THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
NYC REMAC Advisory No. 2006-08 Title: BLS Protocol 403 Non Traumatic Cardiac Arrest Issue Date: July 18, 2006 Effective Date: August 1, 2006 – Sunset January 1, 2007 Re-Issued: N/A Supercedes: Page: 1 of 3
The Regional Emergency Medical Advisory Committee (REMAC) of New York City has revised Basic Life Support Protocol 403 – Non Traumatic Cardiac Arrest, and Appendix D – Automated External Defibrillation (AED) Guidelines, to meet recently updated Emergency Cardiac Care (AHA) Guidelines.
Attached is a copy of the revised: • BLS Protocol 403 – Non Traumatic Cardiac Arrest • Appendix D – Automated External Defibrillation
Owners/operators of Ambulance and ALS First Response Services providing prehospital medical treatment within the five boroughs of the City of New York are responsible to provide copies of the NYC REMAC Prehospital Treatment Protocols to their personnel, and to ensure that Service Medical Directors and EMS personnel are informed of all changes/updates to the NYC REMAC Prehospital Treatment Protocols.
The revised protocol may be implemented beginning August 1, 2006. All EMS personnel must be updated by January 1, 2007.
Lewis W. Marshall, Jr., MD, JD Chair Regional Emergency Medical Advisory Committee of New York City THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
BLS Protocol: 403 – Non Traumatic Cardiac Arrest and Appendix D – AED Guidelines 403 NON-TRAUMATIC CARDIAC ARREST
1. Begin Basic Cardiac Life Support procedures. 2. Request Advanced Life Support assistance. 3. If appropriately trained personnel are present and an automated external defibrillator is available, see below. In EMS witnessed arrests, perform CPR until defibrillator is attached. In arrests not witnessed by EMS, perform two (2) minutes of CPR prior to defibrillator use. 4. Transport. NOTE: WHEN AVAILABLE, PEDIATRIC AED-CAPABLE PADS AND CABLES SHALL BE USED FOR ALL PEDIATRIC PATIENTS AGED 1 – 8 YEARS OLD. IF PEDIATRIC AED-CAPABLE PADS AND CABLES ARE NOT AVAILABLE, THE ADULT AED AND ADULT AED-CAPABLE PADS AND CABLES SHALL BE USED FOR ALL PEDIATRIC PATIENTS AGED 1 YEAR AND OLDER. AED PADS MUST NOT OVERLAP EACH OTHER; IF OVERLAP OCCURS, APPLY PADS ANTERIORLY AND POSTERIORLY. DO NOT USE ADULT AED AND ADULT PADS AND CABLES ON PATIENTS UNDER THE AGE OF 1 YEAR.
GUIDELINES FOR AUTOMATED DEFIBRILLATION 1. If present, remove Nitroglycerin patch and wipe off remaining paste; avoid contact with your skin. 2. Attach automated external defibrillator to patient. NOTE: THE DEFIBRILLATOR’S ANALYSIS OF THE RHYTHM MUST BE DONE WITHOUT CPR IN PROGRESS. IF THE PATIENT HAS A PERMANENT PACEMAKER IN PLACE, POSITION THE SEMI- AUTOMATED DEFIBRILLATOR PADS AT LEAST ONE (1) INCH AWAY FROM THE PACEMAKER DEVICE. 3. Whenever the “NO SHOCK INDICATED” message appears, CPR should be performed for 2 MINUTES followed by the next analysis.
4. After a total of three (3) cycles of CPR and analysis, continue CPR. NOTE: DURING TRANSPORT, OR IF TRANSPORT IS DELAYED, CONTINUE CPR, RE-ANALYZE EVERY 2 MINUTES, AND SHOCK AS INDICATED.
Regional Emergency Medical Advisory Committee Advisory 2006-08 New York City Page 2 of 3
THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
BLS Protocol: 403 – Non Traumatic Cardiac Arrest and Appendix D – AED Guidelines
APPENDIX D AUTOMATED EXTERNAL DEFIBRILLATION (AED) GUIDELINES
ABC’s In arrests witnessed by EMS, perform CPR until defibrillator is attached In arrests not witnessed by EMS, perform two (2) minutes of CPR prior to defibrillator use
Press ‘Analyze’
Shock Indicated Shock Not Indicated
Defibrillate one (1) time only
If no If spontaneous spontaneous breathing: breathing: Assess vital signs perform two Support airway Perform two minutes of CPR minutes of Support breathing CPR
Return to ‘Analyze’
Transport patient to hospital
After three (3) cycles of CPR or if spontaneous breathing occurs, begin transport procedures
During transport, or if transport is delayed, continue CPR, re-analyze every 2 minutes, and shock as indicated
Regional Emergency Medical Advisory Committee Advisory 2006-08 New York City Page 3 of 3