Warm, handle the slow pulse deliberately, and follow the hypothermic-arrest pathway when indicated.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Use the longer 30–45 second pulse assessment specified for apparent hypothermic arrest.
Do not merge ordinary bradycardia treatment into the source’s hypothermic-with-a-pulse pathway.
Patient with a pulse
Remove wet clothing, cover to conserve heat, and initiate available active warming. Monitor and document the rhythm.
Expect a slow heart rate and weak pulse. The thermal order directs against trying to reverse hypothermic bradycardia in the field.
Apparent arrest
When not obviously dead, assess for a pulse for 30–45 seconds before initiating CPR. If no pulse is detected, follow the adult cardiac-arrest standing order.
Assist ventilation with BVM without hyperventilation. Continue warming and limit unnecessary interruptions in resuscitation.
Contact and transport
Contact base when further stabilization orders are needed. The hypothermia pathway directs against field pronouncement.
Provide transport to the nearest ERC, with ALS escort for the apparent-arrest branch. Continue monitoring for rhythm and perfusion changes.
Handoff
Report environmental exposure, wet clothing, initial and serial pulse findings, warming measures, arrest/ROSC times if applicable, and all resuscitation treatment.
Keep the thermal diagnosis visible during handoff so the slow rate is not mistaken for an unrelated routine bradycardia presentation.