Date Published

September 13, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


Refractory V-fib for the new medical cardiac VSA directive. Are we to only get our three shocks and go. Or can we give an additional shock if time permits due to extrication or extenuating circumstances? Just looking for clarification.


The intent of the directive is to leave scene if the underlying ventricular arrhythmia is refractory to defibrillation (3 consecutive shocks). However, if extrication or extenuating circumstances take longer than the 2 minutes between analyses, further defibrillation can be administered, as appropriate for the underlying rhythm above the initial three shocks.



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