Date Published

September 13, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


There has been a lot of debate in regard to the new medical cardiac arrest directive, especially when it comes to pediatric patients (1 day to less than 8 years old). Based on my understanding of the new directive, patients 24 hours old now fall under medical cardiac arrest which states that scene time is now 20 minutes unless you have a reversible cause or 3 consecutive shocks, since TOR would not apply here. Some paramedics express significant discomfort staying on scene for that long if the patient has been stabilized with good airway, quality compressions, and possibly defibrillation. Do you support paramedics leaving early in this setting where everything is done early or do you encourage us to stay on scene for 20 minutes? Does this benefit the patient when they could be receiving life saving drugs in a hospital, also knowing that we will eventually have to transport to a hospital no matter what?


There has been a lot of discussion provincially with regards to the updated Medical Cardiac Arrest Medical Directive. The latest direction is now for patients who do not fit into the Medical TOR (including any patient with a medical cardiac arrest <16 years old) to complete a minimum of four analyses prior to transport. However, the directive allows up to 20 minutes of on-scene resuscitation. Many factors will come into play when deciding upon the optimal time to transport to hospital, including ensuring that resuscitation has been initiated up to your standard prior to departing scene. For full details on this clarification in practice change, please see the memo sent out to all SWORBHP paramedics July 19, 2023 (here).



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