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

[NomadicMedic]

I don't oppose CPR in an ambulance, just CPR performed by a human. CPR performed by a Lucas device while moving is just fine.

 

[Christopher]

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?

We just don't do manual CPR while moving. Work it on scene or stop the truck to work it if they rearrest. Point becomes moot then.

 

[Handsome Robb]

We just don't do manual CPR while moving. Work it on scene or stop the truck to work it if they rearrest. Point becomes moot then.

If you never regain pulses does that truck go out of service then until the coroner can come take custody of the body?

Makes sense why you do it that way though, just wondering where resource management comes into play.

 

[Christopher]

If you never regain pulses does that truck go out of service then until the coroner can come take custody of the body?

Makes sense why you do it that way though, just wondering where resource management comes into play.

Yes, if other means of transport are unavailable we'll hang out. If a transporter is available they'll come take the body or if on scene we can leave them with LEO.

 

[STXmedic]

I think I'd step in, grab Granma and haul her to the hospital in my car if you proposed to sit and watch in my living room.

I've yet to have any family oppose my decision to stay and work the arrest on scene, but you do you, booboo.

 

[mycrofft]

" but you do you, booboo."

Say huh?

Well, might not if it was obvious she was dead or resusc was pointless. Or I stood to inherit.

 

[TheLocalMedic]

Again, why transport a patient to somewhere where they will only do what you should already be doing? Doing CPR while moving a patient and then transporting is not effective. Provided you have an ALS provider on scene, you should stay and work the code. Period.

 

[mycrofft]

" they will only do what you should already be doing"

Then you have a piss-poor hospital and they deserve to lose their license.

Again and again and again...show us the facts, the citations. In the majority of cases in adults and increasing with age, dead is dead; however, I'm also waiting to see the ambulance with an OR, ICU, CT or MRI, even a lab beyond basic oxygen monitoring, fingerstick glucometry, and if you're lucky, a urine dipstick.

If the above is true, start writing on run reports those very words.

 

[Christopher]

" they will only do what you should already be doing"

Then you have a piss-poor hospital and they deserve to lose their license.

Again and again and again...show us the facts, the citations. In the majority of cases in adults and increasing with age, dead is dead; however, I'm also waiting to see the ambulance with an OR, ICU, CT or MRI, even a lab beyond basic oxygen monitoring, fingerstick glucometry, and if you're lucky, a urine dipstick.

If the above is true, start writing on run reports those very words.

I'm fairly certain the only areas with Utstein survival to discharge numbers >25% are those which work all arrests in the field.

I'm not aware of any systems which transport patients with ongoing manual CPR that have comparable outcomes to Wake or Seattle.

 

[Veneficus]

I'm fairly certain the only areas with Utstein survival to discharge numbers >25% are those which work all arrests in the field.

I'm not aware of any systems which transport patients with ongoing manual CPR that have comparable outcomes to Wake or Seattle.

Nobody should be shocked by this.

You have populations most likely to suffer vfib as a complication of MI, with relatively few advanced comorbid conditions.

ACLS is designed for this patient population.

The King County system is completely designed aroud this pathology and epidemiology.

But I would maintain that cardiac arrest resuscitation is a very poor indicator of effective EMS. The return on investment is relatively nil. You would be better off with a bunch of BLS running around. It would be cheaper and I would wager the outcomes would be the same.

 

[Christopher]

But I would maintain that cardiac arrest resuscitation is a very poor indicator of effective EMS. The return on investment is relatively nil.

I think cardiac arrest survival is a great indicator of systems which ignore "traditional" EMS. Tube tube tube tube tube...

You would be better off with a bunch of BLS running around. It would be cheaper and I would wager the outcomes would be the same.

This is actually what I preach. Cardiac arrest resus is a layperson skill. ALS is here for when we get a pulse back.

 

[Veneficus]

I think cardiac arrest survival is a great indicator of systems which ignore "traditional" EMS. Tube tube tube tube tube.

So should we shut down all EMS systems that serve populations incondusive of cardiac arrest survival because of their ineffectiveness?

Determining the effectiveness of any form of medicine on bringing people back from dead is a fools errand, as the results will always call into question the worthiness of spending.

 

[Brandon O]

You would be better off with a bunch of BLS running around.

Hey! We don't run.

I think the idea is more that if your system can handle the challenges of high-performance cardiac arrest care, it's probably doing okay on the rest, too. Not necessarily true but a reasonable metric.

 

[Veneficus]

Hey! We don't run.

I think the idea is more that if your system can handle the challenges of high-performance cardiac arrest care, it's probably doing okay on the rest, too. Not necessarily true but a reasonable metric.

Like pain control?

 

[KellyBracket]

Like pain control?

Indeed.

 

[TomB]

But I would maintain that cardiac arrest resuscitation is a very poor indicator of effective EMS. The return on investment is relatively nil. You would be better off with a bunch of BLS running around. It would be cheaper and I would wager the outcomes would be the same.

Good luck with that wager.

 

[Veneficus]

Good luck with that wager.

I am not so sure it is that bad.

The only proven interventions to work are cpr and defib.

Hypothermia I think would add something, but it is not exactly wide spread in EMS use.

 

[Brandon O]

Like pain control?

This sort of thing is probably more linked to culture and attitudes (both institutional and provider). Certainly important, but somewhat distinct from technical adequacy.

You could similarly use something like the number of patient complaints as a metric. Your providers could all be very competent but a bunch of jerks. Just different aspects.

 

[Rialaigh]

Good luck with that wager.

I would bet on BLS having higher save rates. In fact in several systems with mainly BLS trucks and Medic QRV's stationed very far apart with longer response times they find that those systems have higher save rates then trucks that run medics on all trucks. I believe (I will have to find the study) that the save rate is higher in systems with a medic and a basic on each truck then systems with 2 medics on each truck.

 

[Rialaigh]

This sort of thing is probably more linked to culture and attitudes (both institutional and provider). Certainly important, but somewhat distinct from technical adequacy.

You could similarly use something like the number of patient complaints as a metric. Your providers could all be very competent but a bunch of jerks. Just different aspects.

Bringing up a good point of what to you use as a standard measurement of a good EMS system. In some ways I would argue that patient complaints or satisfaction ratings would be the best measurement. If the patients feel they should have had better medical care they will complain. If you run a system with good medical care and EXCELLENT customer service, you deserve to be recognized for that. 95%+ of our calls are customer service calls, not excellence in medical care calls.