#1  
Old 07-01-2013, 07:43 AM
TheBatman TheBatman is offline
 
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Default Rural VSA

Random scenario we were discussing the other day.

It was discussed from the PCP paramedic crew point of view, just wanted to see what other people/services think...


Dispatched code 4 for Chest Pain in the county, only back up is volunteer fire, no ALS. Patient is STEMI positive so you choose to go to the cath lab which is approximately 45 minutes away rather then the closest hospital. En route patient goes VSA. You pull over you've gone through your 4 shocks, fire department states there 3 minute out. As per protocol you must leave and head to the hospital. Hospital is still approximately 20 minutes away.

Do you deviate from protocol and wait for the volunteer fire department to show up and assist with CPR since you still have approximately 20 minutes to the hospital and your CPR will diminish on your own or do you stick to your protocols and leave right away and run the rest of the VSA on your own?


Any thoughts would be great.
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  #2  
Old 07-02-2013, 06:27 AM
Labrie Labrie is offline
 
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Couple of questions for you about this. First off can this service bypass local hospitals for STEMI's? Because I've worked in two rural services and both are not allowed to bypass for STEMI's. We go to local hospital, they stabilize and then transport out to cath lab if needed.

Secondly, if you are greater than 30 minutes originally, I would see if air would be able to transport the patient. Never hurts to ask and you are in need of ALS. You could also ask for a modified with ALS once you reach the city.

There are a lot of variables but if we stick with the scenario you have given, I would continue on route and not wait for fire. While pulled over doing the arrest protocol, I'd throw in a king LT to help with bagging by myself and given the times I've had to do long periods of CPR to the hospital, I'd be comfortable with it. The patient needs a cath lab as definitive care to survival. I'd feel better justifying NOT waiting for fire, as opposed to sitting on the side of the road waiting for 3 minutes.
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Old 07-03-2013, 11:25 AM
FFEMT51 FFEMT51 is offline
 
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"En route patient goes VSA. You pull over you've gone through your 4 shocks, fire department states there 3 minute out. As per protocol you must leave and head to the hospital. Hospital is still approximately 20 minutes away."


you have done 4 shocks?
does this mean you've sat on the side of the road with your partner, doing 2 minute cycles of cpr with shocks, for approximately 8 minutes?

am i understanding this correctly?
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Old 07-03-2013, 12:56 PM
Labrie Labrie is offline
 
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Quote:
Originally Posted by FFEMT51 View Post
you have done 4 shocks?
does this mean you've sat on the side of the road with your partner, doing 2 minute cycles of cpr with shocks, for approximately 8 minutes?

am i understanding this correctly?

Yes. 4 shocks or 4 analyzes, either way that is the current Ontario medical arrest directive. Although you put the pads on right away as opposed to doing 2 minutes of CPR prior.

Last edited by Labrie : 07-03-2013 at 01:02 PM.
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Old 07-04-2013, 01:09 PM
TheBatman TheBatman is offline
 
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Yes, As Labrie said our current protocol is too perform 4 analysis with 2 minutes of CPR in between.

Our service you can patch to a base hospital physician and they can tell you whether to transport to the closest hospital or to start going code STEMI to the cath lab. There are alot of variables for them. Most will send you to the closest hospital, but there are some that will get you to transport.

I completely agree with your option of throwing in a king LT and doing 30:2 yourself. Depending on the fitness of the person doing the compressions i believe you could do it fairly effectively. I myself would not wait for fire, id be telling my partner to gun it to the hospital!

ALS or air support would be awesome too, something we didn't discuss too much cause normally air would take 12-15 minutes to get there. If your thinking your patient isn't going to make the cath lab, air meeting you at the local hospital is normally your best bet if your not already en route.
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  #6  
Old 07-04-2013, 01:55 PM
FFEMT51 FFEMT51 is offline
 
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stop on the side of the road and begin cpr while pads are being applied. (prime the pump prior to administering shock) Shock patient if necessary. once the airway is secure with a King ltd, i would continue transport. I'm not waiting for FD or sitting on the road continuing cpr. Rapid transport

we are used to running 20 - 40 minute codes with 2 man crews.

we do have ACPs to intercept us to one of our receiving hospitals

bypassing to a cath lab is out of the question because it is over 2 hrs by ground. 45 min by air
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  #7  
Old 07-20-2013, 08:11 PM
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LincweldR LincweldR is offline
 
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The question of bypassing to the Cath lab is a different answer depending on the service the medics work for as well as their Base Hospital's medical director so I won't really touch on it I would simply follow my Service's standard.

As for the question on waiting for fire. I would simply run the code as per the directive and have my partner is assume is driving call dispatch for back up as he is pulling over. Given that fire is not going to make it I would ask to have a rendezous enroute by either fire or another medic crew.

I do however very much like the King thought process however
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