Illinois EMS protocols,
in your pocket.

• Immediately cease resuscitation efforts without further steps.
• Continue resuscitation and transport to the nearest emergency department.
• ✓ Contact Medical Control to consider termination of resuscitation.
• Deliver one round of defibrillation before contacting Medical Control.

The protocol requires contacting Medical Control to consider termination of resuscitation when all medical cardiac arrest criteria are met: patient ≥18 years, cardiac arrest on ALS arrival with no pulse/respirations/meaningful cardiac activity, arrest not witnessed by EMS, no ROSC after ≥20 minutes of high-quality CPR/ACLS with EtCO2 <10 mmHg, no defibrillation/non-shockable rhythm, no hypothermia, and all personnel agree. Providers may not unilaterally cease resuscitation — Medical Control contact is required.

• 1 ventilation every 5 seconds (12 breaths per minute)
• ✓ 1 ventilation every 6 seconds (10 breaths per minute)
• 1 ventilation every 8 seconds (8 breaths per minute)
• 30:2 compression-to-ventilation ratio

The protocol states that if an advanced airway is in place, providers should ventilate 10 breaths per minute (1 ventilation every 6 seconds) with continuous, uninterrupted compressions. The 30:2 ratio applies only when no advanced airway is in place.

• Administer Atropine 1 mg IV/IO and wait to assess response before preparing for pacing
• ✓ Proceed directly to transcutaneous pacing without waiting to administer Atropine
• Administer Atropine 1 mg IV/IO every 3-5 minutes to a total dose of 3 mg, then reassess
• Administer Midazolam 2 mg IV/IO for sedation before initiating any other intervention

Per the protocol, Atropine is NOT effective for Mobitz Type II Second-Degree or Third-Degree AV blocks, and providers SHOULD NOT delay pacing in order to administer Atropine, especially in patients with poor perfusion. The correct action is to proceed directly to transcutaneous pacing.

• 0.4 mg SL, repeat every 5 minutes up to 5 doses if SBP > 90 mmHg
• ✓ 0.4 mg SL, repeat every 3-5 minutes up to 3 doses if SBP > 90 mmHg or MAP > 65 mmHg
• 0.4 mg SL, repeat every 5 minutes up to 3 doses if SBP > 100 mmHg
• 0.8 mg SL, repeat every 3-5 minutes up to 3 doses if SBP > 90 mmHg

The EMT-Basic protocol specifies administering Nitroglycerin 0.4 mg SL and repeating every 3-5 minutes to a maximum of 3 doses, as long as chest pain persists and SBP > 90 mmHg or MAP > 65 mmHg.

• 12-20 breaths/min; titrate to SpO2 ≥ 90%
• ✓ 10-12 breaths/min; titrate to SpO2 ≥ 94%
• 8-10 breaths/min; titrate to SpO2 ≥ 98%
• 10-12 breaths/min; titrate to SpO2 ≥ 90%

The EMR section of the ROSC protocol specifies ventilating at 10-12 breaths per minute and titrating to maintain an oxygen saturation of ≥ 94%. Hyperventilation is explicitly prohibited.

• Infuse cold saline IV and apply ice packs to the bilateral neck, groin, and axillae
• ✓ Apply ice packs to the bilateral neck, groin, and axillae, changing them every 15 minutes or more frequently as needed
• Apply ice packs only to the groin and axillae, changing them every 30 minutes
• Withhold cooling measures and wait for ALS intercept before initiating any temperature management

Per the EMR & EMT-Basic section, providers should apply ice packs to bilateral neck, groin, and axillae and change them every 15 minutes or more frequently as necessary. Cold saline infusion is explicitly NOT recommended in the prehospital setting per the Pearls section.