Question: As per the question posted Feb 5th, 2014, if the FD shocks a patient prior to our arrival, we may count that shock into our protocol assuming we deem their care to adhere to AHA guidelines. In that setting, do we dial up to our second shock dose, or start at our first shock dose and dial up appropriately after that?
Great question, as there are so many defibrillators now and different models it is hard to know which type the fire department is using, the specific model, and even how old and updated it is. The safest, and generic approach is to move forward with your full protocol, starting at the first shock dose, and keep going.
If you are very familiar with the fire defib unit, (you may work with them regularly, train with them, or teach them), and you are happy with the pad placement and care then absolutely dial up if you are sure patient needs the next dose level. Just document your actions and thinking, when dealing with unique situations as always, so we can follow your approach.