Читать книгу Emergency Medical Services - Группа авторов - Страница 321

Cardiac arrest treatment interventions are time critical. Thus, protocols should facilitate prompt initiation of resuscitative efforts. Nonphysician responders should provide initial cardiac arrest care using guidelines and standing orders, as there is inadequate time to consult with a direct medical oversight physician for detailed guidance. The guidelines should detail interventions for the various ECG rhythms likely to be encountered and should provide convenient reference to medication dosages, mixtures, and administration rates. Other practical information should also be included, such as criteria for termination of resuscitation. Many systems use current AHA ACLS algorithms as the basis for cardiac arrest guidelines [1].

EMS personnel should be encouraged to contact the direct medical oversight physician for additional direction after initial successful or unsuccessful resuscitative efforts, as well as for unusual or complicated situations. Due to the time‐sensitive nature of cardiac arrest and the often‐chaotic resuscitation scene, radio or phone interactions with the EMS personnel must be short, directed, and relevant. The physician must understand that detailed medical history or preceding symptoms are usually not known and are largely (although not entirely) irrelevant to the acute resuscitation phase of the patient’s care. Because EMS clinicians’ care is typically guided by protocol or standing orders, calls for physician input are generally for atypical or complex situations not otherwise addressed. Direct medical oversight physicians must be prepared to provide concise direction for these less common situations.