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(CBS New York)   Victim's family shocked that even though a gym is require to have defibrillator, and staff trained to use it, they don't actually have to use it   (newyork.cbslocal.com) divider line 60
    More: Stupid, Long Island, Jonathan Lippman, negligence, gyms, Appeals Court, automated external defibrillators  
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10232 clicks; posted to Main » on 09 Feb 2013 at 10:11 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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Archived thread
2013-02-09 05:06:25 PM  
7 votes:
If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.
2013-02-09 09:18:31 PM  
5 votes:

cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.


They can and will if they detect artifact and the software reads it as ventricular fibrillation.

rtboardreview.com

That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".


Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.
2013-02-10 12:28:13 AM  
4 votes:

BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


Oo! I know the answer to this one: The laypersons were using their thumbs to check for the pulse. Betcha dollars to donuts. Alternatively, the "healthcare providers" were LVNs or RNs and not emergency room personnel and were used to checking wrists, but not carotids--and it was the LAYPERSONS who were finding a pulse (in the neck) where the "healthcare providers" were not.

CSS--we had an incident when I still worked for The Mouse, a friend of mine was "just a security guard" but a paramedic in real life. Disney had just gotten AEDs but only the nurses were allowed to use them. DL nurses are mostly RNs and LVNs and not ER nurses. So a train engineer drops from a heart attack one night, the other engineers start CPR, the fire dept. is called but are 10 minutes out. Our useless nurse shows up with her AED...but won't use it because although she knows how, she isn't "signed off" on the damn thing and is afraid to use it because liability.

My friend rolls up and sees the ambulance crew standing there, the nurse standing there, security standing there, all watching the engineers doing CPR on their buddy who is probably dead by now, and the AED dangling from the nurse's hand. HE, certainly, isn't supposed to use the AED, being just a security guard; but he's also a medic (and an asshole) and says to the nurse, "give me the damn defibrillator", tells the EMTs to get him an airway started, takes over the scene, and gets a rhythm shocked into the engineer before the medics get there. Guy walks out of the hospital 72 hours later.

My friend gets a 10-day suspension and a permanent disciplinary letter put into his personnel file which is only removed after Michael Eisner writes him a personal letter and orders that the disciplinary letter be torn out. And THAT is why nobody is ever going to help you out in the gym locker room, even if they've all been trained and have the equipment handy.
2013-02-09 08:28:47 PM  
4 votes:

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.


Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.
2013-02-09 09:09:04 PM  
3 votes:

vygramul: They treat a very small subset of shockable rhythms to begin with. Like fewer than 20% of them.


yep

fusillade762: Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Yes, you don't use an AED on someone with a pulse. The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

How a defibrillator works
2013-02-09 08:18:39 PM  
3 votes:
I imagine if the doctor that was there doing CPR thought it was needed, he would have said to use it.
2013-02-09 08:08:23 PM  
3 votes:
a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?
2013-02-09 06:17:44 PM  
3 votes:

cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.


They treat a very small subset of shockable rhythms to begin with.  Like fewer than 20% of them.
2013-02-10 01:13:45 AM  
2 votes:

djh0101010: crap

Just stop. Being a medic means that at minimum you've read through many thousands of pages of dry medical text, completed several hundred hours of classroom, practical clinical time, field time, and have picked up the lingo and slang from spending a lot of time around *actual* ems and medical workers. You can't fake that without a huge amount of work: It's like pretending to be ex-military or a doctor -- a real one's going to spot you instantly.

From djh0101010's bio:
Not shy about telling people when they're full of it.

Oh, the irony.

JonPace: Oh boy a ricky rescue

Nice alt.

BronyMedic: Oh good, I was hoping the guy who was impersonating an EMT to troll

I know it gets old having to type that in every thread you post in, but thanks. His attention seeking is pretty sad: I guess some people never work past their shiatty childhood. Beyond pointing out he's a (bad) fake, I'd ignore him.
2013-02-10 12:55:07 AM  
2 votes:

ZackDanger: Wait... What?

What did you read? Because BronyMedic is right... there is no legal duty to act for non-proffessional responders.


Slight nitpick, in VA at least, as of ~2006 when I was a Red Cross CPR for the Professional Rescuer Instructor, you only have a duty to respond if you are IDENTIFIABLE as a medical professional/first responder.  If you're a nurse wearing a track suit around a bunch of strangers, you don't have a duty.  If you are a nurse wearing your hospital garb who stopped at the Kroger to buy some bread on the way home, you do.

