Active Shooter Uvalde TX Elementary School

[TGS]

Yes... My understanding is that the device would get started as soon as possible at scene, relieving responders of having to do CPR.

I think the point we're trying to make is that, generally speaking, patients in cardiac arrest are not transported by air. The standard is to work a patient on scene and either transport them when vitals are regained, or pronounce them where they fell. Transporting people in cardiac arrest is not done as a valid medical protocol, it's done to keep the crews from being assaulted by angry family members.

So, it doesn't really matter if someone already had a Lucas device in place by local crews, because 1) They're probably not going to let you leave with their expensive toy, it's coming off and staying with the ambulance, and 2) a person in cardiac arrest isn't being rushed to an air unit to begin with, regardless if it can fit a lucas. Especially double-doggy-super-secret-extra-probation-so if you're at an MCI and are triaging care: arrests from penetrating trauma have an exceptionally low survival rate, and using any modern triage algorithm during an MCI are black-tagged and treated the same as dead.

And so, asking, "What, can your air units not fit a lucas?" isn't very relevant because it isn't contextually valid to the majority of current day practices.

But, going back to one of the points in the article about EMS crews being brought patients they couldn't help....the biggest gain by employing a robust Rescue Task Force is the ability of embedded EMS to triage. Anyone can apply bandages and TQs, but the ability to triage properly can make a huge difference on outcomes.

[RoyGBiv]

I think the point we're trying to make is that, generally speaking, patients in cardiac arrest are not transported by air. The standard is to work a patient on scene and either transport them when vitals are regained, or pronounce them where they fell. Transporting people in cardiac arrest is not done as a valid medical protocol, it's done to keep the crews from being assaulted by angry family members.

So, it doesn't really matter if someone already had a Lucas device in place by local crews, because 1) They're probably not going to let you leave with their expensive toy, it's coming off and staying with the ambulance, and 2) a person in cardiac arrest isn't being rushed to an air unit to begin with, regardless if it can fit a lucas. Especially double-doggy-super-secret-extra-probation-so if you're at an MCI and are triaging care: arrests from penetrating trauma have an exceptionally low survival rate, and using any modern triage algorithm during an MCI are black-tagged and treated the same as dead.

And so, asking, "What, can your air units not fit a lucas?" isn't very relevant because it isn't contextually valid to the majority of current day practices.

But, going back to one of the points in the article about EMS crews being brought patients they couldn't help....the biggest gain by employing a robust Rescue Task Force is the ability of embedded EMS to triage. Anyone can apply bandages and TQs, but the ability to triage properly can make a huge difference on outcomes.

Thanks for the detailed explanation. Makes sense that careflighting a heart attack should be unusual.
FWIW, the PHI guys made a big show of their Lucas the last time I did an orientation with them.

/tangent

[UncleGabby]

I think the point we're trying to make is that, generally speaking, patients in cardiac arrest are not transported by air. The standard is to work a patient on scene and either transport them when vitals are regained, or pronounce them where they fell. Transporting people in cardiac arrest is not done as a valid medical protocol, it's done to keep the crews from being assaulted by angry family members.

So, it doesn't really matter if someone already had a Lucas device in place by local crews, because 1) They're probably not going to let you leave with their expensive toy, it's coming off and staying with the ambulance, and 2) a person in cardiac arrest isn't being rushed to an air unit to begin with, regardless if it can fit a lucas. Especially double-doggy-super-secret-extra-probation-so if you're at an MCI and are triaging care: arrests from penetrating trauma have an exceptionally low survival rate, and using any modern triage algorithm during an MCI are black-tagged and treated the same as dead.

And so, asking, "What, can your air units not fit a lucas?" isn't very relevant because it isn't contextually valid to the majority of current day practices.

But, going back to one of the points in the article about EMS crews being brought patients they couldn't help....the biggest gain by employing a robust Rescue Task Force is the ability of embedded EMS to triage. Anyone can apply bandages and TQs, but the ability to triage properly can make a huge difference on outcomes.

Thank you for articulating that much better than I could. There are several aspects of that article that were just pure rage porn. “She died in the back of an Ambulance that just sat there for 40 minutes!” That’s actually pretty standard.

Not saying there weren’t major fuck ups, but two of the major lynch pins for that article were based on “Chicago Fire” concepts of what Emergency Medical Care is supposed to look like. I suspect the journalist got their talking points from some of the family’s lawyers.

[Eric_L]

I have several problems with the article.

