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I’ve worked EMS in NYC since 2010. I’ve been frustrated by the reporting surrounding a recent change to the way we approach cardiac arrest care. I’d like to explain a few things. (Thread). https://www.cnn.com/2020/04/03/us/new-york-hospital-cardiac-arrest-patients-memo/index.html
Wether a cardiac arrest occurs in the hospital, the emergency room, the street, or the home. The initial phases of cardiac arrest care in the US typically follow guidelines set by @American_Heart. Paramedics have the same certifications for cardiac arrest care as RNs and doctors.
Paramedics in NYC can pronounce people dead independently if they are found with obvious signs of death (rigor mortis, dependent lucidity, obvious mortal wounds) or a DNR.
If a paramedic crew in the 911 system starts a resuscitation and doesn’t restore pulses after ~20 min they must contact a physician who works for the FDNY to obtain orders which could be for additional medications, transport to the closest hospital or termination of resuscitation
Transporting a person to a hospital with lights and sirens and ongoing CPR is dangerous to the crew, dangerous to the public driving and walking the streets, and very unlikely to result in a meaningful recovery for the patient. (As low as 0.49% in some studies).
Chest compressions delivered in the back of a moving ambulance are far less effective, and nearly impossible to deliver while wearing a seat belt.
Nowhere else in healthcare do we expect the providers to risk their lives for the chance of a miracle recovery for a patient. And all of these things were true before NYC became the epicenter of a deadly contagious disease.
CPR on a patient with #COVID19 puts the crew at a far higher risk of exposure than routine care. At this point we have to act as though every patient has COVID.
So what has actually changed in NYC protocol? A crew can no longer independently decide to initiate transport of a patient who has not regained a pulse. Crews still can’t terminate a resuscitation without speaking to the FDNY doctor.
Also, EMS is no longer required to transport any cardiac arrest that occurs in a public place. The decision to take a patient to the hospital should be based on the clinical picture, not the aesthetics of the location of the incident.
This change to protocol keeps EMS crews safer and it brings NYC protocol in line with long-standing practice in other areas of the country. It is an important adaptation to the rapidly evolving crisis in NYC. It is not worthy of the hysteria with which the media has reported it.
