Question: There was a question posted in January 2012 that asked if CO poisoning leading from VSA would be considered an unusual circumstance and whether performing one analysis and transporting would be acceptable. Medical Councils answer was that this would be analogous to an asphyxial cardiac arrest such as a drowning and hanging. In these cases, the SWORBHP Medical Directors have preferred that the Medical Cardiac Arrest Medical Directive be followed. This question was asked a long time ago, however, during one of my Base Hospital training sessions, I was told by an Educator that CO (it specifically said) does fall under an "unusual circumstance" and therefore you would transport after the first analysis leading to a NO SHOCK ADVISED. Can you clarify what should be done?
Thanks for the question. In this specific rare situation, our answer remains the same. Patients who have suffered a cardiac arrest from an asphyxial cause should have the Medical Cardiac Arrest Medical Directive applied and followed by paramedics.
While the list of unusual circumstances noted in the clinical considerations section of this medical directive is not all-inclusive, paramedics must use judgment as to what should be considered an unusual circumstance which results in a transport decision following the first rhythm analysis that does not result in a defibrillation being delivered. Patching to the BHP for direction remains an option as well for assistance with unusual circumstances given the unique aspects of every patient presentation.