Whup Kits and Chihuahuas

Many of us in EMS love gadgets I remember when I started another EMT sold me a “whup kit,” which was a holster that attached to my belt to hold my tools. I didn’t get a big one, just a modest sized one. It held a pen light, trauma shears, bandage scissors, tweezers, and a window punch. I stopped wearing the whup kit after a month or so. I only ever used the pen light and the trauma shears on any kind of regular basis.

I also remember back then how much I liked c-spining people. There was a craft to it. We didn’t have head blocks then, so we rolled our own towel rolls. You folded a bath blanket into thirds length-wise, then rolled it tightly and taped it with adhesive tape to hold it firm. It was a skill to secure someone to a board. I never did it half-assed, at least not in those early years when we truly thought we were preventing people from paralysis.

There was a pleasure in using equipment, be it a spinal board and towel rolls or a window punch (which I did use once) that made me feel like a craftsman. How I used to enjoy opening my intubation kit, taking out the laryngoscope and clicking in blade after blade to make certain everything was working properly. I even remember briefly for a period entertaining buying my own intubation kit, much like a plumber or carpenter has his own set of tools.

I remember how much I used to like going to EMS Conferences and checking out all the new gizmos, and hoping that some would make their way to my ambulance. And some of the gizmos we have gotten over the years have been great AEDS, pulse oximeters, glucometers, capnography, EZ-IOs, CPAP, 12-leads, power stretchers, stair chairs with tracks, intranasal atomizers. Still many of the conference gizmos disappeared, or just haven’t proven their worth.

I remember I came back from one conference l was all fired up about the ResQPOD. I attended an educational session where the presenter made an outstanding case for it. He was an impressive speaker, and did not appear to have any agenda beyond improving patient care. Only later did I learn that all the studies he cited, including some he had co-authored, were also co-authored by the device’s inventor. In time, I learned that all the studies that the inventor had authored were positive, while most of the independent studies showed there were issues with the device. I felt a little burned by this because I had beaten the band for the device in presentations of my own, and once I realized and learned to examine the literature for myself, I felt like I had been played for a fool.

One day I learned that a large first responder service in our area was going to be using the ResQPOD. This it turned out was news to the service’s sponsor hospital, who put a quash to it. Nevertheless, bizarrely, a member of Parliament over in Great Britain made a speech to that distinguished body about how a city in Connecticut was using this exceptional device, in condemning a British medical director for removing the device from a local service in his district.

ResQPOD Goes to Parliment

The local fire department here, like many, had fallen prey to a vendor’s claims without having the ability to thoroughly understand the research. This is a problem many sponsor hospitals in our state have vendors sell the services on their products, and the services buy them, and then the local hospital says, I don’t think so.

At one of regional meetings, we used to have vendors come in and demonstrate the latest products. A salesman came in to talk about the ResQPOD. While I have been impressed by many of the vendors, this salesman was not good at his work. He lacked the medical knowledge to answer our committee’s questions, falling back on the superlatives in his sales literature. Although it is funny, I remember him at the time saying the ResQPOD was far better for the patient than epinephrine! Perhaps he was a seer. Maybe today, it can be argued, it harms fewer patients in cardiac arrest than epinephrine does.

I remember not long after the disastrous meeting, the salesman forwarded all members of the committee an article from USA Today, about a man who suffered cardiac arrest. The family Chihuahua started barking and alerted family members who quickly started CPR and called 911. The patient received defibrillation and CPR, including the ResQPOD.

Take Heart America

The article said the patient had a full recovery. The salesman’s note said:

see attached article that was published in the USA Today the other day. Just another source for validation. SAVE LIVES NOW!!!

Please let me know if we could set up a time to discuss this further

One of the doctors wrote back:

That was a very provocative article. The evidence was compelling. I think we should launch a campaign to have ever household buy a Chihuahua which clearly is a life saving device. I am not sure if it would be entered in to our database as witnessed arrests or not.

More on the ResQPOD in a minute.

The big device that has been sweeping the EMS World in recent years are the CPR machines. The theory behind these contraptions makes a lot of sense. Good CPR saves lives. Why not make a machine that can do perfect CPR? Yet the studies, and there have been quite a few now of fairly high repute that are not showing this theoretical advantage is bearing fruit. It seems the best that can be said is the machines are as good as human CPR so why have people do it when you can rely on a machine?

For excellent commentary on the recent study involving the LUCUS device, see the following posts by Rogue Medic and Brooks Walsh in Mill Hill Avenue Command, who are far better at analyzing these studies than I am.

Failure of LUCAS to Improve Outcomes in LINC Trial

We Had a LUCUS Save!” No, You Didn’t.

In our region, we addressed the machine issue a few years ago by saying services could only use them with their service’s sponsor hospital’s approval, and then only after comprehensive training to ensure there were no delays in applying them. Several hospitals found themselves in the position of being told by their services that they had already paid the $10,000 each or so for the machine, and so at least one hospital that was not going to approve them, gave reluctant approval.

