Dispatch: Man Down, Possible Cardiac Arrest

[trevor1189]

Here is a question for you on how your service gets dispatched for a possible cardiac arrest. This is obviously an ALS call so around here they dispatch a MICU (Paramedic and EMT). However, every cardiac arrest call I have heard additional manpower is requested on scene. I am not sure why they don't dispatch a minimum of two Paramedics and two EMTs for a CA call right from the start. This is something that I think definitely needs to be changed in my area. That way there is not a delay in getting a sufficient number of people on scene to work the code.

Seems like Paramedic 1, managing airway/intubating; Paramedic 2 getting IV started; EMT 1 chest compressions; EMT 2 getting the drugs out and assisting with getting a 12 lead going as well as checking vitals seems like it would be a good setup for these calls.

How many people do you think should be dispatched for a full arrest call?

 

[Flight-LP]

Thats why god invented first responders. Get them en route on the initial dispatch. 2 Paramedics would be great, but the reality is that its not always possible. So prepare for the worst, hope for the best!

The Medic can focus on identification of the rhythm and getting access initially while BLS measures are performed. Once complete, he/she can start pushing drugs or zap as warranted. Intubation can be done anywhere down the line once he/she frees up.

btw - 12 lead isn't indicated during a cardiac arrest.

 

[Ms.Medic]

Here is a question for you on how your service gets dispatched for a possible cardiac arrest. This is obviously an ALS call so around here they dispatch a MICU (Paramedic and EMT). However, every cardiac arrest call I have heard additional manpower is requested on scene. I am not sure why they don't dispatch a minimum of two Paramedics and two EMTs for a CA call right from the start. This is something that I think definitely needs to be changed in my area. That way there is not a delay in getting a sufficient number of people on scene to work the code.

Seems like Paramedic 1, managing airway/intubating; Paramedic 2 getting IV started; EMT 1 chest compressions; EMT 2 getting the drugs out and assisting with getting a 12 lead going as well as checking vitals seems like it would be a good setup for these calls.

How many people do you think should be dispatched for a full arrest call?

Sometimes there can be way to many people on an arrest. In our service, we have one paramedic, one emt and then the supervisor will make our location if needed so the emt can drive. We handle them like this quite often, and more times than not.

 

[trevor1189]

I would just like to see them requesting manpower right after the initial dispatch rather than waiting for the first rig to get there and realize they need more responders.

In fact, there was one yesterday and as soon as the first ambulance said responding they also asked for the platoon chief and a second ambulance for manpower. Seems like that is the way to go.

 

[trevor1189]

Sometimes there can be way to many people on an arrest. In our service, we have one paramedic, one emt and then the supervisor will make our location if needed so the emt can drive. We handle them like this quite often, and more times than not.

True but I definitely think having extra responders show up is better than just two on a standard ambulance.

 

[PapaBear434]

Ideally, I'd say four. Two medics, two BLS. One BLS to help load and drive, the other helps load and do the "busy work" (help with compressions, BVM, grabbing equipment, ect.) and the two medics can do their medicy thing (drugs, airway, all that stuff.)

This could be done just fine with 3 people too (one driver, two in the back) but I'd rather have the extra on hand just for the extra hands to do CPR. You get tired pretty quick after all.

Anymore than four, though, you are just getting overcrowded.

 

[Ms.Medic]

Ideally, I'd say four. Two medics, two BLS. One BLS to help load and drive, the other helps load and do the "busy work" (help with compressions, BVM, grabbing equipment, ect.) and the two medics can do their medicy thing (drugs, airway, all that stuff.)

This could be done just fine with 3 people too (one driver, two in the back) but I'd rather have the extra on hand just for the extra hands to do CPR. You get tired pretty quick after all.

Anymore than four, though, you are just getting overcrowded.

Lucas device !!!!!!!!!!!!! Its a beauty.

 

[reaper]

Most of the time when you are called for an arrest, you arrive on scene to find that is not the case. Why have two units down, until you verify that you need them.

As Flight stated, that is what first responders are for. They can do compressions.

In times like these, the waste needs to be controlled. Two people can work an arrest. Three would be nice, but two can do it just fine!

 

[pdibsie]

This is why I like being an EMT with a FD. All medical calls are dispatched with an engine (or ladder) as well as an ALS ambulance. Two medics are on scene, one from engine, as well as 3 or 4 EMT-B firefighters. Seems like a lot, but we can immediately begin CPR while one medic places an airway and one or two people get IV's started. That leaves someone to get meds ready as well as document times of drugs given. Plus we can easily switch who is bagging and doing compressions after every few minutes. Works very well. Occasionally the system gets overloaded and this can't happen, but in all the instances I've run on we have had this happen. It's actually kinda cool to see, other than the person we're working.

 

[reaper]

With budget constraints hitting hard, you will see all that go bye bye! There is no justification to running a $500k ladder truck on a medical call. This is the tax waste that cities will cut first. Having FD on a scene is ok. Maybe two of them, in a rescue or brush truck. No need for an engine or ladder company to respond.

