FO dies on AA
- Thread starter rausda27
- Start date
Murdoughnut
Well sized member
Did you guys check the scab list before offering condolences?
In all seriousness, sad to hear. Bad situation for the Cap'n too.
In all seriousness, sad to hear. Bad situation for the Cap'n too.
Richman
JC’s Resident Curmudgeon
AEDs only work in a limited number of situations. They won't shock a flatline, for instance. They are not a replacement for trained medics.
Richman
milleR
Well-Known Member
IIRC, first responders are required to perform CPR until there is somebody with the legal authority to pronounce the person deceased on the scene.
Murdoughnut
Well sized member
Does that only apply to the AEDs and not the hospital variety you see in movies/shows?
skypilot6
Well-Known Member
They are, they have a legal obligation to keep trying, but at 35-40 min it was a lost cause for a long time.
Cptnchia
Dissatisfied Customer
Did you guys check the scab list before offering condolences?
In all seriousness, sad to hear. Bad situation for the Cap'n too.
BRB
Edit: Nope. There's a Robert Grubbs.
mrivc211
Well-Known Member
I was just thinking of this the other day so I'll chime in. My lady friend is an ER nurse. Tells me how sad it is that so many people die in a dark, lonely hospital bed all the time with no friends or family around. My next thought was if I'm going to die, I'd rather do it in the air because theres no place else I'd rather be. I think everyone sends their condolences etc to the poor guy, but I dont wanna go Tango uniform alone in a hospital. Maybe he was coming at it from that approach which I could understand, but there are a lot of trolls out there so.....
Bob Ridpath
Pit Bull love
Certainly not everyone agrees with the change, but Rhode Island EMS protocol now requires THIRTY minutes of CPR ON SCENE prior to patient transport for a cardiac arrest:
http://health.ri.gov/publications/protocols/PreHospitalCareAndStandingOrders.pdf#page111
I'm not sure of specific other places which have implemented this but know NY is at least reviewing the concept.
Boris Badenov
Fortis Leader
If this dude had waited a couple of hours to drop dead, no one here would have noticed. All of this maudlin retail sentimentality is silly.
The monitors carried by paramedics and hospitals are much different than AEDs. AEDs will only deliver a shock if VFib or VTach rhythms are present. Standard monitors can deliver shocks to pretty much anything,as well as pace a rhythm,but as a general rule Asystole is never shocked.
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BobDDuck
Island Bus Driver
I would hope there are exceptions to this when there are other issues too. That seems kind of restrictive to medics making a decision.
The new theory worldwide seems to be more along the lines of stopping efforts when somebody is warm and dead instead of cold and dead.
Bob Ridpath
Pit Bull love
I can't speak to the logic but there is a ton of discussion in professional journals to be found online. The protocol is fairly specific (linked).
From my limited perspective it places a lot more emphasis on the medic's training and skills, with correct use of the available meds while in the field - along with shocks (as indicated) and correctly done CPR in a stable environment - rather than poorly done CPR in the back of a moving ambulance just to get to an E.R. where similiar (or nearly so) intervention would be undertaken with minutes lost. With the meds carried these days, excellent training, and a range of tools, medics are the difference between life and death on the scene, and well before the E.R. Is even close at hand.
Not an apologist, just an interested observer as NYS (and others) watch and evaluate the data.
Murdoughnut
Well sized member
Interesting. So what do they do for you if your asystole?
Nothing. Dead is dead. No electrical activity.
An AED won't even deliver a shock for it. It's one of two non-shock rhythms, of the four rhythms an AED looks for.
Others have well explained the AED usage & such.
We work our arrests in the field for 30 minutes. When a call is declared to be a "working arrest" that means the clock starts ticking, and we will work the arrest for 30 minutes on-scene. (Some departments load & go and do CPR enroute to a hospital, in our environment that's not how our medical direction has seen it best to work arrests.) Unless the family presents us with a valid DNR, we work. If we get pulses (ROSC) back during the 30 minutes, at that point we transport, but if 30 minutes pass and we get no pulses back we call our medical control and tell them and we discontinue CPR and call it.
We work our arrests in the field for 30 minutes. When a call is declared to be a "working arrest" that means the clock starts ticking, and we will work the arrest for 30 minutes on-scene. (Some departments load & go and do CPR enroute to a hospital, in our environment that's not how our medical direction has seen it best to work arrests.) Unless the family presents us with a valid DNR, we work. If we get pulses (ROSC) back during the 30 minutes, at that point we transport, but if 30 minutes pass and we get no pulses back we call our medical control and tell them and we discontinue CPR and call it.
Which is a weird way of doing it because for you urban EMS people, the golden hour isn't an issue normally, with the hospital 5 mins away. One would think it'd be better to load and go, letting the meds and the Zoll do its thing, along with a few minutes of back-of-ambo CPR, than sitting on scene working it.
For my EMS area, we're forced to work on scene until a transport can arrive (may be a few hours) and the golden hour is a definite race against time for us for cardiac events. One we often lose.
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BobDDuck
Island Bus Driver
My work falls way more in your category, where I could be waiting hours (or days in theory) for transport out. That said, the data I've seen for front country medicine shows two medics providing good CPR/AED/drug usage in a stable environment provides a higher save rate than one guy in the back of a bus trying to do it on his own, even though they'll get a patient to a higher level of care sooner. It seems like, especially at the P level, the level of care in the field is high enough now to make a difference the majority of the time.
I still stand by what I said earlier though, that there seems to be a need for tighter criteria about do I stay or do I load and go in the first 30 minutes, but overall with cardiac issues it seems to make sense.
Around the time I was leaving the Valley they were pushing us to work codes on scene until we got ROSC and then load and go,even though we were at most 10 minutes from multiple hospitals. Our medical director did some research on effectiveness of CPR on scene vs in the back of the rescue and our effectiveness dropped significantly while moving. It's likely a combination of being in a moving vehicle and fatigue after doing hundreds of compressions. Not sure if you guys were doing that down in your area @MikeD but we would do CCR compressions and not the AHA standard 30:2
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