Basic Life Support in Cardiac Arrest

Care and Transportation of the Cardiac Arrest Patient for Basic Life Support Personnel

The material provided in this reference guide was designed to offer suggestions and ideas relating to efficient care and transport of the patient in cardiopulmonary arrest. It must be kept in mind that even on routine transports, any patient may develop serious complications resulting in Cardiac Arrest. Developing and maintaining the skills and knowledge to provide quality care is essential to your success in these emergencies.

As an EMT-1A, you often may be called upon to make important decisions that require you to take appropriate actions concerning your patient's physical welfare. Having a PLAN OF ACTION is a crucial element of your patient care and scene management. Without any pre- planning these types of calls can easily turn into scenes of confusion and chaos. It is therefore every EMTs' responsibility to develop and maintain the skills and knowledge applicable to this or any other type of emergency.

The objective of this material is not to retrain you in the general administration of CPR, but to help you better define your roles and responsibilities. It is hoped as a result of this reference you will establish your own strategies, and by doing so it will result in proficient and organized resuscitation efforts.

COMBINED RESPONSIBILITIES

In handling the patient in cardiac arrest , it is imperative that you and your partner function together as a team. In order to achieve this you must first be able to establish an open line of communication. This enables you and your partner to review established procedures and to establish your mutual expectations of the other. It will benefit both of you to have some knowledge of how each other will react and which tasks each of you will be responsible for. Additionally, confusion can be minimized if you will take the time to communicate with each other on scene.

It is important to consider your primary goal: transporting and admitting the patient to the closest appropriate emergency department in a safe, efficient and expedient manner. This can only be achieved through organized and planned team work. REMEMBER, COMMUNICATION IS VITAL !!

RESPONSIBILITY OF THE DRIVER

Your primary responsibility as the driver on scene of a full arrest is to assist your partner. At this point you and your partner should have previously discussed a plan to use in the event of code.

1) See to it that the ambulance is conveniently located and safely parked with the engine at an idle in order to maintain a charge to all electrical systems.
2) Remove the guerney from the vehicle and replace the pillow with a backboard or scoop (may also utilize a CPR board). The blanket should be left with the guerney in order to protect the patient's privacy.
3) If time permits engage the suction device and attach either a tonsil tip or a catheter depending on your partners preference.
4) Turn on the main oxygen tank and attach an extension tube to the flow regulator to be used in conjunction with an Ambu-bag. This should be prepared so the technician will only need to turn on the oxygen flow meter when the patient is loaded into the ambulance.

Depending on the circumstances, your partner may or may not have obtained a brief history on the patient. If not, you should attempt to do this using no more than a couple of minutes.

If you work within a district where volunteer or Fire Department response is a factor, they usually will have gathered most of the information you will need; in addition, they will nearly always have a summary sheet available. If for some reason information is not available from those resources, be sure to quickly ask them to interview bystanders, bystanders, family, or anyone with knowledge of the patient's medical history and events leading up to the cardiac arrest.

Necessary information should include the following:

* Age.
* Activity when arrest occurred.
* How long ago patient arrested.
* How long before CPR was initiated.
* Medical History.
* A current list of medications.
* List of known Allergies

If your partner has gathered a history you should at some point get this information. In most situations it will be your responsibility to perform a radio report to the receiving hospital. Also, if possible, gather the patient's medications and bring them with you to the emergency department. This will be helpful to the physician and E.D. staff in determining the possible cause of the arrest.

When you reach the point were the patient were the patient is ready to be loaded and transported, it is important that you communicate with your partner and it is understood exactly how this will be accomplished. For example, who will perform compression's while pushing the gurney to the ambulance ? Will you be needed to assist with CPR while the Technician and support personnel get settled? These and other questions should be answered in detail well in advance.

When the patient is loaded and ready for transport, your considerations should be focused on preparing a radio report and choosing a safe and appropriate route to the closest emergency department.

RESPONSIBILITIES OF THE TECHNICIAN

As the EMT on the scene of a full arrest, it will be your responsibility to coordinate the rescue effort from the time of your arrival on the scene, to the time your patient is transferred to the care of the emergency department personnel. You will be coordinating the activities of other rescue personnel in addition to ensuring that the patient is receiving effective resuscitative care. All of this should be accomplished in a way which both minimizes confusion and insures expedient transport to the receiving emergency department.

If you are first on scene it is imperative that you initiate care, notify your partner and any other arriving rescue personnel immediately of the situation. At this point, initiate you PLAN OF ACTION and begin coordinating the others as to how you would like to begin transport of the patient.

