Treatment Protocols and Policies
For patients resuscitated from cardiac arrest, why am I staying on scene to stabilize the patient after return of spontaneous circulation (ROSC)?
Re-arrest is common shortly after return of spontaneous circulation (ROSC), occurring in approximately 60% of patients who are resuscitated from out-of-hospital cardiac arrest (OHCA). Particularly, during the COVID-19 pandemic, avoiding CPR en route to the facility not only improves patient outcomes, but can also reduce exposure risk for EMS providers. Nearly all patients are preload dependent after cardiac arrest and most will require vasopressor support. Rapid on-scene stabilization can prevent re-arrest by initiating volume resuscitation and preparing to administer push-dose vasopressors as needed before the epinephrine administered during resuscitation wears off and the patient begins to decompensate. Once the patient has been initially stabilized with intravenous fluids and push dose epinephrine as needed, the patient can be transferred to the nearest STEMI Receiving Center. See Treatment Protocol 1210 Cardiac Arrest and the EMS Agency memo for more information.
For patients without return of spontaneous circulation (ROSC), why am I consulting with the Base Physician regarding the decision to transport?
Per Ref. 814, Determination/Pronouncement of Death in the Field, the Base Physician must determine the decision for transport or termination for patients who do not meet criteria for termination of resuscitation in section II.A. This is based on the physician’s assessment of the patient’s chances of meaningful survival. This has not changed during the COVID-19 pandemic. On-scene resuscitation to achieve ROSC prior to transport optimizes the patient’s chances for a good outcome. If futility is determined by the Base Physician, the patient should not be transported to the hospital.
How does treat and refer work? What if the patient still wants transport?
Reference 834.1 Treat and Refer for Ill Patients During the COVID-19 Outbreak is a policy that was created for EMS personnel to identify low acuity patients with COVID-19 related complaints that do not need immediate transport to the Emergency Department. Use Reference 834.2 Low Risk COVID-19 Screening Tool to determine if the patient meets low risk criteria. Patients must have normal vital signs and pulse oximetry 94% or greater to be treated and referred.
If the patient or legal guardian still requests transport after reassurance by EMS personnel, then the patient must be taken to the Most Accessible Receiving facility (MAR) for adults or Emergency Department Approved for Pediatrics (EDAP) for children
If there is a disagreement between TP 1245 and the treatment protocol corresponding with the provider impression, which protocol should be followed?
During the COVID-19 pandemic, direction under TP1245 will supersede any direction that is outlined in the other treatment protocols.
Is there a treatment protocol for COVID-19 patients?
TP 1245 Potential COVID-19 Patients, is a newly created protocol that is a direct response to the COVID-19 pandemic. This protocol is intended to be used in conjunction with the treatment protocol(s) that correspond to the provider impression(s). The guidance therein supersedes guidance in the other treatment protocols during the COVID-19 pandemic. This protocol was developed to outline practices that ensure quality prehospital care, while maximizing provider safety and minimizing exposures in the field.
