When the emergency medical technician says “clear” who is he talking to and what does he want them to do?
Is it a statment of status of something or a request for some action to be taken?
I don’t have any real life experience but I believe he/she is addressing the other medical personnel nearby, warning them that a powerful electrical shock is about to be administered. If they are in contact with the patient they could get a dose of “heart-starter” themselves, which is generally NOT a good thing if your heart is ticking over already.
“I’ll tell him but I don’t think he’ll be very keen. He’s already got one, you see!”
The EMT or whoever it is is getting ready to administer a large shock to the patient in the hopes that the electrical charge will stimulate and re-fire the electrical currents in the heart that make the heart beat.
Everyone who is touching the patient, the metal rails or bed gets to share the same electrial shock so “Clear” means everyone stand back. And they usually are happy to do so.
Are you driving with your eyes open or are you using The Force? - A. Foley
All of the above is true. In addition, the EMT will say clear so that the defibrilator, the “heart-starting” machine he uses can interpret the rythym of the heart without the assistance of CPR, which can obviously make it seem like the heart it beating on the monitor when it’s really not.
For all the times I actually said clear as an EMT, it never seemed as cool as on TV, and the body never jumped 3 feet like it does on TV.
When I was in school for EMS, we had a student who wasn’t as careful as he should have been during a defibrilation. He got his hands away when the doc called “clear” but didn’t noticed that he was in contact with a lowered gurney railing. It arced through his zipper. By his own admission, he bounced off the wall behind him and whizzed his pants. By the way, it isn’t really done the way you see it on TV. You call clear 3 times and check for anyone in contact at each call before you discharge the paddles. I’ve heard stories about people getting nailed through their stethescope but have no personal experience with this. Anybody else?
-LabRat
A lovely little thinker but a bugger when he’s pissed.
The only time I saw someone share a defibrillation with a patient was when a medical resident (not the sharpest knife in the drawer) forgot to clear before he discharged. Our charge nurse got an unpleasant surprise and that resident was darn lucky she didn’t kill him with her bare hands. She probably would have, if she hadn’t needed to go lie down.
Nobody asked, but…
Pilots will shout “Clear!” before starting the engine on an aircraft. The intent is to let people know that you don’t want them walking into your expensive propeller or rotor.
“I must leave this planet, if only for an hour.” – Antoine de St. Exupéry
Are you a turtle?
One time we responded to a code blue in a patients room. A respiratory therapist had just intubated the patient and was bagging the lady and checking for breath sounds. A newby nurse was manning the defibrillator and didn’t shout out “clear”. The guy got zapped with 300 joules. Luck was not on his side. The timing was just right, and the shock stopped his heart. He had to be defibrillated. His resusitation was successful, however, the patient died. I remember nothing was ever said in the patients record about the incident. That’s one of the reasons I got out of health care.
I agree here. I'm just a driver ( can't take my EMT, I freelance...sadly). I've done a few DeFib calls, and the EMT takes great pains to make sure we are all clear. However, Dream- "Clear" in our corps doesn;t mean stop CPR- the EMT ( or Paramedic ) will verbally command that CPR be halted FIRST, then do a full check for heartbeat....THEN DeFib someone. After all, god forbid that last round of CPR brought them back...and then...you don't check..and defib someone with a pulse. It happens.
It is a terrifying ride. My face is 12" from the person's and I'm bagging for all I'm worth.... I've strained tendons on more than one call, bagging agressively. I've got one CPR save to my name, by dumb luck. We got her back to full sinus by the time the Paramedics got there. Could have gone 15 years and not had one save. But, we've lost a lot- normal, I think. It's actually fairly rare to get a save off of manual CPR. I don't know the stats on saves using DeFib. It's a no-lose situation; that person is dead already when you place your hands on their body. If you are very lucky.....you take them back. Quite incredible, really.
Cartooniverse
If you want to kiss the sky, you’d better learn how to kneel.
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No question, 300 joules will make you forget the order of the presidents real fast!
As an aside, when we do ‘elective’ cardioversions (to shock the heart out of atrial fibrillation) we use oddly small amounts of juice; 10-100 joules. Want to zap the atrium and leave the ventricles out of the picture.
We used to take bets on how low we could go based on waveform, pt. weight, and, I guess, sunspots. I wan a lot of Cokes.
Also, never heard any dramatic music when the paddles were applied. Damn.
You can buy a personal DeFib machine today, costs about $2k. Imagine that in the hands of ordinary folks. whoa.