Always remember that your primary responsibility is to your patient, however, if needed, use other qualified scene personnel effectively in order to accomplish the necessary tasks. If at any time you are free to do so, obtain a brief medical history, and a history of events leading up to the arrest. If you are unable, then advise your partner so that he may do so. The information gathered will be useful to emergency department staff.

Once you partner has arrived with the guerney, quickly decide how the patient will patient will be transferred and advise all assisting personnel of your plan. If adequate help is on scene you should then decide who will push the guerney, who will perform compression's, and who will manage the airway and ventilation's. Once the is established there should be no confusion and you may proceed to the ambulance.

Once there, you should find out who will be accompanying you and have him/her step into the ambulance to await the patient while you and your partner load the patient into the vehicle. Remember, you should see to it that no one gets ahead of themselves and everyone involved is acting as an organized team.

Once you have the patient loaded and ready for transport, your efforts should be directed at maintaining a patent airway and administering good ventilation's. Additionally, you should monitor the person assisting to insure the patient is receiving effective compression's.

Upon arrival at the emergency department, you will first need to communicate how you wish to unload the patient from the ambulance. Once the patient is unloaded, CPR should be resumed immediately. Often times you will have emergency department staff available to assist you with ventilation's and compression's. If so, be sure to utilize them appropriately. Entering the emergency department should be done at a consistent pace so those performing CPR can keep up.

Once the patient has been transferred to the care of the emergency department personnel, you should communicate the patient history. Outline the events leading up to the arrest to either the physician or nurse in charge at the first convenient moment. You may also want to make yourself available to them should they need help.

Finally, after everything else has been accomplished, it will be necessary to do the appropriate paperwork. Due to the critical nature of this call, it is important that your report be accurate and concise.

PATIENT HAND OFF

During your patient hand-off you should take the opportunity to better inform the emergency room staff of the other details not included in your initial radio report. In addition to repeating the information given over the radio you should include information such as a detailed history, current events leading up to the incident, and a list of current medications.

DRIVING

When driving to the emergency department with a full arrest you should consider the following and drive accordingly. First, performing CPR in a completely still room is difficult enough. Performing CPR in the back of a moving ambulance is even more difficult; performing CPR in an ambulance that is being driven too fast for conditions is impossible. Secondly, both attendants are in a very vulnerable position and if an accident were to occur, both could be seriously injured or killed. You should therefore attempt to drive as safe as possible. If it becomes necessary to make a sudden stop or turn, you should always verbally warn those in back of the ambulance.

REMEMBER, Code-3 emergency driving is not utilized to drive at an excessive speed, but is used to maintain a consistent pace and safely assist in moving through traffic and intersections safely.

WORKING WITH THE PATIENT'S FAMILY

When managing the stressful situation of a full arrest, it is easy to forget about the patient's family and the psychological crisis they are going through. It is important that the EMT helps support the emotional needs of the family in a professional understanding and caring manner whenever possible. The EMT should remember to never mislead the family about the patient's condition (i.e. "everything is going to be alright"). Instead you should use comments like "We are doing everything in our power to help him/her.

After you have arrived at the hospital be sure to help the family and show them the appropriate place to wait. Be understanding to their needs . Families are often times left wandering the hospital confused and upset. Always make it a point to take a moment and talk with the patient's family members especially those being of the SIDS patient.

Remember, these people require special care, so try to be receptive to their needs. Many of these patients have gone through a long medical ordeal, and the family often receives little or no support through and of it. Remember, these people are usually scared and very upset over their ill loved one. Words of support can offer strong reassurance that their loved on is being well cared for.

A few kind words can go a long way.....

SELF CRITIQUE

No code runs perfectly, so it usually is helpful to discuss it with everyone involved (your partner, fire personnel, ER. staff). Going over it in your mind you may think you have done one thing instead of another. By expressing your thoughts and listening to those of others, you are likely to receive some input which might prove valuable in the future. If at this point you have a question or feel unsure of something , never hesitate to discuss it with your peers, a supervisor, or a field training officer. The knowledge gained from self critiquing is invaluable to the EMT.

It is often said that anxiety is contagious, therefore, when you are confronted with a full arrest see to it that you are not the one starting an epidemic. Before you enter the scene, take a deep breath, try to relax and concentrate on preparing yourself. Anxiety is often a result of being unprepared. Surprisingly, it takes only a few seconds to come up with a plan of action.

Additionally, try not to get ahead of yourself. Perform your tasks smoothly and purposefully. confidence is just as contagious so if you possess it chances are it will spread to those assisting you. It is also the one thing family members lack and need to see in you.

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