Question: There have been a few discussions flying around about a call where the patient had an internal defib whose activity was captured shocking the patient X 3 by the EMS defib. Of course, the whole discussion is treat vs. transport and shock once vs. follow the entire protocol. Can you provide some insight into these rare cases?
Great question. Occasionally paramedics may be in contact with a patient with an Implantable Cardioverter Defibrillator (ICD) who is conscious and alert however the ICD has discharged or continues to do so. In such cases, rapid transport is the key as long as the patient remains stable and/or has a return of spontaneous circulation following the shocks.
If a patient with an ICD presents in cardiac arrest and the rhythm is ventricular fibrillation (VF), then clearly the ICD is not functioning properly in failing to concert the VF into a perfusing rhythm.
Paramedics when confronted with a patient with an ICD who is in full cardiac arrest should follow their Medical Cardiac Arrest Medical Directive.
The Advanced Life Support Patient Care Standards (the medical directives) apply to patients with an ICD in the same way as patients who do not have an ICD.