Question: Hello, When a crew arrives on scene and finds a patient VSA, the ALS and BLS Standards require CPR per the HSFO guidelines at 30:2. When considering that there is strong evidence showing high quality CPR is the most important care to impact patient survival, my question revolves around what care or priorities should be considered when there are just the 2 paramedics on scene awaiting additional crews or resources.

The questions specifically are:

1) While Early defib, high-quality CPR and BVM ventilation’s are a must, should an IV and medications be attempted with such limited resources? In attempting to do so, there is strong likelihood of compromising the quality of CPR because the compressor is doing about 2 compressions a second, and the 2nd medic is ventilating about every 15 seconds, thus making it next to impossible to perform any other tasks without diluting the CPR quality. This should the early defib, High-quality CPR and BVM ventilation’s be the only focus until more resources show up, or should the IV and medication process be attempted to satisfy the requirements of the directive, even if doing so will compromise the CPR quality?

2) In regard to #1 above, when working in a rural setting, in which allied resources can sometimes take upwards of 20 minutes to arrive on scene, how does this play into the care?

3) As a given, I would love to be able to meet all the requirements of the ACP Cardiac arrest directive effectively, but with only 2 paramedics on scene the problem is there is just so much to do, and with quality of CPR and ventilation’s/ETCO2 being able to be monitored and recorded, you can either violate the directive to maintain high-quality CPR, or risk having this data show your CPR quality was not great but got “everything done”. Which is the preferred method of care?

4) While there is evidence supporting that CPR saves lives, is there any strong evidence supporting that the IV/Meds and the Advanced airways lead to better patient survival?