Code? Code!

 

So I’ve now worked two codes for my new service. I’ve discovered a major difference in the way my training for codes was and how this service runs codes. In fact it’s a difference that to me seems backwards to how I would have expected it, coming from an urbanish area.

First code I worked was a nasty one where an ILS provider was the highest level of care on the scene, with no backup coming. I worked it like I was taught and did ok, even though we didn’t get ROSC. I got a tube, drilled the pt for an IO, ran through my asystole algorithm, and worked it for 30 minutes on scene.

The problem arose when my basic partner made multiple comments that we needed to get this guy to the hospital.

Wait? Transport a dead guy to the hospital? What the hell. Granted I’m not a medic, so I wouldn’t be able to pronounce on scene, but our chief was finishing up with his call by this point and could have come by to do that for us. I was thus informed of the procedure that all working  codes, regardless of who’s working it, get transported to the ED.

This was a large shock coming from a system where you were expected to work codes on scene, even though the hospital was maybe 10 minutes away at max. This seems to be backwards in my thinking, if transporting a working code was actually a good idea.

Out here, I could be upwards of an hour from a hospital with a working code out in the county, yet procedures say that I drive the patient to the hospital code 3 while me or my partner are in the back doing CPR the whole time? I’m not a big fan of that, and I’ve already let my new boss know this. In my opinion it’s too dangerous for too little gain.

You’d figure that being so far away, they’d want to work the code on scene, since in most cases there is very little an ED can do that an ALS ambulance can do for a working code. Hell, even as an EMT-I I’m allowed to shock, drug, and tube during a code.

The second code I worked a couple days ago when I was the on call crew was the first code I’ve ever worked that the whole purpose was the get the patient to the hospital within 20 minutes of getting on scene. We did it, and it was an odd experience. We had 2 crews plus the chief helping out with it. I did compressions (where I managed to give the pt a BP of 160/80-ish according to the monitor NIBP cuff :) ) the entire time, except for where the basic took over so I could push my Epi and Atropine.

Seems to me that doing compressions in a moving vehicle is counterproductive. You just can’t give good compressions when you’re being flung around in the back on the way to the ED. I tried. I failed. I can give great compressions to a pt while I’m standing still, but there’s just no way to steady yourself in that big old monster of a rig that we have to give adequate compressions.

So yea, there’s another thing that is different to me since coming here. And, like I said, it’s something that I figured would be the other way around versus what I’m used to in the city with 7 hospitals within a couple miles and a half dozen medics showing up to most calls.

I do think, however I might research trying to get a grant to get something like the Autopulse to make our crews a little safer if they intend on sticking with this asinine procedure of moving codes.

 

  • http://blankymedic.blogspot.com/ Steve

    Hmph… transporting a code is mandated? Odd.

    My partner told me several times if we got a code we should transport (He’s an EMT) I made it quite clear to him that barring any random circumstance such as me not getting a line, we are working the full thing on scene. He didn’t like that. Oh well, not his call.

    If we have the ability to do either first / second line treatments (in the case of MIs) or the ENTIRE treatment (in the case of cardiac arrests) there is no reason to hasten transport.

    But hey, you’ve worked more codes in the past 2 weeks than I have in 2 years >_>

  • http://www.tooldtowork.com Too Old To Work

    Well, you’re correct. Working cardiac arrest patients who don’t have ROSC is pretty futile. Not to mention dangerous for everyone. I’ve been in EMS long enough to remember when we’d not only work them on scene for 45 minutes, but everyone got transported. Futile and dangerous, as I said before.