For ALS-PCS 5.0: If a patient re-arrested prior to extrication, do we carry out another 20 minutes of resuscitation or do we go after first analysis?
If ROSC was not witnessed in front of you (i.e., you were called for a VSA but arrive to a patient that is alive) then you will treat the arrest as a 1st arrest and follow through the entire medical cardiac arrest algorithm. Especially important here is to consider your reversible causes. If the ROSC was witnessed by paramedics prior to extrication, there is not the requirement to provide 20 minutes of resuscitation on scene and the patient should be transported. There is an ask MAC regarding extrication/ROSC from 2021-September-17. If extrication is truly an issue after 20 minutes of resuscitation, the BHP could be consulted for direction (direction may differ if the patient needs to be freed from under a structure -vs- if they are being fully resuscitated, but cannot get the patient out the door due to obesity)
Bottom line, all of your resuscitation and analysis do not count as extras if you are delayed for extrication reasons or delays on scene issues, you can keep analyzing until you are able to leave. Essentially the ROSC and re-arrest on scene do not count as you have not left scene. You would also still be allowed to pull over ( again on route if there is another ROSC and rearrest to perform a rhythm analysis devoid of potential artifact.