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Bipap For Cc/fps


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#1 medic4cqb

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Posted 10 December 2016 - 08:14 PM

Wow... haven't been on here in quite some time, so hello FW 😃 My question (not really a poll), is whether or not you believe that cc/medics are capable of managing patients on bipap, barring their transport vent has the capability to operate in that setting?
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Steve A., RN, CCRN, EMT-P

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#2 mg/kg

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Posted 13 December 2016 - 02:23 AM

I don't see why not? This boils down to education and training done by the service they work for. Hypothetically, if they are not capable of managing these pts in transport then who should be managing these transports and what would make the personnel selected for said transport capable? Additionally, if they are not by your standard capable, how can one go about making them so? I am also curious to hear others perspectives on this question. 

 

 

Simply seeking to understand.

 

Mike


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#3 medic4cqb

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Posted 13 December 2016 - 03:52 AM

I don't see why not? This boils down to education and training done by the service they work for. Hypothetically, if they are not capable of managing these pts in transport then who should be managing these transports and what would make the personnel selected for said transport capable? Additionally, if they are not by your standard capable, how can one go about making them so? I am also curious to hear others perspectives on this question. 
 
 
Simply seeking to understand.
 
Mike


Mike,

I agree, it comes down to training... Although I've never taken one, most CCEMTP courses cover different modes of ventilation and management. Knowing this, it's up to the particular program to provide and tailor training to their personnel, if they are going to transport said patient population. I don't see why a cc medic can't perform a bipap patient transport in a mixed cc team configuration.
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#4 mg/kg

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Posted 13 December 2016 - 04:11 AM

     I have not taken a CCEMTP course either. All of my CCT training has been either OJT or self study. I am not sure where you are located, but are paramedics (CCT or ALS) allowed to transport pts on BiPAP? I have worked in a few places where it had to specifically be a CCT transport team/flight team, RN, or the pt had to be switched to CPAP so an ALS unit could transport the pt.

 

 

Mike


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#5 ForeverLearning

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Posted 13 December 2016 - 10:44 PM

I didn't see any reason why they would not be capable. Many 911 ALS services initiate NPPV in the field with standing orders. Why would CC Medics have an issue transporting someone on NPPV (Bipap or Cpap)? 


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#6 medic4cqb

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Posted 14 December 2016 - 11:06 PM

Mike,

Medics in this area initial & transport cpap routinely, however bipap patients are accompanied by an RT. This is both ALS & CC medics. We have the option of 1- switching to cpap, if the patient tolerates, 2- go ahead and take a nurse or RT, 3- use NRB if they tolerate or 4- intubate. I don't see why, if we have a vent capable of performing bipap and a competent crew...why not allow us to do, after adequate training?

FL,

Hemodynamics could be in question during these transports, especially for a medic who doesn't understand the effects of bipap. These patients do have potential to crump, especially if they're chronic with multiple co-morbidities. But again, this is nothing training can't fix.
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Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#7 ForeverLearning

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Posted 15 December 2016 - 12:22 AM

If the sending facility initiated NPPV (either they are trying to avoid intubation and trial on NPPV with physician present during the trial, or patient is DNR/DNI, or patient is good candidate for NPPV that is follows commands and intact gag and airway.) 

 

Hemodynamics would be addressed in the sending facility pre departure, in addition you can have pressors etc on standby on the pump. Or if too unstable hemodynamics to begin then intubate pre departure. 

 

If one is diligent on scene to do a through assessment and speak with sending physician about current condition and concerns and address before departure, there is usually rarely surprises. I am not saying things dont happen, but those are rare events if diligence is applied pre departure.  If you load and go then problems arise.

 

Per camts this is standard ALS transport

 

03.01.02 Advanced Life Support (ALS)
Preface – appropriate Authority Having Jurisdiction (AHJ) applies – also includes all aspects of BLS
 
1. Scope of Care – Capability to deliver pre-hospital advanced life support care
2. Clinical Crew
a. A minimum of two medical personnel who are licensed/certified according to state and/
or national requirements. The vehicle operator may be the second crew member for surface
ALS if he/she is at minimum an EMT and is EVOC-trained (or equivalent) and his/her
training is kept current.
b. One is a paramedic with National Registered Paramedic (NRP) or national equivalent
preferred
3. Medical Director
The medical director should be board-certified in emergency medicine, but if he or she is
not, it is strongly recommended that the medical director be board-certified in family medicine,
internal medicine, surgery, or pediatrics with demonstrated EMS education or 5 years
of experience in emergency medicine.
4. Equipment – includes all equipment in BLS plus:
a. Ventilation: Non-invasive ventilators (CPAP / Bilevel Positive Airway Pressure)
b. Cardiac monitoring (e.g., pacemaker/defibrillator)
c. Non-invasive monitoring (e.g., waveform capnography, pulse-oximetry)

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