I remember back when we in EMS did not do anything like ICS. Hell, we did not do anything like ICS in the fire service, either. And looking back I come away with two thoughts. First, it's amazing we did not get more of us killed and hurt. Second, it was pretty damn funny to watch.
But then Chief Bruno wrote his book and it all changed. Maybe not overnight, but it did change.
Well, not quite.
How many resuscitations have you seen that were 'less than organized'? There was a lot of yelling going on, a lot of equipment being thrown around, but not much getting accomplished. Yep, I have seen a plenty of them, too. Even participated in a few of them.
Well, the answer is right in front of us. Apply the concepts of ICS and designate a Code Commander.
No, we do not need any special hats, vests, or badges. The code commander is the one watching the monitor. Calling the shots. Making sure stuff is getting done.
And the concept works.
Your system's design will determine hwo the concept works for you. In ours, we have resources. Lots of resources. Most of the time.
Usually, fire units arrive first. Most of the time the first arriving fire unit brings at least three personnel to the scene (in some instance two, in others four or more). They initiate chest compressions and early defibrillation (if indicated).
The next arriving unit is typically an ambulance, staffed with at least one paramedic. That's your initial 'code commander'. The code commander is tasked with making sure that adequate chest compressions are ongoing and makes sure the monitor is attached to the patient. If ALS resources are initially short, the first arriving paramedic can place the IO.
Place the King airway. In our system EMT-Bs can do this. Attach the ETCO2 and verify the waveform.
Sit back. Oversee.
Other resources will arrive. In our system at least a second ambulance, a district supervisor (EMT-P) and/or an additional supplemental response vehicle paramedic.
If desired, the code commander role can be transferred to another arriving paramedic. But if the first person is getting it doen, then leave it alone. No sense fixing something that ain't broke.
One code I worked recently found the patient on the screened in back porch. Resources arrived quickly and everything was getting done. I was the code commander, so when our medical director arrived (he checks in on calls, drives a marked response vehicle, etc.) there I was, sitting in a chair, LP12 in my lap, good view of the scene, and my feet propped up on an ottoman. All that was missing was a drink and someone to fan me!
The concept works.
And something else that helps is the 'checklist'. Below I have the 'cardiac arrest checklist' that is in use in my system-
Cardiac Arrest Checklist:
____ Code Commander is identified
____ Monitor is visible and a dedicated provider is viewing the rhythm with all leads attached
____ Continuous compressions are on-going
____ O2 cylinder with oxygen in it is attached to BVM
____ Mask travels with bag, regardless of what airway is in place
____ EtCO2 waveform is present and value is being monitored
____ ITD is in place if appropriate
____ Access has been obtained (IV or IO)
____ Gastric distention is not a factor
____ Esophageal temperature probe is in place and temperature is visible
____ D50 and sodium bicarbonate have been considered and/or administered
____ Tension PTX has been considered
____ Family is receiving care and is at the patient’s side
I'llget pictures up pretty soon. More later on the whole checklist thing.
