New Protocol First Arrest On Route If my patient becomes VSA on route (first arrest) am I to complete the full 20 minutes of resuscitation roadside and then continue transport? Our previous protocol was to complete the full arrest protocol and continue transport. Should you be a short distance from the hospital would a BH patch be suggested or should we perform the 20 mins of resuscitation regardless of proximity to the hospital? Thank you. 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!
For patients who arrest for the first time enroute (not a ROSC who re-arrests), the direction is now to find a safe place to stop the ambulance and perform a minimum of one analysis. Utilize clinical judgement (which will entail multiple factors) to decide whether to stay and perform continued resuscitation or depart scene. For full details please see the communication sent out to SWORBHP paramedics on this topic June 22, 2023 (here).
Regarding when to stay and when to go in pediatric arrest (including first-time arrest enroute) SWORBHP Medical Council has not changed its recommendation from ALS-PCS 4.9. Please see the Ask MAC from 2022-Mar-30. Essentially the ALS PCS Cardiac Medical Arrest Medical Directive allows for some clinical judgement when it comes to managing pediatric cardiac arrests. SWORBHP Medical Council recommends scene management when it comes to rhythms that are amenable to defibrillation. In cases where defibrillation is not required (hypoxia, sepsis etc.) paramedics can consider early transport. This allows for paramedic flexibility in assessing each situation. We understand that there are many factors that impact the decision to transport or stay-and-play". Documentation of your decision-making process is valuable so we can better understand and support your thinking and care when we review these calls.