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Cardiac Arrest. BLS or ALS job?
Okay so in my town my buddy and I always question if a cardiac arrest is necessarily a need for ALS or if more BLS hands on is what it will take to make resuscitation more likely. For those who are curious we live in NJ in case someone was curious as to what scope of practice we have.
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Replies to This Discussion
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Permalink Reply by Tom Bouthillet on -
One of the ways that Wikipedia has solved the problem of infighting between editors has been establishing a code of conduct that includes civility (one of Wikipedia's "five pillars"). It helps promote an atmosphere of collegiality (shared responsibility and presumption of good faith). The policy is intended to make editing the Wikipedia as pleasant as possible because it's a voluntary activity and they want to attract as many talented editors as possible who would otherwise find something else to do with their valuable time. This is just a general comment and I am not accusing anyone of incivility but I do think a lot of these threads devolve into debate for the sake of argument which does not lend itself to civil, professional discourse for the purposes of learning and advancement of the EMS profession. It probably also runs off some interesting people. Not that I don't find you all fascinating! :)
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Permalink Reply by Neil White on -
I've been offline for a few days, and when I left we were at 30 odd posts and now 79.
I flicked through one or two and quickly realised the biannual Jems connect copy and paste festival was back in town.
Its a shame that whenever an interesting topic comes up for discussion it quickly derails into a drunken family gathering "you said this" "no I didn't but 24 pages ago you said this and I've used google to find an episode of ER that proves you wrong"
I think that it's been advocated before but for our colleagues from JEMS watching please can we have a forum rule book. Many other forums have a post that always stays at the top of the list covering such things. Although as I type I can't believe its needed for professionals of one of the worlds emergency services.
Skip I saw your question 92 pages back I'll start a new threat because there''s some mileage in discussing the response model. I'll also send some research by message.
Tom Bouthillet said:One of the ways that Wikipedia has solved the problem of infighting between editors has been establishing a code of conduct that includes civility (one of Wikipedia's "five pillars"). It helps promote an atmosphere of collegiality (shared responsibility and presumption of good faith). The policy is intended to make editing the Wikipedia as pleasant as possible because it's a voluntary activity and they want to attract as many talented editors as possible who would otherwise find something else to do with their valuable time. This is just a general comment and I am not accusing anyone of incivility but I do think a lot of these threads devolve into debate for the sake of argument which does not lend itself to civil, professional discourse for the purposes of learning and advancement of the EMS profession. It probably also runs off some interesting people. Not that I don't find you all fascinating! :)
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Permalink Reply by Herb Lutz on -
Am new to this so please be kind. As to the initial discussion a true revivable cardiac arrest is an ALS call. And no I don't want to debate what a revivable arrest is, you all know what I mean. As to the skill of street medics I do believe that most try to do their best. If there is lack of performance the individual may be at fault but the real problem is supervisors and medical directors not doing their job. 1st the individual must having the proper working equipment to do the job. If a individual is having an issue with a skill, teach them. If they don't want to learn, bye-bye. The trust and responsibility is to great for any other solution. I work in a residential/rural area with 2 MICU's one 24/7, the other 16/7. Staffed with an EMT and Medic. It is not unheard of for a call to cover 100 miles. It is in central PA so with the weather there are times when you are simply on your own. It would be irresponsible for me put to someone out there who is not ready to handle it. It is also irresponsible for someone to accept that responsibility when not ready for it. I guess what all this babling means is the each individual EMT or Medic must accept responsibilty for their actions and be held accountable.
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Permalink Reply by Tom Bouthillet on
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"Holding individuals accountable" is the favorite catch phrase of unenlightened management. In the vast majority of cases the problem is not the individual. Most EMTs and paramedics are not "ready" to handle life-threatening emergencies as fresh graduates and it's unrealistic to expect new EMTs and paramedics to turn down employment. It's the responsibility of each EMS system to ensure they deliver high quality patient care. That does not mean that individuals are not responsible or should not be held accountable for willful misconduct. But it does mean that problems with individuals should be viewed in the context of leadership, culture, supervision, quality control, quality improvement, continuing education, and standards of response coverage.
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Permalink Reply by Herb Lutz on
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Thanks for the input Tom. I agree that problems with an individual issue is not simply a black or white issue. I'm a working manager. I get to manage between calls and completing patient care reports. I certainly don't consider myself unelightened. I don't expect new EMT's or paramedics to turn down a job. But I do expect them to understand the resposibilty they are accepting. I do not believe holding an indivual accountable for their actions is unreasonable.
