. Riverside guys, again, please feel free to elaborate if you know of any insightful info.

It seems really straightforward, and hard to screw up. I do agree though that the promises seem tremendous, and to me it sounds "too good to be true" for something that no other system nationwide has implemented, let alone by a medical director who left it in the hands of a neighboring counties director until the next guy comes along and fills the vacany.

Skeptical? Perhaps.

EpiEMS · Sep 28, 2016

VentMonkey said:
It's a CCR-style sounding approach with less emphasis on ETI (nothing new here), and no defbrillation on a shockable rhythm with an ETCO2 less than 20 cmH2O.

No defibrillation on a shockable rhythm with ETCO2 < 20cm H2O...what's the rationale for that?

VentMonkey · Sep 28, 2016

DesertMedic66 · Sep 28, 2016

CalFire surely isn't doing that out in the desert area. We and they are still defibing any shockable rhythm

Carlos Danger · Sep 28, 2016

EpiEMS said:
No defibrillation on a shockable rhythm with ETCO2 < 20cm H2O...what's the rationale for that?

Was wondering the same.

VentMonkey · Sep 28, 2016

Remi said:
Was wondering the same.

If capno isn't 20 or greater the heart isn't capable (according to them) of excepting electrical energy. Shocking below 20 will likely send them into asystole where above will convert them to a sustainable rhythm.

The above statement is a ver batum text sent from my buddy. By them I assume he means the doctor(s) implemting this?

I guess it's supposed to be part of their next EMS protocol update. I'm not 100% sure, again, I don't work out there. I just wondered if anyone else had any working knowledge of such an approach to CPR/CCR/ROSC.

If I hear anything further, I will post it. I'm always interested in learning different ways to "skin" a proverbial "cat" though.

Carlos Danger · Sep 28, 2016

VentMonkey said:
If capno isn't 20 or greater the heart isn't capable (according to them) of excepting electrical energy. Shocking below 20 will likely send them into asystole where above will convert them to a sustainable rhythm.

The above statement is a ver batum text sent from my buddy. By them I assume he means the doctor(s) implemting this?

I guess it's supposed to be part of their next EMS protocol update. I'm not 100% sure, again, I don't work out there. I just wondered if anyone else had any working knowledge of such an approach to CPR/CCR/ROSC.

If I hear anything further, I will post it. I'm always interested in learning different ways to "skin" a proverbial "cat" though.

Hmmm. Never heard of that.

Summit · Sep 28, 2016

Is there some research to back that claim?

VentMonkey · Sep 28, 2016

Summit said:
Is there some research to back that claim?

I asked this same question. I can't find any, but if or when I do, I will be sure to update everyone.

A.R.T.

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