If a patient is suffering a medical event in nature, and goes VSA (for the first time, NOT a re-arrest) en route to the hospital, do we pull over and run the arrest for 20 minutes, or would we use clinical consideration that egress has commenced, and do one analysis and continue transport (under the circumstance that pt at that time is in a non shockable rhythm)? 

New Protocol First Arrest On Route If my patient becomes VSA on route (first arrest) am I to complete the full 20 minutes of resuscitation roadside and then continue transport? Our previous protocol was to complete the full arrest protocol and continue transport. Should you be a short distance from the hospital would a BH patch be suggested or should we perform the 20 mins of resuscitation regardless of proximity to the hospital? Thank you. minutes? I understand the research is trending towards scene times longer than 10 minutes for pediatrics (in some studies) and that earlier epinephrine administration has been associated with ROSC but this also leaves PCP only rural services in a very difficult grey zone to be addressed. I am by no means advocating for a “scoop and run” mentality (the new wording in the directive rules that out quite nicely) but any further guidance or clarification is greatly appreciated!

With the new medical cardiac arrest directive I have multiple questions: 1. If a patient re-arrests after getting a ROSC do we a) start the 20mins over? B) analyze once and then carry on to hospital with no further analyzes, or c) complete the remainder of the initial 20mins of CPR? Also does this answer change if the ROSC is at the initial site or in the back of the ambulance? 2. If patient arrests for the 1st time in the back of the ambulance, do you stop for the whole 20mins of CPR, does location of arrest to hospital make a difference? 3. If you have a refractory v-fib and we start early transport to hospital, do we continue to pull over and shock every 2 mins or so we stop shocking while on route to hospital?