tag:blogger.com,1999:blog-4505990433916682663.post3271261569612890463..comments2024-03-13T02:04:31.476-04:00Comments on Paramedicine 101: EMS Garage Special Edition: How to Improve Survival from Sudden Cardiac Arrest Episode 48Adam Thompson, EMT-Phttp://www.blogger.com/profile/18107359165856983910noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-4505990433916682663.post-84756198744143157052009-09-12T10:22:47.823-04:002009-09-12T10:22:47.823-04:00Not to worry. You're reputation as a cantakero...Not to worry. You're reputation as a cantakerous old coot is intact! <br /><br />TomTom Bhttps://www.blogger.com/profile/18291404904437933272noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-58715640145131937602009-09-11T19:58:14.239-04:002009-09-11T19:58:14.239-04:00Tom,
Wake Count...Tom, <br /> <br /> <br /><i>Wake County EMS is a relatively "young" EMS system and yet they are posting cardiac arrest numbers comparable to King County.</i><br /> <br /> <br />So, it is not out of anyone's reach, just because they are a young system.<br /> <br /> <br /><i>@Rogue Medic (I know you blew your cover already but that's besides the point), I think terms like ALS and BLS are meaningless in this day and age. The procedures we perform either help, hurt, or make no difference. It doesn't matter what labels we attach to them. We should not be emotionally attached to procedures or labels.</i><br /> <br /> <br />I agree. <br /><br />I disagree with the people, who think that it is important to rush a medic to the scene, in order to deliver the <i>magic</i> ALS treatments. I limit myself to what seem to be the convention distinctions of ALS and BLS. In the post, I do mention that both defibrillation and CPR used to be physician-only practices.<br /> <br /> <br /><i>Survival from cardiac arrest may be easy to quantify for those motivated enough to track it, but the Utstein template is complicated and requires the cooperation of the receiving hospitals.</i><br /> <br /> <br />I think that the point was <i>compared to other outcomes</i>, this is easier to quantify. I think you will agree with that.<br /> <br /> <br /><i>If that's so easy to achieve, why do so few EMS systems do it? The EMS systems that take the time to create these mechanisms tend to be a cut above the rest.</i><br /> <br /> <br />Admitting there is a problem is <b>not</b> the first step to recovery. Asking if there is a problem needs to come first. <b>If we never look at what we do, it is easy to remain blissfully ignorant of the damage we do.</b><br /> <br /> <br /><i>Show me an example of a terrible EMS system that reports their survival statistics using high quality data.</i><br /> <br /> <br />I think that a lot of the intubation studies are examples of blissful ignorance. Fortunately, the medical directors seem to try to improve, once they are aware of just how dismal, dismal is.<br /> <br /> <br /><i>Our raison d'être is to save lives, no matter how much we try to pretend otherwise. Just ask the average citizen why they tolerate our existence.</i><br /> <br /> <br />I agree that the average citizen thinks this, but I do not think we should allow the average citizen to dictate what we do. If that were the case, they would have fire departments taking over EMS, because the average citizen can't tell the difference between a fire and a medical emergency. And the average citizen does not speak French. ;-)<br /> <br /> <br /><i>I would argue that tracking our survival statistics for cardiac arrest is the necessary but insufficient precondition to declaring ourselves a successful EMS system.</i><br /> <br /> <br />I completely agree. That was my point. I think that EMS can have excellent citizen CPR/AED, first responder CPR/AED, and BLS CPR/AED. I don't think that tells us that the paramedics will also be excellent. It is more likely, because understanding quality in one area makes it more likely that they will understand quality in another. However, it is far from a guarantee.<br /> <br /> <br /><i>I think a lot of the EMS systems that complain that cardiac arrest survival is not a fair barometer of system performance probably know their chain of survival is broken for a multitude of reasons and they lack the desire or courage to correct the problems.</i><br /> <br /> <br />Again, I completely agree.<br /> <br /> <br /><i>They much prefer the muddy waters within which they can hide like cowards and feed off of the Rescue 9-1-1 myth.</i><br /> <br /> <br />Once more, I completely agree.<br /> <br /> <br /><i>The public deserves to know what level of protection they're getting for their tax dollars.</i><br /> <br /> <br />Yet again, I completely agree. You are going to ruin my reputation as a cantankerous old coot, who can never agree with anyone else. So, . . . let's talk politics. ;-)Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-47634043463858007792009-09-11T19:33:44.762-04:002009-09-11T19:33:44.762-04:00Timothy Clemans,
