FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- This is the OCEMS local sequence, not a substitute for the complete resuscitation policy.
- Base contact is required for CVRC destination after ROSC; adult push-dose epinephrine authorization is governed by current PR-230.
Organize the first cycles
- Use a coordinated CPR approach with minimal compression interruptions and compressor rotation about every 2 minutes. Begin with 200 compressions, or about 2 minutes of CPR, before the rhythm assessment.
- Support oxygenation/ventilation with the indicated airway method. Passive ventilation is limited to its own witnessed-arrest procedure; do not apply it without its criteria. Obtain IV/IO without interrupting compressions.
Shockable rhythm
- For coarse VF or pulseless wide-complex tachycardia, defibrillate at maximum energy or the programmed or manufacturer-recommended setting, with CPR between assessments.
- Fine VF follows a different sequence: continue CPR for another 2 minutes and reassess; persistent fine VF then follows the PEA/asystole instructions.
- For persistent shockable arrest, epinephrine is 1 mg IV/IO using 0.1 mg/mL every approximately 3–5 minutes. Amiodarone is 300 mg IV/IO, then 150 mg in approximately 3–5 minutes if indicated; alternative lidocaine is 1 mg/kg, then 0.5 mg/kg once.
PEA / asystole and later care
- Continue CPR, ventilation, IV/IO access, and epinephrine 1 mg every approximately 3–5 minutes. Assess reversible causes. Give 250 mL saline boluses up to 1 L; reassess lungs and stop saline if rales develop after ROSC.
- At the 10-minute step, follow the airway and sodium-bicarbonate instructions: 50 mL of either 7.5% or 8.4% solution IV/IO. Keep the solution concentration and volume explicit.
- At 20 minutes without ROSC, choose continued scene care, transport, or base contact. At 30 minutes, select transport or base contact for further orders or pronouncement consideration.
ROSC and movement
- After ROSC, ventilate/oxygenate, address reversible problems, obtain a 12-lead when possible, and contact base for CVRC destination.
- Follow the complete policy for mechanical compression during movement/transport, advanced airway timing, implanted devices, and other special circumstances. Report rhythm, shocks, ETCO₂, cumulative medications, and ROSC time.
VISUAL FIELD REFERENCE
Adult arrest: recognize the rhythm branch
Adult / adolescent · ALS
Rhythm checkpoints within the local OCEMS sequence. Continue the complete arrest pathway below.
Coarse VF / pulseless wide-complex tachycardia
For coarse VF or pulseless wide-complex tachycardia, defibrillate at maximum energy or the programmed or manufacturer-recommended setting, with CPR between assessments.
Fine VF
Fine VF follows a different sequence: continue CPR for another 2 minutes and reassess; persistent fine VF then follows the PEA/asystole instructions.
PEA / asystole
Continue CPR, ventilation, IV/IO access, and epinephrine 1 mg every approximately 3–5 minutes. Assess reversible causes. Give 250 mL saline boluses up to 1 L; reassess lungs and stop saline if rales develop after ROSC.
- Use a coordinated CPR approach with minimal compression interruptions and compressor rotation about every 2 minutes. Begin with 200 compressions, or about 2 minutes of CPR, before the rhythm assessment.
- This is the OCEMS local sequence, not a substitute for the complete resuscitation policy.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-C-010 · PR-025 · PR-230
UNDERSTAND THE CARE
How to keep the arrest sequence organized
The guide is a local sequence with different rhythm branches, not a universal list of interchangeable resuscitation actions. Assign someone to track elapsed time, rhythm findings, shocks and medication totals while compressions and ventilation continue. A rhythm label should come from the actual assessment, with the local fine-VF instructions kept visible rather than silently folded into another algorithm.
Applying the guidance
Each cycle creates a new opportunity to verify that the interventions fit the patient and the elapsed time. Announce what has already been given before preparing a repeat. After ROSC, shift the team report to perfusion, breathing, ECG and destination while retaining the arrest timeline. Movement and airway procedures should be coordinated so their preparation does not create avoidable interruptions.
Putting it together
Teaching example: a second crew joins during ongoing CPR. A concise handoff states the present branch, elapsed time, last rhythm check, last shock, medication totals and next scheduled assessment, rather than restarting the history from the dispatch narrative.
Diagram text & teaching checkpoints
- CPR and ventilation
- Coordinate tasks around minimal interruptions.
- Rhythm branch
- Use the local coarse-VF/fine-VF/PEA distinctions.
- Time and totals
- Track shocks, doses and reassessments.
- ROSC transition
- Reassess perfusion and coordinate CVRC.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.