Question: I have a few questions about some of the omissions from these protocols that were in the old protocols. The first one is in the event chest pain resolves and re-occurs it is treated as a new episode and nitro protocol repeated. This isn't stated in the new protocol so if this were to occur can we repeat although it isn't stated? The other question is regarding the medical arrest protocol. No provision is made in regards to on scene ROSC and re-arresting patient in ambulance. The old protocol says we can pull over and analyze once then continue to receiving facility. With nothing in the new protocol do we follow the same format? Thank you.

 Thanks for your question. You are absolutely correct, the current set of directives does not define what to do if chest pain resolves and then recurs. You are also correct that the "old" directives did define that each episode can be treated as a new episode and the nitroglycerin may be repeated (but not the ASA) as long as the other criteria are still met. Until such time as the "new" directives are revised, the SWORBHP Medical Council would recommend that paramedics should proceed as before and treat recurrent ischemic chest pain with nitroglycerin as indicated by the directive.

As for part two of your question, this question has already been asked and the answer posted. It can be found here: http://www.sworbhp.com/askmac/searchengine/med_cardiac_arrest.html

You are correct again. How paramedics should treat a "re-arrest" with a patient who has achieved ROSC on scene and now during the transport phase has re-arrested is not explicitly defined by the current set of directives. This has been addressed with the other BH in Ontario and is on the list of suggested edits.

Until such time as a new uniform approach is adopted by the Ontario MAC (not just the SWORBHP), the SWORBHP Medical Council has decided that paramedics should return to the previous practice which has been: Follow appropriate scene protocol for specific cardiac arrest situation. ROSC? Transport. Re-arrest? Pull over andone analysis then transport with no further stops regardless of shock or no shock. This avoids the endless possible permutations of shocking repeatedly a patient en route to the hospital and also the multiple pull overs that were an issue in the past.

Cardiac Ischemia,Cardiac/Circulation,Return of Spontaneous Circulation (ROSC)

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