What is the correct course of action if a pt goes VSA while crew is on scene, (ex. 1st analyses reveals VF, pt shocked, then 2 more analyses 2 min apart- both PEA), then pt starts spontaneously breathing and has pulse (ROSC)...then rearrests 2 min later and is in VF so crew shocks...CPR continued as pt still pulseless. Keep in mind crew is still on scene waiting for fire to show up as crew needs help with extrication.. this situation has happened and 1 crew member had called BHP for direction as it's 'grey" area as normally you are transporting by then and would do 1 analysis following rearrest and shock if necessary and continue with transport/CPR.. BHP was not clear just kept saying "follow your protocol" when in fact the crew was but at that point was very "grey". Would we treat it as a whole new medical cardiac arrest protocol as its a re-arrest on scene until fire arrives? Or what would be the best course of action?

We are sorry to hear that the BHP in this circumstance was unable to provide more guidance in this grey area. Sometimes providing the potential options to the BHP may assist in some collaborative decision making. Given you were unable to extricate this patient until fire arrived, it would be prudent to continue providing resuscitative care especially since the patient is in a shockable rhythm and has sustained a previous ROSC secondary to your initial resuscitative care. As a PCP, this patient would not meet the TOR criteria and as such, you would transport the patient once extrication assistance has arrived. As an ACP in this case, please patch after your 3rd consecutive analysis (if unable to establish access) or 3rd epinephrine dose for further directions (order for transport, terminate, or continue on scene resuscitation).

In the setting of ROSC and re-arrest, SWORBHP MAC has previously recommended (see Ask MAC 22-Nov-2012 ) to perform one analysis then transport with no further stops to avoid the endless permutations of stopping and or shocking a patient repeatedly en-route to hospital.

Cardiac/Circulation,Medical Cardiac Arrest

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