VENTILATIONS UNSUCCESSFUL

By Brett Patterson

Brett: 

We have a study session here at NORCOMM where new EMDs with less than a year’s experience in providing EMD gather together QAs we have on staff to practice scenarios off the dispatch floor. (This was not an actual call; it was practiced in a scenario-based setting only.) Today, we were drilling in the scenario of a second-party caller reporting a heroin overdose of a 33-year-old male. The caller reported that the patient was not awake, and when Key Question 6 on Case Entry was asked, the caller reported that the patient was not breathing. 

We started down the C Card, reading Panel 1, going to 2, and then 4. On Panel 4, the calltaker selected the Ventilations 1st pathway, since it was an overdose. She proceeded to Panel 5. When the question was asked, “Do you feel the air going in and out?” the answer was “No.” The calltaker proceeded to Panel 13. When the question was asked, “Did you feel the air going in and out?” the answer was again “No.” From there, the calltaker moved to Panel 6. This is where our question comes into play. The calltaker wanted to go down the Ventilations 1st pathway, since that was the initial choice with the call. Others in the group argued to go to the Compressions 1st pathway because ventilations were never successful. I am looking for a clear answer on how to proceed with this call.

 Should the calltaker continue to attempt the ventilations and deliver 30 compressions with two attempted breaths or go to the Compressions 1st pathway and start Panel 11?

Thank you for your assistance.

Best Regards,

Nicole Stewart

Training & QA Manager

NORCOMM Public Safety Communications

Franklin Park, Ill., USA

Nicole: 

Interesting scenario!

Let me start with, “Continuing on with the V-1st” pathway is correct.”

Several years ago, we limited the attempt to open the airway to one try when air didn’t initially go in, considering the time it was taking to reposition the airway, the potential inaccuracy of the rescuer’s assessment, and the very low probability of undiscovered foreign body airway obstruction (choking is almost always reported as choking).

In your scenario, and others like it, we continue down the V-1st pathway for basically two reasons. First, if the problem is simply airway positioning or rescuer inaccuracy in reporting whether air went in, each attempt itself requires repositioning and, eventually, some air should get in. I should mention that in your OVERDOSE scenario, it is unlikely two attempts to ventilate would be unsuccessful considering the flaccid nature of an OVERDOSE patient’s airway.

Second, in the rare event the airway was obstructed by a foreign body, there is a chance that positive pressure from attempted ventilations could force the object into the right mainstream bronchus, thereby opening the left lung to ventilations.

In essence, if the patient’s airway is obstructed by a foreign body, compressions will act to push it out, and, if that doesn’t happen, there is a slim possibility that blowing into the mouth will open up one lung to ventilations. Notice the situational instruction in Panel 7 and Panel 10: “(Previous airway blockage) Check in her/his mouth for an object and remove anything you find.”

We strategically placed this after compressions since the positive pressure created by compressions may expel an object.

I hope that answers your question and settles the scenario debate. Kudos to you and your staff for conducting scenario drills to better prepare your EMDs!

Thanks for submitting your question to the Academy.

Brett A. Patterson

Academics & Standards Associate

Medical Council of Standards Chair

Brett: 

Thank you for the reply! Our team appreciates your time and attention so we have a solid answer.

Nicole

Brett: 

Does the Academy consider it to be “with patient” if, for example, a mother is calling about her son from a hotel room and her son is in the bathroom vomiting? I would consider that with patient, and I would Q the call as such. Some of our communicators would not consider the caller with patient in that scenario and would classify it as a third party. I want to send the communicators an email that better defines second-party callers, and I was composing one when it occurred to me to write you for assistance.

Claude A. Rogers III

Captain of Communications

Reedy Creek Emergency Services

Reedy Creek, Fla., USA

Claude: 

“Party caller” should be thought of not by distance but rather the ability to answer Key Questions about the patient. Certainly, the caller does not need to be in the same room as the patient to be considered a second-party caller, provided the caller has access to the patient and is able to answer questions. Even a third-party caller may be considered second party if a quality assessment can be obtained from his/her recent memory of seeing the patient.

According to the definition in “Principles of EMD”: The second-party caller is directly involved with and in close proximity to the person having the problem. A second-party caller may be the friend who was with the patient when she collapsed, or someone who was in an auto accident and is unhurt, but is calling to report someone else who was injured.

Please let me know if you have any additional MPDS questions.

Brett

ABOUT THE AUTHOR:
Brett A. Patterson is an Academics & Standards Associate and Medical Council of Standards Chair for the IAED.

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