NO CPR is better than moving CPR...true or false?

[mycrofft]

I've heard this said a few times on this forum, that CPR in an ambulance is not worth it.

I wonder if any hospital people, MD's or medical directors would like to comment?

I wonder if anyone would like to defend doing CPR riding on a gurney down a hospital hallway over doing CPR in a moving ambulance?

OR is this really just a thread about calm smooth safe driving with patients, er, people in the back?

 

[Achilles]

High quality compressions consistently.

 

[Medic Tim]

I've heard this said a few times on this forum, that CPR in an ambulance is not worth it.

I wonder if any hospital people, MD's or medical directors would like to comment?

I wonder if anyone would like to defend doing CPR riding on a gurney down a hospital hallway over doing CPR in a moving ambulance?

OR is this really just a thread about calm smooth safe driving with patients, er, people in the back?

Or you could work the pt on scene then transport if you get rosc. If it is ineffective and unsafe for providers what is the point?

 

[JMorin95]

I think if you can straddle the patient and provide compressions that way, you should be able to move at the same time.

In Maine if the patient codes while enroute to the hospital we have to stop the ambulance and run the code until they come back or 20 minutes goes by without any signs of life during compressions.

 

[Medic Tim]

I think if you can straddle the patient and provide compressions that way, you should be able to move at the same time.

You would feel comfortable/safe doing this in a moving ambulance?

 

[JMorin95]

Yes I would and I've also seen it done. Even if you are not moving straddling is more effective then being off to one side because it places more force on the sternum with less effort.

 

[STXmedic]

High quality compressions consistently.

Lol I'm out on the thumper! Hate that thing! Lucas 2 all the way

Yeah, I'm out on the CPR while driving. Very rare circumstance that that will happen. Less effective than no CPR, highly doubtful. Is it worth it from a safety perspective, not in my opinion.

 

[ffemt8978]

Yes I would and I've also seen it done. Even if you are not moving straddling is more effective then being off to one side because it places more force on the sternum with less effort.

Aside from the obvious safety hazard presented to the person doing compressions in this manner in a moving ambulance, there is another issue with it.

When it comes time to switch the person doing compressions, you end up having to stop longer than normal in order for one person to dismount the patient and the other to straddle them. At least with compressions delivered from the side, the switch off takes much less time.

 

[Medic Tim]

Aside from the obvious safety hazard presented to the person doing compressions in this manner in a moving ambulance, there is another issue with it.

When it comes time to switch the person doing compressions, you end up having to stop longer than normal in order for one person to dismount the patient and the other to straddle them. At least with compressions delivered from the side, the switch off takes much less time.

there is the defib thing as well

 

[JMorin95]

As long as you keep the switch off within 10 seconds there is no harm done. And it's a lot safer than trying to provide compressions while standing or being half on a seat.

 

[Medic Tim]

Yes I would and I've also seen it done. Even if you are not moving straddling is more effective then being off to one side because it places more force on the sternum with less effort.

how is it more effective?
what do you do when it is time to swap out? ... 2in+ compressions takes alot out of you
what do you do when you need to shock?
what do you do when the pt os obese? incontinent?

this is all besides the fact it is completely unsafe for the provider

 

[JMorin95]

how is it more effective?
what do you do when it is time to swap out? ... 2in+ compressions takes alot out of you
what do you do when you need to shock?
what do you do when the pt os obese? incontinent?

this is all besides the fact it is completely unsafe for the provider

Effectiveness: less power is needed for 2inches therefore a compressor can go longer in the position. It also is a steady and easy to hold position while being moved.

To swap you have the other provider next to the patient and when you get off thy can kneel down and straddle within 10 seconds.

To shock you simply standup and move over or pick a knee up and move over.

And just like everything else if their obese it may not work for them. For example not all stretchers fit obese people therefore not all ways to do compressions will work for a bariatric either.

This position is a lot easier than it sounds.

 

[medic417]

Short and sweet of it all is that AHA does not recommend rolling CPR. While not a law it is considered standard of care when in a court of law.

 

[JMorin95]

Short and sweet of it all is that AHA does not recommend rolling CPR. While not a law it is considered standard of care when in a court of law.

The AHA is the protocol my state follows for CPR but my state allows for provider discretion. If the provider can document that they believed the patient would be better helped by moving to definitive care for x reasons they would be covered in court.

 

[medic417]

The AHA is the protocol my state follows for CPR but my state allows for provider discretion. If the provider can document that they believed the patient would be better helped by moving to definitive care for x reasons they would be covered in court.

Thing is really nothing going to be done beyond standard ACLS or PALS at the hospital so no reason not to just finish in the field 99% of the time.

Every time compression's are stopped whether on purpose or because of hitting a bump if doing rolling code it takes 10-15 compression's to get circulation back to pre interruption amount.

 

[ffemt8978]

Having done CPR while on a 30 minute transport to ALS and then on the 30 minute transport to the hospital after that, I can say that straddling the patient is NOT the safest method, nor is it the most efficient method. It does win the the "whacker coolness" category, though.

What ever happened to the "Scene Safety, BSI" mantra that is taught to everyone? Does safety suddenly get thrown out the window once the patient is in the ambulance?

 

[medic417]

What ever happened to the "Scene Safety, BSI" mantra that is taught to everyone? Does safety suddenly get thrown out the window once the patient is in the ambulance?

Apparently when they are dead it does.

 

[Medic Tim]

The AHA is the protocol my state follows for CPR but my state allows for provider discretion. If the provider can document that they believed the patient would be better helped by moving to definitive care for x reasons they would be covered in court.

I am very very familiar with Maine protocol and policy. We are only to transport if we find ourselves in an unsafe situation where transport is the safest option or in the rare circumstances where transport would actually benefit the pt... which includes an olmc order to transport.

 

[STXmedic]

 

[JMorin95]

I am very very familiar with Maine protocol and policy. We are only to transport if we find ourselves in an unsafe situation where transport is the safest option or in the rare circumstances where transport would actually benefit the pt... which includes an olmc order to transport.

Basically the gist of what I meant.