Date Published

January 31, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: In our recert course, we were told that ACPs must patch to the BHP after the third analysis (during a medical arrest). Why do we have to patch so early? Shouldn't we patch after three rounds of epi?


 In the directive, it states that Patch to BHP following 3 rounds of epi (or after 3rd analysis if no IV/IO/ETT access). The Medical Directors of SWORBHP debated this specific point as to the ideal time for the BHP to be receiving patches during cardiac arrest. It was felt that given the length of time for a patch to be established with a BHP and then the time to review the case as to what has occurred on scene, it was felt that early patch initiation would be the preferred route to allow on-line direction from BHP to be of any value.

Potentially, with the time required to establish IV or IO (at least 5-7min on scene) then give three rounds of epi (another minimum 9 min) to then try to establish a patch and review the information (another 2-4min), any advice the BHP could provide (bicarb in a suspected TCA or suspected hyperkalemic arrest for example) would be quite late. Every arrest is different, but earlier patching with the BHP is the preference of the SWORBHP Medical Directors.



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