- With regard to MEDICAL cardiac arrests, all providers must continue to obtain medical consultation prior to termination of resuscitation - even if there is no ROSC despite 15 minutes of EMS CPR and other appropriate treatments - regardless of the cardiac rhythm.
- This Baltimore County EMS specific directive is contrary to the bolded item highlighted in the new July 1, 2013 MIEMSS protocol update copied below.
- The new July 1, 2013 MIEMSS protocol allows the EMS provider to independently terminate resuscitation without consultation after 15 minutes of EMS CPR and treatment for patients that meet the three criteria of 1. arrest not witnessed by EMS provider; 2. non-shockable rhythm (AED) or manual monitor showing aystole or PEA; and 3. no ROSC despite 15 minutes of EMS CPR. In Baltimore County we will obtain medical consultation at 15 minutes (or sooner based on the clinical situation) for EVERY medical cardiac arrest where termination is being contemplated - regardless of cardiac rhythm.
- Medical consultation prior to termination of resuscitation will help ensure our providers have rendered all appropriate treatments and that the decision to terminate efforts is completely appropriate. In addition, medical consultation prior to termination of resuscitation in the presence of family members or bystanders often makes the act of stopping resuscitative efforts more acceptable to those parties as it shows we have done everything possible up to and including consultation with a base station physician.
- Termination of resuscitation during transportation of the patient should rarely and probably never occur. This can be prevented by resuscitating the medical arrest patient in the place they are found and obtaining medical consultation PRIOR to initiation of transportation.
- Baltimore County EMS providers are reminded that "medical consultation may be obtained at any time for any patient". When in doubt, consult.
Termination of Resuscitation
o Exclusions: Arrest secondary to hypothermia/submersion, pregnant patient, patient not reached 18th birthday
o Medical arrest:
• EMS providers can terminate without medical consult when all of the following criteria are met
• Arrest not witnessed by EMS provider
• Non-shockable rhythm (AED), or manual monitor with asystole or PEA
• No ROSC despite 15 minutes of EMS CPR and other appropriate treatment
• EMS providers can terminate with medical consult if no ROSC despite 15 minutes of EMS CPR and other appropriate treatment in the presence of a shockable rhythm or an arrest witnessed by an EMS provider
Doc I most ask the question of why has Baltimore County adopted the stand that the providers will still consult for the Pri 4? I do not mean to over step my boundaries here but I am interested in the thought process. Is it a training issue, where they want providers and district officers to complete more in depth training. Miemss has authorized it as a standing order I am just a little confused.
ReplyDeleteCraig - A clear cut Prior 4 where resuscitation is not indicated or initiated should NEVER require base station consultation. We don't do this now - and we don't need to do this in the future.
ReplyDeleteWe are simply asking that a consult be performed if resuscitation has been started, is onging, the 15 minute time marker is approaching, and the patient is unlikely to benefit from continued resuscitation and transport (regardless of rhythm - shockable or non-shockable). We are talking about a consultation to terminate a 'full-court press' resuscitation which has been underway at the scene prior to initiation of transport.