Early access to the EMS system, CPR and defibrillation have been identified as vital to improving

the chances of survival for the patient in cardiac arrest. Rapid access to advanced treatments by

prehospital ALS personnel and hospital personnel is critical to the final patient stabilization. An

EMS provider transport service must be contacted for response to provide additional treatment and

transfer to an appropriate facility.

A. Call for EMS transport, if not already activated.

B. Confirm patient is pulseless and apneic.

1. Open airway:

a. Head tilt-chin lift.

b. Jaw thrust if trauma suspected.

2. Check breathing; if absent, give 2 breaths.

3. Check carotid pulse:

a. If present: Go to F.

b. If absent: Continue to C.

C. Prepare and apply defibrillator:

1. Attach monitor leads to electrodes.

2. Apply electrodes to patient:

a. Upper right anterior chest touching right border of the sternum.

b. Lower left rib area in anterior axillary line.

4. If any significant delay in completing the previous steps, perform CPR until

defibrillator is available.

D. Initial Shocks:

1. Analyze rhythm - stop CPR, do not touch patient and stop all patient movement.

2. Initial shock:

a. “Clear!”, assure that no one is touching the patient.

b. Deliver shock.

3. Analyze rhythm - shock if needed.

4. Analyze rhythm - shock if needed.

5. Check pulse.

E. If no pulse:

1. Resume CPR for 1 minute.

2. Re-analyze rhythm and stop all patient movement.

a. Repeat up to 3 additional shocks if needed.

b. If no shock indicated, continue CPR.

F. If pulse present:

1. Check breathing.

a. If rate and quality adequate, administer oxygen 15 LPM via non-rebreathing

mask.

b. If none or inadequate, ventilate with oxygen via mouth to mask.

2. Check blood pressure.

3. Continuously monitor pulse.

G. Transfer patient to the transporting EMS provider.

a. Check pulse - CPR or monitor as appropriate.

b. Check breathing - oxygenate or ventilate as appropriate.

2. If pulse returns at any time, provide appropriate care.