/YMMV, especially state-to-state.
//As of 2006, according to the Red Cross, no one holding a current Red Cross certification who followed procedure has ever been successfully sued for intervening medically in an emergency.  Good Samaritan laws are usually pretty good in every, or almost every state.
2013-02-10 12:17:08 AM  
2 votes:
Just to clarify one data point for folks.  Defibrillators do not 'jumpstart' a heart.  They erase all electrical activity in the heart in the slight hope that when the heart re-polarizes on it's own afterwards that it will have a normal or better rhythm again.  In fact if one is asystolic and arythmic, defibrillators don't do much.  It's all drugs and CPR in that situation.
2013-02-10 12:11:12 AM  
2 votes:

3StratMan: Please, by all means, explain to us, with a full dose of overcomplicated hyperbabble, exactly what it means.


It means the police do not have a legal obligation to protect individual people. Example: Let's say the cops are legally required to protect each individual person. You get robbed and murdered. Your family could sue the police for failing to protect you. Every crime victim would have a case against the government for failing to protect them from the criminal.

Note that I said a "legal" obligation. The police still have a moral and ethical obligation to uphold the law, and they still have a legal obligation to enforce the law within the confines of the constitution.

You can also sue the police for failing to act. This occurs when the police know there is a violation and fail to take action when they have the immediate ability to do so. Let's say the cops see you getting your ass kicked by another person and they stand there and watch without taking action. You have a case against them.

If you read the case that brought about this ruling, you can see why the ruling was made as it was. Had the court ruled that the police were at fault for not enforcing a restraining order when they did not have the immediate ability to act, it would have meant anytime a person violated a restraining order the police would be liable. That's an impossible responsibility.
2013-02-10 12:10:19 AM  
2 votes:

studebaker hoch: If I ever find someone who is down without a pulse (check the neck), I'm doing CPR until someone with better training tells me to stop, or I stop due to exhaustion, or someone else tags in to help.

If someone wants to use an AED I'll give them a chance, and then when nothing happens, will continue CPR.

/pretty much just CPR for a stopped heart


The purpose of CPR is to keep heart tissue alive and maintain a rhythm long enough for an AED to arrive and make the difference.

For cardiac arrest, CPR will not solve the problem alone. The AED is essential. You shouldn't just be "giving [the aed] a chance"... you should be demanding someone brings you one.
2013-02-10 12:06:11 AM  
2 votes:

Kraftwerk Orange: I'm Red Cross CPR trained.  I've attended several CPR classes for certification.

My takeaway is this:  I really shouldn't try.  I'll call 911, and let the pros handle it.


Please, please don't do this.

I'm begging you not to be the person who calls 911, and doesn't act when you have the training to do so. If that person needs CPR, and you just call 911 and don't do anything else, you're signing their death warrant. Even in cities with rapid EMS response, like Seattle or Wake County, NC (Two of the areas that are considered the gold standard in ECC in the United States), by the time EMS gets there they won't be viable. AHA studies have shown that less than 4% of out of hospital arrests will have a return of circulation, and less than one percent will leave the hosptial neurologically intact.

We're getting better with things like the Dr. ICE/Therapeutic Hypothermia protocols, better CPR training and real-time feedback, and mechanical CPR aids like the Lucas and Autopulse, but all that means nothing if you can't get someone to intervene in the meantime.

zoll.com

If one link is broken, the other links won't pull.
2013-02-09 11:25:38 PM  
2 votes:

djh0101010: BronyMedic: fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?

If they're breathing (laypeople don't check for a pulse), you don't apply it. You can actually cause an AED to deliver an improper shock by shaking the patient while it analyzes the rhythm - if they're having a seizure or shivvering violently, for example.

It's kind of useless to apply one to a conscious and/or breathing patient as a layperson. It will not do anything.

nmrsnr: This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.

Unless they were professional responders or healthcare professionals, they had no duty to act legally. Technically, they could do nothing and still be completely kosher for doing so.

And there it is, BronyMedic pretending to be an educator, when he's really just a pompous ass.  Yet again.  You'd think Bronny would eventually mature and grow out of it, and, yet,  after all this time, he continues to not do so.

Hint: Arrogant and condescending is a bad combination.  Maybe you could, you know, contribute and teach, instead of being your usual self. Oh wait, that's not in your union contract, is it.

/with all DUE respect.  (as in, none).


I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.
2013-02-09 10:57:32 PM  
2 votes:
OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?
2013-02-09 10:51:04 PM  
2 votes:
bmr68: 100 percent of people that  go into cardiac arrest die.

FTFY.
2013-02-09 10:26:18 PM  
2 votes:

Notabunny: I'm ignorant. Will those things fire if the patient has a pulse?


