One more of the great presentations at EMS Expo was on improving outcomes from cardiac arrest.
Lake Sumter EMS does not follow the AHA (American Heart Association) ACLS (Advanced Cardiac Life Support) guidelines.
One member of the audience kept asking about the threat of law suits – the mediocrity response.
But you’ll get sued!
Tell me what to do to avoid getting in trouble.
There is a great scene in The Eiger Sanction. Clint Eastwood (Dr. Jonathan Hemlock) is an art professor and a pretty student wants to flirt her way to a passing grade. Eastwood responds to the suggestion with –
Dr. Jonathan Hemlock: Are you busy this evening?
Art Student: No.
Dr. Jonathan Hemlock: You live alone?
Art Student: My roommate’s gone for the week.
Dr. Jonathan Hemlock: Good. Then… go on home, break out the books and study your little ass off. That’s the best way to maintain a “B” average. Don’t study it all off.
We have too many people in EMS who think a magic pill will keep them out of trouble. The right connections or some magic phrase. Scene safe! BSI!
They don’t want to have to be competent at patient care. They just want to stay out of trouble. Perhaps the best way to avoid trouble is to provide competent patient care.
If they don’t know what competence is, they should stay out of EMS to stay out of trouble.
Dr. Banerjee responded politely to mediocrity fan boy. His results are better than what the ACLS guidelines would produce. You need to show evidence of harm to win a law suit. Evidence of non-conformity is irrelevant.
Fewer than 10 systems produce better than 20% VF (Ventricular Fibrillation) survival to discharge.
We need to stop listening to the defenders of mediocrity and stop killing so many patients.
If we are more worried about the lawyers, than we are about our patients, then we should not be making patient care decisions.
Do these numbers suggest that Dr. Banerjee has any reason to worry about law suits for not following the ACLS guidelines?
No. His only concern would be if he were to start following ACLS guidelines.
No ventilations until resuscitated. Eventually, removing ventilations will the ACLS recommendation, but they part with
voodoo tradition slowly. Ventilations are not based on research.
Dr. Banerjee is a fan of pressors (epinephrine and vasopressin), but he is also not going to go against the research if research ends up showing that epinephrine is harmful.
The PEA (Pulseless Electrical Activity) protocol is interesting – treat for many of the potentially reversible causes automatically. I do not remember if it is already part of their protocol, but if it is not, they might want to add bilateral needle decompressions to rule out tension pneumothorax.
Why do the defenders of mediocrity fight so hard against progress?
Maybe they just don’t want progress.
 Optimizing Outcomes in Cardiac Arrest
Nov 2 2012 1:15PM
Pushpal (Paul) Rocky Banerjee, MD, Medical Director, Lake EMS, FL; Assistant Medical Director, Aviation One – Medical Transport Services
Cardiac arrest is a medical emergency that is potentially reversible if treated early. With fast, appropriate medical care, survival is possible. Administering continuous chest compressions, along with early defibrillation, can improve the chances of survival until emergency personnel arrive. Lake EMS has developed an innovative approach to cardiac arrest care. Dr. Banerjee will demonstrate why the cardiac arrest resuscitation rates at Lake EMS are among the highest in the world.