Answer: Thank you for raising the important and sometimes confusing issue. Also thank you for looking through ASKMAC for what answers had already been provided.
In summary: If a first responder does not deliver any defibrillations, the paramedics are to complete their medical cardiac arrest directive in its entirety. If a first responder has delivered a defibrillation, the paramedics count the number of analysis/defibrillations completed as part of the medical directive and continue within the medical directive from that point.
To elaborate: This information was covered during the 2016-2017 Mandatory CME, but a refresher is a great idea. As stated in the Companion Document, as a general rule, Paramedics do NOT count pre-arrival interventions into their patient care. Care delivered prior to arrival can be “considered” and documented. However, in the setting of cardiac arrest where a medical termination of resuscitation (TOR) might apply, the Paramedics will complete three (3) rhythm interpretations/analyses themselves rather than “count” the number completed prior to their arrival.
A “first responder” is defined as any responder to a victim of out of hospital cardiac arrest who arrives ahead of paramedics and performs CPR and rhythm analyses using an AED in an organized and appropriate AHA-HSFO Guideline compliant fashion such that, upon arrival of paramedics, the paramedic is readily able to determine the number of analyses completed and the current sequence to follow.
SWORBHP Medical Council believes that ANY defibrillation delivered to a patient during a cardiac arrest resuscitation should be “counted” and “considered” as a contraindication to the application of the TOR.
If a defibrillation has been delivered to a patient by first responders, the TOR rule would not be considered. Any analyses (NSI and “shock delivered” analyses) may be “counted” or “considered” into the total number of analyses performed by paramedics upon their arrival and transport initiated/patch performed as per the Advanced Life Support Patient Care Standards Medical Cardiac Arrest Medical Directive. In essence, the care provided by the first responder should be considered as part of the number of analysis/defibrillation allowed within the cardiac arrest medical directive.
If no defibrillations/shocks were delivered ahead of paramedic arrival, paramedics must continue to obtain 3 additional analyses themselves resulting in No defibrillation/No Shock Advised (NSI) prior to patching to the BHP for consideration of Termination of Resuscitation (TOR)/pronouncement regardless of the number of NSI analyses obtained by first responders. Hence, the care provided by the first responder should not be considered as part of the number of analysis/defibrillation allowed within the cardiac arrest medical directive.