Pennsylvania EMS protocols,
in your pocket.

• Immediately terminate resuscitation on your own judgment since ETCO2 is below 10 mmHg.
• Continue resuscitation and transport immediately since ETCO2 is below 10 mmHg.
• ✓ Contact medical command and request an order to terminate resuscitation.
• Attempt endotracheal intubation to improve ETCO2 before considering termination.

Per Protocol 3091, EMS providers may terminate resuscitation ONLY after receiving an order from a medical command physician. While an ETCO2 <10 mmHg after 20 minutes of continuous resuscitative efforts with no change in rhythm or perfusion supports consideration of field termination, the provider must contact medical command first. Providers cannot unilaterally terminate resuscitation.

• Withhold CPR and declare DOA because he has been in cold water too long
• ✓ Begin CPR, protect against heat loss, and transport ASAP to a facility capable of bypass rewarming
• Begin CPR and follow standard Cardiac Arrest Protocol #3031A/P only, since hypothermia protocols do not apply to submersion
• Begin CPR and focus on aggressive field rewarming before transport

Protocol 3035 states that when accidental hypothermia is suspected as the cause of cardiac arrest, providers should begin CPR, protect against heat loss, and transport ASAP to the closest center capable of bypass rewarming. The protocol also notes these patients may have excellent outcomes after prolonged CPR and bypass rewarming. Field rewarming should not delay transport, and the standard cardiac arrest protocol exceptions apply here since temperature is well below 34°C.

• The nearest emergency department regardless of VAD capability
• ✓ The facility that placed the VAD, or a closer tertiary care facility that also places VADs
• Any Level I trauma center
• The destination is solely at the paramedic's discretion without medical command input

Protocol 5090 states that ideally VAD patients are taken to the facility that placed the VAD or to a closer tertiary care facility that also places VADs, and that medical command should be consulted to determine the appropriate destination.

• Administer Atropine 1 mg IV/IO immediately
• ✓ Begin transcutaneous pacing immediately without waiting for IV access
• Initiate IV/IO access, then administer Atropine before pacing
• Contact Medical Command before initiating any intervention

The Adult Bradycardia protocol states: 'If patient has severe hypotension or impending cardiac arrest, begin Pacing IMMEDIATELY.' Note 2 further reinforces: 'Application and initiation of transcutaneous pacer should not be delayed while awaiting IV access if patient has severe symptoms.' Atropine is an option while preparing the pacer, but pacing is the priority for this severely hypotensive patient.

• Cardiac arrest with asystole on the monitor after 25 minutes of CPR
• ✓ Cardiac arrest in a public place with bystanders present
• Wide complex PEA at a rate of 40 BPM with no central pulse
• Cardiac arrest where ETCO2 remains at 7 mmHg after 20 minutes of CPR

Protocol 3091 explicitly lists 'cardiac arrest in a public place' as one of the situations where field termination should NOT be performed. The other options describe findings that may meet criteria for field termination (asystole, wide complex PEA <60 BPM, ETCO2 <10 mmHg after 20 minutes).

• Greater than 30°C (86°F)
• Greater than 32°C (89.6°F)
• ✓ Greater than 34°C (92.3°F)
• Greater than 36°C (96.8°F)

Protocol 3035 explicitly states: 'If measured temperature is >34°C (>92.3°F) or if patient is rewarmed to >34°C (>92.3°F), then this protocol no longer applies. Follow standard Cardiac Arrest Protocols #3031A/P.'