Mechanical CPR: Three CHEERS or a boo?

There has been a fair bit about mechanical CPR devices floating around the FOAMasphere lately, so I thought I should probably do a post.

These devices are not exactly new (check out the Thumper, in use in Victoria in the 70s) However, there seems to be a surge in interest in these devices, and I must say there seems to me to have been a largely positive buzz about them in spite of the evidence for their effectiveness being somewhat lacking to say the least.

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The AmboFOAM Google+ Community

Hi everyone.

I have a post in the works to follow up from the excellent SPA 2014 Conference from last weekend (as promised)  In the meantime, I have started a community on Google+ for ongoing discussion of stuff.  AmboFOAM, #FOAMed, #FOAMems stuff that is.

It’s kicked off with a fantastic conversation about mechanical CPR devices.

Sign up to Google and head over to AmboFOAM Discussion community and join in.

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Surviving your first year on road part 5 – Clinical Concepts

The clinical concepts that no-one teaches you about at university

 

You’ve spent the last three years or so getting to know the intricacies of morphine metabolism and the cardiac cycle.  Those things are all important as background, but in your operational life it is at least as important to have a collection of rules of thumb to fall back on until you’ve got a bit of experience.  Rules of thumb are formally known as heuristics, intellectual shortcuts which mostly work, most of the time – they’re not perfect but they can get you out of a lot of scrapes.  Here are some which I’ve found useful, both clinically and in learning to live the paramedic life.

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Necromancy and the law: step away from the corpse sir…

Robbie (@AmboFOAM):

As most of you know, I have a fairly strong view on how we go about resuscitating all and sundry, even when it does not appear to be the right thing to do. One thing I had not really considered in the past was the actual case law side of things in the jurisdiction in which I work. This is not to say that I had never considered the legal ramifications of the decisions I made, but I have always tried to do what I believe to be the best thing for the patient, rather than what will keep me out of court.

Fortunately in Australia, we have someone who does consider the actual legalities of providing care as paramedics – Dr Michael Eburn.  Dr Eburn runs a blog called Australian Emergency Law, and if you have not seen it before and work in Australia, you probably need to head there now.  Michael responded to a tweet of mine following some comments coming out of the NZRC conference last month with the following post on the legal view of starting, or withholding resuscitation when it is not in the best interests of the patient.

In a nutshell, it seems that in Australasia at least, resuscitating a patient in whom resuscitation is not in their best interests (for example the terminally ill or the terminally old) is probably a very bad idea:  “the law is clear, if treatment is not in the persons best interests it is not only appropriate to withhold that treatment, in Lord Browne-Wilkinson’s view it may be both a crime and tort to administer treatment that the practitioner has reasonable grounds to believe is not in the patient’s best interest”

Read the entire post below, and as always I welcome feedback, comment or criticism.

Originally posted on Australian Emergency Law:

I’m responding to an issue on ‘twitter’ (but a word of caution, I really don’t follow twitter and rarely look at my account, so this is not an efficient way to get in touch with me; but it worked this time).

The ‘tweet’ says

“NZ case law confirms no requirement to resus when medically not in their best interest. #nzrc2014” same in Oz? Ping @EburnM

The link is to, I think, the New Zealand Resuscitation Council.

The case law is clear and that may be because the key cases come from the UK. I’m not sure what NZ case law the speaker was referring to; but in Australia the law that justifies treating a person who cannot give consent is the principle of necessity.  In In Re F [1990] 2 AC 1 Lord Justice Goff set out the test for necessity.  He said (p 25, emphasis added):

… not only…

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Surviving your first year on the road Part 4 – Trauma

Trauma

  • Psychological trauma

When I first started the job, members of my family were convinced that I was going to be a gibbering wreck within the first week.  It wasn’t the case but I understand their concern.  The public perception is that paramedics routinely deal with horrific and gruesome incidents – it doesn’t happen as often as people think but if you stay around a while you’ll get your fair share.  More important than that though is the chronic stressors of other people’s emotions, the pressures of shift work, problems at home *plus* graphic jobs.  I personally knew two paramedics who have killed themselves in the past two years – I don’t know why they did it but it’s incumbent on all of us to look after ourselves and our mates to try to prevent that sort of thing in future.

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Surviving your first year on road part 3: Miscellany

Food, exercise and other stuff

 

  • Eat sensible food.  

You know what’s sensible, you don’t need me to tell you that the 3am burger is probably a bad idea.  Ambulance shifts are long and you can’t survive on biscuits and chewing gum.  Eat real food, preferably food you made yourself.  If you’re having trouble getting organised, set aside one evening a week to make a big batch of something that reheats well, then freeze five or six servings.  Bang, that’s next week’s meals.  I do this every week – it’s not exciting but it means that I never have to try to work out what eating.  I just grab something out of the freezer and find out what it is when lunchtime rolls around.  Also, buy a slow cooker.  They can cure cancer.

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Surviving your first year on the road part 2: Getting along

Workplace relationships and expectations

 

For many people entering paramedicine as a career the workplace environment will be quite different from what you are used to.  Here are some important things to know.  Bear in mind that these are things that I think are important – you may disagree or think I’m wrong and that’s fine too.

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Surviving your first year on the road – Part 1

Part 1: Sleep and Study

 

Introduction

 

You’ve put on your shiny new uniform and you’ve turned up at work for your first day at your new job – Junior Paramedic.  Congratulations!  All those years of study and hard work have paid off, you’ve made it. From here on in it’s plain sailing, right?  Living the dream?

Not yet, unfortunately.  What many new paramedic recruits don’t understand is that your intern year is likely to be one of the toughest years of your life.  Not only are you taking on a new job which, let’s be honest, you’re probably underprepared for, but the ambulance lifestyle is about to usher in huge and far-reaching changes to the way you spend your time that you’re probably only dimly aware of at the moment.  It’s a pretty awesome way to spend your life and one I highly recommend but you need to come into it with a bit of preparation.

Luckily, I’m here to help.  I spend most of my professional life training recent graduates to work as independent operational paramedics and I’ve seen a lot of issues arise in that first year.  But the good news is that others have trodden the same path before and a lot of good solutions have been accumulated.

So here then is my guide to surviving your first year on the road as a paramedic.  Not all of these issues may arise for you, with any luck none of them will.  But it never hurts to be prepared and even if you escape unscathed you may be in a position to help someone else who is struggling.

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A chat with ECG Quiz Guru Christopher Watford

Earlier this week I was honoured to be able to chat to the designer of the fantastic ECG Quiz that took the #FOAMed world by storm, Christopher Watford.

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Prehospital airway management- what is the gold standard?

Robbie (@AmboFOAM):

Good post from Minh discussing where we are at in terms of prehospital intubation. My take on it remains the same: it doesn’t matter who you are or what tool you use. What matters is doing it well. This means good education, good training, ongoing exposure and robust oversight.

Originally posted on PHARM:

Dr Seth Trueger's gold standard laryngoscope

Dr Seth Trueger’s gold standard laryngoscope

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