Top 10 signs your agency’s cardiac arrest protocols need updating

Do your agency's cardiac arrest protocols make it possible for your patients to achieve ROSC and later attend a survivor celebration?

In a recent Facebook post linking EMS1’s article on 10 tips for organizing a cardiac arrest survivor celebration, I jokingly commented, “Step 1: Have survivors,” and went on to point out that if you still routinely transported cardiac arrest victims to the ED with CPR in progress, or intubated every arrest victim early in the resuscitation, or believed that antiarrhythmics are the key to an effective resuscitation, you’re not likely to have many survivors.

And then I said to myself, “Self, some agencies actually still do operate like that, and their crews are none the wiser.”

So if your last cardiac arrest save dates back to the days when the ACLS course was on 35mm slides and the books had white covers, I give to you the Top 10 Signs Your Agency’s Cardiac Protocols Need Updating:

If you still use one of these, it may be time for a change. (Image Greg Friese)
If you still use one of these, it may be time for a change. (Image Greg Friese)

You still repeat to yourself, “Little shock, big shock, everybody shock.”

Your procedure for treating cold water drowning arrests includes rolling the patient over a barrel.

Your supply officer complains that it’s getting hard to find code drugs with intracardiac needles these days.

Your defibrillation procedure includes the phrase, “Twenty-five pounds of paddle pressure.”

Your supraglottic rescue airway is an Esophageal Obturator Airway.

Any crew members at your agency under the age of 40 know what an EOA is.

You stock more tourniquets than any other agency in your state … because you need at least three for every CHF patient, to rotate around their limbs.

Your dosing guidelines for nitro and morphine are in grains.

You’re the most progressive agency in your county because you administer fibrinolytics in the field … and the fibrinolytic you use is streptokinase.

Your medical director consults with his colleagues over the ongoing drug shortages, but none of them seem to know of an alternate source for Bretylium.

Got any of your own? Share ‘em in the comments!


About the author

Kelly Grayson, NRP, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 24 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is president of the Louisiana Society of EMS Educators and a board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. Kelly's books are available on his author page at You can follow him on Twitter (@AmboDriver) or Facebook, or email him at Kelly is a member of the EMS1 Editorial Advisory Board.

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