Date Published

September 13, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


If My patient goes VSA in the back of the truck (witnessed, first time VSA). We do not do 20 min CPR? Or we do 3 analysis and go after? And/or 1 analysis and go? Does the same apply witness VSA in the home? Do these require patch to leave early? There has been excessive talk over this and little clarification.


The direction regarding Medical Cardiac arrest that has occurred enroute, as well as direction regarding arrest management and when to depart scene has been updated recently. The inherent nature of the Medical Directive system is to continually seek optimized care for our patients. As such, the Medical Cardiac Arrest Medical Directive has had a few nuances added to it. Specifically, if the patient arrests for the first time enroute (not a ROSC who re-arrests), the direction has changed with the release of the latest OBHG Companion Document. The direction is now to find a safe place to stop the ambulance and perform minimum one analysis. Utilize clinical judgement (which will entail multiple factors) to decide whether to stay and perform continued resuscitation, or depart scene. For full details please see the communication sent out to SWORBHP paramedics on this topic June 22, 2023 (here).

For witnessed arrests on scene (for which the patient would then not qualify for a Medical TOR) the direction has also recently changed. Please see the memo from July 19, 2023 (here). Paramedic judgement should be used, balancing many different patient, environment and clinical factors to determine the optimal time to leave scene. Unless there is a suspected reversible cause as outlined by the Primary Considerations, or refractory VT/VF, a minimum of four analyses should be performed before departing scene. However, the directive allows for up to 20 minutes of on scene resuscitation should the paramedic deem this as the best course of treatment.



Keywords are not available for this question at this time.

Additional Resources

No additional resources are available for this SWORBHP Tip.