They said, “_______”. What does that mean?

While witnessing and/or participating in saving someone’s life, your senses are heightened. You may hear certain things said by paramedics, which may not register when it was happening, but it may all come back after you are removed from the situation. It could be hours, days, or weeks after this traumatic event. This feeling of not understanding the situation can bring stress and sleepless nights. 

Using our collective experience, we have compiled some of the phrases and words often said by paramedics to communicate with each other while resuscitating someone after cardiac arrest.   

Cardiac arrest: This term is used to indicate that the patient’s heart has stopped beating effectively, and there is no blood circulation to the rest of the body.

Start compressions: This instruction prompts the initiation of chest compressions, where the paramedics apply rhythmic pressure to the chest to create an artificial pump and help maintain blood flow.

LUCAS or Auto-Pulse: Paramedics are referring to an automated CPR compression device that can assist during resuscitation.

CPR in progress: This phrase is used to alert others that CPR is currently being performed on the patient.

Check pulse: This command prompts a pause in compressions to see whether the team can find the pulse or signs of a heartbeat on the monitor.

Shock advised: This indicates that the defibrillator (AED) has identified a shockable rhythm, such as ventricular fibrillation or ventricular tachycardia.

Clear or Everyone clear: These words, screamed by the code leader, ensure that no one is touching the person before delivering an electrical shock by a defibrillator. It signals for everyone to move away from the person temporarily.

Pause Compressions or Analyzing: The pause in compressions allows the AED to understand the heart’s rhythm without CPR, which can produce a false reading. The analysis determines if the person needs a shock to reverse the abnormal heart rhythm. 

Resume compressions or Back on the chest: After the AED delivers a shock or if the rhythm remains non-shockable, paramedics instruct the team to resume chest compressions to maintain circulation.

Establish a line: This is often a shorthand way to instruct paramedics to obtain or start setting up an intravenous (IV) access point for medication delivery.

Administer epinephrine (or other medications): Paramedics may use this phrase to direct the administration of specific medications that can support the heart’s function or restore a regular rhythm.

Medication onboard or Medication delivered: This lets the team know that the medication has been successfully delivered to the person. The person administering it says the name of the medication out loud, as they all want to follow the same algorithm.

Code Mark: This is a command given to drop a “pin” or mark on the electrocardiogram (ECG) recording indicating when a certain task or medication has been performed or administered.

Secure the airway or Tube: This instruction prompts paramedics to establish a secure way for the person to breathe. It may involve techniques such as intubation with a plastic tube or using inflated airway devices placed inside the throat and through the mouth to assist with breathing.

____ Compliance: For example, stating “good” or “poor compliance” with a specific process or procedure like intubation or IV access. This command is said out loud for everyone on the team to know. 

 I’m going to Patch: This is to let the other paramedics know that a phone call to the hospital physician or medical director is about to occur. This could be for any reason, including to request more medications or help with advanced procedures.

ROSC” (Ross-ka): This is stated when a paramedic has determined that the patient has regained a consistent pulse or heartbeat. It’s a short form of Return of Spontaneous Circulation (ROSC).

Prepare for transport: Once the patient’s condition is stabilized to some extent, paramedics may give instructions to prepare for transportation to the nearest hospital equipped to provide advanced cardiac care.

VSA: This abbreviation for Vital Signs Absent is stated when the patient is unconscious, not breathing, and the heart stops beating. It is another way to say “clinically dead.” This can sometimes be after sustained efforts to salvage the heartbeat.

TOR or Call for a TOR: This stands for Termination of Resuscitation, which is stopping CPR. Paramedics will use this term when talking amongst themselves or consulting with a medical director.

You may also hear a paramedic counting down and saying 1 minute, 2 minutes, or 30 seconds. This allows the entire team to know when something will happen. It could be another analysis from the AED or when the next round of medication is to be delivered. During resuscitation, it may look chaotic to an outsider looking in. However, for almost every paramedic service, the act of resuscitation is like a NASCAR pit crew, with different actions and procedures all occurring at specific times and points to ensure the best possible outcome.

Thank you to our contributors

Paul Snobelen & Sachin Agarwal

We Appreciate Your Feedback

Please leave any feedback you have regarding the content of this article. Have you found it helpful? What would you change or like to see differently?