Use the OCEMS arrest sequence, track medication totals, and coordinate post-ROSC destination.
OCEMS source summary · Updated 2026-09-16
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. Follow the source’s initial 200-compression/about-2-minute assessment sequence.
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/pulseless wide-complex tachycardia, follow the source’s shock steps at maximum energy or the programmed/manufacturer-recommended setting, with CPR between assessments.
The local source treats fine VF differently: continue CPR for another 2 minutes and reassess; persistent fine VF follows its 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. The source lists 250 mL saline boluses up to 1 L; reassess lungs and stop saline if rales develop after ROSC.
At the source’s 10-minute step, follow its 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, the source lists continued scene care, transport, or base contact; at 30 minutes select transport or base contact for further orders/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.