Well, cardiac arrest is an emergency, until we get there. By we I refer to any prehospital provider, be it a BLS fire crew, ALS ambulance, or any combination thereof.
We should, of course, treat any and all cardiac arrest with alacrity. We of course know the things that we as providers need to focus on doing: performing quality chest compressions, providing prompt defibrillation (if warranted), securing the airway, and providing ventilations. These are all things that have been shown to have any usefulness, and are all BLS interventions, at least where I work.
Once any reversible causes of cardiac arrest have been treated, and once those interventions I just mentioned have been performed, there isn’t much else to do. Sure, the AHA says we should give epinephrine to cardiac arrest every 3-5 minutes. But epinephrine doesn’t save lives in cardiac arrest.
My system frowns upon pronouncing cardiac arrest in the field. It’s been done, but pretty rarely. We have a few doctors at the hospital who are more than willing to call an arrest when requested by telephone, but the majority insist on transport to their hospital. The vast majority of providers in this area, be it firemen or ambulancemen, would never think to pronounce a patient at a scene without signs of obvious death, so the call to the doctor never gets made.
“But asystole is a sign of death!”
“No it’s not; asystole is a workable rhythm!”
Asystole is, of course, an absence of electrical activity in the heart. The heart is done. Finished. Checked out. It sucks, yeah, but it’s going to happen to each and every one of us at some point.
In my years in EMS, I have been a part of 15 cardiac arrest saves. Not a single one of those saves received a single drug prior to their conversion to a normal rhythm. Some of those did receive some drugs, be it amiodarone, lidocaine, or whatever, but not one got any medication prior to converting into a perfusing rhythm. Not one.
I have performed CPR on at a minimum, hundreds of patients in asystole. Not a single one of those has ever been resuscitated. Not one.
Asystole is a confirmation of death, and not a workable rhythm.
If we can wrap our heads around that fact, then we stand a better chance of gaining more respect in the healthcare field.
Funeral homes don’t drive as fast as they can to the hospital to have someone pronounced dead. Why do we?