Question: After consistent review of the new ALS, I just came across something that I am hoping you may clarify for me. In regards to the Medical Cardiac Arrest directive, under the "clinical considerations," it states that under certain circumstances we transport after first rhythm analysis (and lists some examples). In the old ALS, one of these examples was "pediatrics" but now i notice that in the new ALS, also under clinical considerations, it mentions to plan for extrication and transport of pediatric cardiac arrest patients after 3 analyses. So, does this mean we do not transport after first rhythm analysis for pediatrics and must complete the full directive now?
The majority of peds cardiac arrest cases fall under reversible causes, so yes, go ahead and transport after one analysis (generally, these will present as Asystole or PEA). However, the directive allows for use of clinical judgment, case by case where you can stay on scene for peds VF/VT.
Very basically, the medical directive allows for transport after the 1st analysis (because most peds arrests are from reversible causes), OR stay on scene for 3 analyses (plus one immediately prior to transport) in cases of shockable rhythms.