Adult cardiac arrest victims who cannot be resuscitated at the scene will not be transported to a hospital with CPR in progress, unless the patient’s pulse or breathing has returned, under a new EMS protocol now in effect in New York State.
The Suffolk County EMS director late yesterday notified all agencies that the new protocol takes effect immediately.
Under the new protocol, EMTs will continue to use CPR, defibrillators, medication and other techniques at the scene, but if the patient does not respond to those efforts within 20 minutes, the EMTs are directed to terminate resuscitation rather than rush the patient to the local hospital.
Similar protocols were adopted in Nassau County on March 29 and in New York City on March 31.
The “COVID-19 Public Health Emergency EMS Cardiac Arrest Standards of Care” mandated statewide by the State Department of Health was issued yesterday and took effect immediately.
The protocol “reflects recommended revisions that predate the COVID-19 public health emergency and have been successfully used in many areas of the U.S., as well as other locations throughout the world,” NYS EMS director Ryan Greenberg wrote in the new guidance document, an April 17 memorandum to all EMS providers in the state.
The changes are based on “well-accepted, widely published evidence, and are widely agreed upon by the physician leaders of Emergency Medical Service Regional Medical Control Systems across New York State,” Greenberg wrote.
NYS Cardiac Arrest Protocol… by RiverheadLOCAL on Scribd
Riverhead Volunteer Ambulance Corps Chief Bill Wilkinson said in an interview after the Nassau and New York City protocols were announced he anticipated the new directive would soon be in place in Suffolk County, as Suffolk’s hospitals came under more and more strain from the coronavirus pandemic.
“When we bring a cardiac arrest into the hospital, it immediately requires one doctor, three nurses, two aides, a respiratory therapist and an x-ray technician,” Wilkinson said. “These are resources they just don’t have right now.”
Hospital staffs have been stretched to the breaking point dealing with coronavirus patients, the Riverhead ambulance chief said.
“We do the same cardiac support protocol as the hospital,” Wilkinson said.
“There is no medical benefit to transporting patients in cardiac arrest with CPR in progress,” according to the Nassau County advisory.
Wilkinson said cardiac arrest patients who are not resuscitated in the field are not resuscitated at the hospital, either.
“That doesn’t happen,” the chief said.
“We do the same cardiac support protocol as the hospital,” Wilkinson said.
As a practical matter, he said, if a cardiac arrest victim is not revived in the first 10 minutes “even if you do get them back, there’s serious brain damage,” he said.
Still, the new protocols are a major change for EMTs, who are trained to continue lifesaving measures until transferring a patient to the care of a hospital.
One paramedic, who spoke on the condition of anonymity, disagrees with the new protocol.
“I’ve had patients regain their pulse as the ambulance was backing into the ER bay,” he said.
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