There was a chance with the old ones that it would, but after what Cretinbob said I wonder if it's just kept in the guidelines as apopcryphia. I know our SOP with the Zoll PD1700s when I was a first responder said not to attach it if they had a pulse. it also has to do with the fact that those defib/pacer patches are about 150 bucks a pop, and they'd rather you not waste them. AEDs are useless if the patient had a pulse at any rate. Modern AEDs did away with the EKG monitoring screen (you can use the pads to monitor in Lead II) years ago because people realized they were added cost with no added value.

I do know that as of December 2012, a certain large nation-wide ambulance service I work for has in their guidelines that EMTs cannot use an AED while going down the road because of the risk of a false firing event. I've been monitoring patients on a Lifepak 12 that would literally look like they were in ventricular fibrillation when you go over some roads in Memphis, and the v.fib alarm would go off.

When you're dealing with BLS providers, namely First Responders and EMTs, you also have the issue of them performing a skill they are not legally allowed to perform - namely attempting manual cardioversion.
2013-02-09 10:09:11 PM  
2 votes:

BronyMedic: They can and will if they detect artifact and the software reads it as ventricular fibrillation.


You need a better AED.. Ever download the data after they've been deployed? We provide a LifePak 500 for our local PD. It analyzes twice before deciding whether to deliver a shock or not. You aren't as likely to see artifact in both segments.  Movement detection is also built in, but it does need to be turned on. The Lifepak 12 does the same thing if left in auto mode, but that may have more to do with the software version.
2013-02-09 09:24:10 PM  
2 votes:

Ed Finnerty: I'm not questioning anything anyone did, or why. I would have no idea what to do in that situation. I just pictured the paramedics walking in with gorilla masks on and scaring the guy. I was much funnier in my head, I assure you.


NOOO! That's not what I was insinuating! I was just illustrating what is poorly worded journalism.

Besides, everyone knows we come up to the patient like this.
2013-02-09 08:10:39 PM  
2 votes:
This seems reasonable, they're gym staff, not doctors. They should know how to use the medical equipment on hand, but it's not like any time someone has a heart attack the defibrillator is the proper device to use, so if they missed the signs of proper use of the defibrillator and went with CPR instead, I don't think that's something they should be liable for.
2013-02-09 07:19:29 PM  
2 votes:
  This is inherent risk.  If not at the gym, this would have happened at some point.  Can't hold the gym responsible for the inevitable.  Infarction builds up over decades, not over 10 minutes on a treadmill.
2013-02-10 04:52:53 AM  
1 votes:

Smgth: I understand protecting Good Samaritans from prosecution, I'm all for it. But I don't see how forcing the building to contain life saving measures will help anyone if there's no obligation.


You want to help this dying guy, but there's no AED in the building.  That's the problem the law addresses.

Would you want somebody sending electricity through you who didn't want to do so?
2013-02-10 01:49:51 AM  
1 votes:

cretinbob: If he wasn't in a shockable rhythm, it wouldn't have mattered anyway.
AED's give a false sense of security.


You're right about the rhythm,  but "false sense of security" is nonsensical.  How many gym members even notice AEDs?  If I saw one, it would remind me that I might have a heart attack, and that thought would not make me feel any more secure.  Nobody says to himself, "Hah - AED!  I can work myself as hard as I want and not worry about the heart attack!'
2013-02-10 01:43:28 AM  
1 votes:

vygramul: Aigoo: Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.

I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.


As Brony said, depends on the doc. I've been on a scene where a guy damn near cut his hand off in a generator fan--both an ortho and I were on the scene, buying gas. As you say, ortho gets this "oh shiat" look on his face, I look at the dude behind the counter and start telling him what I need (and when he doesn't have 80% of it, what I'll settle for...because I just cannot sit and watch someone bleed all over the place needlessly when I'm trained and capable of doing something about it). Other times, I've seen pediatricians handle MVAs like pros until the paramedics arrived on scene. It honestly depends on the doctor, and, as Brony says, you're way better off with Emergency Medicine guys, but sometimes, you do get pleasantly surprised.
2013-02-10 01:06:53 AM  
1 votes:

vygramul: I've been told by paramedics who were fellow instructors that you really don't want a doctor in an emergency, except perhaps an ER doc.  Most of them, in their experience, don't know what to do in first responder situations.


It's not that they're useless - they're Doctors after all - it's that their not in their environment in a prehosptial setting. Many of the things a doctor would do in a hospital for a patient in an emergency situation are impractical or impossible to perform in the field. A surgeon is not going to open someone up for abdominal trauma in the field, or crack a chest to check for a pericardial tamponade. The interventions and maneuvers a Paramedic or EMT performs are geared around doing as much as possible to stabilize while minimizing on scene time and optimizing rapid transport to a definitive care facility in a critical patient.

