With the new medical cardiac arrest directive I have multiple questions: 1. If a patient re-arrests after getting a ROSC do we a) start the 20mins over? B) analyze once and then carry on to hospital with no further analyzes, or c) complete the remainder of the initial 20mins of CPR? Also does this answer change if the ROSC is at the initial site or in the back of the ambulance? 2. If patient arrests for the 1st time in the back of the ambulance, do you stop for the whole 20mins of CPR, does location of arrest to hospital make a difference? 3. If you have a refractory v-fib and we start early transport to hospital, do we continue to pull over and shock every 2 mins or so we stop shocking while on route to hospital?
Thank you for the questions.
1. If the patient re-arrests after ROSC, you should complete one analysis and continue on. Full details are available under the Re-arrest section of the Medical Cardiac Arrest Medical Directive within the OBHG Companion Document (most recent version 5.1).
2. This direction has quite recently changed. For patients who arrest for the first time enroute (not a ROSC who re-arrests), the direction has changed from previous iterations of the ALS PCS, wherein the direction had been to complete your full resuscitation. The direction is now to find a safe place to stop the ambulance and perform minimum 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). The OBHG Companion Document v5.1 aligns with this direction.
3. No, if you have a patient in refractory VF or pulseless VT, you do not stop en-route to hospital to shock.