Dallas Fire Department EMS Care - Quality

[foreverbound]

Interesting, Fish!

How are the survival rates looking?

 

[Fish]

Interesting, Fish!

How are the survival rates looking?

TO soon to tell, plus not all first responders have been educated on the new protocol yet.

 

[TomP]

Fish, please tell me you meant BVM not NRB on a cardiac arrest

 

[rescue1]

Fish, please tell me you meant BVM not NRB on a cardiac arrest

There have been studies involving NRB use as opposed to BVM use. If it wasn't 5am I'd try to dig it up for you... but night shift has been kinda sleepy.

 

[Clare]

Ventilation is not a priority in cardiac arrest, there are only two things that are and these are 1) CPR and 2) defibrillation.

Experience has consistently shown that even very experienced ambos hyperventilate; in cardiac arrest this can lower venous return to the heart by increasing intrathoracic pressure .

Then there is the whole "flooding ischaemic cells with 100% oxygen free radical damage" thing which I don't know a whole lot about, well, that's all I know about it, but apparently its bad?

 

[rescue1]

Yeah, what she said.

 

[TomP]

I'm a AHA instructor for BLS, ACLS and PALS and I've never heard of such a thing, you are very right about hyperventilation and intrathoracic pressure, but this is the first I've ever heard of advanced level providers not being told to ventilate. I'm gonna have to do some research on the subject. Thanks

 

[Clare]

Yeah, what she said.

Thank you sir

 

[Fish]

Fish, please tell me you meant BVM not NRB on a cardiac arrest

No, I ment NRB. For reason that peeps stated below.

This is NOT something the AHA pushes, but studies have shown it works. It is relatively new however

 

[NomadicMedic]

We're not at the point where we are using an OPA and NRB on arrests, but we are using a nasal cannula with high flow O2 as we RSI. It's part of our protocol that we start with a baseline end-tidal CO2 with nasal prongs, so it just makes sense to flow it at 15.

 

[medic417]

As for the colors, I think they use the "standard" color boxes just like nearly every EMS system although it does sound like nit he past they were taught to give "the red box" to "X patient" not because it was easier, but because they saw no need to teach the real function/effect of the medications.

.

No he was talking about a box that was a certain color and contained sometimes several medicines in it. They would look up protocol and if it said red box they would give all the various meds in the red box. Required no training or education. Very bad idea, no telling how many patients were harmed or killed.

 

[RocketMedic]

Except it doesn't happen like that in reality...external motion does not correlate well to internal motion against the cord. Besides, if what you're saying is true then you're negligent by placing them on a spine board as forces will be directed into the cord by virtue of lying on a rigid board.

I do agree that you'll be gigged in the courts, as they are probably 20 years behind reality (you should see what we deal with in software engineering). You'll be faulted for not forcibly manipulating the person onto a rigid spinal non-immobilization device with a cervical-doesn't-actually-provide-immobilization device.

We need to find an enterprising lawyer who will work to sue EMS and Fire departments when their protocols are awful; e.g. placing people on backboards or using lasix for CHF or for stopping at 3 sprays of NTG with pulmonary edema...

I think I suggested this last month lol.

 

[Aidey]

I'm a AHA instructor for BLS, ACLS and PALS and I've never heard of such a thing, you are very right about hyperventilation and intrathoracic pressure, but this is the first I've ever heard of advanced level providers not being told to ventilate. I'm gonna have to do some research on the subject. Thanks

Look up "apneic oxygenation"

 

[RocketMedic]

I think it's a cultural issue myself, I reckon there's departments/services/agencies everywhere that do things this way due to education and "protocols". Education and individual responsibility for patient care (guidelines vs protocols) would go a long way towards improving this.

 

[TomP]

So I've done a lot of reading about apneic oxygenation and I do understand it although it still seems like proper ventilation with a BVM/ETT would benefit the pt more. Almost seems like your medical director doesn't have enough confidence in ems to even let them bag a pt, which is stupid! Not like were RT's, who are the worst at over bagging, mainly because that's all they can do in a code. I'm also curious if using sodium bicarb is a big part of your cardiac arrest protocol to counter act the respiratory acidosis your causing by not bagging the pt.

 

[usalsfyre]

So I've done a lot of reading about apneic oxygenation and I do understand it although it still seems like proper ventilation with a BVM/ETT would benefit the pt more. Almost seems like your medical director doesn't have enough confidence in ems to even let them bag a pt, which is stupid! Not like were RT's, who are the worst at over bagging, mainly because that's all they can do in a code. I'm also curious if using sodium bicarb is a big part of your cardiac arrest protocol to counter act the respiratory acidosis your causing by not bagging the pt.

For a guy who's an ACLS instructor you sure have a limited understanding of both the physiology of and team member roles during resuscitation...


The profound metabolic acidosis caused by an extended amount of time without circulation makes any respiratory issues moot.

RRTs are in my anecdotal experience,
on average, far better at mask ventilation than EMS. In addition in many places they manage all the airways outside of the ED.

 

[medicsb]

So there seems to be a lot of hear-say... "They don't intubate... I don't think they have X drug..." blah blah blah

Their protocols are online for everyone to see for themselves: http://www.biotel.ws/

 

[usalsfyre]

So there seems to be a lot of hear-say... "They don't intubate... I don't think they have X drug..." blah blah blah

Their protocols are online for everyone to see for themselves: http://www.biotel.ws/

Quick word...the protocols are straight forward, some of that is optional per dept though.

Again, the huge issue is departmental culture. I've been involved in the care of some their patients before, and seen many, many more brought to EDs. Some of the malarkey I've seen is astounding.

 

[RocketMedic]

Quick word...the protocols are straight forward, some of that is optional per dept though.

Again, the huge issue is departmental culture. I've been involved in the care of some their patients before, and seen many, many more brought to EDs. Some of the malarkey I've seen is astounding.

Are they using the ambulance as punishment duty or ???

 

[triemal04]

I'm a AHA instructor for BLS, ACLS and PALS and I've never heard of such a thing, you are very right about hyperventilation and intrathoracic pressure, but this is the first I've ever heard of advanced level providers not being told to ventilate. I'm gonna have to do some research on the subject. Thanks

You just finished paramedic school and you're allready an ACLS and PALS instructor? Were you a nurse before becoming a paramedic? PA? Something else?

Cardiocerebral rescucitation (continuos compressions with passive ventilation or no ventilation) was looked at awhile back with fairly promising results. After the 2005 changes in CPR (which in my personal opinion it helped drive) the differences between CCR and CPR started to decline. Still think the theory is sound, and things seem to be moving more and more in that direction anyway.