FO dies on AA

BobDDuck said:
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.
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That's the thing though, once the meds are given, the CPR and shocks can be done anywhere. If the ER is only a few minutes away in an urban area, you're really not losing much with a few minutes of transport time, especially with automated monitors delivering a shock, and some units that even have automated chest compression machines. May as well be getting someplace if you can, doing work that is easily done in the ambo, when initial on-scene interventions have already been given.
 
MikeD said:
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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She's in Indiana.

And you know how "they" are. :)
 
azmedic said:
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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CCR is standard down here, as are a number of units with automated compression machines.
 
Derg said:
She's in Indiana.

And you know how "they" are. :)
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Well, seeing how little Indiana allows its basic EMTs to do, it's not surprising :D

Actually it's interesting seeing how different all the states are with what they allow their field medical personnel to do. Some far more and some far less, than others.
 
MikeD said:
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.
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Huh. So shows where they shock a flatlining patient are wrong? And when they say they "bring people back from the dead"?
 
MikeD said:
Well, seeing how little Indiana allows its basic EMTs to do, it's not surprising :D

Actually it's interesting seeing how different all the states are with what they allow their field medical personnel to do. Some far more and some far less, than others.
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I had some volunteer EMT friends in Illinois, they were basically glorified taxi cab drivers. They couldn't even give O2 without higher approval.
 
FlyingAccountant said:
I had some volunteer EMT friends in Illinois, they were basically glorified taxi cab drivers. They couldn't even give O2 without higher approval.
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Wow. When I moved to Arizona and began practicing as a Basic there I was surprised how limited their scope was too..not as bad as Illinois but not far off. I decided to goto paramedic school shortly after.


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As they say, there are no dumb questions, so can anyone help us understand how the Captain's training kicked in to deal with those last seconds of "..2 miles from landing when the captain declared an emergency, citing "a medical issue" aboard, according to a Federal Aviation Administration spokesman."
 
Bear said:
As they say, there are no dumb questions, so can anyone help us understand how the Captain's training kicked in to deal with those last seconds of "..2 miles from landing when the captain declared an emergency, citing "a medical issue" aboard, according to a Federal Aviation Administration spokesman."
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He flew the airplane? Not to be dickish about it, but landing a jet single pilot is not that hard to do.
 
FlyingAccountant said:
I had some volunteer EMT friends in Illinois, they were basically glorified taxi cab drivers. They couldn't even give O2 without higher approval.
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Where I am (Marion Co. IND) we (EMTs) can give O2 per protocol without having to call for approval. In recent years we've been given the ability to use O2 sats and now we can even use a glucometer! (gasp!) We can use OPs & NPs and do non-visualized airways (combis & kings). Marion Co protocols are quite generous at the medic level.

The philosophy behind working codes on scene, as explained by our medical director, is that our medics have the tools to appropriately work a code onscene, and the reduction in quality CPR during transport is undesirable. (We don't have those handy dandy automated ones. I think some of IFD's medic squads may have them, but we don't.) So we work 'em on scene.

On my FTO I did actually witness a coded patient recover and sit up & talk... We showed up, IFD had arrived prior to us, put their AED on her and it shocked her twice, our medic shocked her again with our Zoll (at the time, we have Phillips now), got pulses back, medic was just about to intubate when she started breathing on her own. Transport. By the time the medic was done with her report, she walked back in the room and the Pt was sitting up talking. Pt was confused about how/why she was in a hospital, stated her chest hurt (yeah, cause 4 burly fire guys were beating on your chest for 15 minutes) but was fully coherent and conversational. She signed our run report herself. That was pretty cool. Our agency has like a 36% cardiac arrest "success rate".
 
MQAAord said:
Where I am (Marion Co. IND) we (EMTs) can give O2 per protocol without having to call for approval. In recent years we've been given the ability to use O2 sats and now we can even use a glucometer! (gasp!) We can use OPs & NPs and do non-visualized airways (combis & kings). Marion Co protocols are quite generous at the medic level.