If a physician doesn't specialize or work in the Emergency Field, they may actually perform an incorrect or inappropriate intervention and cause harm. Most doctors do not deal with spinal immobilization, for example, outside of an orthopedic, neuro, or ER setting. I've seen nurses placing pillows and towels under the head of an ejection patient before without even considering immobilization of the neck.

On our end, the problem with having someone come up and claim to be a doctor is one of verifying they actually are one. We have very, very specific guidelines (Control-F and skip to Protocol 606, at page 100) at the state level when this happens, and typically when a doctor is told about it, they step back or stop barking orders. Even if this occurs, a Paramedic is still responsible for ANYTHING that happens on scene, even if it's done by a bystander.
2013-02-10 01:00:47 AM  
1 votes:

BronyMedic: davidphogan: I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.

I'm really honored about that then. I didn't even know why they made you do that until I asked a Zoll Rep a few months back when eh was doing our initial training on the new ProPaqs we went to. We weren't taught the "why" we do a lot of things in school as EMT-Basics, just the how and when.

As far as djh0101010 goes, he's gone on several bizarre diatribes in which he uses improper and blatently wrong terminiology, incorrect assumptions that only someone who has never been in the EMS profession could make (like NREMT Licensure), and has constantly claimed to be better at, well - everything, since he's been a volunteer "EMT" for 10 years. I called him out as a fake in a thread a few weeks ago, and he abandoned ship.


I saw the link you posted. I can't imagine why someone would pretend to be an EMT to troll Fark, but there it is.
2013-02-10 12:50:51 AM  
1 votes:

BronyMedic: felching pen: Exactly. I would say the implied obligation is in the existence of the state mandate. Presumably, there is more backstory to the law than good lobbying. My state requires me to have working brakes on my car; I would probably not get away with failure to stop if I told the officer I didn't think the circumstances required me to use them.

That's a little bit of a slippery slope there. The idea of the mandate is to have the equipment available to use appropriately by people trained to use it. The problem with creating a legal duty to respond in a case which would have otherwise been covered by the Good Samaritan statue is that you remove any protection people have for acting in good faith to aid another person, and open them up to medical malpractice and damage litigation. That is a POWERFUL motivator for people to not do anything but call 911.


This.

I'm trained and certified in advanced first aid and lifesaving... in a combat environment or MASH setting. Could I adequately determine whether or not I should use the AED? Yes. If a doctor (of any sort--they all went to medical school) and a med student are on scene, then guess what? They take charge. Period, end of story. Doc is licensed (I hope), I'm merely certified to render aid and to keep you from bleeding to death--or keep idiots from doing dumb shiat like moving you or what have you--until the licensed guy (doc or paramedic) gets there.

Now, if I think the doc is being a farktard, I'll take the chance of using the AED. Sorry about the expense, but I don't place dollar signs on someone's life (massive potato clocks that we are...you owe me a keyboard, Brony!). But the fact that we live in a world where you can sue me for saving your life (I've seen cases where people have sued for getting broken ribs during CPR... sweetie, if your ribs aren't broke from CPR, something is very, very wrong) makes me sympathize with anyone whose gut instinct is to pick up the phone, call 911, and wait for a professional.
2013-02-10 12:37:25 AM  
1 votes:

Aigoo: Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.


It's nothing a few hundred thousand volts won't fix, Aigoo. To be honest, the human body's one big potato clock.

images2.wikia.nocookie.net
2013-02-10 12:34:04 AM  
1 votes:

fusillade762: a trainer detected breathing and a pulse and didn't use the AED

Not a doctor, but do you use those things when someone still has a pulse? I thought they were supposed to re-start a stopped heart?


Opposite. They actually stop a heart that's beating incorrectly, creating a stable rhythm (flat, actually) and allowing the heart to begin to beat properly (normal rhythm) again. They will not re-start a heart that has stopped beating (dead guy) because they are incapable. If that's what you're looking for (television and movies), you need to be paging Dr. Frankenstein and setting up a lightning rod.

Fun fact: shock at the wrong time and you can kill someone rather than helping the heart restore normal rhythm.
2013-02-10 12:14:47 AM  
1 votes:
AEDs at gyms give people a false sense of security, he said, because nowhere in the U.S. are they mandated to use them.

Defibrillators do not give me a false sense of security. There is nothing about a publicly available defibrillator that says "it's ok if I have a heart attack here." The only place I feel safe having a heart attack is in a bed in a hospital room with a cardiologist and surgeon in the room.
2013-02-10 12:10:47 AM  
1 votes:

studebaker hoch: If I ever find someone who is down without a pulse (check the neck), I'm doing CPR until someone with better training tells me to stop, or I stop due to exhaustion, or someone else tags in to help.

