Date of Issue: 07/01/2019 - Indian Mills Vol. Fire Co.



SUBJECT:Cardiac ArrestPURPOSE:To provide uniform and systematic patient care to a patient experiencing cardiac arrestSCOPE: This Operating Guideline shall be applicable to all personnel operating as an agent of the Shamong EMS and to all agents of a department that receive Medical Direction through the Virtua Health MORE Program.RESPONSIBILITY:All Department Officers will ensure overall compliance with this operating guideline. Procedure:Ensure patient does not have a pulse, is in cardiac arrest, and potential a viable candidate for resuscitation. CPR will be performed based off of current American Heart Association (AHA) guidelines. Use of a metronome and/or feedback device is always recommended.Establish the following responsibilities:Position 1 (P1) – if possible positioned to patient’s right sideAssess responsiveness/plusesInitiates manual chest compressions immediately (will alternate with Position 2).Assembles, applies and operates mechanical CPR device (if applicable)Position 2 (P2) – if possible positioned to patient’s left sideApplies AED/Defibrillator padsOperates AED after each 2 minute cycle of compressions if no ALS present.If AED allows for compressions during charging, ensures compressions are being performed during charging.Alternates chest compressions with P1 every 2 minute cycle.If after first rhythm check, a responder has not filled Position 3, P2 can establish passive ventilation (15lt/min O2 via NRB mask) on patient if it is will not interfere with chest compressions and AED usage. Position 3 (P3) – if possible positioned to the patient’s head and if availableThis position is only filled after P1 and P2 positions are filled.Assembles/checks and applies all equipment for airway and ventilations within their scope of practice. Opens/clears/maintain the airwayInserts Oral Pharyngeal Airway (OPA) – If trained to do soIf unable to insert OPA a Nasal Pharyngeal Airway may be placed. An option is to insert both an NPA and OPA to facilitate airway managementEnsures patient is ventilated by either active (use of a BVM) or passive ventilation (15lt/min O2 via NRB mask). If using a BVM PEEP valve should be attached and set to 10cmH20.Can alternates with P1 and P2.Position 4 (P4)Acts as team leaderKeeps time and record of interventions and CPRCan rotated into P1, P2 or P3 if needed. Patient movement: Crew and patient safety is paramount. If a safety issue is established or arises crew and if possible the patient, should move to a safe location immediately. Patient should not be moved until after the AED has analyzed a rhythm 5 times.Patient should not be moved after being defibrillated until a non-shockable rhythm is identified during a rhythm check.Mechanical CPR Integration (if applicable)Mechanical CPR should not start until after the fifth rhythm check. ALS Integration (if not initially present):Upon ALS arrival, report will be provided to ALS crew members interventions preformed and CPR preformed. ALS providers may take over as team leader.ALS will deem which interventions/treatment and when movement of patient is needed.Pearls:High quality compressions are being provided and are paramount in a successful resuscitation. If initially only two responders are on scene, priorities are usage of the AED and high-quality compressions. Limiting “off chest time” will increase patients chances of regaining pulses. The first ten minutes of resuscitation are the most vital to the success of the resuscitation efforts. Currently there is no data providing Mechanical CPR outcomes are higher than outcomes of High Quality Manual CPR. Airway management should not interrupt CPR or use of the AED. ................
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