C-Pap In Westchester?

[x635 4,066]

Just curious as to if any agencies in Westchester are using/considering using C-Pap???

I feel it's an extremly useful tool, coupled with Nitrates, in the treatment of CHF. Most often, it resolves the CHF episode and the patient is sent home 1-2 days afterwards. Many progressive agencies nationwide are begining to use this device, which is not a hard one to learn.

With CPAP, many agencies also take Morphine out of the protocol. It decreases preload, but it also can lead to repiratory depression which is leading those agenicies to pull it.

The only downside is it consumes a large amount of Oxygen. Your ambulance has to have dual mains to be the most prepared for it.

Why can't patients in the WC have the latest and best? Why must they settle for the current standard? Why can they travel 10 minutes from the WC and get more advanced ALS care?

[WAS967 97]

Because certain agencies have suck a** medical control doctors who live in the 19th century mentality. I would love to CPAP. I would love to see RSI. I would love to see us carry more Versed. Heck, I'd settle for an alternative airway. But as long as our pprotocols and procedures are limited by conservative medical direction, we don't stand a chance to be on the cutting edge of anything.

[WAS967 97]

Oh yeah. And cost. Most directors would balk at the startup cost of placing multiple CPAP units into service in thier system, and balk even more at the idea of having to retrofit ambulances with a second onboard. I would bet that you could get by with only one, but still, how much does each unit cost? Multiply that by an average of 4-5 medic units per agency, and your talking quite a bit of startup capitol.

[x635 4,066]

Oh yeah. And cost. Most directors would balk at the startup cost of placing multiple CPAP units into service in thier system, and balk even more at the idea of having to retrofit ambulances with a second onboard. I would bet that you could get by with only one, but still, how much does each unit cost? Multiply that by an average of 4-5 medic units per agency, and your talking quite a bit of startup capitol.

There is portable CPAP, but it sucks down 02.

As far as costs, just note what is spent for the startup (which is nothing compared to some of the BS that ALS services spend their money on) is really nothing, considering that CPAP, and this is proven by multiple studies, reduces hospital in-stay time significantly, which therefore reduces hospital expenses and costs to insurance companies, and also frees up beds. I think it is something like 5,500 for regular CHF admission, and $1,100 for a CPAP admission where the patient recieved CPAP and Nitrates.

[WAS967 97]

But can you bill for it? If you can convince the higher ups at certain agencies that you can recoup your costs by billing for use of the CPAP then you might stand a chance. But then you go back to our original problem, getting it past your medical director. (Good luck)

[x635 4,066]

But can you bill for it? If you can convince the higher ups at certain agencies that you can recoup your costs by billing for use of the CPAP then you might stand a chance. But then you go back to our original problem, getting it past your medical director. (Good luck)

I think sometime in the near future it can and will happen. C-PAP is a growing trend and I think it will be a standard at some point, at which time WREMSCO will pick it up.

[WAS967 97]

WREMSCO picked up RSI. You don't see that everywhere now do you?

[x635 4,066]

WREMSCO picked up RSI. You don't see that everywhere now do you?

A good amount of progressive systems have it. Unfortunetly, with RSI, it's very dangerous when placed in a weak system or with an inexperienced,overconfident, or just plain weak medic.

[Skooter92 7]

OK, let's get a couple of things on the record here..

1) WAS, he's overcautious and not the most progressive doc we know, I'll agree. BUT, we all practice under his license-a.k.a. the source of his livelihood-he has the RIGHT to be cautious. We ain't that busy, and we don't do that many tubes, so he's hesitant about RSI. If we could show we were more aggressive with our CME and continuing education to show skills reinforcement and knowledge retention.....but we suck in that area. Fix it, and maybe he'll go for it. Want to carry more Versed? Make a strong case, with proof, not anecdotal evidence.

2) CPAP units that are patient triggered, with lower oxygen consumption, are on the market. The cost has come down considerably to the point where entry-level units are actually, well, almost cheap. All well and good. BUT: my points are similar to my arguements above. Also, when it comes to cost-make an arguement there too. If it benefits the hospital, it might make sense in the long run to acquire CPAP. Will they pay for CPAP? Probably not. Will they support us in its use? Yes, as long as patient/cost benefits can be demonstrated. Again, factual not anecdotal.

[x635 4,066]

Several studies have been done proving the effective use of CPAP both in the pre-hospital and ER arenas. I have also witnessed its effectivness personally.

As Skooter said, we need to prove that we are "worthy". Unless systems get behind their medics, do QA/QI and educate (Mandatory CMES's/educational reimbursment) inservices, etc), then we're going nowhere. Let's not forget......behind every strong medic is a strong and progressive agency, strong educatiors, even stronger managers, and strong funding, and of course strong medical direction. Unfortunetly, in Westchester County, we don't have the support or funding we need to do studies or research,or provide more than basic education and equipment to EMS personel. We can't even communicate or have a working radio system to contact medical control when we need them.

I agree strongly with the RSI comments. You can easily kill a person with RSI, IF DONE WRONG or you are overconfident. Westchester County does not have the resources to support such a protocol, IMO. That's a whole seperate discussion.

[WAS967 97]

WAS, he's overcautious and not the most progressive doc we know, I'll agree.

Not entirely sure who you are referring to as I didn't mention names.....but heck, I definatly catch your drift. I would love to see a lot of things change at the various places I work. Now one place I work actually has a decent QA/QI process but I don't often see PCRs back from them except for the occasional one pulled at call audits (thankfully more good than bad lately). Ironically, I see more PCRs kicked back at the agency with seemingly NO QA/QI process. I would love to see us do CPAP and realistically, I can see that comming to our bags long before RSI. And I'd be more than willing to help gather the necessary "ammunition" to make a case for us carrying additional items (I could mention a few drugs that I think should be added to the forumlary). I fear however that all the proof in the world will not sway the beliefs of certain doctors.

As i mentioned to a crew member today, there are quite a few docs out there that just plain treat us like crap. Now I go into the ER everyday with a smile on my face and the best attitude possible. I've NEVER ripped int o a nurse or doctor for treating me less than I should be. Yet still it happens. I can say the situation has definatly improved over the years (and I can only hope that my positive demeanor has contributed). But there are still those docs out there that think we are just glorified ambulance drivers and would probably be HAPPY to see us bounced back to the days of loading patients and running. I could definatly mention names, but it would be inappropriate and unprofessional. I can only HOPE that one day we can sway these negative minds to see that we DO make a difference, and that we DO save lives. YES, there ARE the doctors that see what we do and realize that we are good people and we try our best. I just wish there were more of them.

[x635 4,066]

Take nasal narcan for example. An easy addition to our toolbox. Just add an MAD. What is the issue with that? Easy to administer, just like a nasal spray, and reduces risk for needlestick or bloodborne pathogen transmission.

[WAS967 97]

And narcan isn't the only drug in our regimen that can be used with the MAD.....I

I just had a funny thought.....imagining a new medic trying to go intranasal with D50.....ah man...that just made my weekend......