First, it talks about how the teacher died in the back of the ambulance and the ambulance never left the scene. Under the EMS protocols we operate under at my agency, we work codes on scene, meaning, we do CPR and everything that comes with it on scene (often in the bedroom, the living room, I worked a nasty one in the middle of a restaurant once, or in the back of the ambulance) and the medics do everything for the patient that the ER would do. So the fact that the ambulance never left the scene means nothing.

Second, it talks about how the helicopters could have flown critical patients faster, if it had been on the ground, specifically, the boy Xavier. But, in my experience as an EMT, patients have to be stable enough for air transport because the flight crews don’t have enough room to perform CPR in the back of the helicopter. Because I’m just an EMT-Basic, and used to work at a rural agency that was very lacking when it came to ALS providers, I called for a helicopter several times. Sometimes they would fly my patient in, sometimes they weren’t stable enough, but it was a way to get top notch care to the patient pretty quickly, and when the patient was in too critical a condition to fly, the paramedic and the flight nurse would ride in the Ambulance with me. From the description in the article, it sounds like Xavier was already too far gone to fly.

This was penetrating trauma. Not a typical cardiac code. If you are doing CPR on a trauma, they need blood/ blood product and surgery immediately. Not time in the back of an ambulance. No I’m not chastising you.

[Dog Guy]

Lets not conflate transporting someone in cardiac arrest from a medical issue (i.e. heart attack) with transporting a traumatic arrest (shot, squished, etc.) When I retired five years ago, local practice was that traumatic arrests usually didn't get CPR at all. If CPR was started, the medics made contact with medical control and they were invariably pronounced dead at that time. Contrast this with when I started in 1979, and everybody got CPR and transport.

For medical arrest, the medics can do almost everything the ER will do. For traumatic arrest, this isn't the case.

There are exceptions to the "no trauma code" rule, including pediatric patients. Not that we expect them to survive; it's just too wrenching for many responders to not at least make the attempt.

Our FD and PD got along great. We had implemented the rescue task force paradigm during my last year or so. If trained and practiced, I think it's a great concept.

I get that many here, especially LE, don't believe ICS helps them handle a total shit show incident. Too much to do right farging now, not enough cops to get after the bad guys, no time to pull people out to fill ICS slots. I lay the responsibility for this directly at the feet of the American fire service. FDs usually teach a gold plated, personnel-sucking IC system based on slowly developing events like wildland fire. LE needs to be taught the bare bones, modular concepts that focus on the core fundamentals which are relevant in the first 5-15 minutes of an event. The terminology and structure needs to fit how LE operates every day instead of shoving the LE response into the wildland fire terminology. It's very doable; it just isn't often taught that way.

Keeping control in order to correctly focus effort is far easier than trying to regain it.

[UncleGabby]

This was penetrating trauma. Not a typical cardiac code. If you are doing CPR on a trauma, they need blood/ blood product and surgery immediately. Not time in the back of an ambulance. No I’m not chastising you.

You are absolutely correct. I was speaking in generalities that do not apply to that particular case.

[Spartan1980]

For a bit of perspective of what will fit in a helo. My daughter's crew playing with their new bird figuring out how to load.

[Lon]

I think the point we're trying to make is that, generally speaking, patients in cardiac arrest are not transported by air. The standard is to work a patient on scene and either transport them when vitals are regained, or pronounce them where they fell. Transporting people in cardiac arrest is not done as a valid medical protocol, it's done to keep the crews from being assaulted by angry family members. And to keep the patrol cops from having to do a report.

Fixed it for you.

[feudist]

Fixed it for you.

Ha!
Most of the Patrol cops I know would pass up a chance at Heaven to avoid writing a report.
It's Kryptonite.

[ccmdfd]

Most if not all of this has been covered by the previous posters.

The article does read like a hit piece to me. Not totally surprised. Heck, wouldn't be surprised to see upcoming hit pieces against the cafeteria workers as well as the local Street crew. Yes, that's a bit facetious but in this day of creating as much outrageous you can, and as many dollars as you can, nothing would surprise me.

The previous level one Trauma Center I worked at had a protocol for no CPR for pulseless trauma victims in the field. Can't say what the current recommendations are or protocols.

Perhaps some of those people didn't receive care because the triage officer put them in the Beyond hope category??

Then again, it would certainly wouldn't surprise me for there to be screw ups. Heck, even large city EMS could potentially have a problem with something like this. Did that particular EMS system have frequent training for mass casualty shootings? Even with good training if they don't actually have the incidents, they're still not going to do as well has larger city, County units that see these things more frequently.

It's also quite possible that the lead EMS officer on the scene was taking his cues from the lead law enforcement officer on the scene. Remember, it was a barricaded suspect, not an actual school shooting with dozens injured and dying on the floor.