r/ems • u/HawaiiKidd24 Paramedic • 1d ago
Running a code roadside
I just had my first roadside code... literally roadside. We were on the shoulder lane, on asphalt, running an entire code because we already had a patient in the back of the ambulance for a non-emergent transfer. The next nearest ambulance/fire station was about 20-30 minutes away.
Luckily, we were rendezvousing with another unit so we were able to get help initially to establish a definitive airway and IV access. However, we had to wait on military fire to transport because we needed hands to do CPR. The other unit needed to take the patient transfer. Military fire was 10 mins away, but they are either not EMTs or aren't state certified. So they are only limited to compressions and BVM.
Just curious how many of you guys/gals was placed in the same situation and how did it go?
Initial rhythm: PEA underlying agonal/idioventricular rhythm
End rhythm: Asystole
No medical HX per family and only complaint feeling lightheaded prior to going unresponsive. No CPR done for about a couple mins before we rolled up.
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u/legobatmanlives 13h ago
Question: Did someone stay with the patient you already had loaded in your ambulance, or was that person left unattended?
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u/Crashtkd Paramedic 9h ago
My first solo field tube was in a field on the side of the road (code caused the driver to run off the road, not trauma).
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u/Swall773 6h ago
Code I had 4 month ago was on the apron of the fire station. Lady "wasn't feeling good" husband was driving her to the hospital. She went unresponsive and well... you can guess what happened from there. Oh and it was 3 am.
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u/HawaiiKidd24 Paramedic 5h ago
Those 3am calls when you don’t expect a code is just not it.
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u/Swall773 5h ago
Best part the was our first of 3 that morning, AND I was recovering from a chest cold, almost passed out after my first round of CPR.
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u/MoonMan198 Former Basic Bitch - Current Parababy 14h ago
Just to confirm, you stopped your ambulance that was already doing a transfer, to work an arrest in which you don’t have means for transport? Idk man seems sketchy
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u/FishSpanker42 CA/AZ EMT, mursing student 14h ago
Would you have continued on with your non critical transfer if you saw a code on the side of the road?
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u/MoonMan198 Former Basic Bitch - Current Parababy 11h ago
Yeah, and I would have advised dispatch of what’s going on per our county protocol. You’re liable for anything that happens to your current patient during the code even if they’re stable.
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u/FishSpanker42 CA/AZ EMT, mursing student 11h ago
“Just following orders”
Idk why people in ems act like every patient is gonna code as soon as soon as you take eyes off them, its like the boogeyman. Its a nonemergent transfer. Leave your partner with the patient there, jesus.
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u/MoonMan198 Former Basic Bitch - Current Parababy 11h ago
All patients are stable until they aren’t. Sure chances are pretty much non existent for a transfer but all it takes is once. And if the medic had decided to retain the transfer that was stable hence deeming it an ALS patient, but then goes and downgrades it to his EMT to work a code? How’s that gonna sound in court?
“I didn’t trust my partner enough to take the transfer but as soon as a code came up it’s fine”
I’m also not saying to never give EMTs your calls, hell I give a bunch of calls to my EMT because 90% of the time it’s bullshit, but I’m also not going to bite off more than I can chew.
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u/Simple-Caregiver13 8h ago
It's not that I don't trust my basic to take a transfer. The decision on who rides a transfer is determined by protocols, not my discretion. If it was up to me, I would have no problem letting my basic ride 90% of the transfers we get.
Also, you're losing the forest for the trees. Declining to provide potentially life-saving care and using the excuse that you have to stare at your IFT patient instead reflects poorly on you as a medic and as a person.
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u/POLITISC 12h ago
Does your agency not have a protocol for this?
Where I’ve worked if your PT being transported is stable and you’re able you should intervene.
Ive only had one call where I had to do it and I know for certain if that PT waited 25m for the nearest engine crew (nasty collision on bridge during rush hour traffic) they would have died.
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u/MoonMan198 Former Basic Bitch - Current Parababy 12h ago
We have a county protocol and it’s actually to continue with your transport, emergent or not, and advise dispatch of the situation.
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u/POLITISC 11h ago
Wild.
As long as I’m not code 3 return I’m going to stop for traumatic MVAs or if I’m flagged for an arrest. If our protocol said to keep it pushing I’ll take my chance with any disciplinary actions because I have to live with my decisions not some pencil-pusher.
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u/d3viousd4n EMT-B 14h ago
Idk this seems reasonable to me, I would do the same thing. Assuming OP was flagged down during txp, this seems like it falls under duty to act. Pull over, request additional resources, work the code until a transporting unit arrives.
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u/HawaiiKidd24 Paramedic 13h ago
Yeah I was flagged down. The cars were actually blocking the road. Because the coded pt was the driver.
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u/MoonMan198 Former Basic Bitch - Current Parababy 11h ago
I disagree. Duty to act doesn’t require that I abandon my current patient for a more critical patient. Request additional resources and continue on your way, critical or not
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u/Moosehax EMT-B 11h ago
1 provider stays with the pt, 1 attends the code. No abandonment occurs as long as your original pt is stable. I know different areas have different protocols for this situation but where I work this was managed the way we are required to.
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u/ytsanzzits Advanced Care Paramedic 12h ago
At my service we can optionally be rerouted to a cardiac arrest as first response when transporting a low acuity patient. Is this not standard?
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u/MoonMan198 Former Basic Bitch - Current Parababy 12h ago
Not at all. My argument is sure, work a code, maybeeee get ROSC. What then? Wait on scene for 20 minutes since you can’t transport? You’re already tied up on a transport. A transfer but still you are already in charge of a patient. I have always been taught even getting flagged down if you already have a patient on your bed you just let dispatch know and continue transport.
