Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Capnography Use Saves Lives AND Money – Part II

Continuing from Capnography Use Saves Lives AND Money – Part I.

Patricia A. Brandt writes –
 

Another common cause of EMS lawsuits is injuries or deaths resulting from emergency vehicle crashes. In 1997, more than 15,000 accidents related to emergency calls occurred with emergency vehicles in the U.S. resulting in 8,000 injuries, 500 fatalities and millions of dollars in liability claims and vehicle repairs.(4) One area in which these types of emergency transport crashes can be reduced is by not transporting nonviable cardiac arrest patients.[1]

 

Why do we transport cardiac arrest patients who have no chance of being resuscitated?

This is where we admit our ignorance. Most of us have no idea what the difference between merely dead and most sincerely dead or between mostly dead and all dead.

Mostly dead is slightly alive. With all dead, well, with all dead there’s usually only one thing you can do.

Go through his clothes and look for loose change?

No. Stop resuscitation.

Continuing resuscitation, by transporting from the scene to the hospital, only endangers living people without providing any possibility of an improved outcome for the all dead person.

Mostly dead is what chest compressions and defibrillation are for.

All dead is what funeral homes are for.
 

Civil rules, administrative concerns, medical insurance requirements and even reimbursement enhancement have frequently led to requirements that indicate the transport of all cardiac arrest patients to a hospital or emergency department. If these requirements are nonselective, they’re inappropriate, futile and ethically unacceptable. Cessation of efforts in the out-of-hospital setting, following system-specific criteria and under direct medical control, should be standard practice in all EMS systems.(5) [1]

 

So how does waveform capnography fit into this?
 

One component of cardiac arrest termination protocols is a sustained EtCO2 of less than 10 mmHg, often secondary to asystole present after two rounds of cardiac arrest drugs.(5) The continuous monitoring of capnography can confirm a EtCO2 reading of less than 10 mmHg, along with your protocols and other clinical assessment parameters, and assist you in terminating resuscitative efforts and prevent unnecessary, and often dangerous, emergency transport.[1]

 

We are discussing the use of waveform capnography as a tool to protect people from those, who are too cheap to provide equipment for appropriate care, but are also too afraid to make any decisions they do not understand.

The problem is that they misunderstand what they misunderstand.

In other words, they don’t know what they think they know, but they also don’t know what they think they don’t know.
 

Can anyone demonstrate that more people are resuscitated with a waveform capnography reading of less than 10 than are killed by EMS transporting these same patients?

Killed by EMS transport of patients with EtCO2 <10 vs. People with EtCO2 <10 resuscitated.

Would anyone like to place a bet on this?
 

How many people have ever been resuscitated after good CPR and appropriate defibrillation do not raise EtCO2 to 10 or higher? Not just ROSC (Return Of Spontaneous Circulation), but leaving the hospital with good brain function.

Should we continue to endanger everyone, just so that we can say that –

We gave it our all

We gave it that college try

Rah! Rah! Rah!
 

Here is a rough translation, from EMS to English, of that pathetic phrase – We did everything we could.

What we are really saying is – So we kill the occasional kid crossing the street, or some people in an oncoming vehicle, or a family member in a car following us, or one of our partners.

What really matters is that we tried.

I’m sure that at the eulogy for a dead child, sacrificed to the EMS mantra of We did everything we could, the parents will say, What is most important is that EMS flogs a dead horse until even those around the horse are dead.

To be continued in –

Capnography Use Saves Lives AND Money – Part III
Capnography Use Saves Lives AND Money – Part IV
Capnography Use Saves Lives AND Money – Part V

An excellent source of information about waveform capnography can be found at Capnography for Paramedics.

Footnotes:

[1] Capnography Use Saves Lives & Money
By Patricia A. Brandt, RN, BSN, MHR
JEMS.com
Article

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Comments

  1. Amen

  2. An interesting article from NEJM on continuing CPR on a “sincerely dead” patient:

    http://www.nejm.org/doi/full/10.1056/NEJMp1006331?query=TOC

    Kevin

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