ER docs... do your paramedics transport patients without ROSC?

[frosted2]

Florida father dies after ambulance breaks down; took nearly one hour to get to hospital

Where I work, we work on scene for 20-30 minutes and call the code if we don't have ROSC. Obviously, everything in medicine is situational, but it is often an exception when we transport patients who do not have ROSC. Many people in the comments were saying that hospitals have more capabilities than an EMS crew... sure they do... only if there is ROSC! Otherwise, I've never seen a dead patient go any further than the ER bay.

Thoughts anyone? @wook ?

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[seanm028]

(Not a doctor)

I think most EMS agencies have protocols now that call for delaying transport until after ROSC. And yes, hospitals have more capabilities, but we know that most cardiac arrests are treated with straight ACLS, which can be performed in the field or in the back of an ambulance. It may seem counter-intuitive to a layperson, but I doubt any medical professional is going to be up in arms about delay transport in cases like this.

 

[frosted2]

(Not a doctor)

I think most EMS agencies have protocols now that call for delaying transport until after ROSC. And yes, hospitals have more capabilities, but we know that most cardiac arrests are treated with straight ACLS, which can be performed in the field or in the back of an ambulance. It may seem counter-intuitive to a layperson, but I doubt any medical professional is going to be up in arms about delay transport in cases like this.

I agree!

On the flip side, I still see a lot of people grab and go with kids. Hopefully Dr. Antevy (HandTevy) is going to help with a culture change. I don't care who you are, manual CPR in the back of a moving ambulance is not effective.

 

[seanm028]

I agree!

On the flip side, I still see a lot of people grab and go with kids. Hopefully Dr. Antevy (HandTevy) is going to help with a culture change. I don't care who you are, manual CPR in the back of a moving ambulance is not effective.

Mmhmm. I think that's a byproduct of stress. People get really spun up when it's a kid and start doing things differently from how they normally operate.

 

[Apollyon]

I had a code last week that was dead. BLS found the guy down outside - he was walking out to go bow hunting. Bystander CPR had been started. BLS gets him. ALS meets enroute. That's the first time the monitor is placed. Asystole the entire time. I told the paramedic that he couldn't bring me a dead body, so, just "do the dance" BLS coding the guy, and I declared him right when he hit the ED.

Had the vollies had a defib, they could have just waited for ALS, and left him there.

But, it's what I do.

 

[Apollo1]

I work in this neck of the woods, re: posted link. Yes, Hillsborough Fire and Tampa Fire transport w/o ROSC.

 

[alpinism]

They commonly transport patients without ROSC where I work in Detroit.

Usually the outcomes are poor however I've had multiple patients walk out of the hospital the majority being witnessed arrests in healthy patients with shockable rhythms.

As far as capabilities our scope far exceeds ACLS and includes thrombolytics, beta blockers, nerve blocks, double sequential defibrillation, and ECMO at some places.

 

[frosted2]

They commonly transport patients without ROSC where I work in Detroit.

Usually the outcomes are poor however I've had multiple patients walk out of the hospital the majority being witnessed arrests in healthy patients with shockable rhythms.

As far as capabilities our scope far exceeds ACLS and includes thrombolytics, beta blockers, nerve blocks, double sequential defibrillation, and ECMO at some places.

That is awesome!!

 

[InternistDO]

We would transport refractory v-fib/v-tach, or patients who would lose ROSC several times. Asystole or PEA without ROSC got left on scene.

Unfortunately there are a lot of hospitals that won't do more than normal ACLS, so transporting there was really no different than staying on scene as far as obtaining ROSC. Other hospitals would have a cath lab, ultrasound, beta blockers, TPA, etc etc. To be honest, we should only have been transporting to the more capable centers, but I didn't make the protocols.

 

[arjusmc]

Another thing to consider is the receiving hospital. My service has protocols to terminate efforts after certain ALS procedures have been completed without ROSC. However one of the major hospitals in our county does not give orders to terminate. We do not use our medical director as medical control, we use our receiving hospital's physician. This is not the case for all of the facilities we use, just one, but it is the only hospital for this portion of our county. I've been told it has to do with either the physicians group's insurance or the hospitals.

 

[southerndoc]

More private services transport without ROSC. It's hard to justify keeping a unit onscene for 30-45 minutes administering medications and tying up manpower without much reimbursement from CMS or insurance companies. The non-transport reimbursement is abysmal.