The philosophy behind working codes on scene, as explained by our medical director, is that our medics have the tools to appropriately work a code onscene, and the reduction in quality CPR during transport is undesirable. (We don't have those handy dandy automated ones. I think some of IFD's medic squads may have them, but we don't.) So we work 'em on scene.

On my FTO I did actually witness a coded patient recover and sit up & talk... We showed up, IFD had arrived prior to us, put their AED on her and it shocked her twice, our medic shocked her again with our Zoll (at the time, we have Phillips now), got pulses back, medic was just about to intubate when she started breathing on her own. Transport. By the time the medic was done with her report, she walked back in the room and the Pt was sitting up talking. Pt was confused about how/why she was in a hospital, stated her chest hurt (yeah, cause 4 burly fire guys were beating on your chest for 15 minutes) but was fully coherent and conversational. She signed our run report herself. That was pretty cool. Our agency has like a 36% cardiac arrest "success rate".
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That is tremendous. You're (plural) clearly doing something right!
 
Holy insert bad word here,that is amazing!! I've had several saves over a decade in EMS where they left the hospital with no deficits post code,but to have someone wake up after working them never happened to me. That's awesome that you guys can do combitubes and King airways...honestly even though I could intubate,Kings were my preference especially on traumas.


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151,600 humans die every day. Let's be just ludicrously generous and say that only 150,000 of them were objectively less fortunate than the departed in question. The "tailwinds" squad have their work cut out for them if we're going to be equitable about all of this. Yeah, it sucks that people die. Maybe it's time to do something about it rather than repeating laughable bromides about the transience of consciousness, etc. sens.org <----unpaid advertisement!
 
Bob Ridpath said:
That is tremendous. You're (plural) clearly doing something right!
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azmedic said:
Holy insert bad word here,that is amazing!! I've had several saves over a decade in EMS where they left the hospital with no deficits post code,but to have someone wake up after working them never happened to me. That's awesome that you guys can do combitubes and King airways...honestly even though I could intubate,Kings were my preference especially on traumas.
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Yeah that was pretty damn cool. Amazing, and soooo not typical but amazing! We were all just standing there in the doorway like, "She's talking. She's sitting up in the bed talking." She was fully alert & oriented, was telling the doc her name, address, date, everything. It would nice if most arrests could end that way! :D She remembered talking to her daughter in her living room, then she was in the hospital. She had no memory of slumping over in her chair, nor of anything that had happened between then and waking up. Daughter witnessed the arrest, called 911 immediately, started CPR herself while on the phone with dispatch, so it's kind of the poster child example of what "to do" for a witnessed arrest and the value of immediate start of CPR. Most people who arrest don't sign their own run reports though!

All the other cardiac arrest dispatches I've responded to have had more typical outcomes.... :)
 
Derg said:
What happened to the attorney with the, well, you know… beautiful fingernails? :)
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Murdoughnut said:
Huh. So shows where they shock a flatlining patient are wrong? And when they say they "bring people back from the dead"?
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Yes, they are very wrong. What a de - fibrilate - er (stop - beating - er) does is actually stop your heart for a split second.

This is done because the heart's electircal system is going haywire. Stopping the heart for one beat lets it restart itself, hopefully with a good rythm. It's the equilivant of the old movies where the hero slaps the hysterical woman back to her senses.

If the heart is asystole (AKA flatline) it is completely stopped already. Stopping it again won't do a thing. Using my example from before, you can slap a corpse all you want but he won't wake up.


The problem is that everyone watched ER and Grey's and thinks you can save Grandma if you just run enough volts through her and don't understand why the paramedics are giving up without even trying those shocker thingies. I trained with a medic who responded to a heart attack in the mall food court on black friday (the morbidly obbese guy litterally dropped dead in front of Sabbaro). The traffic was so bad that it took 50 minutes to get there. The medic actually got out and ran the last 1/2 mile which took the truck another 30 minutes. By the time the medic arrived, he had been flatlined for almost a half hour despite over 20 people taking turns doing CPR. However, this had caused such a sceene that they trasported him to the ER anyway just to keep up apperances.
 
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