I was just wondering if SWORBHP is still maintaining the same stance for pediatric medical cardiac arrest (as discussed in the May 2022 Tip of the Week and other posts) for the new medical cardiac arrest directive in ALS PCS version 5.0? Is paramedic judgement still recommended for rhythms not amendable by defibrillation or is it expected that we run the cardiac arrest on scene for the full 20 minutes? I understand the research is trending towards scene times longer than 10 minutes for pediatrics (in some studies) and that earlier epinephrine administration has been associated with ROSC but this also leaves PCP only rural services in a very difficult grey zone to be addressed. I am by no means advocating for a "scoop and run" mentality (the new wording in the directive rules that out quite nicely) but any further guidance or clarification is greatly appreciated!
Thanks for the thoughtful question. Our messaging on pediatric cardiac arrests is prescriptive only when there is a refractory shockable rhythm. In these circumstances, as is written into the new ALS-PCS 5.0, you should stay on scene for 3 shocks, then initiate transport.
For non-shockable rhythms, SWORBHP Medical Council is less prescriptive. Similar to our messaging from our Ask MAC 30-Mar-2022, SWORBHP Medical Council knows that every situation is unique and that optimal resuscitation varies based on location of call, suspected underlying cause of arrest, on-scene capabilities etc. If resuscitation is not up to your standard on scene, then SWORBHP Medical Council would support leaving early, rather than staying for 20 minutes on-scene. However, as you allude to the scoop-and-run approach has proven worse outcomes. In many situations, you have the skill needed to help save a life on-scene.
Please see the SWORBHP podcast (here) on pediatric cardiac arrest and evidence-based principles here for a deeper dive into the evidence.