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Permalink Reply by Tom Bouthillet on
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It does seem reasonable. The problem is that it doesn't work if your goal is to prevent errors and improve care. The exception is the employee who does not share the organization's values or is not operating in good faith. Even then, the organization should examine its hiring practices and determine whether or not it appropriately articulates its values, and whether or not it lives by those values or only pays lip service to things like quality, public service, or integrity.
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Permalink Reply by Joe Paczkowski on -
Herb Lutz said:Thanks for the input Tom. I agree that problems with an individual issue is not simply a black or white issue. I'm a working manager. I get to manage between calls and completing patient care reports. I certainly don't consider myself unelightened. I don't expect new EMT's or paramedics to turn down a job. But I do expect them to understand the resposibilty they are accepting. I do not believe holding an indivual accountable for their actions is unreasonable.
How many services 'hold an individual accountable for their actions' yet provide practically no field training or CQI until a major event occurs? I agree that individuals should be held accountable for their actions, but services similarly need to be held accountable for their continuing evaluation and feedback, or lack there of. Feedback and CQI is especially important if you have a provider providing care at a different level than most other employees, regardless of if that care is above or below the average provider. If a provider is operating at a higher level, then a dialogue and understanding needs to be achieved sooner than later before a seemingly inappropriate action becomes a larger issue than it really is.
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Permalink Reply by Herb Lutz on
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Thanks Joe. You and Tom make some good points. I reread my initial post and does read like holding an individual accountable is like holding a hammer over their head. Not what I intended. I'm lucky in that I work for a small service and get to work with most everyone over a two week period. I also do the CQI. Our idea is to use the CQI to see trends and correct them before they become major issues. Most of the time I'm aware of mistakes before I see the PCR because the staff has already told me about them. We try share our mistakes (mine included), so that everyone learns from them.
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Permalink Reply by Skip Kirkwood on -
I've got an idea - how about a Peer Review forum. No statements can be made unless they are supported by peer-reviewed literature published in an indexed publication? Wouldn't that be fun?
Just kidding, of course.
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Permalink Reply by Pascal Hay on -
Cardiac arrest is a joint venture. Good and early CPR is a start. We are teaching CPR in the schools and local groups (Lions, etc) so that bystander CPR can hopefully be in progress before our arrival. We are useing Autopulse mechanical CPR that works great with the exception of battery problems. Advanced airway is still used but doesn't have as high a priotity in the protocol now. We are working the arrest on scene and if the patient is not respnsive to therapy calling medical control after speaking with the family and pronouncing the patient on scene. If we do get ROSC we are transmitting post resuscitation 12 leads to the hospital and begin cooling. My shift has had four arrests this month. We pronounced one on scene, one is in cardiac rehab with no nurological disabilities, one is still in ICU in an induced coma with a good prognosis, and one is at home with her family a healthy six week old. Without a team effort none of this is possible. BLS and ALS provided in a team approach is key to not only ROSC but a productive out come for the patient.
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Permalink Reply by Rogue Medic on -
The association between emergency medical services staffing patterns and out-of-hospital cardiac arrest survival.
Eschmann NM, Pirrallo RG, Aufderheide TP, Lerner EB.
Prehosp Emerg Care. 2010 Jan-Mar;14(1):71-7.
PMID:19947870 [PubMed - indexed for MEDLINE]http://www.ncbi.nlm.nih.gov/pubmed/19947870
It is important to note that, as is shown in Table 1, crews with two paramedics treated fewer cardiac arrest cases with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia than crews with three or more paramedics. Yet the unadjusted and adjusted odds ratios demonstrated that two paramedics conferred a survival advantage. This seems counterintuitive and may indicate an even stronger association between crew size and survival.
The Milwaukee County EMS system operates with a minimum of two paramedics on ALS ambulances. During the study period, no cases were treated by one paramedic. A single paramedic’s influence on outcome was not able to be evaluated.
The more paramedics on scene, the less likely the resuscitation, even with increased bystander CPR.
The number of paramedics does not appear to interfere with ROSC, only with long term meaningful outcome.
The studies of ALS interventions keep pointing out the increased ROSC with ALS interventions. Unfortunately, the surrogate endpoint of ROSC does not appear to lead to improved survival to discharge.
That which is asserted without evidence should be dismissed without evidence.
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Permalink Reply by Rogue Medic on
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Sorry, that should read -
The more paramedics on scene, the less likely the resuscitation, even with decreased time to CPR.
not -
The more paramedics on scene, the less likely the resuscitation, even with increased bystander CPR.
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