There aren’t many huge differences between prehospital protocols for traumatic cardiac arrest compared to non-traumatic arrest within NYC. As you might imagine, ambulances in the city aren’t equipped to crack chests or initiate MTP when they’re likely a stone’s throw away from a trauma center. As such, the protocol puts a heavy emphasis on rapid transport, beginning at the BLS level of care. Until the patient has gotten to the ED, much of the arrest care is otherwise the same – CFRs will start CPR and apply an AED, and BLS will request ALS backup (although if they are able to get the patient into the ambulance and transport before ALS arrives, they will – hence why you may receive such patients without vascular access or an airway, so be prepared!).
Once you get to the ALS level, the patient will get a definitive airway, as well as a needle decompression if there is concern for a tension pneumothorax. Paramedics will start cardiac monitoring and adjust their management based on the presenting rhythm – namely, whether or not defibrillation is indicated. Otherwise, crystalloid fluid resuscitation will be initiated – up to 3 liters for adults, or up to 40 mL/kg for pediatrics.
That’s really it as far as the prehospital traumatic arrest toolbox. Given the proximity of trauma centers in the city, “scoop and run” tends to be the name of the game rather than “stay and play.” There aren’t big pushes for things like prehospital TXA or blood products at this point, although I’m happy to hear people’s thoughts on that if anyone disagrees. Just remember that at least this way you’re left with something to do once the patient gets to the ED!
Happy resuscitating! www.nycremsco.org for more!
Dave