If someone wants to use an AED I'll give them a chance, and then when nothing happens, will continue CPR.

/pretty much just CPR for a stopped heart


This is my understanding. 1 person should always do CPR, period. If two people are capable of assistance, one person should do CPR while the other gets the AED ready and verifies that it's the correct time to use. But CPR is first and foremost.

I review a lot of safety plans for construction work and I really think modern AEDs are quite good and relatively cheap, so every job site should consider having them available, but there's just no replacement for having two CPR basics trained people on every job.
2013-02-10 12:01:18 AM  
1 votes:
If I ever find someone who is down without a pulse (check the neck), I'm doing CPR until someone with better training tells me to stop, or I stop due to exhaustion, or someone else tags in to help.

If someone wants to use an AED I'll give them a chance, and then when nothing happens, will continue CPR.

/pretty much just CPR for a stopped heart
2013-02-09 11:45:29 PM  
1 votes:

BronyMedic: The Voice of Doom: OTOH, if they did CPR...I remember being told during some quickie first-aid course not to do CPR if someone is just unconscious, but still breathing normally.
So given that they thought CPR was necessary, shouldn't they also have tried the AED?

That's what's not adding up here.

You have two people who would, at the very least, be considered professional rescuers who have ascertained the person had no pulse, and required CPR. At that instant, yes you would. It's the exact situation the AED was designed for.

On the other hand, you have two laypeople, who are NOT trained to check for a pulse, who claim the guy had a pulse and that's why they didn't apply the AED. However, since they did NOT have a duty to act, they're still covered under the good samaritan act for not attaching it. If they had actually said they still attached it and thought that, IANAL but it would seem like their protection under the act would then go out the window, as they willingly commited a negligent act.


VTac with a Pulse (and unresponsive) and profound bradycardia (and unresponsive) are two situations where an experienced medical provider may decide, in the field, to initiate CPR... or at least chest compressions... but *not* apply an AED.

That said, I still have no idea if this is what happened in this situation.
2013-02-09 11:43:39 PM  
1 votes:

ZackDanger: As a point of clarification from something posted earlier in the thread, I also want to point out that an AED can shock a person who is conscious, not in VFIB, and not even moving. AEDs are designed to shock a variety of rhythms, one of which can support life in some cases and thus it is not benign to put an AED on a person who is awake.

I've even heard of EMTs proactively placing electrode pads on someone who is awake and experiencing Chest Pain "just in case." Not only is this directly in contradiction to manufacturer's guidelines, it is very dangerous and potentially deadly.


THIS.

Not only that, if someone reports an EMT for doing that, they can lose their license for practicing outside of their scope of practice, and open themselves up to a lawsuit.

All the AED sees is this: Ventricular Tachycardia.

media.tumblr.com

The AED cannot determine if it has a pulse or not with it. It is quite possible to be in V.Tach and have a perfusing blood pressure at the same time (I had a patient the other day who was refractory to adenosine, amioderone and synchronized cardioversion, and lidocaine was contraindicated), and you WILL kill them by delivering an unsynchronized shock.

This is why EMT-Basics are taught NOT to apply an AED to a patient with a pulse and a rapid heart rate.
2013-02-09 11:39:50 PM  
1 votes:

The Voice of Doom: OTOH, if they did CPR...I remember being told during some quickie first-aid course not to do CPR if someone is just unconscious, but still breathing normally.
So given that they thought CPR was necessary, shouldn't they also have tried the AED?


That's what's not adding up here.

You have two people who would, at the very least, be considered professional rescuers who have ascertained the person had no pulse, and required CPR. At that instant, yes you would. It's the exact situation the AED was designed for.

On the other hand, you have two laypeople, who are NOT trained to check for a pulse, who claim the guy had a pulse and that's why they didn't apply the AED. However, since they did NOT have a duty to act, they're still covered under the good samaritan act for not attaching it. If they had actually said they still attached it and thought that, IANAL but it would seem like their protection under the act would then go out the window, as they willingly commited a negligent act.
2013-02-09 11:33:38 PM  
1 votes:
davidphogan:
I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.

As a point of clarification from something posted earlier in the thread, I also want to point out that an AED can shock a person who is conscious, not in VFIB, and not even moving. AEDs are designed to shock a variety of rhythms, one of which can support life in some cases and thus it is not benign to put an AED on a person who is awake.

I've even heard of EMTs proactively placing electrode pads on someone who is awake and experiencing Chest Pain "just in case." Not only is this directly in contradiction to manufacturer's guidelines, it is very dangerous and potentially deadly.