The services all seem to love the machines. Their members boast of amazing pulses during CPR and an increase in ROSC, but we have seen no evidence of improved neurological outcomes. All the saves in the service I most directly oversee have come from witnessed arrests of people aged 40-69, in public, who get bystander CPR, and early defib, and not much if any epi before they come around. We have no saves we can attribute to the machine. And as far as prolonged CPR, we have a case of a man who got nearly 20 minutes of human CPR on scene before the ambulance could arrive and defibrillate him. He survived neurologically intact.

Some say, well, the machines are great for transportation. Responders are less likely to get hurt, You can do CPR while carrying someone down the stairs. All of which may be true and be a worthy use of the device. But, in our region, we now work nearly all cardiac arrests on scene. We have no cases at our hospital of patients whose arrest precipitated a 911 call, being revived in a moving ambulance, and later walking out with full neurological recovery.

We just approved our state going to Cardiocerebral Resuscitation, which emphasis continuous quality chest compressions. Included in that document is a reference to the CPR machines.

Delay application of mechanical device until 5th cycle of CPR unless it can be reliably applied in less than 10 seconds, without delay in compressions.

During the debate, Brooks Walsh spoke up, and started to question the utility of the machines at all. While I agreed with him (as I do on most issues), I spoke against deleting it because the document was a consensus document, and many of the players had already spent a great deal of money on the machines, which they use extensively in their systems, and were unlikely to approve their elimination. I just wanted to get the document done.

My personal belief is that while the machines may save some people, they likely kill as many through the delay in application. When we arrive, these patients in cardiac arrest are on the precipice of no return. They may not have 30 seconds or even 10 more seconds without perfusion to spare. I believe what we do in those first few minutes makes the difference, not the quality of the CPR as we bump down the road 30 minutes later bringing another dead body in to have the time called on it officially.

I would on another day bring the issue of the eliminating the machines back up for discussion, along with getting rid epinephrine in cardiac arrest, unless the literature changes to show clear benefit. I like to pick battles I think I can win, or if not win totally, get to a compromise position I wouldn’t have otherwise gotten to without first extending my argument.

The problem with the machines is that they are so expensive and so many services have already shelled out for them, it is hard to just say no. Despite the lack of evidence of benefit, their supporters persist. I was amused to hear that some have even linked the CPR machine with the ResQPOD and saying it is possibly the combination of devices that make the difference. Maybe it is. But I would like for once, to have it proved. I am all for quality research trials for these devices. But the selling and the buying should halt until their worth can be proved.

Perhaps we should add a Chihuahua?

And speaking of research, instead of seeing all the research center on these expensive devices, I’d like to see the research funding go to questions that likely matter more such as does epi hurt or help? But there is not as much money in epi as there is in CPR machines and ResQPODs.

6 Comments

  • Chihuahuas may save lives, but they DO NOT obey the command “Clear!” before you shock the patient. Trust me, I know this.

    Now, if we could just buy everybody a Chihuahua and name it Lucas… that’s so crazy, it just might work!

  • Rogue Medic says:

    We should not act as if the chihuahua is a bad idea.

    I am going to keep using chihuahuas until there is clear proof of harm – and not just a study from someome skeptical of chihiahuas, because we know they have an agenda.

    Chihuahuas seem to access energy fields around the patient that science just does not understand. “There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.” Shakespeare – because quoting a work of fiction proves that I am right.

    Bark if you believe in chihuahua power.

    /(sarcasm)

  • Greg Friese says:

    While we are investigating the efficacy of dogs using AEDs can we also take a look at the need for responders to be equipped with non-rebreather masks for delivering supplemental oxygen to cats and dogs. Of course saving the family pet from a burning home is wonderful, but the risk rarely outweighs the benefit.

    On a related note….I might officially name my next lab “Friese’s Geezer Squeezer” and then call him “Geeze” in the field.

  • Brandon O says:

    The only effective combination is the LUCAS, ResQPod, IV infliximab, on-scene ECMO, and a device to be named later.

    Plus quality CPR. Which is like saying weightloss pills are effective “when combined with diet and exercise.” Durrr.

  • Brooks Walsh says:

    Peter –
    What is it about the allure of the whup kit? I started my EMS career carrying everything short of a Batarang on my duty belt. I ended up with a pen in my pocket, and shears tucked in my belt. I would forget my ‘scope sometimes, but never my pen.

    Funny enough, as an attending EM physician, I also carry a Chihuahua in my white coat. True story.

  • Bob Sullivan says:

    For those who use the safer transport argument to justify the cost of a compression device, I would ask them to invest that money in designing safer ambulances for the 99% of our patients who have a pulse.

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Peter Canning

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  • Comments
    Don
    STEMI Call
    Thank you for a good honest post. I think those classic or "typical" presentations we learn in school are the exceptions really.
    2014-10-18 17:34:21
    Ezio
    STEMI Call
    Someone has rearranged the position of the leads for a quicker reading, personally I would use that format because I read the leads in groups (II III AvF, I AvL, AvR)
    2014-10-16 05:22:59
    medicscribe
    STEMI Call
    Hi Alex, feel free to use. Peter
    2014-10-16 00:02:25
    Alex
    STEMI Call
    Fantastic case for education. Would you mind if I shared with some colleagues at med school (will give credit of course)?
    2014-10-15 23:02:25
    medicscribe
    STEMI Call
    Great, thanks, Christopher. Mystery solved. Best, Peter
    2014-10-15 02:37:40

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