Date Published

December 22, 2017

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: I was looking through Ask MAC and there are a few questions pertaining to cardiac arrest and shocks or no shocks of other responders. Are Paramedics are to include shocks delivered by the Fire Department prior to arrival in their treatment of a VSA patient?

My understanding from teachings in 2014/2015 is that if Fire delivered shocks we could count what they did. If they did not, we did not count their no shocks and conducted our own working towards the medical TOR which is also covered in the Summary of Changes document.

The question on ASK MAC seems to say if we trust the responders we can count everything I was hoping for a clarification that can be searched when the question comes up again.


Thank you for raising the important and sometimes confusing issue.   Also thank you for looking through ASKMAC for what answers had already been provided.

In summary: If a first responder does not deliver any defibrillations, the paramedics are to complete their medical cardiac arrest directive in its entirety.  If a first responder has delivered a defibrillation, the paramedics count the number of analysis/defibrillations completed as part of the medical directive and continue within the medical directive from that point.

To elaborate: This information was covered during the 2016-2017 Mandatory CME, but a refresher is a great idea. As stated in the Companion Document, as a general rule, Paramedics do NOT count pre-arrival interventions into their patient care. Care delivered prior to arrival can be considered and documented. However, in the setting of cardiac arrest where a medical termination of resuscitation (TOR) might apply, the Paramedics will complete three (3) rhythm interpretations/analyses themselves rather than count the number completed prior to their arrival.

A first responder is defined as any responder to a victim of out of hospital cardiac arrest who arrives ahead of paramedics and performs CPR and rhythm analyses using an AED in an organized and appropriate AHA-HSFO Guideline compliant fashion such that, upon arrival of paramedics, the paramedic is readily able to determine the number of analyses completed and the current sequence to follow.

SWORBHP Medical Council believes that ANY defibrillation delivered to a patient during a cardiac arrest resuscitation should be counted and considered as a contraindication to the application of the TOR.

If a defibrillation has been delivered to a patient by first responders, the TOR rule would not be considered.  Any analyses (NSI and shock delivered analyses) may be counted or considered into the total number of analyses performed by paramedics upon their arrival and transport initiated/patch performed as per the Advanced Life Support Patient Care Standards Medical Cardiac Arrest Medical Directive. In essence, the care provided by the first responder should be considered as part of the number of analysis/defibrillation allowed within the cardiac arrest medical directive.

If no defibrillations/shocks were delivered ahead of paramedic arrival, paramedics must continue to obtain 3 additional analyses themselves resulting in No defibrillation/No Shock Advised (NSI) prior to patching to the BHP for consideration of Termination of Resuscitation (TOR)/pronouncement regardless of the number of NSI analyses obtained by first responders. Hence, the care provided by the first responder should not be considered as part of the number of analysis/defibrillation allowed within the cardiac arrest medical directive.



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