Only ever place an AED on a person with "no signs of circulation."

blogs.laweekly.com
2013-02-09 11:31:18 PM  
1 votes:

davidphogan: I used to be an EMT-D and learned why we were trained to pull over before using an AED from him now, fifteen years after I was first licensed, from him in this thread. Not sure why you have an issue with him, but he's educated at least one person here.


I'm really honored about that then. I didn't even know why they made you do that until I asked a Zoll Rep a few months back when eh was doing our initial training on the new ProPaqs we went to. We weren't taught the "why" we do a lot of things in school as EMT-Basics, just the how and when.

As far as djh0101010 goes, he's gone on several bizarre diatribes in which he uses improper and blatently wrong terminiology, incorrect assumptions that only someone who has never been in the EMS profession could make (like NREMT Licensure), and has constantly claimed to be better at, well - everything, since he's been a volunteer "EMT" for 10 years. I called him out as a fake in a thread a few weeks ago, and he abandoned ship.
2013-02-09 11:25:02 PM  
1 votes:

JonPace: Oh boy a ricky rescue who tries to look smart every time something EMS related pops up. Prime example of why a little knowledge can be a bad thing.


Please point out what I've said that is wrong, or contrary to the AHA's 2010 guidelines for emergency cardiac care?
2013-02-09 11:24:14 PM  
1 votes:

ZackDanger: Wait... What?

What did you read? Because BronyMedic is right... there is no legal duty to act for non-proffessional responders.


Just ignore him. He's a person who claims to have been an "EMT-Basic" who shows up to troll threads I post in. He's been doing it ever since I made an off color joke a few months ago and that apparantly rustled his jimmies. This is pretty par for the course for him.
2013-02-09 11:22:11 PM  
1 votes:
djh0101010:And there it is, BronyMedic pretending to be an educator, when he's really just a pompous ass.  Yet again.  You'd think Bronny would eventually mature and grow out of it, and, yet,  after all this time, he continues to not do so.

Hint: Arrogant and condescending is a bad combination.  Maybe you could, you know, contribute and teach, instead of being your usual self. Oh wait, that's not in your union contract, is it.

/with all DUE respect.  (as in, none).


Oh good, I was hoping the guy who was impersonating an EMT to troll would show up to cause his standard stupidity.

Actually, I'm an American Heart BLS-Healthcare Provider and an AAP Pediatric Education for Prehospital Provider Instructor. Nothing I've said has been arrogant or condescending in this thread. And I'm not even a member of a union, I work for a 403 Not for Profit Childrens Hospital.

What are you again, by the way? You never really answered which state the NREMT "licensed" you in?
2013-02-09 11:17:54 PM  
1 votes:

BronyMedic: ZackDanger: UsikFark: ZackDanger: OR

The guy had a pulse and respirations when the trainer first got there... but then deteriorated by the time the Doctor got next to him?

Maybe the doctor strangled him with a stethoscope just to be sure he didn't have a pulse.

Maybe the trainer accidentally checked the pulse on a guy lifting weights *next* to the victim... and then the doctor did CPR on a punching bag that was laying in the corner and THERE NEVER WAS A VICTIM.

The paramedics were just milk men.

Maybe, just maybe, the reverse vampires actually set this up to murder him!


Maybe there was this guy in the midwest who invented a car that runs on water... and then the government decided to silence him... and they framed the trainer for the murder. But he was going to talk... so the government had to kill that random guy in the gym, so the trainer would mistakenly not do CPR (the government implanted into the gym guy, unbeknownst to him, during his sleep, a device in his blood stream to mimic a pulse), and then the trainer would be found negligent and sent to jail, and then when he was in jail his cell mate, tripping on government supplied acid, would murder the trainer, and then that other jail guy would fry in the electric chair.

All wrapped up nicely.
2013-02-09 10:56:32 PM  
1 votes:

dark brew: BronyMedic: UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!

QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.

This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.

Unless you are using another article, by my count you have a trainer at the club who detected a pulse/respirations and therefore no need for the AED.  Then you had the doctor (article doesn't specify which kind of doctor and who knows, it could be a podiatrist) and med student not detect a pulse since they initiated CPR but they also did not apply the AED. Finally you have the medics who used their own monitor and shocked the pt, although it isn't known if that was done right away or after meds were given.  The only layperson was the trainer, unless I missed something.


WHAT IF?!!??

If the patient had a run of VTac... The trainer felt the pulse and was right to not start CPR... But then the doc felt for a pulse and it was so rapid he didn't feel one, or only caught it occasionally, or recognized the inadequate perfusion... so started CPR.... then the Medics shocked it when they got there.

