Date Published

February 4, 2020

Updated For

ALS PCS Version ALS PCS Version 5.2


For a VSA patient who is in refractory vfib after 3 analyses, can we call BHP for double sequential defibrillation if we have a second PCP unit?


This method of treatment, although promising, is neither well-studied nor endorsed by the American Heart Association (AHA), and is a less common practice in management of Refractory VFib. It is currently being studied in some Ontario sites. However, at this time is not supported by the literature and there are potential risks including the possibility of harm to the patient and equipment without appropriate training. Until there is sufficient evidence and training provided to our paramedics, SWORBHP has asked most BHPs NOT to grant an order for, nor request Double Sequential Defibrillation. There are some areas where paramedics have received the training to assist with refractory VFib in the ED utilizing the second defibrillator, operationally have two defibrillators present on scene, and have had successful outcomes. In these exceptional circumstances where both BHP and paramedics have operational training this intervention is allowable under direct online control. Research is continuing on this issue, and will continue to guide future prehospital practice.

Daya MR et al. Out-of-hospital cardiac arrest survival improving over time: results from the Resuscitation Outcomes Consoritum (ROC). Resuscitation. 2015 Jun; 91:108-115.

Hamilton R, Ramzy M. Dual defibrillation is highly variable: an analysis of pulse interval delivered in dual defibrillation. Prehospital Emergency Care. 2019 Jun 14:1-6.

Hajjar K et al. Dual defibrillation in patients with refractory ventricular defibrillation. Am J Emerg Med. 2018. 36:1474-1479.

Ramzy, M. Dual external defibrillation: Close but not touching. July 3, 2019. Accessed via Nov 11, 2019



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