Question: My question had to do with attending to a call where a patient is VSA and then throughout our medical directive the patient receives a ROSC and then a re-arrest. I know that in the old medical directive we would at this time do one further analysis and then transport the patient but in our current medical directives this is not mentioned. I would like to know if I should be attempting any analysis on a patient who re-arrests after receiving an initial ROSC with our current medical directive.
Great question! A similar question was posted on this site on Feb 15th. How paramedics should treat a "re-arrest" with a patient who has achieved ROSC on scene and now during the transport phase (or still on scene) has re-arrested is not explicitly defined by the current set of directives. This has been addressed with the other BH in Ontario and is on the list of suggested edits.
Until such time as a new uniform approach is adopted by the Ontario Base Hospital Medical Advisory Committee (OBHG-MAC, not just the SWORBHP), the SWORBHP Medical Council has decided that paramedics should return to the previous practice which has been: Follow appropriate scene protocol for specific cardiac arrest situation. ROSC? Transport. Re-arrest? Pull over and perform one analysis then transport with no further stops regardless of shock or no shock.
This avoids the endless possible permutations of shocking repeatedly a patient en route to the hospital and also the multiple pull overs that were an issue in the past.