San Andreas Fire Rescue
Department of Forestry & Fire Protection
Medical Cardiac Arrest (CPG A0201-1)
Stop
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The intent is to prioritise high performance CPR with minimal interruptions and rapid defibrillation
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Time to first defibrillation ≤ 2 mins
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Fluid administration in shockable rhythms may be detrimental and should be limited
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Compression/ventilation ratios
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No SGA/ETT:
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30:2 (pause for ventilations)
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100 - 120 per minute
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SGA/ETT:
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15:1 (no pause for ventilations)
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100-120 per minute
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Mechanical CPR
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Should not be applied <16 mins into the arrest unless inadequate resources or crew fatigue
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If ROSC achieved, apply in anticipation of re-arrest.
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See Mechanical CPR transport criteria checklist for transport guidance
Hypothermic cardiac arrest
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<30°C double the interval for Adrenaline (Epinephrine) and Amiodarone doses
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Standard DCCS initially
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>3 DCCS is unlikely to be successful without rewarming - consider AAV, MCPR for transport (where unavailable continue DCCS as per standard cardiac arrest).
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Where hypothermia is the clear cause for cardiac arrest, consult with Clinician and transport with mCPR. See Mechanical CPR transport criteria checklist for transport guidance
Status
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Unconscious and pulseless OR unsure of the presence of pulse with gasping/agonal or absent resps
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Hx, MOI or injuries do not suggest traumatic cause
Standard cardiac arrest
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Immediately commence CPR and continue with minimal interruptions
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Interpret rhythm off the screen in manual mode @2/60 intervals.
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Charge during chest compressions
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DCCS at 200J (Adults)
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Pulse check only if potentially perfusing rhythm
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Supraglottic airway is an appropriate initial airway
ALS
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Adrenaline 1 mg IV every 2nd cycle (or @ 4/60 intervals)
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N/Saline IV TKVO.
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If Pt is suspected hypovolaemia, anaphylaxis or asthma, N/Saline IV 20 mL/kg
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If TPT suspected, decompress bilaterally (should not be routinely done for medical cases)
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When time and resources permit, measure BGL and treat as per CPG A0702 if required
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CPR interfering patient
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Fentanyl 100 mcg IV every 1 - 2 minutes (no max. dose).
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Fentanyl ineffective: Ketamine 50 - 100 mg IV every 1-2 minutes (no max. dose) (ALS on consult only).
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No IV access: Fentanyl 200 mcg IM or Ketamine 200 mg IM (single dose).
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Advanced Paramedic
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If persistent VF / pulseless VT Amiodarone 300 mg IV after 3rd DCCS
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If VF/pulseless VT continues, Amiodarone 150 mg IV after 5th DCCS
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If TCA OD, Sodium Bicarbonate 8.4% 100 mL IV
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If Hyperkalaemia (Hx renal failure / dialysis or crush injury), Sodium Bicarbonate 8.4% 100 mL IV and Calcium Gluconate 10% 2.2 mmol (1 g) IV (slow push)
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Consider ETT if achievable with NO additional pause in CPR
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Early ETT if copious vomitus or Supraglottic airway failure
Flow Chart