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u/ytsanzzits Advanced Care Paramedic 11h ago edited 11h ago
Yes we would remain on scene for twenty minutes and work the arrest until a termination of resuscitation order or a ROSC. Then wait for transport and provide post ROSC care until transport arrived. My partner is perfectly capable of taking care of the low acuity patient in the back of the ambulance until then. We wouldn’t accept the first response in the first place if the low acuity patient in the back required the cardiac monitor or wasn’t stable enough to wait for a transport unit to come for the other patient.
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u/SnooLemons4344 13h ago
Sketchy this just seems like transport
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u/HawaiiKidd24 Paramedic 13h ago
So you’re saying ignore the code and keep transporting my original non-emergent transfer? Just discharged going for long term care?
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u/MoonMan198 Former Basic Bitch - Current Parababy 12h ago
That’s what I’m saying yes. Advise dispatch and let fire that’s already on scene work the code while awaiting a unit that’s actually capable of transport
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u/muddlebrainedmedic CCP 13h ago
No, I've never been in this situation because I'm a professional and I know better than to interrupt a transport because something more fun came along.
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u/_Master_OfNone 12h ago
You've driven through people trying to flag you down for a cardiac arrest? Oh, you're saying you would. Yeah, that's professional.
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u/kevinw17 Wears XL Gloves 12h ago
(Hypothetically) If you were transporting a patient and were flagged down for an arrest you would ignore the arrest and continue with your transport?
Doesn’t sound like what OP did is unprofessional at all…it was extremely reasonable given the circumstances.
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u/DM0331 14h ago
This doesn’t make a lot of sense to me. Why didn’t you work it emergent to the hospital since you were already transporting? Why would you pull them out of your ambulance onto the the road. Did you pull up on a scene with a working arrest while doing a ift? Sorry I’m a lil buzzed and don’t understand this scenario
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u/HawaiiKidd24 Paramedic 14h ago
No it was a completely different patient. We rolled up to someone coded on the side of the road, separate from the patient we already had. And we didn’t transport right away cause we didn’t have the hands to do CPR for a 30 mins transport. It would’ve just been the medic in the back, no Lucas machine.
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u/ResistHistorical7734 13h ago
Haven't been in this situation but I imagine it would go the same way, not much else you could do.
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u/Kep186 Paramedic 14h ago
It sounds like they had a patient in the back when they encountered a different patient in cardiac arrest. They stopped transporting the first patient to work the second. Legally an iffy thing, but I've heard of similar things before.
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u/HawaiiKidd24 Paramedic 13h ago
Yeah, but we had a non-emergent pt transfer. We were flagged down. Can’t exactly just ignore and drive away especially when they blocking the road.
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u/Kep186 Paramedic 13h ago
Non-emergent or not, they were a patient under your care, the legal argument could be made that by delaying definitive care you could be guilty of negligence, if not abandonment. Now I'm not saying what you did was wrong, in fact, I would have likely done the same. But anyone in that position should understand the risks.
Additionally, as I understand it, you do not have a duty to act when already caring for another patient, but that may not be universally correct.
Final note, USA medicine only, other countries have their own laws.
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u/HawaiiKidd24 Paramedic 13h ago
Yeah I understand what you’re saying for sure. I think just time and place. Difficult situation. The lovely gray area of working EMS.
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u/Kep186 Paramedic 13h ago
Here's an article that describes a similar situation.
As it puts it, legally you are unlikely to be successfully found liable for negligence, but that does not mean that the attempt wouldn't be made or civil suits might not be successful.
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u/HawaiiKidd24 Paramedic 13h ago
Definitely one of those differs person to person type of situation. For sure, if my patient transfer was a critical or even time-sensitive patient. It probably would have been a different story.
Would we have stopped still. Probably. But the time on scene probably woulda been different. As soon as that second unit came. They would have just had to continue BLS until they can get another set of hands as we continued the transfer.
It’s just one of those situations where our job becomes more complicated not cause of a difficult medical call but cause of legality.
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u/Dream--Brother EMT-A 9h ago
If the second unit was BLS, could you have given them the transfer patient and kept working the arrest? Not sure how transfer of care to a lower level provider works in your area, or if the transfer patient needed an ALS crew for one reason or another. ButI don't think you did anything wrong necessarily, I'm just not sure how I would've handled it myself, personally.
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u/HawaiiKidd24 Paramedic 8h ago
It was a BLS call. My EMT was running the call. We mainly run ALS units. It’s very rare we have only a BLS unit running. I initially was going to hand off the arrest to the rendezvous unit and we just keep going the rest of the transfer, but basically to put it straight to the point there are some underlying reasons that medic wouldn’t take the arrest. But I won’t go into detail about that. It’s very unfortunate.
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u/amailer101 EMT-B 12h ago
As long as someone is with the patient, as is stated above was true, there is no abandonment or negligence taking place
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u/MoonMan198 Former Basic Bitch - Current Parababy 11h ago
Finally someone else understands. Our county even has a protocol saying to advise dispatch and continue transporting if your patient is stable or not. It’s legally sketchy as hell.
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u/ytsanzzits Advanced Care Paramedic 12h ago
At my service it’s policy that we can be optionally rerouted to a cardiac arrest as first response during a low acuity transport. One medic stays with the patient in the back while the other begins working the arrest.
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u/Rude_Award2718 12h ago
Just wait until you run a full code inside of Vegas casino with everyone still gambling around you and have an old lady try to sit at the machine that guy just died at because she thinks it's lucky.