OR

The patient didn't have a pulse, but the trainer wasn't sure whether he felt one or not, and just figured he did, or confused his own muscle tremors from his excitement as a pulse and therefore mistakenly didn't start... and then the doctor of some variety was correct in assessing the lack of pulse, but then was too ignorant to think about a defib, etc... and screwed up in this regard and then the medics got on scene and saved the day.

OR

We have no idea what happened because bystanders have no clue about what's going other than some doc started UPS on the guy.
2013-02-09 10:51:53 PM  
1 votes:

BronyMedic: This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.


And that's why the court should throw this case out.  It will do more harm than good if they rule that the club was negligible.
2013-02-09 10:44:50 PM  
1 votes:

BronyMedic: HAH. People need to check and see if their State's Good Samaritan protections cover them if they have any kind of healthcare training or licensure/certification. Tennessee pretty much gave the middle finger to anyone who did a few years ago when they removed the good samaritan protections for people who had a license or certification - like EMTs and RNs - and held you accountable to act as if you were on the clock.


THIS.  There should be a federal standard for Good Samaritan laws if you ask me.  People going into cardiac arrest and the method for which you provide help to them isn't an issue that should be left up to states.
2013-02-09 10:43:46 PM  
1 votes:

UsikFark: BronyMedic: It will not do anything. But, but, but, DO SOMETHING! Save Grandpa!


QUICK! GO BOIL WATER! AND I NEED TOWELS. LOTS OF TOWELS!

ltdanman44: the automated external defibrillator  can determine this. it just needs to be hooked up to the patient, and they did not do this.


This is what's not adding up. You have two healthcare providers insisting the person does not have a pulse and to attach the AED, and you have two laypeople - who are not trained nor are supposed to check for a pulse, only signs of circulation - insisting this person DID have a pulse.
2013-02-09 10:41:53 PM  
1 votes:
How Dead Dave got his name: Years ago this supervisor at NJ Bell (Dave) treated everybody like shiat. One day Dave had a heart attack in his office right in front of a field tech. The tech said "oh well" and just left. A secretary found Dave near dead not long afterward and called an ambulance.

When Dead Dave came back to work he tried to get the tech fired. But there was nothing in the union handbook or the employee manual stating you had to call an ambulance or notify someone in such an emergency so the guy kept his job. And from that day on a certain dooshbag was forever known as Dead Dave.
2013-02-09 10:35:00 PM  
1 votes:

skinink: "...they aren't required to actually use them on a stricken patron, the state's highest court ruled Thursday."
For heaven's sake why not? As Farkers above have said, you can put the pads on a person and the defib won't shock the person unless it detects that the person needs it. And remembering my training, compression is very important, even more than breathing into the person's airway. You have to keep the blood moving and everything oxygenated or the person's brain is screwed.

The funniest part of the training is when they tell you that before pads are applied, you should quickly shave down any hairy chests and remove any body piercing on the victims including nipple piercings. Or else if a shock is applied it will just jump in between the piercings (at least that's how I remember the trainer explaining it).



Compression just buys time till defibrillation or until the underlying cause can be corrected by keeping the coronary tissue and, to a lesser extent, the brain and end organs perfused. Unless you get a shockable rhythm where the heart can be bullied into a reorganized electromechanical activity, or unless you treat the reason their ticker won't tock, compressions will not bring someone back. The only exception to this is in neonates and children, where they have a primarily respiratory cause for their arrests. (The reason why hands-only CPR is not taught for children)

They have no legal duty to act is the reason the court found their findings, more than likely, since they are not licensed/certified healthcare providers, and they were acting in the capacity of good samaritans, not as rescuers. While it's ethically questionable, legally it's perfectly gold for them to do what they did.

Even Healthcare Providers only have an ethical duty to act when off duty and not on the clock. Alabama was the only state I knew with a law mandating that people who are licensed and/or certified in that state stop to render aid in an emergency, and they struck it off the books three years ago because it was unenforcible.

As far as the shaving thing now, the AHA recommends you keep two pairs of defib patches in each AED. They dont even recommend it anymore, because you have to interrupt CPR to do so. You just jerk the first pair of patches off to rip the hair off their chest, and try to either reattach them, or apply a new set.

Britney Spear's Speculum: The court needs to carefully examine this lawsuit.  Society and good Samaritans could be ruined infinitely because of one fark up.  Because this is an extremely small minority of cases, more people could die if the risk/benefit gets skewed by knee-jerk media outrage.


