After reviewing the Vector change defib video on the paramedic portal,  the video shows when switching to AP position (after the initial 3 AL shocks), "3 more remaining shocks in AP".  However, in the protocol it states there are no max number of doses.   
 
My question is, do we only do 3 analyze/shocks in AP position, OR , continue analyze/shocks in AP position , every 2 minutes, until the 20 minute scene time is complete? 

In a patient in refractory pVT/VF you would complete 6 defibrillation attempts prior to initiating transport.   

The reason the Medical Cardiac Arrest Medical Directive does not list a maximum number of doses for defibrillation is that there are instances outside of the 6 consecutive defibrillation attempts, that defibrillation would be indicated. 

For example: If a patient is in refractory VFib and you deliver 6 shocks, but is still in the process of extrication after a further 2 minutes, prior to transport: You could deliver another (7th) shock. In this same scenario, if you are a manual interpretation service, and are transporting a patient in refractory pVT/VF, you could continue to defibrillate during transport (please see the memo from Aug 29, 2025 titled, “Rhythm Interpretation While En Route”). 

Another example where more defibrillation may be given outside of the 6 consecutive defibrillation attempts, is when a patient falls out and back into a shockable rhythm. Note that once a patient has either obtained ROSC or has converted into a non-shockable rhythm (and therefore does not meet the Conditions for Medical TOR), that transport should be initiated. 

Due to these instances in which case it is possible more than 6 defibrillations will be administered, there is no maximum number of defibrillations in the Medical Cardiac Arrest Medical Directive. 

Cardiac/Circulation,Medical Cardiac Arrest

Cardiac Arrest, defibrillation, Maximum Dose, pulseless VT, pVT, Refractory rhythm, VF, VFib

SWORBHP-MEMO-Rhythm-Interpretation-While-En-Route-20250829.pdf