Two additional responses here. No, I’ve never seen ANYONE’s body “jump” like it does on the Tee Vee when they are shocked. Artistic license. It does get that twitch, though.
The other thought is this. I don’t know about the level of quality of the 2K defibs. You want them to be AED’s- Automatic Electric DeFibrillators…airlines are teaching flight attendants the "D"class. Brilliant idea, I say. Trapped in an airplane is one of the few modern places where you simply CAN NOT get a Paramedic in your face in a relatively quick amount of time. And remember, those who are intrigued- bad CPR is almost always better than NO CPR. Take a locally given class in CPR, and spend the $ 3.95 on a keyring CPR protective mask…and be prepared ! Never know- you might change someone’s life.
If you want to kiss the sky, you’d better learn how to kneel.
2K defibs are not too bad – Many ambulance services that do not have paramedics (atleast in NM) use these as their first line of response to a heart attack. These defibs are, as previously stated, semi, or even fully, automatic. The machine will aduibally walk you though the entire process once you place the pads (they have pictures and are color coded) and turn the unit on.
“analyzing the patient, do not touch the patient”
“Shock advised, do not touch the patient”
at this point the machine either shocks, or a light flashes and you have to push it
“analyzing the patient, do not touch the patient”
At this point if a shock is advised, the process continues, up to a 3rd shock, if not…
“Shock not advised. It is safe to touch the patient. Check airway, check breathing, check pulse. If needed bgin CPR”
After a minute the whole process begins again.
They dont jump when shocked, not at all. The little jumping that can be noted on the ECG when you are touching the patient is called artifact. A pure CPR save is pretty much unheard up. CPR is ment to buy time for the Defib. You start at about a 100% chance of survival if you code right in front of me and I have the unit. %'s go down 10% a minute with CPR in progress, and even faster w/o the CPR.
…for more silky smooth segues, write to “silky smooth segues” 610 n 10th street, Albuquerque NM 87109.
When I used to be on a volunteer aid crew in my seaside home town, we used to have quite a few CPR cases on the beach. While the paramedics would usually work on the patient pretty much where he lay, we had to get them on the gurney if they were on wet sand. No one was really sure if there was much danger, but no one wanted to find out if the charge would conduct through the sand into the knees of all the people around the stricken clamdigger.
“If you prick me, do I not…leak?” --Lt. Commander Data
Why does this myth persist? Defib’s don’t start the heart - they obliterate all the spurious electrical chaos, hopefully allowing the sinus stimulus to generate a rhythm. Failing that, hopefully another part of the myocardium will have enough automaticity to take up the role of pacemaker, which can then be supported with oxygenation and stimulant drugs such as adrenaline and atropine.
There! I feel so much better now…
On the subject of AED’s, In South Australia we use the LifePak 12 and the Laerdal HeartStart 3000, both of qwhich have proven to be more than adequate for our needs.
Knock softly but firmly, 'cause I like soft firm knockers…
Well, I have to suck it up here. WE also use AED’s ( Automatic Electronic DeFibrillators) in our corps. Since I’ve not been trained in their use, I wasn’t sure. The biggest failing seems to be that the batteries are forever trickling, and so don’t do so well when left on and NOT charging-i.e., on a call !!!
I have to look and see if they are NiMH or LithIo. God help us if they are NiCd…
Cartooniverse
If you want to kiss the sky, you’d better learn how to kneel.
A quibble here. Other places you cannot get the EMT’s/Paramedics to you quickly are in many outdoors and rural areas.
One of the best things I have done is taken a course in Wilderness First Aid. Wilderness is defined as any area where you are more than one hour from definative medical care (i.e. the EMT’s/Paramedics). If you think about it, hiking 20 minutes in on a trail could fit this definition if getting medical care required a companion to hike out 20 minutes, 20 minutes for the medics to get to the trailhead, and another 20 minutes for them to hike in.
In any event, I would urge anyone involved in outdoor activities to obtain wilderness medical training.
Cartoon,
I hope that soon you will join the ranks of the EMTs, although my license is about to expire. I must say that for all my codes (50+), I’ve had one semi-save. The person is probably a vegetable by now. For all the people who don’t know, unless you’ve got a Medic right there when you croak, things do not look good for you.
My services AED is a Heartstart 3000 – I’ve never had the battery croak on me, but then again we carry 2 extras for a reasion too…
…for more silky smooth segues, write to “silky smooth segues” 610 n 10th street, Albuquerque NM 87109.