Transport cardiac arrests?

Discussion in 'Firefighter/EMS Talk' started by M7425, Apr 3, 2020.

  1. Yes- no online medical control needed

    4 vote(s)
    28.6%
  2. Yes- with consultation with online medical control

    10 vote(s)
    71.4%
  3. No- all cardiac arrests are transported

    0 vote(s)
    0.0%
  1. M7425

    M7425

    Messages:
    733
    Likes Received:
    1,041
    Joined:
    Jan 26, 2015
    There is a locked thread in Okie with a comment about “death panels” and a change in EMS clinical protocols in NYC to no transport out of hospital cardiac arrests. Given the poor survival outcomes associated with this, it made me curious- does your EMS system allow for EMS to cease resuscitation in the field? This is not about death declarations in cases of obvious death...rather those situations when resuscitative measures are started and later stopped in the field.
     
    DocPoison and jimcorbin like this.
  2. jimcorbin

    jimcorbin

    Messages:
    3,055
    Likes Received:
    10,091
    Joined:
    Jan 20, 2008
    @Ordell Robbie was asking about this. Hopefully this will clear it up. Feel free to ask any questions you might have.

    Witnessed arrests get transported so they can go to the catch lab, even under CPR. Other cardiac arrests get worked in the place we found them.

    Our protocol states 30 minutes of good quality CPR/BVM, an advanced airway placed with capnography, IV or IO in place and ACLS drugs administered. If no ROSC in 30 minutes we call the MD at University of Cincinnati and tell them what we have and what we have done. They give us the order to cease efforts. Once we are done we leave the body where we worked it, and we turn it over to the PD or SO. They call the coroner. We go back to restock and clean up.

    If they have ROSC we transport to the closest hospital. I have gotten one back at 29 minutes and we transported her but she died in the ER.

    NOTE: ROSC means Return Of Spontaneous Circulation (pulse)
     

  3. DocCasualty

    DocCasualty Wolverine

    Messages:
    8,160
    Likes Received:
    16,758
    Joined:
    Apr 12, 2010
    Location:
    Northern Michigan
    Michigan
    *EMERGENCY* SPECIAL OPERATIONS
    CARDIAC ARREST IN A PATIENT WITH SUSPECTED COVID-19 CRISIS STANDARDS OF CARE
    Initial Date: 03/23/2020 Revised Date:
    Section 10-21
    Cardiac Arrest in a Patient with Suspected COVID-19 Crisis Standards of Care
    I. Applicable patients are patients in cardiac arrest with known previous symptoms of respiratory illness and fever.
    II. Personal Protective Equipment
    A. Standard, contact, and airborne precautions
    B. CPR and assisting ventilations are aerosolized procedures. N95 masks or equivalent are
    required. Do not perform CPR without respiratory precautions in place.
    III. Treatment
    A. For patients with no known fever or respiratory illness, follow General Cardiac Arrest Protocol.
    B. For arrests of patients with known recent history of respiratory illness and fever, treat according to General Cardiac Arrest Protocol EXCEPT:
    i. Airway interventions will be limited to BLS procedures, including supraglottic airway. DO NOT INTUBATE.
    ii. When CPR is being performed, only necessary personnel should be next to the patient. Personnel should distance themselves when not performing interventions.
    iii. If no return of spontaneous circulation (ROSC) within 10 minutes of resuscitation, contact medical control for possible termination orders.
    iv. Patients in continuous cardiac arrest WILL NOT BE TRANSPORTED, regardless of mechanical CPR device. Resuscitation will either be terminated on scene or ROSC sustained (continued palpable pulse and systolic BP ≥60 mmHg for >5 minutes) BEFORE moving the patient to the patient compartment of a vehicle.

    C. For witnessed arrests inside the patient care compartment:
    MCA Name:
    MCA Board Approval Date: MCA Implementation Date:
    i. ii.
    Pull vehicle to the side of the road and perform resuscitation in full PPE, with doors OPEN.
    If patient has mechanical CPR device in place and has lost ROSC, the device may be resumed with continued transport to the hospital, as long as all personnel in the patient compartment have sufficient respiratory PPE in place.
    Page 1 of 1 Protocol Source/References: https://www.cdc.gov/infectioncontrol/guidelines/isolation/precautions.html
     
    DocPoison, jimcorbin and M7425 like this.
  4. jimcorbin

    jimcorbin

    Messages:
    3,055
    Likes Received:
    10,091
    Joined:
    Jan 20, 2008
    Very nice! We are supposed to have a protocol somewhat like this within the next 7-10 days. But we are just starting into our upswing of COVID patients here. Our county is around 250 patients so far.
     
    DocPoison and DocCasualty like this.
  5. WT

    WT Millennium Member

    Messages:
    5,190
    Likes Received:
    3,967
    Joined:
    Jan 12, 1999
    According to the Rule Book ...

    Ambulances staffed by EMT-Basic will transport to the ER while performing CPR.

    Ambulances staffed by EMT-Paramedics in consultation with medical command may cease their efforts on scene.

    As an aside, NYC EMS is seeing something like 7,000+ calls per day, almost double their usual load.

    Our local hospital has been diverting critical care patients for several days now.
     
    Last edited: Apr 4, 2020
  6. chiefjack

    chiefjack

    Messages:
    2,205
    Likes Received:
    1,883
    Joined:
    Mar 16, 2014
    Location:
    Kalifornia
    This has been our local protocol for at least the past 15+ years. I'm retired now and have not kept current on recent COVID-19 related changes, if any.
     
    G30 Medic, DocPoison and jimcorbin like this.
  7. Tvov

    Tvov

    Messages:
    9,147
    Likes Received:
    6,432
    Joined:
    Sep 30, 2000
    Location:
    CT,USA
    Are you NYC EMS? Just have question about diverting patients - is that Navy hospital ship being used? I haven't heard about it except that not long after it arrived, it only had 20 patients on it, and they weren't really expecting too many more.
     
    DocPoison likes this.
  8. Quickling

    Quickling

    Messages:
    225
    Likes Received:
    424
    Joined:
    Apr 26, 2018
    Location:
    Hills of NY
    If we don't get ROSC or rhythm change within 20 minutes, then we can call for termination orders.
     
    chiefjack, G30 Medic and DocPoison like this.
  9. Navy HMC

    Navy HMC

    Messages:
    1,143
    Likes Received:
    11
    Joined:
    Oct 23, 2005
    Location:
    Piped ashore
    We can call it on a number of conditions:
    If EtCO2 is below 20mmHg after 20 minutes of resuscitation with the protocol followed through to completion
    30 minutes with no ROSC or changes.
    Other than that, we call for orders at 30 minutes and see what the doctors want. We always have the option of transporting.

    IRT COVID: We can call it early with medical consult, but we have to have all the ducks in a row to be able to articulate well how/why we think this is a COVID caused cardiac arrest. While the thinking is that cardiac arrest due to COVID has a very poor outcome, we've had 2 suspected and one confirmed ROSC outcome. Your milage may vary.
     
  10. WT

    WT Millennium Member

    Messages:
    5,190
    Likes Received:
    3,967
    Joined:
    Jan 12, 1999
    UPDATE:
    Show up and attach the leads.

    Once they confirm a patient’s heart has flatlined — “asystole” or “agonal” rhythm on an EKG — paramedics are to pronounce the victim dead, with no attempt to resuscitate. No hands on.

    Hand the paper strip to the police and leave the scene.

    Out of state EMTs who work with the locals are 'flabbergasted' by this policy.