Question: In the situation of being an ACP making a rendezvous with a PCP crew to assist on a medical cardiac arrest patient that they already initiated transport with and did not arrest on route, would you suggest once we make patient contact to administer 3 EPI q4/lidocaine or amio/saline bolus (depending on rhythms), BHP patch and then continue transport or continue transport and administer epi q4 until transfer of core or ROSC? There seems to be different opinions about this in my service. I appreciate you taking the time to answer.
Thanks very much for this question about an often complex situation. We think when considering this issue, we have to support our policy that the ACP is the lead medical authority once entering the scene and needs freedom to assess the situation and work the problem. The very fact that the PCPs on the call have requested a rendezvous could speak to a situation for their patient in which they feel ACP assistance could be necessary, and this request is routinely operationally supported by their service. We know that in some cardiac arrest situations, the ACP scope of practice may be beneficial to patient outcome, therefore a rendezvous can appropriate in certain situations. Although we certainly support not delaying transport once in motion for an arrested patient, we wish not to be prescriptive to the responding ACP. Each situation could present different challenges and will require unique situational awareness. Certainly a patient with a very poor airway 18 minutes from the hospital may represent a different ACP/ PCP team plan than a patient 4 minutes from the hospital is being ventilated very well, with good CPR, but it could be argued both may benefit from interventions depending on arrest situations, rhythm, and clinical history. What we would like to see, is that when there is delay to transport that it be appropriately explained on the ACR, and that it is as brief as possible. Also, we would advise you to consider not pronouncing in a stationary vehicle in order to not tie up valuable clinical resources. In summary we wish to support the ACP/ PCPs clinical decisions in these situations as we see that they may be quite different and unique and wish not to curtail clinical freedom to intervene for patients, or continue transport depending upon the clinical circumstances.