Trauma Cardiac Arrest Medical Directive

Question 1

Trauma Cardiac Arrest Medical Directive

Answer 1

A Primary Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.

Question 2

Indications

Answer 2

Cardiac arrest secondary to severe blunt or penetrating trauma.

Question 3

Conditions - CPR

Answer 3

Age: N/A
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: Performed in 2 minute intervals

Question 4

Conditions - Manual Defibrillation

Answer 4

Age: ≥30 days
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: VF OR pulseless VT

Question 5

Conditions: AED Defibrillation

Answer 5

Age: ≥30 days
LOA: Altered
HR: N/A
RR: N/A
SBP: N/A
Other: Defibrillation indicated

Question 6

Conditions: Trauma TOR

Answer 6

Age: ≥16 years
LOA: Altered
HR: 0 
RR: 0
SBP: N/A
Other: No palpable pulses AND No defibrillation delivered AND Monitored HR = 0 OR Monitored HR <30 with the closest ED ≥30 min transport time away.

Question 7

Contraindications - CPR

Answer 7

• Obviously dead as per BLS PCS

- Meet conditions of Do Not Resuscitate (DNR) Standard

Question 8

Contraindications - Manual Defibrillation

Answer 8

Rhythms other than VF or pulseless VT

Question 9

Contraindications - AED Defibrillation

Answer 9

Non-shockable rhythm

Question 10

Contraindications - Trauma TOR

Answer 10

• Age <16 years
• Defibrillation delivered
• Monitored HR >0 and closest ED <30 min transport time away

Question 11

Treatment

Answer 11

• Consider CPR
• Consider Manual defibrillation (if available and authorized)
• Consider AED defibrillation (if not using manual defibrillation)
• Mandatory Provincial Patch Point

Question 12

Consider Manual defibrillation

Answer 12

Age ≥30 days to <8 years:
Dose: 1 defibrillation
Initial dose: 2 J/kg
Dosing interval: N/A
Max. # of doses: 1

Age ≥8 years:
Dose: 1 defibrillation
Initial dose: As per BH/manufacturer
Dosing interval: N/A
Max. # of doses: 1

Question 13

Consider AED defibrillation

Answer 13

Age ≥30 days to <8 years:

With Pediatric Attenuator Cable:
Dose: 1 defibrillation
Max. single dose: As per BH/manufacturer
Dosing interval: N/A
Max. # of doses: 1

Without Pediatric Attenuator Cable:
Dose: 1 defibrillation
Max. single dose: As per BH/manufacturer
Dosing interval: N/A
Max. # of doses: 1

Age ≥8 years:
Dose: 1 defibrillation
Max. single dose: As per BH/manufacturer
Dosing interval: N/A
Max. # of doses: 1

Question 14

Mandatory Provincial Patch Point

Answer 14

Patch to BHP for authorization to apply the Trauma TOR if applicable. If the BH patch fails, or the Trauma TOR does not apply, transport to the closest appropriate receiving facility following the 1st analysis/defibrillation.

Question 15

Clinical Considerations

Answer 15

If no obvious external signs of significant blunt trauma, consider medical cardiac arrest and treat according to the appropriate medical cardiac arrest directive.