EMTs/Paramedics arriving on scene

There is no one answer to that except they would take over CPR first.

From there it depends on the skills of the responders and that differs by location. If you get fully trained paramedics, taking over CPR (assuming the person has no pulse or respirations) would include intubating the person and hooking up an EKG monitor. (It might be a quick look with the AED first.) From there they would attempt defibrillation if that's what the monitor showed. They would also be starting an IV line.

In other settings it might be take over CPR and get the person to the hospital.

Onsite defibrillation is much more common these days. I can't imagine many fire departments without that capability now.

MaeZe said:

There is no one answer to that except they would take over CPR first.

From there it depends on the skills of the responders and that differs by location. If you get fully trained paramedics, taking over CPR (assuming the person has no pulse or respirations) would include intubating the person and hooking up an EKG monitor. (It might be a quick look with the AED first.) From there they would attempt defibrillation if that's what the monitor showed. They would also be starting an IV line.

In other settings it might be take over CPR and get the person to the hospital.

Onsite defibrillation is much more common these days. I can't imagine many fire departments without that capability now.

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lots of places, malls, schools, even apartment buildings have these devices on-site now. they're pretty cool, you stick on the pads, and the machine tells you what to do.
we had a course on how to use them while my husband was managing a condo building. also depending on where/when you did your last first aid course, some things have changed, others not so much. there is nowadays a face mask with a valve to give mouth-to mouth without catching anything nasty. but in both with that and the AED, my question is how you would reach such equipment in an emergency, within a reasonable amount of time. (my last course before this one was, ugh, 18 years ago. and geared towards motor vehicle accidents.)

around here, I've found paramedics actually spend a good deal of time with patients before they get transported.
main thing i always note with paramedics and firefighters - they do not rush. no running to open doors, etc. they're not slow by any means, just deliberate.

A lot depends upon how many people you've got. A lot of places would roll an ambulance (two man crew) and an engine company (four man crew). Other places just roll an ambulance and then would call for extra personal. An ambulance needs four people ideally for CPR -- driver, airway, compressions, and everything else.

But assuming a two man crew, I'd keep the person who is doing CPR to continue on compressions. The first step, however, is to confirm no pulse and also the person is not long dead. 9-1-1 tells people to do CPR and I've arrived on the scene to see a person performing CPR on someone who has post-mortem lividity.

Once we've confirmed no pulse, as I said, I'd have the person who was there continue compressions. One person would work on establishing and maintaining an airway. Once the airway is established, which would depend upon the certification of the EMT as to the type, the airway EMT would monitor compressions, while using a bag-value mask to administer high-flow oxygen.

Second person would hook up the monitor, and attempt defibrillation if indicated. If qualified, the EMT would then administer a large-bore IV, and use what drugs the protocols call for.

By this point, hopefully more manpower will have arrived, and we'd phase out the person doing compressions. The additional manpower would also start working on transport, using a backboard and strapping the patient to the backboard. Backboard would then be placed on a stretcher, if one can be used. Otherwise, we take the patient out of the house on the backboard. I've had to do this through a bedroom window because that was the easiest path. Compressions and oxygen continue throughout the trip to the ambulance.

Time on scene is going to be somewhere between three and ten minutes. We want to get going but some things can't be done easily in the ambulance and need to be done before we start transporting.

Jim Clark-Dawe

Some EMS agencies are using automatic CPR devices, like the AutoPulse. Columbus Division of Fire tried several units out on a random basis several years ago.

CPR is an exhausting process to do, usually at least two switching off. Often, police are the first on scene and they are all trained in chest compressions and many departments carry defibrillators now. The defibrillators won't fire if there is a pulse so many officers will use it on any unconscious person, at least here in Florida where there are a ton of rescue calls for older folks.

The next step depends a lot on where it happens. Six blocks from a hospital the victim will be moving asap. 40 minutes away and the victim will be stabilized first, if possible, and life saving procedures will continue in route.

Every department I'm familiar with will roll ambulance and a fire rescue truck on every medical call, as well as an officer. Fire personnell are often paramedics as well and will continue in the ambulance if needed. Major departments are testing automatic systems but I haven't seen any here invest in it completely yet. My county can barely afford ambulance repairs, let alone pricey systems that the hospitals aren't familiar with either.

CPR would continue to the hospital if needed, regardless of what else is done. Nobody wants to see a medical examiner's report that even hints that the victim could have been saved but first responders didn't try hard enough.

Jeff

MiloMinderbinder said:

I've got a character performing CPR on another character. The character in trouble is not breathing (obviously). When the EMTs arrive they asked the CPR performer to recap what happened (which is what I was told to expect in my CPR class)

But what happens next. Would they rush the distressed character into the ambulance and whisk him away to the hospital? Or would they continue CPR? Or attempt something else?

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How long ago was the CPR class, because whether or not they're breathing is irrelevant - if their heart is still beating the CPR is going to do more harm than good.