Question: When arriving at a scene that turns out to be a ROSC, say Fire applied two shocks and now patient is alert and oriented, and fire pads are not compatible. Do we apply monitor electrodes, defib pads or choose based on our gut of how unstable the patient looks and might re-arrest? Having chosen and justified on the remarks section, what would you like to read to feel we were justified?

 Great question. While the standard procedure is to apply monitor electrodes to a patient that is not VSA, and this would not be incorrect, given the relative frequency with which a patient who was recently VSA re-arrests, the preference of the SWORBHP Medical Directors would be to have you apply defib pads in this scenario. We realize that there is a cost issue with this, and this may be service dependent, however VSA patients are not that frequent overall compared to other types of calls so the cost should be minimal. Balancing this cost is the fact that timely defibrillation as you know is an essential component to survival. Having defib pads already applied in a high risk re-arrest situation would be prudent.

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