AED use in a moving ambulance
- Thread starter BrushBunny91
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If they went pulseless during transport, absolutely. If they are a traumatic arrest with penetrating trauma and we are within 10 mins of the TC they are getting packaged and transported unless they have injuries incompatible with life, per protocol. I can be seated and belted and do quality CPR in our units, only bummer is you aren't forward or rearward facing. We use the Philips qCPR puck on any patient who receives compressions so we know we are getting adequate depth, recoil and rate and if you aren't the monitor will yell and scream at you telling you what your doing wrong haha.
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The puck is one of the most disparaged but useful devices in an arrest, given how important compressions are. It's a shame they aren't on more/any AEDs as well.
Sent from my out of area communications device.
DV_EMT
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I heard that Phillips Heartstart FRx AED is supposed to calmly tell you what your doing wrong in order to calm the responder down and have them refocus on their training... which I think is pretty useful
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It is really calm actually haha Just annoying. "Push Harder" "Push a little deeper" "Slow down" "Speed up".
Usually it gets muted and you just tell whoever is pumping on the chest to keep the peaks of the waves between the two lines on the monitor and the number above 100.
Usually it gets muted and you just tell whoever is pumping on the chest to keep the peaks of the waves between the two lines on the monitor and the number above 100.
DV_EMT
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We need an AED with a Barry White voice telling you what you need to do... that'd be epic and I'd totally buy one if it was ever made
nyirishemt
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In my opinion its way more important to get the pt into the hospital where advanced care can be given, i would never EVER pull over on a code....
Angel21228
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As I have experienced doing CPR and AED in the back of the Ambulance. If you pull the Ambulance over while you are enroute with a Code you are delaying the treatment the pt could be receiving at the hospital. While enroute to the hospital, you should not pull over to Shock the pt!!!!
WuLabsWuTecH
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I have heard this from a few different sources though...
Once again, with our lifepack 12's there is no issue, even in advisory mode, at least I don't think, but I don't know about an AED...
An AED and manual defib from a monitor are completely different. An AED will not properly analyze the rythm if in the back of a bumpy Ambulance with 2 freaked out Basics driving as fast as they can. However, on a monitor that a Medic uses, we can see the rythm and do not depend on letting it analyze since we are analyzing it ourselves.
In a pimary CARDIAC related arrest, your AED and high quality compressions are definitive care. Yes, ALS ambulances and Hospitals have meds. But so long as the code was Cardiac in nature, the best treatment is high quality CPR and early electricity (not waiting till the ambulnace finally comes to a stop at the hospital to shock with an AED.)
So, my answer. If you have a patient who complained of left sided chest pain and then coded while enroute. You can bet your bottom dollar this was most likely cardiac, have you driver pull over while you are doing some awesome compressions the driver puts on the AED while you are still doing compressions. Let it analyze then shock if needed. Then continue to hospital, if you need to pull over to let it properly analyze again then so be it. Proper AED usage is what the patient needs.
In a pimary CARDIAC related arrest, your AED and high quality compressions are definitive care. Yes, ALS ambulances and Hospitals have meds. But so long as the code was Cardiac in nature, the best treatment is high quality CPR and early electricity (not waiting till the ambulnace finally comes to a stop at the hospital to shock with an AED.)
So, my answer. If you have a patient who complained of left sided chest pain and then coded while enroute. You can bet your bottom dollar this was most likely cardiac, have you driver pull over while you are doing some awesome compressions the driver puts on the AED while you are still doing compressions. Let it analyze then shock if needed. Then continue to hospital, if you need to pull over to let it properly analyze again then so be it. Proper AED usage is what the patient needs.
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where I work we have to do a min of 5 cycles at scene. We use the Mrx with the qcpr data. they have found that in aed more or advisory mode it cannot properly analyse or if it does it will read the artifact as vfib or vtach. It is policy for us to use the aed mode. If we think we see something on the monitor worth shocking on the road we pull over and hit the analyse. on extended transports we stop half way.
WuLabsWuTecH
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Are you considering a lifepack 12 in advisory mode as an AED or a Monitor? Basics around here are allowed to use the LP12 in advisory mode. The tracings we get from it are usually pretty good (I know how to interpret EKGs but I'm not technically allowed to do so in the field). If we see a shockable rhythm, we can call medical control, fax over the ekg, and have them prescribe a "dosage" of shock. It's simple enough, for us, turn the knob to the desired joulage, and hit the shock button.
The way were were taught in school is 3 tries with the AED (~3 cycles of cpr) and then load 'em and go. In urban areas, we might pull over to shock up to twice more, but in a rural area, it's pointless. If we stopped every 2 minutes, that 30 minute transport is now getting closer to an hour...
WuLabsWuTecH
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This is a grey area for me. I can read the rhythm clear as day, but I'm not allowed to interpret. I have no idea if the machine can interpret the rhythm I'm seeing (Yes, I have a degree in Biomedical Engineering, yes I have designed an ekg machine before, no, no computer is as good as a human reading it)
I've had time to think, this questions answer is full of variables and what ifs. I would say if you have a ten minute transport, full over and shock. 30mins out? get driving! If your own a smooth road? why pull over, bumpy as crap and only 10mins out? pull over, etc etc etc
pertinente
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is it safe to use a manual aed in a moving ambulance?
i have experience in using aed in moving ambulance, the aed started "shock advised, shock advised" constantly, it was not a safe situation, then i turned off the aed for safety reasons, because one slight touch, the fall of the aed, the bump against the wall of the ambulance could trigger the shock button at anytime.
even going down the stairs with the victim is a tricky situation.
is this the right thing to do?
should i risk all the trip hearing "shock advised"?
what is your experience?
i have experience in using aed in moving ambulance, the aed started "shock advised, shock advised" constantly, it was not a safe situation, then i turned off the aed for safety reasons, because one slight touch, the fall of the aed, the bump against the wall of the ambulance could trigger the shock button at anytime.
even going down the stairs with the victim is a tricky situation.
is this the right thing to do?
should i risk all the trip hearing "shock advised"?
what is your experience?