For me ALS in King County means ...Timothy Clemans,<br /><br /><i>For me ALS in King County means when something bad happens you have a good chance of EMS experts showing up.</i><br /> <br /> <br />That is important, but not initially necessary. I think that is why they spend so much time on the by-stander CPR and dispatcher pre-arrival instructions.<br /><br />Having well experienced people on the job says a lot about how a system treats its people. Do they value competence? Do they just want people who will follow orders? Do they just want the cheapest people they can get? Do they burn their people out? Et cetera.<br /> <br /> <br /><i>I have met a number of county medics who have been there in the 20 year range. In fact you can instantly tell if one of those medics are in the 20 year range because they wear gray instead of white.</i><br /> <br /> <br />They probably are using the wrong detergent. Some sort of color-safe formulation will prevent the uniform from turning gray. Perhaps a vision check-up every 10 or so years, so that they can recognize the difference in the colors. :-)<br /> <br /> <br /><i>I think that in itself is key. You need people who have successfully run hundreds of resuscitations.</i><br /> <br /> <br />There was one study that looked at this. The odd thing was that the experience of the person running the code did not matter. The experience of the person starting the IV, or intubating, or pushing the medications, was what mattered. I think that this indicates that it is easy for a less skilled person to significantly interfere with the BLS, which does affect outcome, when medics are performing these unnecessary procedures.<br /><br />The effect of paramedic experience on survival from cardiac arrest.<br />Gold LS, Eisenberg MS.<br />Prehosp Emerg Care. 2009 Jul-Sep;13(3):341-4.<br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/19499471?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum" rel="nofollow">PMID: 19499471 [PubMed - indexed for MEDLINE]</a>Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-77316316456732393052009-09-11T11:44:16.594-04:002009-09-11T11:44:16.594-04:00Wake County EMS is a relatively "young" ...Wake County EMS is a relatively "young" EMS system and yet they are posting cardiac arrest numbers comparable to King County.<br /><br />@Rogue Medic (I know you blew your cover already but that's besides the point), I think terms like ALS and BLS are meaningless in this day and age. The procedures we perform either help, hurt, or make no difference. It doesn't matter what labels we attach to them. We should not be emotionally attached to procedures or labels.<br /><br />Survival from cardiac arrest may be easy to quantify for those motivated enough to track it, but the Utstein template is complicated and requires the cooperation of the receiving hospitals.<br /><br />It that's so easy to achieve, why do so few EMS systems do it? The EMS systems that take the time to create these mechanisms tend to be a cut above the rest.<br /><br />Show me an example of a terrible EMS system that reports their survival statistics using high quality data.<br /><br />Our raison d'être is to save lives, no matter how much we try to pretend otherwise. Just ask the average citizen why they tolerate our existence.<br /><br />I would argue that tracking our survival statistics for cardiac arrest is the necessary but insufficient precondition to declaring ourselves a successful EMS system.<br /><br />I think a lot of the EMS systems that complain that cardiac arrest survival is not a fair barometer of system performance probably know their chain of survival is broken for a multitude of reasons and they lack the desire or courage to correct the problems.<br /><br />They much prefer the muddy waters within which they can hide like cowards and feed off of the Rescue 9-1-1 myth.<br /><br />The public deserves to know what level of protection they're getting for their tax dollars.<br /><br />TomTom Bhttps://www.blogger.com/profile/18291404904437933272noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-41002053573800504622009-09-11T11:23:41.314-04:002009-09-11T11:23:41.314-04:00For me ALS in King County means when something bad...For me ALS in King County means when something bad happens you have a good chance of EMS experts showing up. I have met a number of county medics who have been there in the 20 year range. In fact you can instantly tell if one of those medics are in the 20 year range because they wear gray instead of white. I think that in itself is key. You need people who have successfully ran hundreds of resuscitations.Anonymousnoreply@blogger.com