Question: What is the rationale behind no longer doing a 45 second pulse check on a severely hypothermic patient? BLS patient care standards in section 4-11 assessments #3 states a 45 second pulse and breathing check.

I understand that ALS standards trump BLS standards. Other than a summary that came from RPPEO August 2011 on the new November Directives where it stated no more 45 second pulse checks, there is no mention in the new Directives of this change that I could find.

 Great question! Thanks for taking the time to review additional resources on this. This is not about ALS trumping the BLS. When the 2010 American Heart Association Guidelines came out, we performed an exhaustive review to see what needed to be changed not only in the Advanced Life Support Patient Care Standards but also in the Basic Life Support Patient Care Standards.

In the AHA Guidelines (Berg et al, Part 5: Adult Basic Life Support) it states: "In an unresponsive patient with hypothermia, assessments of breathing and pulse are particularly difficult because heart rate and breathing may be very slow, depending on the degree of hypothermia. If the victim is unresponsive with no normal rescue breathing, lay rescuers should begin chest compressions immediately. If the adult victim is unresponsive with no normal breathing (ie, only gasping) healthcare providers can check for a pulse, but should start CPR is a pulse is not definitely felt within 10 seconds."

This guideline resulted in the change you see in the Advanced Life Support Patient Care Standards for hypothermia. In February 2010 the recommendation was made to the Ministry of Health (MOH) from the Provincial Medical Advisory Committee (MAC) to amend the Basic Life Support Patient Care Standards to reflect this (and a host of other changes). As of today, we are awaiting these changes to be included in an upcoming revised new edition of the BLS Manual from MOH. That is why as of today, the ALS and the BLS standards seem to conflict.

A link to the above AHA Guidelines can be found here: http://circ.ahajournals.org/content/122/18_suppl_3/S685.full

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