RustyShackleford
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If you are receiving a "shock advised" prompt then you must have your pads on the patient unless you are using a funky monitor that I am unfamiliar with, if so then the patient is either in arrest or pre arrest therefore I would be hesitant to ignore a shock advised from an AED in this situation, I am unfamiliar with a machine giving a shock advised without an analysis with pads on, are you referring to a "check patient" prompt which you may receive regularly on rough roads. I work in a more rural area so if my patient goes VSA during transport depending on the distance to the receiving facility I will pull over and run the arrest there with my EMT partners assistance and then either transport after a ROSC or a stabilization or TOR the patient if they meet the protocol either on scene or during an arrest during transport. This will obviously vary depending on the area you work with and the road conditions, where I am the roads are atrocious and the call distances are long.
EMT91
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We have the textbook Prehospital Care 9th Edition. According to it, you should stop the ambulance to use the AED because the movement of the ambulance might mimic V tach or V fib and thus shock when the heart is asystole or in another unshockable rhythm. I think it would depend on the timing as well, as during the circulation phase, (minute 4-10) the chances of having a shockable rhythm are rather low, from what I understand.
pertinente
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my concern is with my safety.
yes, the sticky pads are on the victim.
but the road movements influence the aed, and the "shock advise" reading cant never be real in movement,
my doubt is,
what prevents me from the aed fall, or a road bump trigger the shock button during the shock advise alert?
i work regulary on street and i have experience that a sudden break of the ambulance can make aed fall and trigger the shock button,
a 5 minute trip to hospital, constantly breaking the ambulance to aed evaluation, can became a 30 minute trip.
all the time to move the victim in local and during transportation to hospital is enough to stop the cpr by exhaustion.
my safety isnt reason to turn off the aed in a moving ambulance?
my aed button as no protection, is wide open with a tissue/fiber protection.
a doctor has paddles that removes from lifepack only when needed and then stores again in lifepack,
the lifepack paddles doesnt go all the way atttached to the victim.
i think my doubt is stupid, but i have serious doubts in using a aed in movement, even if we can stop near the road,
imagine we are down a 5 floor building stairs moving the patient, isnt impossible the aed to fall? isnt impossible the oxygen bottle to fall?
if the aed fall, cant it trigger the shock button, even if we are ignoring it?
yes, the sticky pads are on the victim.
but the road movements influence the aed, and the "shock advise" reading cant never be real in movement,
my doubt is,
what prevents me from the aed fall, or a road bump trigger the shock button during the shock advise alert?
i work regulary on street and i have experience that a sudden break of the ambulance can make aed fall and trigger the shock button,
a 5 minute trip to hospital, constantly breaking the ambulance to aed evaluation, can became a 30 minute trip.
all the time to move the victim in local and during transportation to hospital is enough to stop the cpr by exhaustion.
my safety isnt reason to turn off the aed in a moving ambulance?
my aed button as no protection, is wide open with a tissue/fiber protection.
a doctor has paddles that removes from lifepack only when needed and then stores again in lifepack,
the lifepack paddles doesnt go all the way atttached to the victim.
i think my doubt is stupid, but i have serious doubts in using a aed in movement, even if we can stop near the road,
imagine we are down a 5 floor building stairs moving the patient, isnt impossible the aed to fall? isnt impossible the oxygen bottle to fall?
if the aed fall, cant it trigger the shock button, even if we are ignoring it?
First thing should you be transporting a dead pt? Why not work them on scene and either call it or get ROSC and transport. But that is besides the point I suppose.
The biggest thing about an AED in a moving ambulance would be if the machine incorrectly interprets Vfib or Vtac because of the movement. But i'd argue how would it hurt the person if you shocked PEA/Asystole... they are already dead.
It has been shown that you can do compressions right through the defib without removing your hands, so I wouldn't be worried about being close to the pt.
If you are worried about the AED falling all over the place then secure it. Put it between the pt's legs, put it under the head of the cot, maybe tell the chap driving to slow down and not drive like a bat out of :censored:.
If you are worried about the O2 tank rolling down the stairs... well the pt managed to still be alive when you showed up so a few more minutes of no O2 probably won't kill him. Or.. you could get fire (or a helper) to carry it.
The biggest thing about an AED in a moving ambulance would be if the machine incorrectly interprets Vfib or Vtac because of the movement. But i'd argue how would it hurt the person if you shocked PEA/Asystole... they are already dead.
It has been shown that you can do compressions right through the defib without removing your hands, so I wouldn't be worried about being close to the pt.
If you are worried about the AED falling all over the place then secure it. Put it between the pt's legs, put it under the head of the cot, maybe tell the chap driving to slow down and not drive like a bat out of :censored:.
If you are worried about the O2 tank rolling down the stairs... well the pt managed to still be alive when you showed up so a few more minutes of no O2 probably won't kill him. Or.. you could get fire (or a helper) to carry it.