ALS Intercept for Cardiac Arrest

[emt_student_1678]

I have a question. This has been a discussion in our EMT class., that has drawn a lot of "heated" emotions between our different instructors.

You are a EMT-Basic Crew, as you arrive on the scene of a patient, enter the house, the patient goes into cardiac arrest. Do you:

1) Put the patient on the cot and load the patient in the ambulance, shock the patient once in the ambulance, and go to the hospital which is 15 minutes away.

2) Send someone to get the AED, start CPR, use the AED when it comes in, and call for a Paramedic intercept- the intercept is 8 miles away (about 7-10 minutes)

3) Perform CPR, Shock, Load and go and see if a paramedic can meet you en route.

I would have had the AED with me, and have done CPR/AED, called for intercept, and got the patient loaded and checked ETA's when the patient was loaded. I just can't see not calling for an intercept, but that's what some people said they would do.

 

[8jimi8]

1 person CPR w/ aed while your partner calls for ALS intercept. Load and go. there is no point in waiting 10 minutes to then drive for 15 more.

Your best shot is an immediate aed with a witnessed arrest and then definitive care asap

 

[fma08]

They wouldn't call for an intercept?? How far away from the hospital are you?

 

[emt_student_1678]

about 15 minutes from the hospital.

 

[AJ Hidell]

Your best shot is an immediate aed with a witnessed arrest and then definitive care asap

In the scenario given, definitive care is closer by intercept than by transport, so intercept at the scene, without transporting, is the way to go. This allows for the best possible CPR and the quickest possible turnover to ALS.

If the hospital were a good five minutes closer than the intercept, then I would say transport without intercept.

 

[8jimi8]

i can understand that rationale. i don't know why my brain was thinking that resuscitation in the hospital > resuscitation in the field. Medics can hang the antiarrhythmic drip and transfer to the ER for continuity of care.

 

[AJ Hidell]

Yeah, cardiac arrest (assuming cardiac origin) is one of the few scenarios where "definitive care" is actually within our capabilities. And what care we can render is a lot better when we're not trying to transport at the same time.

 

[medicdan]

It depends. Is the intercept 10 minutes down the direction of the hospital. At that point, I would call for the intercept, load, and meet them in 5 minutes (each moving 5 min towards the other), and transport the additional 10 to the hospital with ALS on board.

 

[AJ Hidell]

I completely disagree with this type of intercept in most cases. The loading and transportation efforts decrease the effectiveness of the BLS resuscitative efforts, as well as endangering the crew for no significant gain. I know it cheats the BLS crew out of an opportunity to play with the siren, which is a real bummer, but this is about the patient, not them.

 

[RDUNNE]

Being a First Responder student and very new to the EMS field, I am in no position to place an arguement, but I do agree with Aj. It seems to me care would be better on site then while in transport.

 

[MSDeltaFlt]

You must also realize something. The new AHA guidelines suggest that once chest compressions are started, they are not stopped until a ROSC. Answer me this. How can two people load a limp, dead weighted dead person out of a house and into an ambulance without significant pauses of effective chest compressions?

Work it on scene. Wait for ALS.

 

[JPINFV]

You can't, but then again basics are ingrained with the idea of getting a patient to definitive care as quickly as possible, even if it kills the patient.

 

[CAOX3]

I have a question. This has been a discussion in our EMT class., that has drawn a lot of "heated" emotions between our different instructors.

You are a EMT-Basic Crew, as you arrive on the scene of a patient, enter the house, the patient goes into cardiac arrest. Do you:

1) Put the patient on the cot and load the patient in the ambulance, shock the patient once in the ambulance, and go to the hospital which is 15 minutes away.

2) Send someone to get the AED, start CPR, use the AED when it comes in, and call for a Paramedic intercept- the intercept is 8 miles away (about 7-10 minutes)

3) Perform CPR, Shock, Load and go and see if a paramedic can meet you en route.

I would have had the AED with me, and have done CPR/AED, called for intercept, and got the patient loaded and checked ETA's when the patient was loaded. I just can't see not calling for an intercept, but that's what some people said they would do.

Usually you dont waste resources on dead people, in this scenario I would be inclined to call for an intercept being a witnessed arrest you just increased the percentages of survival.

In my area we work a tiered system. Ideally we send an ALS and a BLS for a cardiac arrest. If for some reason a BLS truck receives a a CPR call alone chances are there is no ALS available and its probably going to stay that way.

Response times and bystander CPR is what saves cardiac arrests patients. If I get to CPR and its unknown downtime and no bystander CPR and it took us seven minutes to get there. There is no point in requesting an ALS intercept. Load and go. Leave the ALS truck to tend to someone who is going to benefit from their services. This isnt one of them.

 

[RMSP05]

I would load and go ALS is 30 mins away where i am, same as the hospital, but if we get an intercept we will have ALS in 15 mins. I would rather have my crew of basics workin on them for 15 mins then have a medic as appose to 30 mins have a medic get there, and still have to transport 30 mins to definative care. Its a numbers game, and i can save 30 mins of time before being at the hispital if i use a intercept so u better beleive im gonna load and go

 

[Epi-do]

Response times and bystander CPR is what saves cardiac arrests patients.

Wait a minute, you can save someone in cardiac arrest?!?!?!?!

(In 10 years, I have never had a true save...)

Seriously, because I am in an urban system and we have a medic on every corner it is very rare for BLS to have to work an arrest by themselves for more than 2-3 minutes. Given the scenario the OP presented,and pretending I was still working as a basic and not a medic, chances are I wouldn't have the AED with me since the run most likely wasn't dispatched as an arrest. Therefore, I would alert my incoming medic of the situation, begin CPR, get the AED and wait for a medic to arrive onscene. Chances are, in my particular EMS system, the medic would be onscene before the AED made it back into the house.

I don't think there is any one right answer to this question because there are so many other factors to consider when deciding to transport, stay onscene, or leave the scene and intercept while enroute to the hospital. Every EMS system is slightly different in how it is set up, number of available medics varies, dispatch protocols vary, and the list goes on and on. What it comes down to is you have to know the system you are working in, and make the most appropriate choice for that particular set of circumstances.

 

[spisco85]

I'd add another check mark to wait on scene.

 

[Juxel]

I'm going to echo what has already been said. Unless the hospital is significantly closer than ALS care, you should stay on scene and provide GOOD CPR and shock if indicated by the AED.

Here's an interesting tidbit. Despite all of the research that has been done, all the drugs that are given by paramedics during an arrest have NEVER shown a scientific improvement to outcome for the patient. By no means am I arguing against the drugs, but why would you stop doing something (CPR) that is PROVEN to improve outcome to get them closer to something that is not proven?

 

[marineman]

I'd start CPR, send my partner for the AED and tell him to call for ALS on his way to the truck. If they are available and can be on scene in a shorter amount of time than it takes for us to transport then I'd stay and work it.

Now, to throw a slight curve ball at it because we all love what if's, every rig in our company has an autopulse on it. 2 people can move a patient without interrupting compressions. Outside of the autopulse the scenario is the same, now what do you do?

 

[AJ Hidell]

I'd still stay on the scene and wait for ALS. Code-3 transports of dead bodies is big risk for no benefit.