HAH. People need to check and see if their State's Good Samaritan protections cover them if they have any kind of healthcare training or licensure/certification. Tennessee pretty much gave the middle finger to anyone who did a few years ago when they removed the good samaritan protections for people who had a license or certification - like EMTs and RNs - and held you accountable to act as if you were on the clock.
2013-02-09 10:32:32 PM  
1 votes:
what i couldn't figure out about the article is that it said a TRAINER found a pulse and breathing, but a doctor and medical student did CPR??  personally if you have an unresponsive casualty, hook the damn defib up!  We also have the life pac, and find it pretty infallible.    The paramedics shocked him when they arrived, so there had to be some kind of rhythym when they arrived.  I have had several people confuse agonal resps with "breathing", and be hesitant to start CPR...

i see a few people in this thread who could benefit from a basic first aid course... defib's do NOT start the heart, unless we are talking hospital care settings, and that is usually in conjunction with cardiac meds if i am not mistaken.  (way above my pay grade).  Portable defibrillators like the PAP ones just detect a rhythym that it can disrupt, and hopefully the heart will establish a new, normalized rhythym on it's own...
2013-02-09 10:30:17 PM  
1 votes:
The court needs to carefully examine this lawsuit.  Society and good Samaritans could be ruined infinitely because of one fark up.  Because this is an extremely small minority of cases, more people could die if the risk/benefit gets skewed by knee-jerk media outrage.
2013-02-09 10:26:39 PM  
1 votes:
And if they had used it and the guy died anyway - which he surely would have - they'd be suing over that. Yes, it doesn't make sense to require them to have the equipment and be able to use it to save lives, but not require that they use it to save lives. That would be like requiring a public pool have a lifeguard that knows CPR, but the lifeguard can just ignore drowning people. In this case, though, it would be like requiring the lifeguard to give CPR to everyone in the pool.
2013-02-09 10:26:08 PM  
1 votes:
As mentioned above, AED's are trendy and are not a viable substitute for good CPR, until trained medical personel arrive who can properly interpret the cardiac rhythm. Reliance on that technology is faulty at best.
/Been there, done that, dozens of times.
2013-02-09 10:21:44 PM  
1 votes:

BronyMedic: cretinbob: The AED won't fire if they have a pulse though, so there's no harm in applying the pads.

They can and will if they detect artifact and the software reads it as ventricular fibrillation.

[rtboardreview.com image 498x155]

That run of artifact there can be read by an AED as V Fib, and shocked inappropraitely. It's why even EMTs have to pull over if they use an AED during a transport before they can analyze, but a PAramedic can make a manual reading of the EKG and determine if it's needed.

American Heart and Red Cross standards both state that you do not apply an AED to a patient who has signs of circulation. Lay Rescuers do not check for a pulse anymore, and have not since the 2005 standards were released. The only people who are legally covered if they do so are Advanced Life Support personel, i.e. Paramedics, Registered Nurses, and Doctors/Mid-Level Providers who do so in a peri-arrest situation where they anticipate a patient is about to code.

If you apply an AED to someone who you know has a pulse, you have just lost ANY coverage against lawsuits as a layperson or BLS Healthcare Provider, and could actually face professional and civil sanctions as one.

Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


I'm ignorant. Will those things fire if the patient has a pulse?
2013-02-09 10:17:49 PM  
1 votes:
img2.timeinc.net

Zap the son-of-a-biatch again
2013-02-09 10:17:15 PM  
1 votes:
Sounds like the club did the absolute best they could do under crappy circumstances.
2013-02-09 09:56:31 PM  
1 votes:

serial_crusher: CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.


I'm pretty sure that's not legal, or a great way to avoid lawsuits. The financhial relationship between a w/c van attendant and their charge creates a legal duty to act to provide first aid care under the state statutes that regulate them, at least in Tennessee.
2013-02-09 09:54:11 PM  
1 votes:

serial_crusher: CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.


that's farked up.
2013-02-09 09:37:46 PM  
1 votes:
CSB: One of my high school buddies manages a taxi company, which also does van service for the various old folks homes in town.  All the drivers of that part of the company are legally required to learn CPR, but they're also legally forbidden from using it.
2013-02-09 09:25:11 PM  
1 votes:
Damn you images!

bloximages.chicago2.vip.townnews.com
2013-02-09 09:22:30 PM  
1 votes:

BronyMedic: Ed Finnerty: And that is why paramedics are no longer allowed to participate in "Wear Your Favorite Halloween Mask to Work Day".

Not all arrest rhythms are shockable, and are only able to be treated by identifying the reversable causes and correcting them as quickly as possible. Some of those you can reverse in the field, some of those you can't. Even shockable rhythms can turn into an irreversable asystole depending on how long the patient has been down, and what's going on with them to cause it in the first place.


I'm not questioning anything anyone did, or why. I would have no idea what to do in that situation. I just pictured the paramedics walking in with gorilla masks on and scaring the guy. I was much funnier in my head, I assure you.
 
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