 

[amberdt03]

i think at least 2 medics and 2 basics but i think ideal would be 3 medics and 1 basic.

one medic can intubate, the other can start an iv and push any meds, one basic to put pt on monitor for the medic and use the bvm when necessary, and the other basic to drive.

or

on medic can intubate, second can start a line and push meds, and third can set up monitor and shock if necessary and the basic can drive.

 

[Ms.Medic]

i think at least 2 medics and 2 basics but i think ideal would be 3 medics and 1 basic.

one medic can intubate, the other can start an iv and push any meds, one basic to put pt on monitor for the medic and use the bvm when necessary, and the other basic to drive.

or

on medic can intubate, second can start a line and push meds, and third can set up monitor and shock if necessary and the basic can drive.

Shock ? What good is pushing meds if you have no chest compressions to circulate them ?

 

[Sasha]

What!?!?! You mean shock isn't the magical cure all?

(I'm starting to like this face )

 

[Ms.Medic]

What!?!?! You mean shock isn't the magical cure all?

(I'm starting to like this face )

I do too, it fits you well !!! Always got the mouth open, hehe.

Now go find one for me.

 

[trevor1189]

With budget constraints hitting hard, you will see all that go bye bye! There is no justification to running a $500k ladder truck on a medical call. This is the tax waste that cities will cut first. Having FD on a scene is ok. Maybe two of them, in a rescue or brush truck. No need for an engine or ladder company to respond.

That is what's nice about fire based ems, the medic can call for manpower and if there are ffs in house they can respond in a special unit truck or members can go directly to the scene to assist.

I definitely hate seeing fire apparatus responding to medical calls.

 

[Ridryder911]

Three for a half arrest and four for a full arrest!

R/r 911

 

[amberdt03]

Shock ? What good is pushing meds if you have no chest compressions to circulate them ?

i've only worked one cpr, and there were 3 medics and me as the basic, and another basic driving. i did compressions until fd got there and we loaded her up and off we went. during the transport there were no compressions being done. one medic was intubating, another got a line and pushed meds, and the other had her on the monitor to see what rhythm she had. all meds were pushed before they confirmed she was in vfib and one shock was applied that corrected it, so no need for compressions after that. i definitely not an expert but i saw that it worked great. the only words that were said was "she's in vfib" and "clear" other than that those 3 guys worked great together. obviously it would have been handled differently if she was in a different rhythm

 

[fma08]

Thats why god invented first responders. Get them en route on the initial dispatch. 2 Paramedics would be great, but the reality is that its not always possible. So prepare for the worst, hope for the best!

The Medic can focus on identification of the rhythm and getting access initially while BLS measures are performed. Once complete, he/she can start pushing drugs or zap as warranted. Intubation can be done anywhere down the line once he/she frees up.

btw - 12 lead isn't indicated during a cardiac arrest.

I'm just curious and not trying too nit pick at people, but I saw several posts saying they should be intubated right away. It had always been my opinion that an OPA and quality bagging would suffice while other things such as a monitor and defib would be slightly more needed than (and I'm being pescimistic here) fiddling around trying to place a tube, since that's a big controversy too, the whole successful intubation rate thing... But not to digress too much. My opinion is OPA and QUALITY bagging are good. While 2 medics would be ideal. It can be managed with 1, and I'd say 4 basics/FR.

... Ok, let the stoning commence for the intubation comment :blush:


p.s. If in a hospital, let's not forget to add the doc standing and checking a femoral through the process

 

[rmellish]

But not to digress too much. My opinion is OPA and QUALITY bagging are good.

I prefer NP over OP. Of course in my state a basic can drop in Combi-Tube or King Airway (yuck), so if vollie BLS is on scene first we often roll up on a patient with a semi-secured airway. This is usually left in place.

i've only worked one cpr, and there were 3 medics and me as the basic, and another basic driving. i did compressions until fd got there and we loaded her up and off we went. during the transport there were no compressions being done. one medic was intubating, another got a line and pushed meds, and the other had her on the monitor to see what rhythm she had. all meds were pushed before they confirmed she was in vfib and one shock was applied that corrected it, so no need for compressions after that. i definitely not an expert but i saw that it worked great. the only words that were said was "she's in vfib" and "clear" other than that those 3 guys worked great together. obviously it would have been handled differently if she was in a different rhythm

No compressions during transport? Ok, guess I wasn't there. Also, meds before rhythm interp? :unsure:

 

[amberdt03]

No compressions during transport? Ok, guess I wasn't there. Also, meds before rhythm interp? :unsure:

there wasn't a long period between the stoppage of compressions and the shock.

i don't know for sure but aren't there basic meds that get pushed for all cpr's regardless of rhythm.

its been a few years since this has happened so i could be wrong on the sequence of events.