I need some clarification on the updates to the trauma arrest algorithm. With a patient with penetrating trauma in asystole with LTH less than 30 minutes are we to transport to the lead trauma hospital as we do with PEA? Also, if the lead trauma hospital is greater than 30 minutes, I am assuming we transport to the closest ED with both asystole and PEA with penetrating trauma.

If a patient is VSA due to a trauma related mechanism, do you still trauma bypass to a LTH (lead trauma hospital).

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!

Should I ask for a DNR in every scenario where I may use what’s contraindicated? If I were to show up for an unconscious but not VSA female and her husband is on scene and doesn’t mention the DNR, should I assume they want treatment and continue with inserting an OPA and bagging if necessary or should I ask for a DNR before starting treatment? Would I get in trouble in this scenario if I treated this patient without the husband saying anything and then once we got to the hospital found out they had a DNR?

If our patient has been accepted for Bypass under STEMI protocol, and pt goes VSA on route, in the event of a ROSC do we continue to proceed to Cath lab or do we now reroute towards closest ED?

Question: For a pediatric VSA do you stay and run the full cardiac arrest, (4 analysis) or should you depart scene after the first analysis if they are in a non-shockable rhythm? PCP question.