Question: I have overheard a couple of crews recently discussing the ACP cardiac arrest protocol for when you arrive on-scene and a PCP has already initiated their protocol.

I've overheard that some crews use what the PCP crew has done (say two no shocks) and then just do two more and either call for pronouncement or transport. I also know other crews that will show up and do their entire three rounds of epi, etc. and then call/leave regardless of how many or what the first arriving PCP crew has done.

I know what I do but which one is actually correct because now I'm wondering if I'm doing the right method.

 No doubt, there is some ambiguity here that has led to variation in practice.

The OBHG Companion Document for the ALS PCS, Nov 2011 v3.0 from July 2013 pg 6 states: "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 TOR might apply, the Paramedics will complete 3 analyses themselves rather than "count" the number completed prior to their arrival." We have interpreted this to mean, in the setting where an ACP arrives on scene where a PCP crew has already initiated care there are essentially two scenarios:

1. PCP crew on phone with BHP requesting TOR - in this scenario, do nothing until the determination of TOR or no-TOR is made. If the decision is no-TOR then work in conjunction with the PCP crew and initiate any appropriate ACP skill sets.

2. PCP crew is in the middle of the medical cardiac arrest - as the ACP you are now the higher medical authority and therefore should take over the call and work in conjunction with the PCP crew adding your ACP skill set. If you are considering patching for a field pronouncement you may consider any previous interventions (shocks or no shocks) but must complete 3 epis (or 3 analyses if no IV/IO access) before patching.

This topic will be addressed during your 2014-2015 Recert. Until then, you are welcome to continue your practice without change.

Cardiac/Circulation,Medical Cardiac Arrest

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